More states propose nurse staffing and patient ratio laws.

Lawmakers in three states are considering legislation around healthcare worker staffing and nurse-to-patient ratios after the pandemic caused the industry to suffer major workforce challenges.

More state lawmakers are considering bills around nurse staffing this year after shortages and other workforce challenges have hampered hospitals throughout the COVID-19 pandemic.

Labor unions representing nurses and other healthcare workers have been instrumental in getting those measures to pass in other states and are proponents in new legislation, but hospitals have long pushed back on such rules — particularly those outlining nurse-to-patient ratios — saying a one-size-fits-all approach would limit flexibility and could strain operations.

Lawmakers in Washington state are considering a bill around nurse-to-patient ratios this session after failing to pass a similar bill last year. The latest bill would spell out exactly how many patients a nurse can be assigned to, determined through rulemaking by the state’s department of labor and industries. It would also cap mandatory pre-scheduled on-call hours at 60 hours per month, up from 24 hours a week currently.

Service Employees International Union Healthcare 1199NW, a labor union representing healthcare workers in the state, is backing the legislation, while the Washington State Hospital Association is not.

“We are deeply concerned about the negative impacts to patient access that will result from this bill,” WSHA said in a statement.

In Massachusetts, lawmakers plan to file a bill in partnership with the Massachusetts Nurses Association that would create nurse-to-patient ratios in each unit of acute care hospitals, with exact ratios determined through public stakeholder meetings held by the state health department, according to a release from the union.

And in Oregon lawmakers introduced a bill that would require nurses, along with technical and service staff at hospitals, to develop staffing committees. Those committees would establish standards and hospitals could face financial penalties for failing to comply.

Other states already have varying staffing laws on the books, like California.

California’s staffing law was passed nearly two decades ago and is considered to be one of the country’s strictest. It spells out exact nurse-to-patient ratios in the law, stipulating exactly how many patients a nurse can be assigned to in certain units. In intensive and critical care units, one nurse can be assigned to a maximum of two patients under that law.

New York also passed its own staffing law in 2021 prompted by the pandemic, but it does not impose ratios. It requires hospitals form clinical staffing committees that include front-line nurses and other direct care staff when setting annual staffing standards for units.

Colorado also passed a staffing law last year similar to New York’s, requiring hospitals to form nurse committees and develop staffing plans. Under Colorado’s law hospitals also must report the baseline number of beds they can have current bed capacity, which the health department will use to ensure hospitals are meeting required staffed-bed capacities.

Even in states with staffing laws, like New York, healthcare workers have still waged strikes over adequate staffing levels they want better defined in their employment contracts.

About 7,000 nurses at two hospitals in New York waged a three-day strike this January, which ended through a deal containing enforceable staffing ratios — a key point of contention in negotiations.

Healthcare workers in California also waged a number of strikes over staffing levels last year.

Published Jan. 24, 2023

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