Nursing shortage renews push for patient load limits

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By NICHOLAS SIMON
Capital News Service

LANSING — A staffing crisis at Michigan hospitals has renewed efforts to protect nurses from unmanageable patient loads and too many hours of consecutive work.

The Safe Patient Care Act, first introduced in 2017, has picked up additional cosponsors from both parties in the House and Senate. It seeks to regulate how many patients a nurse can care for and the number of consecutive hours that they can work.

It would also publicize hospital nurse-to-patient ratios.  

Nurses are “forced to make painful choices every day,” Jamie Brown, the president of the Michigan Nurses Association, said in a statement.

“The hospital industry has been purposely getting by with inadequate (registered nurse) staffing levels for years,” said Brown, who leads the state’s largest nurses union.

“Nurses have long warned that our communities would suffer the kind of dangerous crisis that nurses and patients are facing now. The pandemic has only worsened and exposed hospitals’ emphasis on money above all else,” Brown said.

The union says that those choices are a result of hospitals trying to protect their bottom line. But Brian Peters, the chief executive officer of the Michigan Hospital Association, argues that government mandates for every hospital would be ineffective and make it harder for hospitals to operate.

“The one-size-fits-all approach inherent in legislatively mandated decisions impacting clinical care typically fails to recognize the complexity of patient care and the diversity of healthcare environments,” Peters said in a statement.

Unlike truck drivers, air-traffic controllers, pilots and rail operators, nurses have no federal limit on how many consecutive hours they can be forced to work, according to the Michigan Nurses Association.

Nurses can be fired and have their licenses stripped for refusing forced overtime even if they don’t feel fit to work because hospitals can claim that they are abandoning their patients.

Medical errors are the leading cause of preventable death, beating out smoking and obesity, according to the Journal of Patient Safety.

Nationally, the Nurses Association estimates that 440,000 people in the United States die every year due to infections and delayed or incorrect medications, problems that proper nursing care could prevent.  Studies over the past two decades have linked  patient mortality and staffing ratios, according to the union. 

In Michigan, even before the pandemic, one in five nurses was aware of when understaffing led to a patient’s death, and half of registered nurses said they are assigned unsafe patient loads at least half the time they are working, according to the union.

Hospitals say that staffing is a collaborative process and fixed ratios “don’t allow for flexibility and innovation,” said John Karasinski, the communications director for the Michigan Hospital Association. 

“Every hospital in Michigan has a process in place to ensure that each of their clinical units is appropriately staffed,” Karasinski said. “These processes are based on individual patient needs and the training, experience and capabilities of the entire clinical care team, including nurses.”

However, half of Michigan nurses say hospitals rarely or never adjust their schedules, even when they report unsafe workloads, according to a survey paid for by the Nurses Association. The majority (80%) of Michigan nurses are not protected by a union and face harsh repercussions for speaking out against hospital practices. The Nurses Association reports that multiple nurses have been fired over the last two years for trying to raise the alarm over this issue, worsening staffing shortages that are already at crisis levels.    

Staffing shortages are affecting hospitals across the state. The Michigan Hospital Association says 80% of nursing groups nationally have reported an increase in turnover due to the pandemic and that there are nearly 2 million openings for nurses across the country.

“Hospitals want to hire more nurses, and they want to retain the nurses they currently employ, but the current national demand for nurses far exceeds the available supply,” Karasinski said.

The Michigan Nurses Association said that the Safe Patient Care Act will bring nurses back to work. It points to data from the federal Department of Health and Human Services that indicates Michigan was on track to have a more than 5,000 nurse surplus by 2030 as proof that there are plenty of nurses, but that hospitals are causing them to leave their jobs. 

Brown, who also works as a critical care nurse at Ascension Borgess Hospital in Kalamazoo, said nurses are staying away from hospitals for safety concerns.

“Evidence shows there are enough qualified nurses to fill needed positions,” Brown said. “However, unless there is a serious commitment to safe staffing, fewer and fewer nurses will continue to choose to work in these dangerous settings.”

The Safe Patient Care Act was introduced in March and is a continuation of previous failed efforts. But supporters say they hope the pandemic has refocused attention to safer hospital care. 

The legislation dealing with limits on forced overtime has 45 sponsors in the 110-member House. That’s 34 more cosponsors than it did the last time it was introduced in 2017.

The package of legislation was sent to a committee in March and there are currently no meetings scheduled to take up the issue.

Brown said the problem cannot be put off any longer, and she hopes to see movement on the issue before the end of the term. 

“We are seeing this downward spiral happen in real time,” Brown said. “Michigan legislators need to address the problem. We don’t need Band-Aids, we need substantive solutions.”