The No. 1 issue for all healthcare workers is inadequate staffing that interferes with the effective performance of their jobs. A 2003 study by AFT Healthcare, conducted by Peter D. Hart Research, showed an overwhelming majority (82 percent) of all hospital nurses favor legislation that would establish a maximum number of patients that nurses can be required to care for at one time.
A substantial body of research conducted over the past two decades clearly shows the benefits of proper staffing. Just a sampling of findings includes:
- Nurse staffing shortages are a factor in one out of every four unexpected hospital deaths or injuries caused by errors.
- Hospitals with higher RN-patient ratios had lower-than-predicted patient mortality rates.
- A study in two hospitals over a six-month period found that nurses intercepted 86 percent of all medication errors made by physicians, pharmacists and others involved in providing medications for patients.
- Low staffing levels are associated with higher rates of adverse outcomes that are sensitive to nursing attention, such as urinary tract infections, pneumonia, pressure ulcers and falls.
- Statistical models show that when nursing units are understaffed, the additional costs associated with patients who develop complications are greater than the labor savings from understaffing.
California is the only state that has passed and implemented legislation establishing required staffing ratios. The law was passed in 1999 and went into effect in 2004. The results have been favorable; California saw an influx of nurses from other states wishing to practice in a state with mandated nurse-patient ratios.
Several other states have considered similar legislation. In the 2009 legislative session, 12 states introduced ratio legislation. Nevada (A.B. 121/B.D.R. 40-492) passed a law in 2009 that requires any facility with at least 70 beds in a community of at least 100,000 people to develop a staffing ratio plan. However, unlike California’s legislation, no ratios are specified.
2009-2010 Staffing Ratio Legislation Introduced
Massachusetts (HB 3912/SB 890 and SB 876): SB 876 focuses on creating a comprehensive approach to staffing committees in the state. This is in conjunction to SB 890 which requires that the Department of Health and Human Services to develop standards of patient assignment ratios that are determined to be the ideal of patients to direct-care nurses. Staffing plans developed by the facility should be flexible, with it being possible to make adjustments for the time of day, the registered nurse’s experience level, and varying patient acuity. The Department is also responsible for determining guidelines of the maximum number of patients that can be assigned safely to direct-care registered nurses in specific units.
Michigan (H.B. 4008): This bill requires the creation of a staffing plan and an acuity assessment tool by every hospital. The staffing committee of each hospital is responsible for writing the plan, and at least half of the committee must be direct-care RNs.
New York: The Safe Staffing for Quality Care Act (A.B. 2264 and A.B. 731) and the Safe Staffing for Hospital Care Act (A.B. 5370/S.B. 1780) both involve establishing staffing plans for safe ratios in healthcare facilities. The Safe Staffing for Hospital Care Act extends to other healthcare workers and includes protection from mandatory overtime.
New Jersey (AB 660/SB 963): Establishes ratios for registered professional nurses in hospitals, ambulatory surgery facilities, state developmental centers and psychiatric hospitals. The bill establishes the introductory ratios for the different units and facilities and requires that all hospitals and ambulatory surgery facilities employ a commission-approved acuity and staffing system. As part of the acuity system, the facility must maintain a pool of qualified registered nurses to accommodate staffing needs. The ratios specified are the same as in California.
Pennsylvania (SB 32): Would set minimum staffing ratio of caregivers to residents in a long-term care facility. For the purpose of this legislation, a licensed nurse would be either an LPN or an RN. They would be limited to having no more than a: 15-1 patient-to-nurse ratio during a morning shift; a 25-1 ratio during an afternoon shift; and a 35-1 ratio on a nighttime shift. They are also restricted from doing any: food preparation, housekeeping, laundry or maintenance. The average staffing ratio is required to be posted daily where residents, their families, caregivers and other potential consumers may see it.
West Virginia (HB 2377): Would require W.Va. nursing homes to maintain a ratio of direct caregivers to residents of at least: one to five in the morning shift; one to 10 during the afternoon shift; and one to 15 during the evening shift. A direct caregiver is a certified nurse assistant, an LPN or an RN. They are prevented from performing: food preparation; housekeeping; laundry or maintenance services.
Other Staffing Legislation
Some states have chosen to address the issue of inadequate staffing in healthcare facilities in ways other than mandated minimum ratios.
Connecticut enacted legislation (H.B. 5902) in February 2008 that requires each hospital to establish a hospital staffing committee to assist in the preparation of a nurse staffing plan. At least half the members of the staffing committee must be registered nurses, employed by the hospital, whose primary responsibility is to provide direct patient care. Each hospital, in collaboration with its staffing committee, must develop and implement to the best of its ability the prospective nurse staffing plan.