Growing Number of Laws Seek to Address Hospital Staffing Concerns but Core Problem Persists
What’s Trending: An Increasing Number of States Are Passing Legislation Related to Hospital Staffing
In response to daunting provider workforce challenges, states are passing hospital staffing laws intended to increase patient safety and reduce nurse burnout. As of February 2024, 15 states have passed acts regarding hospital nurse staffing, and a handful of other states are in the process of considering similar bills.
This state-level activity has also prompted policy discussions and introduction of the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023, which would be the first federal law to address nurse staffing if passed.
Why It Matters:
Existing and Proposed Requirements
Nurses have been discussing staffing standards for decades. Many feel overwhelmed with their workloads and worry that existing staffing levels do not always allow for safe patient care. High turnover rates and the loss of experienced nurses put a higher burden on the remaining experienced nurses, who have a greater workload and must train travel nurses and/or new nurses. In addition, many feel their contributions are minimized by hospital administrators and patients, despite their significant efforts to provide high-quality care while also feeling under-resourced. Given these dynamics, nursing associations, state legislatures, and other healthcare advocacy organizations have been advancing this topic.
The specifics of state laws and mandates vary, though most fall into 1 or more of these 3 categories:
Established nurse-to-patient ratios are more widespread than the states with laws in place. Although only 3 states—California, Massachusetts (ICU only), and Oregon—have mandated ratios, hospitals throughout the U.S. have adopted similar practice standards.
On the federal side, the Nurse Staffing Standards bill proposes tailored minimum direct care nurse-to-patient ratios for the following units: trauma ER, operating rooms, critical care, emergency department, step down, medical/surgical, acute care psychiatry, intermediate care nursery, inpatient rehabilitation, post-partum, and well-baby. The bill also would require staffing committees to be responsible for developing and implementing the organization’s staffing plan, which would need to comply with the stated minimum nurse-to-patient ratios. The committee must have “at least one registered nurse from each hospital unit and shall be composed of at least 50% direct care registered nurses.”
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The Major Issue That Remains Unaddressed
Minimum staffing ratios are intended to support safe patient care and a healthier workforce, shared objectives of both organization leaders and front-line workers. Although these requirements can achieve some of these objectives, they don’t solve the supply-demand imbalance: the pervasive, persistent shortage of nurses that is unlikely to abate in the near or distant future.
This imbalance of nursing supply and patient demand is driven in part by a lack of nurse educators (creating a bottleneck in the pipeline), early retirement (largely due to burnout), and an increasing number of established nurses taking on more flexible hours and/or administrative roles, among other factors.
What’s Next:
Hospitals must navigate through these complex dynamics, developing a planning process that can produce a staffing model that is safe, fair, and achievable. Hospital administrators should view their staffing committee as a partner, working together toward a common goal. Critical factors include:
The following questions can help hospital executives get started or extend existing workforce planning efforts in a more productive way:
The nurse staffing shortage is unlikely to significantly abate anytime soon. While mandated or negotiated staffing ratios do not address that problem, they are a reality for many organizations. Hospitals should take a planful, strategic approach to staffing. This approach should include empowering their staffing committees to identify opportunities to optimize the planning process and implement innovative solutions. The ultimate goal is ensuring a professionally satisfied, engaged workforce that is well-equipped to provide excellent patient care.
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