Pennsylvania takes step to become the second state to require nurse staffing minimums in hospitals

Pennsylvania has taken a step to join California as the second state that requires a set number of nurses in hospitals, a move that proponents say could improve patient safety and help retain nurses in bedside jobs.

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The Patient Safety Act would require each hospital unit to meet specific staffing ratios based on the level of the care delivered. It passed Tuesday out of the Health Committee in the state House of Representatives, but its prospects of becoming law this year remain uncertain.

The legislation would require, for example, one nurse for each patient in active labor or every two patients in intensive care. Hospitals failing to meet the requirement would be fined.

“Nurses deserve to have an assignment that they feel they can deliver the best possible care to their patients,” said Rep. Bridget Kosierowski, a Democrat from Lackawanna County, who worked as a registered nurse prior to joining the House. “That’s why we are here today.”

Unions representing nurses throughout the state lobbied in support of the bill, including the Pennsylvania Association of Staff Nurses and Allied Professionals that represents nurses in a number of Philadelphia-area hospitals.

A trade group for state hospitals, the Hospital and Healthsystem Association of Pennsylvania, and multiple health systems opposed the requirement. Critics contend that a one-size-fit-all mandate lacks flexibility for hospitals’ financial, staffing, and patient care needs. They also say hospitals already are struggling to fill a high number of vacant positions for nurses.

A similar version of the bill had been proposed in the previous legislative session. But the then-Republican chair of the committee, Rep. Kathy Rapp of Warren County, did not bring it up for a vote.

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The bill’s prospects changed when Democrats took control of the House last November, and then held onto their narrow majority in recent special elections.

Tuesday’s vote split along party lines, with Republicans voting against the bill, and Democrats voting in favor of advancing it.

Prior to the vote, Rapp said that the bill would force already financially struggling small and rural acute care hospitals to downsize services or close. She also called the legislative push an effort to force collective bargaining on hospitals statewide.

“This bill will decrease care, not increase it,” she said. “Mandating safe staff ratios when hospitals are struggling to find nurses is not going to suddenly create a pool of ready-to-work nurses.”

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California is the only state that currently mandates nursing levels. The law took effect there in 2004 and it did not lead to the negative fallout that opponents feared, Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, told the committee in a hearing last month. She noted that Pennsylvania has sufficient registered nurses, just not enough nurses providing patient care in hospitals.

Her analysis of the bill found that if Pennsylvania hospitals had the staffing levels it would require, the state could prevent 1,155 hospital deaths and 771 hospital readmissions every year.

More than half of House members, including some Republicans, have cosponsored the bill, which can get a floor vote as early as this month. But if passed, the bill would face an uphill battle in the Republican-controlled state Senate.