Citing huge patient load, nurses seek staffing rules
When the emergency room fills up — whether it’s a big accident, flu season or a stroke of misfortune — Brooklyn nurse Rose Green says she can find herself sprinting from room to room, trying to keep ahead of the whims of calamity.
She and other nurses from around New York state are urging state lawmakers to pass legislation that would set minimum staffing levels for hospitals and nursing homes, a rule that they said would improve patient outcomes by addressing a chronic staffing problem.
“There are times when you wind up with 16, 17 patients,” she said. “You cannot provide appropriate care to that many people.”
California already has such a law, and the proposal has been debated in New York for years. This year it has bipartisan support in the Legislature. Nurses will gather in Albany on Tuesday to push for the bill.
Hospital executives say such a mandate would raise health care costs for patients, and that state lawmakers shouldn’t constrain hospitals by dictating unnecessary and inflexible rules.
Hospitals and nursing homes estimate the mandate would add about $3 billion a year in costs statewide, said Dennis Whalen, president of the Healthcare Association of New York State, which represents hospitals, nursing homes and other facilities.
Whalen said health care facilities already set staffing levels incorporating the input of nurses. He said a “one-size-fits-all” approach doesn’t make sense when hospitals around the state vary so much when it comes to size and scope of practice.
The legislation would set out different staffing ratios for specific units. Operating rooms and trauma emergency units would have one nurse for each patient. Emergency rooms and newborn units would have one nurse for three patients. Rehabilitation units would have one nurse for every five patients.
Kenneth Raske, president of the Greater New York Hospital Association, said the mandate doesn’t make sense given that new technologies, medications and procedures are transforming hospitals and the demands on staff.
“The best way of handling staffing is to handle it on a local, individual, hospital-by-hospital basis,” he said.
“Nursing staffing ratios is a 1960s view of health care. It would lock you into the past.”
California implemented its staffing mandate in 2004. A 2010 study led by researchers at the University of Pennsylvania compared data from hospitals in Cal-
ifornia, Pennsylvania and New Jersey and found that lower staffing ratios are associated with fewer patient deaths.
Nurses say in addition to the number of patients, the types of patients they see has changed. Many people now take a variety of medications to manage complex illnesses.
Also because relatively healthy patients are increasingly discharged to recover at home, those patients who stay in the hospital often present more
difficult cases.
They point to thousands of formal protests filed by nurses last year about shifts in which there were not enough nurses scheduled to handle patient loads.
“The hospitals that are doing better shouldn’t worry about standards,” said Jill Furillo, a nurse and executive director of the New York State Nurses Association. Furillo worked for the California Nurses Association when the 2004 law passed. “There are standards all over the place, standards in the airline industry. You can’t have one pilot on a commercial airplane,” she said.