Taken from NJSpotlight
By Lilo H. Stainton
July 21, 2021
For years, nurses in New Jersey have raised concerns about workforce shortages and staffing levels they believe put patients and employees in danger. The coronavirus pandemic exacerbated this situation and, according to New Jersey nurses unions, the state’s continued suspension of staffing regulations is further adding to the strain.
While COVID-19-related hospitalizations continue in New Jersey at a steady rate, the numbers are just a fraction of what health care providers battled during peak points in the pandemic. But nurses’ unions said their members are still enduring stressful conditions, traumatized by what they have experienced, exhausted by working long hours caring for multiple patients. They are skipping breaks, working weekends and, in some cases, missing out on the time off they enjoyed in past summers, nurses said. Labor leaders point to workforce shortages and a lack of government control as problems.
“Before we went into COVID we had staffing issues,” said Barbara Rosen, first vice-president for HPAE, the state’s largest health care union. When the pandemic struck, nurses and other frontline workers also fell sick, further limiting the pool, she said. But while the impact of the virus has diminished significantly, “our members are still struggling with staffing issues,” Rosen added. “Even a lot of (bonus) money isn’t enough to bring them in. Nurses are so burnt out.”
Staffing ratios in stone?
HPAE and other nurses unions, including JNESO, which represents some 5,000 health care workers in New Jersey and Pennsylvania, said the problem is complicated by the state’s decision to suspend regulations governing nurse staffing and scheduling at hospitals, to provide greater flexibility under the pandemic. But even when they are active, labor leaders said these regulations are insufficient and they believe it is time for New Jersey to codify in statute specific staffing ratios that govern how many patients each nurse can care for at one time.
The unions, which have pursued this quest for nearly two decades, said fixed staffing ratios have been proven to improve patient outcomes while reducing staff injuries and hospital costs.
“Really the whole point of staff ratios is safety of the patient, safety of the nurses,” said Barbara Johnson, a longtime nurse and vice-president of the JNESO board.
But Cathy Bennett, president and CEO of the New Jersey Hospital Association, said the flexibility provided by this state waiver was an essential tool for acute care facilities during the pandemic. “Throughout the pandemic our hospitals have had a singular priority — safety. The safety of our patients and the safety of our staff,” she said. “Empowering our professionals to make real-time decisions afforded a flexibility that would not have been available if those rigid staffing ratios were in place,” she said, noting they are better positioned to make these decisions than public officials.
Going forward, Bennett favors continued flexibility, not a staffing-ratio statute. Hospitals have also raised concerns in the past about the lack of nursing staff available to fill the additional positions such a law would create and the cost of this additional staff.
“The pandemic revealed the weakness of the staffing-ratio policy and approach. Over the past year and a half, we successfully delivered care via a dynamic workflow and the adaptability of teams of nurses, care techs, nursing assistants, therapists and others,” Bennett said. “Now is not the time to double down on rigid staffing ratios.”
Labor leaders insist the research proves staffing ratios make clinical, operational and economic sense. According to National Nurses United, which has 170,000 members nationwide, patients are more likely to suffer medical errors, falls or other complications when nurses are short-staffed. Overworked nurses are more likely to experience burnout, injuries and health issues of their own, they note, and by adding nursing staff hospitals can save significantly on overtime and per-diem workers.
In California, the only state with comprehensive nurse-to-patient ratios, the law led to a nearly 32% reduction in occupational injuries among nursing staff, National Nurses United reports. If New Jersey adopted the California standards it would reduce patient deaths by nearly 14%, the group contends.
These standards may not have been sufficient during the pandemic. National Nurses United will hold actions Wednesday at nearly two dozen hospitals in California and several in Texas to highlight the need for greater workplace protections.
Staffing minimums and other safety requirements can be negotiated as part of the contractual bargaining process — something National Nurses United is now engaged in for tens of thousands of members — but labor leaders in New Jersey would prefer a state law to establish uniform standards for all facilities.
The impact of the COVID-19 pandemic on New Jersey’s nursing homes — where more than 8,000 residents and staff have died since March 2020 — prompted state officials to approve a number of reforms, including a measure that sets staffing ratios for those frontline caregivers. The requirement, which took effect in February, led some long-term-care facilities to boost their wages, drawing nurses from hospital jobs, according to labor leaders here.
But the regulations that govern nurse scheduling and staffing at New Jersey’s hospitals have now been suspended for more than 15 months. In March 2020 the state Department of Health lifted the requirements governing overtime, vacation and staffing levels, including regulations that set a ratio of one nurse to three patients for critical care, emergency services, the operating room and a few other units. And while many pandemic-related precautions have since lapsed, these regulations will be reinstated in September under a law Gov. Phil Murphy signed last month to officially end the COVID-19 public health emergency.
“The waivers are in place to support the crisis-level-of-care staffing that may be required during a surge like the one experienced last year, at the height of the first surge,” DOH communications director Donna Leusner said. That flexibility remains important this summer not because of potential vacation schedules, she said, “but rather is related to monitoring surge COVID census past the summer as we saw increased census into the fall last year. This is monitored by the Department every day.”
However, Leusner added, that hospital “staffing in the summer due to vacations sometimes is less than optimal and the Department responds to those issues on an ongoing basis.”