Patient limits for nurses has majority support, but won’t advance in Harrisburg. Why?

The culprit is legislative rules that have troubled reformers and advocates in many fields, not just health care

By: - January 25, 2022 3:41 pm

State Rep. Kathy Rapp, R-Warren, takes questions from reporters after a House Health Committee meeting on September 14th, 2021 (Capital-Star photo).

A majority of state House lawmakers support passing a law regulating how many patients a single nurse can take care of in hospitals. But don’t expect it to come up for a vote any time soon.

As of Tuesday, 105 lawmakers — 29 Republicans and 76 Democrats — have signed on as co-sponsors to the bill, currently sitting in the House Health Committee. 

Despite this broad bipartisan support, the committee’s chairperson, state Rep. Kathy Rapp, R-Warren, said at a hearing in her home district last week that the bill would not advance as long as it was before her panel.

“I believe that would be very irresponsible for us to pass that legislation,” Rapp said according to her hometown newspaper, the Times Observer, of Warren, Pa., “and I believe that it [is] best left to the hospitals and the [staff] themselves to work out those agreements.”

The bill, whose prime sponsors are Rapp’s fellow Republican Reps. Tom Mehaffie, R-Dauphin, and K.C. Tomlinson, R-Bucks, would forbid hospitals from allowing the ratio of nurses to fall below a set number.

The exact ratio will differ depending on their respective responsibilities: From one nurse to each patient in labor, to one nurse for every five patients in a rehabilitation unit.

The bill also would give nurses the right to refuse assignments from supervisors if the nurse “does not have the necessary knowledge, judgment, skills and ability to provide the required care without compromising” the patient’s safety, as well as provide workplace protections for staff and patients who challenge a hospital policy.

While rare, bills do sometimes get the support of a majority of lawmakers, such as redistricting reform and infrastructure funding

But even though Mehaffie and Tomlinson theoretically have the votes to get their bill through the 203-member chamber on sponsorship numbers alone, that’s not typically how things work. 

That’s because chamber rules put a huge amount of power into the hands of committee chairs, such as Rapp, whose whim can decide what bills see a vote and which wither and die without action.

Reformers hope redistricting can open broader conversation on changing Harrisburg

Rapp’s public promise to block legislation is not novel, either. Republican committee chairpersons in the last few years have announced an embargo on specific policies, such as extreme risk protection orders, or even any bill authored by members of the Democratic Party.

“As committees, it is our responsibility to vet these bills and bring them forth, so the whole General Assembly can vote on them,” Mehaffie told the Capital-Star. 

He added that ​​”if we don’t do something soon, we are going to have a crisis like we’ve never seen before — and our healthcare systems will fail.

Nurses have argued that the proposal will protect patients by making sure they get the care they need, rather than a few minutes with an overworked nurse. 

“We’re supposed to turn patients every two hours,” Debbie Vandover, 38, an ICU nurse from York, said at a Capitol press conference Tuesday. “Every nurse wants to do this. It’s part of our basic nursing care.”

But even this simple task, which sometimes requires more than one nurse, becomes difficult amid a hectic workday. 

Vandover was one of a number of caregivers and lawmakers from both parties who pushed for Rapp to reconsider her opposition due to the bill’s widespread support.

But hospitals have opposed the proposal, with one administrator telling Rapp’s committee that the bill would be detrimental to rural hospitals by removing flexibility and adding expenses.

Rapp added that she viewed staffing as “a contractual issue and that she doesn’t “believe legislators should really get involved with contractual issues,” the Times Observer reported.

But to Vandover and other policymakers, the bill would lessen nurses’ workload, making it easier to retain them amid rising demand for their care.

Even before the COVID-19 pandemic, America was experiencing a shortage of trained nurses, due to a mix of increased demand as Baby Boomers age, and due to the high levels of burnout in the profession.

Fifteen states have some law or regulation addressing nursing staff ratios in hospitals, according to the American Nurses Association, though just one state, California, lays out specific ratios that must be maintained at all times.

Jason Gottesman, spokesperson for House Republicans, did not address questions about the House’s process. But he said the House GOP’s “goal is to make sure that our healthcare facilities, especially in rural Pennsylvania … have the resources they need to recruit and retain staff.”

A plan to use $250 million in federal funding to go to staffing issues was set to move through the General Assembly this week. Gottesman added that Republicans also hoped to provide student debt relief to nurses. 

Gov. Tom Wolf allocated $6.5 million in discretionary funding to similar issues last year.

The political forces fighting over the proposal wield political muscle. The state’s hospital association regularly spends more than $1 million a year on lobbying the legislature, according to state records.

On the campaign side, both the association and health care unions, such as SEIU Healthcare and the Pennsylvania Association of Staff Nurses and Allied Professionals are active. 

The hospital association has contributed $3.2 million to politicians coffers in the past 24 years according to Follow the Money, an online database; SEIU Healthcare has given almost $900,000 over the last 10.

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Stephen Caruso
Stephen Caruso

Stephen Caruso is a former senior reporter with Pennsylvania Capital-Star. Before working with the Capital-Star he covered Pennsylvania state government for The PLS Reporter.