Nurse staffing mandates begin journey through state legislatures

Five states have recently proposed staffing ratios, which would limit the number of patients a nurse could be assigned at once. The battle to pass those measures will likely be uphill. 

Nurses and the unions representing them say understaffed hospitals are dangerous for patients and clinicians alike, spreading clinicians thin and decreasing care quality. In California, the only state which currently mandates RN-to-patient ratios, the legislation reduced these problems — and other states aim to follow suit. 

Yet, hospitals and health systems fear that if they can not meet the mandated ratios, they will be forced to close inpatient beds, depriving communities of care entirely. 

Here are states with legislation on the table:  

1. Minnesota: Members of the Minnesota Nurses Association joined bipartisan state legislators Feb. 13 to introduce a bill designed to address healthcare worker retention. The Keeping Nurses at the Bedside Act, authored by state Sens. Erin Murphy, Lindsey Port and Jim Abeler, would require hospitals to establish committees of direct care workers and management. The committees would weigh in on staffing levels on a hospital-by-hospital, unit-by-unit basis, including the maximum number of patients on each inpatient care unit than any individual direct care nurse can typically safely care for.

2. Washington:  In 2022, workers, including members of the Service Employees International Union Healthcare 1199NW, supported efforts for safe staffing standards during the legislative session. However, proposed staffing legislation that would have limited the number of patients direct care registered nurses could be assigned for any shift ultimately failed to become law.

A coalition of healthcare workers in Washington relaunched their efforts Jan. 5. The current proposal would direct state officials to set staffing standards for healthcare workers, including nurse-to-patient ratios. Washington's Senate Committee on Labor and Commerce held a public hearing on Jan. 17 related to the bill, and a public hearing in the Senate Committee on Ways & Means is scheduled for Feb. 16. 

3. Connecticut: On Jan. 23, Connecticut lawmakers proposed legislation to mandate nurse-patient staffing ratios. The American Federation of Teachers union — which represents nurses and physicians — called upon them to do so, sharing stories of assaults by patients and mandated 16-hour shifts. 

The Connecticut Hospital Association opposes staffing mandates, the organization told Connecticut Public Radio. If hospitals cannot meet the required levels, they will be forced to close beds on inpatient floors, which they said will backlog the emergency department. 

Yet, the legislation has garnered early support from lawmakers. United States Senator Richard Blumenthal has elevated the conversation to a federal level, and says he believes a bill could get 60 votes in the Senate with Connecticut leading the way. 

4. Oregon: Oregon lawmakers will consider nurse staffing legislation this session that would require hospitals to establish staffing committees for technical staff and service workers. It would also require hospitals to set minimum standards for staffing plans for direct care registered nurses. Minimum standards would vary by unit. For example, the proposed legislation requires hospitals to ensure a direct care registered nurse is assigned to no more than one patient in the operating room, and in an oncology unit, no more than four patients.

The Oregon Health Authority would enforce staffing plans for nurses, with fines for hospitals that fail to adopt or to comply with staffing plans. 

Supporters of the bill argue the legislation would improve retention, while hospital administrators argue the legislation would destabilize a healthcare system that is already facing the effects of the pandemic, according to The Lund Report. A public hearing on the bill is scheduled for Feb. 28.

5. Massachusetts: Massachusetts has proposed legislation to mandate safe staffing ratios. The specific ratio would be determined through public stakeholder hearings held by the Department of Public Health. Similar state legislation was struck down in 2014 and 2018. 

The Massachusetts Nurses Association partnered on the bill. In a Jan. 19 news release, the union said at least 8,320 unsafe staffing reports were filed last year by hospital nurses in the state.

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