Staffing ratios and mandatory overtime have long been topics of discussion among nurses, unions, health systems, and even governments. Those topics are irrevocably intertwined and have made news in a few locations to the start of the new year, specifically Connecticut, Massachusetts, and the Philippines. Here's our nursing news roundup for our readers.
Will Connecticut Lead the Way?
Here's the current Connecticut status to provide context for what is being proposed. Currently, mandatory overtime is legal in Connecticut, the only exceptions being persons over the age of 66, persons with a handicap, and disabled veterans. Nurses are not one of the exceptions, although they can only be forced to work up to a scheduled shift. Hospitals must have a staffing plan, but nurse-to-patient staffing ratios are within their purview.
Lawmakers Sen. Richard Blumenthal, D-Conn., and State Sen. Dr. Saud Anwar, D-South Windsor, co-chair of the Public Health Committee, met with union leaders and nurse voices at the state's capital to advocate for legislation this week. The federal senate bill 1567, "Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021," was introduced last year. Still, Blumenthal isn't confident in its success, so he urges his home state to lead the way by stating, "Connecticut can help show it is possible to win — for patients, for nurses, for everybody." State Sen. Dr. Saud Anwar reported that the state senate's public health committee is preparing legislation for minimum staffing requirements.
Massachusetts Set to Adopt Nurse-to-Patient Ratios?
State lawmakers state Sen. Lydia Edwards (D-Boston) and state Rep. Natalie Higgins (D-Leominster) introduced legislation last week, " An Act Promoting Patient Safety and Equitable Access to Care." The Massachusetts Nurses Association has joined lawmakers in support of the bill, which, if passed, would open the door for the state's DPH (Department of Public Health) to gather information and input through stakeholder meetings to identify appropriate limits for how many patients one nurse can be assigned to care for.
In a press release, the union's president Katie Murphy (also a working ICU nurse), made this statement, "There is no question that limiting the number of patients a nurse cares for at one time is safer for patients and the only solution to the current nurse staffing crisis. To be clear, there is no shortage of nurses in Massachusetts. There is a shortage of nurses willing to continue working under the current conditions and staffing practices implemented by profit-driven hospital administrators over the last 15 years. The benefits of safe patient limits were settled science before the pandemic, and today there is even more research and nurse experiences to support this legislation."
Murphy refers to data published by CT Data Collaborative, which showed that the state has 86,483 licensed registered nurses and licensed practical nurses. Still, only around half that number are actively working nurses in the industry. According to the report published by the AFT Healthcare Staffing Shortage Task Force, the entire country suffered a loss of 100,000 registered nurses between the years 2020 and 2021, all of whom were under the age of 44 years, which means this doesn't take into account the number of nurses who left the industry for their retirement.
Philippines Nurses Are Leaving the Country
On the 27th of January, Manila is hosting the International Labor Organization-High-Level Tripartite Mission (ILO-HLTM). A group of Filipino nurses is taking the opportunity with the ILO on their home turf to ask the ILO to investigate nurse staffing violations. The Department of Health has set standards for nurse-to-patient ratios for no more than 12 patients in general wards. Allegations made by the group say nurses are caring for 20-50 patients per shift.
Filipino Nurses United (FNU) reports that the risks nurses faced during COVID, excessive working hours, the face of contracting COVID themselves, and no leave time or benefits have prompted a "massive migration of nurses to other countries." In contrast, the country itself remains in dire need of nurses.
In comparison to, California
California currently has laws prohibiting mandatory overtime for nurses and limiting their scheduled shift times to 12 hours in 24 hours. The state has mandatory staffing ratios for nurses as well. Research supports that setting staffing limits in California has been positive since its implementation in 2004, showing some of the following results:
- nurses believe the limits reduced their workloads and improved recruitment efforts
- emergency departments found it to be beneficial
- improved survival rates of heart attack patients found
- costs associated with more nurses offset by savings in better patient outcomes
- increase in nurse satisfaction
How do you feel about mandatory overtime or the idea of set nurse-to-patient ratios being established and enforced? Many nurses hope for their states to follow the example set by California. We'll be watching to see what happens with these legislative efforts. Not all states have laws governing mandatory overtime. Out of all of the United States, only 18 have regulations making mandatory overtime illegal. For more information about mandatory overtime, check out our article "Is Mandatory Overtime Ethical?".