Will States Implement Nurse Safe Staffing Legislation?

Written by
Miranda Kay, RN
May 15, 2019

Amidst the nationwide rise in voices fighting for fair pay and safe staffing ratios for nurses, such as the UAW nurses strike at Mercy Health St. Vincent Center, lawmakers push for safe staffing legislation in several states.Traveling registered nurse Brandi Combs worked during the heat of the St. Vincent strike at a Detroit hospital and had this to say:

This was my first experience working a strike and in this hospital, I worked my tail off and came home exhausted each night after a 12-hour shift. I was only there a week and I can’t imagine how tiring it is to do all the time and then be mandated to work past your 12 hours! Why wouldn’t the hospital just bring in travelers to help their dedicated staff instead of pushing them past the point of exhaustion? These hard-working staff members aren’t asking for more money. They just want decent insurance and better staffing. I get it.

Illinois is the most recent state to try passing legislation that limits how many patients a nurse can take care of at once, which is part of an effort made by the union to eliminate the dangerous conditions. Not alone in their efforts, other state assemblies of New York, Michigan, and Pennsylvania have held recent discussions of bills written to mandate the number of patients a nurse can be assigned at any given time.

Learn More About Nursing Legislation Proposed by the ANA

Nurse Staffing Laws Show Promise, but Opposition Ensues

Gerard Brogan, a union official, told Healthcare Dive that the National Nurses United is "more optimistic than ever about these bills." He explains that the problem has been swelling for years and is now coming to a boiling point.The director of labor employment relations at Penn State, Paul Clark also told Healthcare Dive that:

"Every nursing union has been active in promoting other states to pass a safe staffing law. And the issue of a national safe staffing law has been going on for years."?

Regardless of the obvious need for such safety legislative measures, lawmakers are pushing back. California was the first state in the country to set these mandatory staffing ratios, and lobbying associations often cite California's staffing law that enforces nurse-patient ratios as "failed" and claim the benefits have yet to be proven of such measures.In fact, the Illinois Hospital Association argues that "studies indicate that one-size-fits-all nursing staffing ratios do NOT improve quality of care or patient outcomes." Linda Aiken is the founder of the University of Pennsylvania's Center for Health Outcomes and Policy Research and she rejects those claims. Aiken has helped build most of the body of work that's been done on safe staffing for nurses. She told Healthcare Dive:

"There is absolutely no evidence that anything with negative consequences for the public happened in California as a result of ratios or would happen in other states if ratios were adopted. No hospitals or services closed because they could not recruit enough nurses, neither patients nor taxpayers were charged more for nursing."

Only one California hospital that closed last year cited the pressures of staffing laws as the reason for their closure. In fact, hospital closures in California have been consistent with level closures experienced in other states.

Illinois Lawmaker Reintroduces Safe Staffing Bill for Nurses

A bill was reintroduced in the Illinois Congress during the first week of May by Democratic Illinois representative Jan Schakowsky that would effectively set mandatory levels for nurse-to-patient staffing in the hospital setting.Nurses in the state of Illinois claim that the state hospital association is using similar tactics that were used by the peer association in Massachusetts last November. Illinois nurse Marti Smith told Healthcare Dive that "they used fear with the general public and intimidation with nurses." In both instances, these hospital associations make the claim that hospitals will be forced to close if the safe staffing laws were to go into effect. Smith also claims that internally, the nurses have their "clinical autonomy" threatened if they do not go along with the stance of their employers.The Illinois safe staffing law is called the Safe Patient Limit Act, and it's gaining steam in the state and has a good chance of becoming law. Progress is moving quite quickly for this legislation and it's set to be voted on in the Democratic-majority state house before the end of May.Many of the supporters of the bill are optimistic and feel that there's a good chance of it moving onto the state Senate and eventually making its way to the desk of the governor. This piece of legislation has been modeled largely around the safe staffing laws in California, making it the second of its kind should it go into effect. The biggest difference is the fact the Illinois bill has codified rations, which California's does not.

Safe Staffing Laws in Massachusetts Pushed Despite 2018 Setback

The Massachusetts Nurse Association (MNA) continues to push for its safe staffing law, despite the failed attempt last November to pass on the ballot referendum. The voters in the state of Massachusetts then rejected the measure, however, the voters may have been confused by the question explains Joanne Spetz, a researcher at Healthforce Center at UC San Francisco. She told a publication "that is not a state that does a lot of propositions. It's hard to say what voters were thinking about that."Leading up to the election, the bill seemed promising that it would pass, but then, just days before the vote, the state's Health Policy Commission published a claim that if the bill passed, it could potentially cost as much as $949 million per year.However, union nurses are skeptical of the timing and methodologies used in the study. The MNA recently conducted a survey of both union and non-union nurses who agreed that the hospital industry's campaign strategy they implemented last fall was largely "inappropriate."

Safe Nurse Staffing Legislation in Other States

New York State has recently commissioned a study that will take a deeper look at staffing ratios. Once the research has been completed, the results will be used to inform the future vote on safe staffing legislation. The governor of the state has expressed an interest in signing such a bill into law, and the New York State assembly is majority-Democrat.Republican state senator Ed McBroom of Michigan has just recently re-introduced mandatory staffing legislation for the third time - along with a twin bill - in the House.Pennsylvania nurses continue to fight for the passage of mandatory safe staffing legislation. the Democratic Pennsylvania Governor, Tom Wolf, promised to sign any safe staffing legislation that makes it to his desk, but a union coalition's legislation tracker says the bill has a ways to go before it will ever reach the governor.At Elite Specialty Staffing, our nurses always come first. We're hopeful that these and other efforts towards passing safe staffing legislation go into effect. We will continue to monitor and report on mandatory staffing ratio legislation at our blog. If you're interested in travel nursing opportunities, give us a call today at 208-378-1338.

Blog published on:
May 15, 2019

Miranda is a Registered Nurse, Medical Fact Checker, and Publishing Editor at Nursa. Her work has been featured in publications including the American Nurses Association (ANA), Healthcare IT Outcomes, International Living, and more.

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