A package of bills introduced today in Lansing would require hospitals to meet nurse-to-patient staffing ratios and end mandatory overtime as a regular practice.
The legislation pushed by Democratic lawmakers in the state House and Senate and backed by the Michigan Nurses Association aims to retain and bring nurses back to the profession, and to improve patient safety after thousands of nurses have left their positions or the professions from burnout and stress.
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That has left an estimated 8,500 open nursing positions at hospitals across the state and, proponents of the legislation say, resulted in degraded patient safety.
"Dangerous understaffing is a serious problem at hospitals across Michigan. The crisis we are facing is not that there is a 'nursing shortage.' The crisis comes from the fact that we are working in positions that are so awful that one-third of our registered nurses in our state are choosing not to work at the bedside. This takes a toll on patients, too," said Jamie Brown, president of the Michigan Nurses Association and a critical care nurse at Ascension Borgess Hospital in Kalamazoo.
"It's past time we hold the hospital executives accountable and require them to follow evidence-based practices to keep patients safe. The problem is not going to get better on its own," Brown said during a morning press conference in Kalamazoo. "The good news is that we know from nurses what will keep them at the bedside and protect our patients."
The Michigan Health & Hospital and the Michigan Organization of Nurse Leaders quickly voiced strong opposition to the legislation, claiming that what backers labeled as the Safe Patient Care Act "has the potential to severely harm hospitals and access to important services for patients, if ultimately passed."
"Proponents of the legislation falsely claim this will address nursing shortages in Michigan, but those claims couldn't be further from the truth," MHA CEO Brian Peters and Kim Meeker, president of the Michigan Organization of Nurse Leaders, said in a joint statement. "Michigan hospitals are trying to fill 8,500 job openings for nurses. Instituting a one-size-fits-all mandate requiring hospitals hire more nurses who do not currently exist will limit the services hospitals can offer to their communities, prolong the time it takes for a patient to receive care and hinder the ability of hospitals to respond to a crisis in fear of violating Michigan law."
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The two organizations said they are pushing efforts to bring more nurses into the profession that include funding for workforce development through the Michigan Reconnect program and having Michigan join a multi-state nursing compact that allows for licensure across state boundaries.
Brown, in response, said that "'one size fits none' is what their model is right now."
"Obviously, what they're doing is not working because nurses are leaving the bedside, and we are only asking for a minimum nurse-to-patient ratio," Brown said in an interview Crain's Grand Rapids Business. "Health care is becoming a much more corporate model and they are looking at putting the money first when health care is a business of taking care of people and making them better, and you cannot out a price tag on a person's life."
The bills that make up the Safe Patient Care Act follow survey data that the University of Michigan released in April that found that 39 percent of responding nurses planned to leave the profession within a year. That's up from prior findings of about 20 percent in a prior survey conducted in December 2019 and January 2020.
Among the 1,224 nurses the University of Michigan surveyed last year who had recently left a job, 70 percent cited concerns about adequate staffing levels. Nearly three-quarters said they were less likely to leave if they had a favorable work environment.
In a separate survey the Michigan Nurses Association released in February, a "vast majority" of respondents said working conditions were the cause of the present staffing crisis. Seven out of 10 believed they were assigned too many patients at a time, creating unsafe conditions. Three-quarters of the registered nurses who answered the union's survey said they are more likely to stay in their present position if the state Legislature enacts requirements for staffing ratios, according to the union.
The companion bills in the House and Senate would require hospitals to publicly post the number of patients a nurse is caring for at one time, end forced mandatory overtime as part of a hospital staffing model, and create staffing ratios of one nurse per patient in critical care units and one-to-four nurses per patient in medical and surgical units.
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The state presently has no law in effect mandating staffing ratios. Hospitals will make nurses care for up to eight patients at once on a medical surgery floor and three to four in a critical care unit, depending on the facility, Brown said.
Similar legislation has been proposed in past legislative sessions, but failed to gain enough support among lawmakers. Brown believes the state Legislature's transition this year to Democratic control improves the chances of getting the bills passed this time.
"We have more sponsors and co-sponsors than ever before," she said. "It's important to realize that this is not a partisan issue. This is a public health issue."
Legislation enacted 20 years ago in California mandating staffing ratios led to nurses returning to the profession, and decreases in patient falls, infection rates and hospital re-admissions, Brown said.
The Michigan Nurses Association has made staffing ratios a key issue in union contract negotiation with hospitals and health systems.
"It's proven to work," she said.
This story first appeared in Crain's Detroit Business.