As the Affordable Care Act dominates the news cycle, the battle over a critical piece of healthcare legislation here in Pennsylvania goes unnoticed. Two bills meant to address the dangerous understaffing issue in many hospitals today are working their way through the House — one would set safe minimum RN-to-patient ratios that all hospitals would be legally required to follow; the other creates “staffing committees” which would make recommendations to the hospital, but give hospital administrators final say and has no mechanism for enforcing those recommendations.
Countless academic research teams, many here in Pennsylvania, have established that setting safe minimum RN-to-patient ratios in hospitals saves lives and improves patient outcomes. It also reduces healthcare costs, while curing nurse job dissatisfaction and burnout. California already enjoys legislated nurse-to-patient ratios and 71% of nurses polled there report improvement in quality care. Additionally, 65% report that workloads are reduced; 64% report that nurse retention has improved; and 60% believe that nurses outside California will migrate there for work due to legally-binding RN-to-patient ratios. One study conducted at the University of Pennsylvania found that California-type RN to patient ratios legislation, if enacted here, would reduce patient deaths by 11% and significantly improve the likelihood that experienced nurses would remain at the bedside.
Here in Pennsylvania, House Bill 1631 would only establish “nurse staffing committees,” comprised of an even split of direct-care nurses and hospital administrators. These committees would only be required to meet twice a year and make recommendations to the hospital regarding staffing. Unfortunately, under HB1631, hospitals can legally alter the recommendations if they don’t meet with their budget concerns. What’s more, if hospitals fail to follow the recommendations agreed to, the only mechanism in place for reporting the failure is the staffing committee itself — a committee half comprised of hospital administrators for whom reporting the hospital’s failure to comply would be against their best interest. It’s easy to see why big hospitals and health systems prefer this approach.
But Pennsylvania also has HB 923, a bill that sets minimum RN-to-patient ratios in each hospital unit based on recommendations from nationally-recognized nursing organizations like the American Association of Critical Care Nurses, the American Academy of Medical-Surgical Nurses, and the Association of Women’s Health, Obstetric and Neonatal Nurses. What’s more, it does not apply a “cookie cutter” approach. HB923 sets a minimum floor and calls for healthcare facilities to take into account the acuity of current patients in a unit and the geographical layout of the unit when making assignments. It would also ensure patients are cared for by nurses who have received special training and proven competencies to care for the particular patient in their charge and allows for nurses to refuse an assignment that they know personally they are not adequately trained to care for.
Other benefits of HB 923:
- It calls for healthcare facilities to be transparent in reporting the number of patients a nurse cares for in each unit. Facilities will not be allowed to “mask” the actual number of patients each nurse is assigned by including nurses who are not direct patient care providers such as managers, caseworkers, supervisors, etc.
- It provides for assignment of support staff to hospital units so that professional nurses are not burdened with non-nursing duties like clerical assignment and house-cleaning duties.
- It creates a reporting system so that facilities will be required to maintain records on staffing decisions and will report their staffing plans, methodology and staffing tools used to the Department of Health. That information will also be made available to the public.
- It protects those nurses who report violations of the law or actions that violate the rights of patients.
In the coming weeks, supporters of HB1631 will be holding town hall meetings around the issue and urging legislators to vote for their flawed solution to hospital staffing problems. If you care about the safety of your patients and the quality of your work, urge your local elected officials to support HB 923 and safe RN-to-patient staffing ratios. Tell them committees are not the answer.