UP lawmakers propose minimum nursing requirement for hospitals

The Safe Patient Care Act (SPCA) has been reintroduced to the state Legislature, cosponsored in the Senate by District 38 Sen. Ed McBroom and in the House by Rep. Sara Cambensy of the 109th District.

The package of bills would mandate that hospitals staff according to certain nurse-to-patient ratios, report the ratios used to the state, and prohibits imposing mandatory overtime on nurses “except in an unforeseen emergent situation.”

“This is an issue that’s not really new,” Laura Wotruba, the director of public affairs with the Michigan Health and Hospital Association, said. “Typically, we have not been supportive of this legislation at all.”

Hospital administrators are concerned with their ability to meet the staffing mandates of the bill, particularly in rural areas. Wotruba pointed out the difficulty with age demographics and the availability of educated, qualified people in the Upper Peninsula. She said young people often leave the area for higher education downstate or in Wisconsin, and don’t always return once that education in completed.

“You need to get them to stay there (in the UP),” she said. “And also we’re going to have to replace people who are aging out of the workforce who are currently in those jobs.”

The MHA is also concerned with the increased cost of staffing under the SPCA. Those costs would likely be reflected in the cost of healthcare and insurance premiums. This concern was also raised during the debate over a 2018 ballot initiative in Massachusetts about nurse-patient ratios.

“(The Massachusetts Health Policy Commission] estimated that it was going to cost close to a billion dollars to have those mandated staffing ratios in place,” Wotruba said. “That was statewide.”

The Massachusetts Nurses Association disputed that estimation.

In 2014, Massachusetts instituted regulations on nurse-to-patient ratios in Intensive Care Units (ICUs).

“In neonatal ICUs it sometimes resulted in the splitting up of twins,” Wotruba said.

She also said that the regulation resulted in longer waiting times for patients to enter ICUs and in some cases unnecessary transfers to other hospitals.

However, a study from the Beth Israel Deaconess Medical Center in Boston, Massachusetts found that “the Massachusetts nursing regulations were not associated with changes in staffing or patient outcomes.” The study found that changes in nurse staffing were not significantly different from that in states without mandated ratios.

Wotruba said that hospitals like to maintain in staffing not allowed under potential statewide regulation.

“That doesn’t always account for the clinical needs of our patients,” Wotruba said.

She said that the nature of healthcare sometimes requires staff to work outside normal schedules, but that healthcare providers try to avoid mandatory overtime while keeping staff available.

Tools like on-call incentives, volunteer overtime, part-time staff and utilization of traveling nurse agencies can be used, in addition to having managers or supervisors with nursing backgrounds step back into the role temporarily.

“We need that flexibility to react and care for patients during times that we might not have foreseen in the process of scheduling,” Wotruba said.

TOMORROW: The Michigan Nurses Association offers their stance on the Safe Patient Care Act.