Four states have recently proposed staffing ratios, which would limit the number of patients a nurse could be assigned at once.
The majority of nurses agree that hospitals are understaffed — and if they continue to suffer under high patient loads, up to 75 percent could flee the profession.
But unions and hospitals tend to disagree when it comes to staffing mandates. Unions representing nurses say the current conditions are unsafe, causing care quality to fade and nurses' well-being to falter. They reference California — the only state that currently mandates RN to patient ratios — as a success story, as the law reduced nurse workloads, improved recruitment and retention and positively affected care quality. However, many hospitals believe staffing mandates are a one-size-fits-all approach that could lead to service cuts and closures at financially struggling institutions.
In all four states with legislation on the table, the battlegrounds are contentious.
1. Washington: In 2022, workers, including members of the Service Employees International Union Healthcare 1199NW, supported efforts for safe staffing standards during the legislative session. However, proposed staffing legislation that would have limited the number of patients direct care registered nurses could be assigned for any shift ultimately failed to become law.
A coalition of healthcare workers in Washington relaunched their efforts Jan. 5. The current proposal would direct state officials to set staffing standards for healthcare workers, including nurse-to-patient ratios.
2. Oregon: Oregon lawmakers will consider nurse staffing legislation this session that would require hospitals to establish staffing committees for technical staff and service workers. It would also require hospitals to set minimum standards for staffing plans for direct care registered nurses. Minimum standards would vary by unit. For example, the proposed legislation requires hospitals to ensure a direct care registered nurse is assigned to no more than one patient in the operating room, and in an oncology unit, no more than four patients.
The Oregon Health Authority would enforce staffing plans for nurses, with fines for hospitals that fail to adopt or to comply with staffing plans.
3. Massachusetts: Massachusetts lawmakers will propose a bill this week that — if passed — would limit the number of patients a nurse can be assigned. The specific ratio would be determined through public stakeholder hearings held by the Department of Public Health. Similar state legislation was struck down in 2014 and 2018.
The Massachusetts Nurses Association partnered on the bill. In a Jan. 19 news release, the union said at least 8,320 unsafe staffing reports were filed last year by hospital nurses in the state.
4. Connecticut: Healthcare workers with the American Federation of Teachers in Connecticut are asking lawmakers to address the nursing shortage, The Connecticut Mirror reported Jan. 23. The state legislature's public health committee said it was open to "exploring" mandatory staffing ratios, although officials with the Connecticut Hospital Association openly oppose them.
"A focus on government-mandated nurse staffing ratios will stall the work we need to get done," said Jennifer Jackson, CEO of the hospital association. "In fact, staffing ratios would exacerbate the problem, causing delays in care and raising costs with corporate nurse staffing agencies as the likely beneficiaries."