Pat Kane, executive director of the New York State Nurses Association, has seen the pandemic intensify the decades-long fight over adequate nurse staffing.
Before COVID-19 struck, the Midtown South–based union of more than 42,000 frontline nurses made safe-staffing ratios a top priority for its members, who work in major hospitals and other health care settings across the state. The ratios regulate the number of patients that may be assigned to a single nurse.
Those efforts continued through the height of the crisis. Nurses felt their facilities were unprepared in terms of the size of their staff to take care of the vast number of critical care patients, said Kane, who is a registered nurse herself.
"Our feeling was that staffing was so tight, when this came to be, the system broke. It just broke," she said.
The most recent bill about the issue proposed in the state Legislature is the Safe Staffing for Quality Care Act of the 2019–20 legislative session. It's currently in committee. Some of the proposed ratios include one nurse to two patients in critical care and intensive care units, one nurse to four patients in medical-surgical units, and one nurse to six patients in well-baby nursery units. The union's position is that mandatory nurse-to-patient staffing ratios would improve safety, quality of care and staff retention at a time when nurses are more essential than ever.
Hospitals, however, are steadfast in their belief in flexible staffing, which they say enabled them to handle the COVID-19 surge and save patients. Flexible staffing operates without mandated nurse-to-patient ratios and allows providers to adjust their number of nurses in real time based on how they view the needs of patients.
The hospitals also say meeting set staffing ratios is unachievable thanks to fiscal constraints arising from the current crisis, which resulted in a loss of revenue as most nonmandatory procedures were postponed or canceled.
Sean Clarke, a registered nurse and executive vice dean and professor at New York University's Meyers College of Nursing, said he believes the pandemic could fan the flames of the staffing battle.
"We may see that debate continue," Clarke said.