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Facing Burnout And Worker Shortages, PA Nurses Say COVID-19 Shows Need For Staffing Ratios

TRANSFORMING HEALTH—Nurses in Pennsylvania’s largest health care union say COVID-19 has shown the need for a state policy requiring a minimum nurse-to-patient staffing ratio.

For several years, SEIU Health Care and some state lawmakers have made the case that staffing ratios would save lives and improve patient care in hospitals.

This year, however, nurses came to the state Capitol carrying the trauma of the pandemic, said registered nurse Mary Lou Arocena.

“With COVID, a lot of nurses got burned out,” Arocena said. “A lot of them quit, and sometimes it takes forever for them to hire somebody, because actually nobody wants to work there.”

Arocena, 60, is one of those nurses who got burned out. She worked for a Montgomery County-based health system for 35 years. Last year, after having chest pains and shortness of breath due to chronic stress, she quit.

Now advocating for the union, she said higher staffing ratios will keep more nurses like her from leaving the field despite their passion for the work.

She pointed to California’s nurse staffing ratios as a model for what she’d like to see in Pennsylvania. In California, law requires hospitals to have one nurse for every two patients in intensive care and one nurse for every four patients in emergency rooms.

Republican state Rep. Tom Mehaffie of Dauphin County sponsored the House version of the proposed bill, HB 106. He said Republicans and Democrats should be able to agree on legislation that would make patients safer.

“This is bipartisan legislation,” Mehaffie said. “This is not about what goes on here. It is about what goes on out there, and how we take care of our patients.”

Pa. state Rep. Tom Mehaffie, R-Dauphin, speaks at an event in support of legislation known as the Patient Safety Act, which aims to require a minimum nurse-patient staffing ratio in Pennsylvania.

Not everyone agrees that it would do so. At the Hospital and Health System Association of Pennsylvania, spokeswoman Rachel Moore said there is no clear link between staffing ratios and improving patient care or satisfaction.

“There are lots of reasons only one state in the U.S. mandates such ratios,” Moore said. “Staffing ratios do not create more nurses. There is a national shortage of many types of medical workers, including nurses.”

Moore said the proposed mandated ratios — about one nurse for every three patients, she estimated — would put “a huge and unnecessary burden on hospitals and nurse leaders.”

Research does seem to connect lower staffing ratios with a reduction in nurse burnout and better patient outcomes in certain circumstances:

  • 2017 study published in Annals of Intensive Care concluded that “exposing critically ill patients to high workload/staffing ratios is associated with a substantial reduction in the odds of survival.”
  • In 2017 Agency for Healthcare Research and Quality said it found a connection between lower ratios and higher patient safety.
  • A2018 Marshall University paper concluded that “The nurse-patient ratio is a direct determinate of the effects of psychological,
    mental, emotional health and nurse productivity in the workplace which also determines the
    patients’ overall health.”

Arocena and her colleagues want the House Health Committee, chaired by Republican state Rep. Kathy Rapp of Warren, to hold an emergency meeting on the proposal.

Rapp did not respond to requests for comment.