NEW YORK, N.Y.—Pat Kane, executive director of the New York State Nurses Association [NYSNA], laughs when she’s asked if the bill intended to lessen understaffing at hospitals, recently passed by the state Legislature, was a “milestone.”
“Absolutely,” she says. Similar legislation had been introduced regularly since 1996 and largely gone nowhere.
“I do think the pandemic had a lot to do with this finally being addressed,” she adds.
The bill, not yet signed by Governor Andrew Cuomo, is a compromise. Unlike its companion measure for nursing homes, it does not set specific staff levels for hospitals, as hospitals objected to what they called one-size-fits-all mandates. Instead, hospitals will have to establish committees to recommend staffing standards by January 1, with at least half of their members being nurses or others directly caring for patients.
Still, Kane believes that will get the job done. In California, where the state health department sets staffing ratios, it took 10 years to develop them. Here, the state Department of Health will begin that process in 2024, after three years of reports from the hospital committees.
Another advantage, Kane adds, is that while some NYSNA contracts have staffing minimums for nurses, the union can’t demand that a hospital hire more ancillary staff, because those workers’ unions negotiate separately.
“We’ll be the only state that’s including the entire care team,” she says. “Management will have to talk to all of us at the same time.”
For critical-care units, however, the Health Department is supposed to establish staffing ratios by January. That’s an area Kane knows well. She was a nurse for more than 30 years before she became director of NYSNA in December 2019, mostly at Staten Island University Hospital.
In critical care, she says, the optimum is one nurse for every two patients, but sometimes, that’s not enough. When she worked in an open-heart surgery operating room, “they couldn’t figure out a way to have me take care of more than one patient,” she says. The overall aim, however, is to prevent one nurse from having to pick up a third or fourth patient.
Even for less critical patients, she says, having six patients per nurse “doesn’t give you any flexibility.”
One impetus to pass the staffing bill, Kane says, came in March, when the journal Medical Care published a study led by Linda Aiken of the University of Pennsylvania’s School of Nursing. In surveying the outcomes for more than 400,000 Medicare patients at 116 hospitals in New York State in 2017-18, it found that staff ratios ranged from 4.3 to 10.5 patients per nurse, with an average of 6.3. An increase of one patient in their average workload, it estimated, correlated with a 13% increase in the death rate, as well as longer hospital stays and more readmissions.
The report estimated that if the ratio of patients per nurse had been reduced to 4:1, that would have saved more than 4,000 lives.
“We finally have the pathway,” Kane says. “We need to be involved in setting these standards.”
