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As we talked to nurses who support legislation to mandate staffing ratios and a representative of hospitals, which oppose the bill, we heard about a system in crisis. As people have become sicker, and mental health and substance use disorder needs go untreated, hospitals — particularly emergency rooms — have become increasingly dangerous and unpleasant places to work.
Both groups agree that this crisis needs immediate attention. They also agree more nurses are needed in hospitals and other health care settings. They disagree on how best to accomplish this.
The Maine State Nurses Association supports LD 1639, which would mandate specific ratios of registered nurses to patients. For example, one-on-one care would be required in operating rooms and intensive care units. Nurses could care for four patients receiving pre-surgical and rehabilitative care.
The bill is sponsored by Sen. Stacy Brenner, D-Scarborough, who worked as a nurse-midwife.
“The bill … accomplishes two primary goals: increasing patient safety and encouraging nurse retention,” she said in a press release.
“The care and touch of a knowledgeable and dedicated nurse in those times when you are feeling most vulnerable greatly increases patient satisfaction, dignity, and the overall perception of their hospital experience,” she added. “This is a bill for everyone. But, most especially, this is a bill for bedside nurses.”
Brenner and other nurses told us of their increasing frustration with working long, and sometimes unpredictable hours, while worrying that their patients were not getting the care they need and deserve. This stress is wearing on nurses, prompting many to leave the profession.
This situation is unsustainable, Cokie Giles, who has worked as a nurse at Northern Light Eastern Maine Medical Center in Bangor for 34 years, told us. There is not a nurse shortage, Giles, who is the president of the Maine State Nurses Association, told us. Rather, there is a shortage of nurses willing to work under current conditions.
And here is the crux of the problem. While studies have found that patients have better health outcomes when nurses care for fewer patients, there are, unfortunately, economic and human resource realities to consider.
There are already 1,500 nursing vacancies, according to Jeff Austin of the Maine Hospital Association. The association estimates that another 1,000 nurses would be needed to meet the standards in Brenner’s bill.
We are skeptical that requiring fewer patients per nurse will solve the many reasons driving people to leave the nursing profession or choose not to work in hospitals. Many nurses now work as traveling nurses, which typically pays more than being on staff at a hospital, or work in medical offices that don’t have the stress and chaos of a hospital, which must take any patients that show up at their door.
At a time when Maine already has a nursing shortage, we are concerned this bill would make the situation worse without addressing the underlying causes of worsening conditions in hospitals in Maine, and across the country. This could mean that hospitals would have to close units and deny care if they couldn’t hire enough nurses to meet the mandates in LD 1639. This could be one reason that no state, except California, has adopted broad nurse staffing ratios like these. Massachusetts has mandated nurse staffing ratios for intensive care units.
Without more mental health beds, for example, too many patients are spending time — often weeks or even months — in hospital emergency rooms. This is horrible for the patients and the medical care caring for them. Solving problems like this requires a much larger commitment — namely funding — from the state to grow the availability of mental health services.
This is just one of the significant and complex issues facing hospitals. That is not to say that hospitals, and other medical practices, should not invest more in improving working conditions. They cannot, however, hire more workers if those workers don’t exist.