Should hospitals be required to have a certain number of nurses?

The Pennsylvania House of Representatives is considering a bill that would require hospitals to meet staffing minimums for nurses to improve patient care at a time when hospitals are experiencing a nursing shortage.

If it advances, Pennsylvania could become the second state to enact such rules.

The proposal’s supporters include unions representing nurses, who say it will help to address working conditions in hospitals that result in nurses burning out, a factor contributing to the hospital staffing shortages. The requirements would allow nurses to stay in bedside jobs for longer, they argue.

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“When too few staff are in charge with too many patients, those nurses feel overburdened and overwhelmed,” said state Rep. Dan Frankel, a Democrat from Allegheny County and majority chair of the House Health Committee. “Then, unable to bear the strain, they are quitting.”

On Tuesday, the House Health Committee held a hearing on the Patient Safety Act, which would require hospitals to meet specific staffing levels in each unit, based on the level of the care delivered.

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

The legislative discussion comes as a new poll reported that one-third of nurses nationwide plan to quit the profession. A survey of 18,000 nurses released last week by the AMN Healthcare Services Inc., a medical staffing provider, found that 69% of nurses are looking for higher pay and 63% want a safer work environment.

Shannan Giambrone, a board member of the Pennsylvania Association of Staff Nurses and Allied Professionals, said the number of nurses currently leaving jobs in the hospitals exceeded anything she had seen in her 25-year career.

“If you don’t fix the root cause of staffing in the hospital, you are never going to fix the problems that hospitals are facing right now,” said Giambrone, a registered nurse at Suburban Community Hospital in Montgomery County.

California is currently the only state that requires nurse-staffing ratios. Last year, when a similar bill was introduced in the Pennsylvania legislature, a majority of House members endorsed the measure by signing on as cosponsors. That bill, however, did not advance due to opposition by then-chair Rep. Kathy Rapp, a Republican from Warren County.

In Tuesday’s hearing, Rapp raised concerns about the impact on rural and suburban hospitals, many of which are struggling financially.

“The last thing we want to do is put our hospitals at risk of closing in our communities,” she said.

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Andy Carter, president and chief executive of the Hospital and Healthsystem Association of Pennsylvania, said 30% of hospital nursing jobs are unfilled, despite incentive programs to attract nurses.

“If hospitals are unable to meet mandated ratios due to the scarcity of available RNs, they will have little choice but to close beds and reduce other health-care services,” Carter warned.

One health system struggling to hire is St. Luke’s, a representative for the Lehigh Valley health system told legislators.

“In the past 15 months, St. Luke’s hired over 1,000 nurses and would gladly hire more if they were available,” said Stephanie Pollock, a registered nurse and a patient care manager at St. Luke’s Hospital in Bethlehem.

Surveys that warn of a mass exodus of nurses from the field tend to be exaggerated, said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. She has been studying nurse staffing for 25 years.

She said Pennsylvania does not have a shortage of trained nurses, but rather a shortage of nurses who are currently working in hospitals.

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The commonwealth has one of the nation’s greatest concentrations of registered nurses per resident, with about 100 nursing schools graduating roughly 9,000 nurses every year, Aiken said.

But the shortages of those willing to work in hospital jobs impacts patients directly.

Nurse-to-patient ratio is one of the most important measures in predicting the quality of patient care. It is also “the single most important predictor of patient satisfaction in our hospitals,” Aiken told the House committee.

By her research estimates, if the nurse staffing bill were to pass, more than a thousand lives would be saved, and hundreds of readmissions prevented each year. It would also reduce length of hospital stay by tens thousands of days annually, saving hospitals millions of dollars, Aiken said.