State health officials have released a study questioning a proposed bill in Albany that would mandate smaller nurse-to-patient ratios as a way to improve quality patient care.
In a 43-page study released late Friday, the Health Department evaluated whether the proposed Safe Staffing For Quality Care Act, which failed to pass in the state legislature last year, can even work given the nurse staff shortage impacting the state. Under the bill, the nurse-to-patient ratio would be mandated at 1-to-1 for emergency care and 1-to-5 for rehabilitation units. Supporters of the bill argue the ratio would reduce work-related stresses that often lead nurses to file grievances against their employers.
The report, which was released months after its original deadline of December 31st, relied on testimony from nurses and opponents of the Safe Staffing bill taken in October 2019. It also focused on a 50-page study by Cornell University that suggested 24,779 full-time registered nurses and licensed practical would be needed at hospitals to achieve the bill's staff ratio requirement, with 12,011 needed exclusively in New York City. For nursing homes, the total number of RNs and LPNs needed is 45,158. The state currently has a nursing pool of 72,969 full time equivalent.
The Cornell University study states that the nursing workforce could be bolstered by transitioning part-time nurses to full-time, hiring minority and male nurses, recruiting out-of-state nurses, and training new ones. The state estimates the total cost to be $1.8 to $2.4 billion for hospital nurses and between $1.9 and $2.3 billion for nursing home nurses to achieve this. Nurses insist hospitals have the money to pay for more nurses, arguing many have spent lavishly to acquire other hospitals.
But the DOH study states that increasing the nurse workforce will be impossible, citing data showing a rising number of nurses approaching retirement. They also argue that while the nurse graduation rate has increased in the last five years, there are few new nurses graduating with the required bachelors in nursing degree, which is state-ordered. "Some research suggests that New York State will continue to experience a nursing shortage through the next decade, which could make meeting any mandated minimum staffing levels unachievable for some providers," the report reads.
Researchers for the state’s report also pointed to California and Massachusetts, which have mandated staffing levels at hospitals and ICUs, as showing no significant improvement in patient outcomes.
The report suggested nurses form committees that devise plans for quality care instead of simply creating a nurse-to-patient ratio that the report likened to a "one-size-fits-all" approach, since every hospital and its demands are different. It also recommends hospitals respond to retention by preventing burnout through practices "that promote work-life balance, support workers’ wellbeing, and foster a climate that addresses underlying sources of worker stress."
DOH officials told legislators at a hearing last week the department had delayed the report in order to include the experience by nurses during the COVID-19 pandemic. Pat Kane, executive director of the New York State Nurses Association -- which has been advocating for increased staffing for years -- told Gothamist the report glossed over some examples that illustrate the need for more nurses during the pandemic, including the need for extra nurses to help properly turn over a patient on a respirator.
"Maybe if you were going to wait and you wanted the COVID experience in here you would have bought back the people on the frontlines to tell you about what that experience was in relation to staffing,” said Kane, adding researchers did not contact nurses to discuss their experience during the height of the pandemic. “I mean, we had nurses that hadn't been at the bedside in 20 years that were working in specialty areas that were all of a sudden really mandated to work on these inpatient units with very little training. And it was, was very, very distressing to those professionals. And, you know, if we had better staffing to begin with, we would have had more experienced nurses in those areas."
The Safe Staffing For Quality Care Act was reintroduced in both chambers this year and is currently in committee.
In a statement, the DOH said, “Maintaining a nursing workforce that effectively meets the needs of patients requires a comprehensive approach to address today’s multifaceted and complex healthcare delivery challenges. While the Department supports measures to improve quality of care and patient outcomes, the COVID-19 pandemic has only highlighted the need to maintain workforce flexibility. The team-based approach to healthcare that fundamentally requires flexible staffing solutions is essential to a sustainable system that can support an effective pandemic response.”