Rules limiting nursing workload brought back to Harrisburg

Denelle Weller is a 14-year veteran nurse. She knows all about what happens when she and her colleagues are overtired and overworked: She once had to stop a fellow nurse from administering medicine to her daughter incorrectly, which could have led to kidney damage.

She directly attributes the mistake to the heavy workload.

“I’ve personally watched nurses go through entire shifts without a break, being unable to eat or go to the bathroom,” said Weller, also a local chapter president of Service Employees International Union, which represents state nurses and other healthcare workers.

Weller and others rallied in the Capitol Wednesday in support of legislation that would limit the number of patients state nurses can be assigned at a time.

The idea has the backing of Democrats and Republicans in the General Assembly, as well as state nursing groups and organized labor. The idea has percolated since at least 2015. Despite the different names attached growing, it has yet to receive committee consideration.

Two bills, one in the House and one in the Senate, would limit the ratio of patients per nurse based on the severity of care for different types of patients.

For example, as written, the legislation mandates a one-to-one ratio of nurses to trauma patients or delivering mothers, and a one to five ratio for rehab centers. Ratios for other patients fall somewhere in between.

The bill also includes whistleblower protections for staff who report violations, and fines to punish hospitals who flaunt the rules.

Weller and other nurses argued that the reform would not only improve working conditions, but care for patients.

Since 2004, California has been the only state to legislate wide ranging ratios — though Massachusetts has required a set ratio of nurses to patients just for intensive care units .

Since, results have been mixed.

According to a American Nurses Association white paper, some studies found “nurses having a more balanced life, financial security, and stable home life.”

But others found that professionally, rigid enforcement of the ratios meant less decision making by nurses. This hurt their professional growth, and especially impacted nurses who work closely with patients compared to nurses more removed from patients.

The nurses’ association white paper also reported limited change for patient safety in California. A Massachusetts study of the 2018 ICU-centered law also found no impact on mortality or complications.

Other studies looked at by the California HealthCare Foundation, a state nonprofit focused on improving low-income health care, found increased hiring and an increase in the time nurses spend with patients.

Rob Shipp, vice president of Population Health Strategies for the Hospital and Healthsystems Association of Pennsylvania, said the industry trade group opposes the legislation or anything similar.

Shipp said a quarter of Pennsylvania hospitals are operating at a loss — including more than half of the state’s rural hospitals, so the bill’s price tag is too high.

“These additional burdens that don’t seem to have an effect isn’t the right move,” he said.

He argued that hospitals needed to stay flexible to meet health needs, and that the state should focus on keeping nurses trained in Pennsylvania practicing in Pennsylvania.

The impact on cost is unclear. The HealthCare Foundation overview found that decreasing revenues among state hospitals “could not be tied directly to the nurse staffing legislation.”

Massachusetts voters rejected an expansion of the nursing ratios to all nurses last November. A government study put costs between $675 million to nearly $950 million, according to Modern Healthcare. Unions projected just a $50 million price tag.

Republican Sen. Judy Ward, of Blair County, is sponsoring a bill that doesn’t spell out specific ratios in law. Instead, it would ask individual hospitals to set up committees to dictate their own staffing ratios. The bill, like the staffing ratio bill, has bipartisan cosponsors.

“The bill does not contain state legislated ratios, and instead addresses this issue by establishing professional nurse staffing committees through collaborative efforts of the bedside nurses and hospital administration,” Ward said in a co-sponsor memo.

Seven states, according to the ANA, require similar commissions in hospitals.

But Sen. Maria Collett, D-Montgomery and a registered nurse, echoed other caregivers when she said that commissions would just co-opt their complaints.

“Nursing commissions a great way for people to feel like they are giving nurses a voice in terms of patient care,” Collett said. “Unfortunately it’s just not working.”

Instead, she said the state needs “to do something that has a little bit more bite to it.”