Nurses push state by state for hospital staffing standards

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WASHINGTON — How many nurses does it take to run a hospital?

Legislatures in at least seven states and the District of Columbia are trying to answer that question as they debate bills that would require hospitals to have a minimum number of nurses on staff at all times.

California's Legislature passed a minimum nurse staffing law in 1999. While no other state has done so since then, the nursing unions backing the bills have grown increasingly powerful in statehouses across the country.

Hospital administrators are vehemently opposed. They argue that the bills would strip them of their ability to make basic staffing decisions and would be a financial burden. Many nurses and nursing unions counter that the legislation is needed to prevent cost-conscious hospitals from endangering patients by putting too large a workload on too few nurses.

"Hospitals right now are run like businesses, and they're focused on the short-term bottom line," said Jeff Breslin, the president of the Michigan Nurses Association, a union that supports a minimum staffing bill in the Michigan Legislature. If the bill becomes law, he said, "it doesn't matter what part of the state you're in, you can be assured you're going to have adequate nursing care whatever place you're going into."

Lawmakers in D.C., New York, Texas, Florida, New Jersey, Iowa and Minnesota also are considering legislation. While the language differs across the states, a minimum nurse-to-patient ratio is at the heart of all the bills.

The measures call for different ratios in different parts of a hospital. For example, the proposed law in Michigan would require hospitals to maintain a 1-to-1 ratio — no fewer than one nurse for every patient — in all operating rooms across the state. In pediatric units, that ratio may go as high as one nurse for every four patients.

A 2004 survey of research conducted by the U.S. Agency for Healthcare Research and Quality, part of the Department of Health and Human Services, found that patients at hospitals with low nurse-to-patient ratios fared worse than those at hospitals with higher ratios. But nursing and hospital advocates say there's scant research on what the ideal ratios should be, and studies conflict on whether mandating a ratio by law improves patients' health, according to hospital and nurses' groups.

Joyce Young, a nursing administrator with St. Joseph Mercy Health System in the Detroit area, said many hospitals were creating minimum staffing levels on their own and didn't need laws to tell them what to do.

"Hospital nursing leaders are in positions such that they can be able to determine staffing levels," Young said. It shouldn't be "based upon a legislator who mandates a number. It should be left to the nurses."

Hospital administrators also worry that minimum nurse staffing laws would force them to hire more nurses than they need, adding costs that aren't reimbursed by insurers. Robert Malson, the president of the District of Columbia Hospital Association, said passage of the bill now before the D.C. Council would lead directly to bankruptcies. "The most precarious would be the first ones to go down," he said.