Pennsylvania House approves bill to require nurse staffing minimums in hospitals

The Pennsylvania House of Representatives approved a bill that would require nurse staffing minimums in hospitals, bringing the state closer to enacting a measure that proponents said will address patient safety and help retain nurses in bedside jobs.

The Patient Safety Act would make Pennsylvania among the nation’s first states, behind California, to enact specific staffing-level requirements for nurses in hospitals. Nurses’ unions have advocated for the measure, which many hospital systems and trade groups oppose. Critics say the requirements are unrealistic and may force rural and small hospitals to reduce services or even close.

Under the legislation, each hospital unit has to meet specific staffing ratios based on the level of care delivered. For example, one nurse for each patient in active labor during childbirth, or every two patients in intensive care.

Hospitals failing to meet the requirement would be fined.

» READ MORE: Pennsylvania takes step to become the second state to require nurse staffing minimums in hospitals

The measure passed in a 119-84 vote. More than a dozen Republicans joined the Democrats who voted in favor of the bill on Wednesday afternoon.

Rep. Tarik Khan, a Democrat representing parts of Northwest Philadelphia, spoke about his time as a hospital nurse. He said that nurses juggling too many patients are prone to errors.

“Nurses like me know all too well the fear of going to work and feeling like they’re going to harm a patient because of the effects of unmanageable workloads,” Khan told the chamber.

Other Democratic lawmakers advocated for the bill by sharing personal stories, such as of family members who were ignored in their last days because nurses were too busy, or of medical errors that ended costing their loved ones their lives.

“I rise in support of HB106, and in memory of my Aunt Julia who passed away so unnecessarily and so tragically in a hospital that was tremendously understaffed,” said Rep. Christina Sappey, a Democrat from Chester County.

Nurses’ unions lobbied in favor of the bill and celebrated the vote. Maureen May, president of the Pennsylvania Association of Staff Nurses and Allied Professionals, called Wednesday “a historic and proud day for nurses.”

“Legislators listened to the most trusted profession in the country,” the Temple University Hospital nurse said in a statement.

Republican opponents said the bill’s fines would be financially devastating to smaller and rural hospitals. Rep. Kathy Rapp, a Republican from Warren County, said that fines can be up to $127,500 a day.

“This bill creates a one-size-fits-all approach to mandating staffing ratios with extreme sanctions for our hospitals,” said Rapp, the Republican chair on the House Health Committee.

Hospitals may be forced to admit fewer patients to avoid violating the law, critics added, and even without a mandate are struggling to fill nursing positions.

“It is unrealistic to assume that a rigid mandate will bring to the bedside the tens of thousands of nurses who will be needed, in the specialties and geographic areas where they will be needed,” Nicole Stallings, president and CEO of a hospital trade group, the Hospital and Healthsystem Association of Pennsylvania, said in a statement after the vote.

» READ MORE: As many nurses say they plan to leave bedside care, these Philly-area grads can’t wait for their first hospital job

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.

Oregon lawmakers passed a nurse staffing-ratio bill last week.

In Pennsylvania, the bill now goes to the Republican-controlled state Senate, where its chances of passing are uncertain.