PA House Approves Staffing Ratios

Pennsylvania nurses gained a long-awaited win last week when lawmakers in the House of Representatives passed legislation by a margin of 119-84 with 19 Republicans in support and two Democrats in opposition. The legislation now advances to the Senate floor, where nurses hope the bill will receive the same bipartisan support as it did in the House.

What is House Bill 106?

House Bill 106, also known as The Patient Safety Act, requires hospitals to set appropriate nurse-to-patient ratios according to the acuity of patients in each unit. Lawmakers believe a lower patient-caregiver ratio would facilitate better care coordination and reduce staff burnout. 

Nurses repeatedly have claimed that increasing unsafe staffing levels have continually been driving RNs to leave the bedside, causing a staffing and retention crisis affecting the quality of bedside care and the health and safety of nurses across the state. Lawmakers have addressed their claims, prompting the bipartisan decision in the House. 

Research published by the Pennsylvania State Nurses Association PSNA) website and conducted by the University of Pennsylvania’s Center for Health Outcomes and Policy Research found that nurse staffing on med-surg units in PA hospitals averaged 5.6 patients per nurse and could range from 3.3 to 11 patients per nurse.

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Support of House Bill 106

The Patient Safety Act was authored by Representative Thomas L. Mehaffe and co-sponsored by Representatives Kathleen C Tomlinson and Bridget Kosierowski.

In a June 28 press release, Representative Tomlinson said, “By alleviating the burden on individual caregivers, we would allow them to maintain their well-being, job satisfaction, and overall performance.”

The bill also outlines stipulations requiring hospitals to face fines when not complying with the staffing mandates, including $1000 to $2500 minimum for each violation. Fines collected would go into a grant program that will aid staff recruitment and retention in hospitals throughout the state.

An amendment to the bill allows hospitals to exceed ratios during a declared emergency or mass casualty event. However, facilities must demonstrate they attempted to comply with the staffing mandate.

Impact of House Bill106

Proponents of the bill believe it will reduce the number of nurses leaving the profession after being overwhelmed by consistently high nurse-to-patient ratios.

In a speech on the House floor before the vote, Mehaffie said, “We don’t have a nurse shortage but a nurse retention problem. The turnover is nearly 30%, and we need to change that environment. We are going to work with nurses and listen to what they say. This brings nurses back to the bedside.”

Kathleen Tomlinson, the bill’s co-sponsor, said “The Patient Safety Act will enhance patient care by ensuring health care professionals can respond properly to their patients. A lower patient-to-caregiver ratio would facilitate better care coordination among health care professionals and reduce staff burnout.”

In a statement by the PSNA, “The Patient Safety Act has the support of every major organization of bedside nurses in Pennsylvania. It is the answer to the current nurse staffing crisis that is driving down the number of nurses willing to work at the bedside and depressing the quality of patient care across Pennsylvania.”

Arguments against House Bill 106

Lawmakers opposed to the bill believe the legislation will work against hospitals, leaving them to fill vacancies. Representative Kathy Rapp, a staunch opponent of the bill, is concerned it will ruin small-sized hospitals and health services in rural communities. According to a June 29 press release, state hospitals will need approximately 500 registered nurses to comply with the mandate, costing the state more than $30 million annually.

Rapp said in her press release, “While this bill’s intention is to try to bring more nurses to the bedside, I fear it could lead to hospitals being forced to close those beds. House Bill 106 could be a death sentence for the hospitals of our Commonwealth.”

The Pennsylvania Provider Advocacy Coalition, a group of healthcare provider organizations across the state, in a May 2 letter to the PA General Assembly, also voiced opposition to the bill. According to the letter, government-mandated ratios will not produce more nurses but will likely:

• Strain non-hospital providers relying on RNs to provide care for Pennsylvanians.

• Decrease the availability of health care services from providers.

• Exacerbate the mental health crisis, increasing the number of patients without proper post-acute care facility placement.

• Pressure ED’s to “divert” when they can’t meet staffing ratios

• Increase patient wait times in the ED and delay patient admissions

The coalition’s letter proposed alternative policy changes such as, “Investing in nurse educators, expanding nursing education programs and apprenticeships, supporting nursing students, and forgiving the educational debt of currently practicing bedside nurses.”

The only other state to pass and enact legislation mandating safe nurse-to-patient staffing ratios is California, and it is still sparking debate between hospitals and nurse associations after two decades.

Gerard Brogan, the director of nursing practice at National Nurses United, told Becker’s Hosptial Review that “safe ratios have “unequivocally” made a difference in the profession for the better.”

On the other hand, the California Hospital Association argues that mandatory ratios are ineffective and require more money and resources.

Pennsylvania Nurses Association (PSNA) members believe that the real winners are the patients of PA.

“Today’s vote for the commonsense protection of patients has been a journey of nearly two decades,” said Wayne Reich, DEO of PSNA. “And with every passing year, and every new legislature, and every well-intentioned governor, that protection has been delayed and denied. But no more.”

“Nurses from every corner of Pennsylvania have been carrying out the legacy of Florence Nightingale and advocating for their patients for decades,” said Debbi Bozeman, a surgical trauma nurse at St. Mary Medical Center in Bucks County. “Today, a mark in history was made when the Patient Safety passed the House. It’s on to the Senate!”