Taken from NJ.com
By Susan Livio
January 6, 2024
Nurses and managers at Robert Wood Johnson University Hospital in New Brunswick settled a bitter, 120-day strike last month, resulting in a groundbreaking agreement setting limits on the number of patients nurses may be assigned.
On Thursday, the momentum from that contract reached the Statehouse in Trenton, where union leaders urged a state Senate panel to make enforceable staffing ratios the law in hospitals and surgery centers across New Jersey..
Without a law limiting the number of patients, bedside nurses will continue to flee the profession out of exhaustion and the fear of making mistakes, said Debbie White, president of Health Professionals and Allied Employees, the state’s largest healthcare union.
“It’s as if we are trying to fill a bucket full of holes with water. We pour new nurses in, but they leave once they realize how unsafe it is,” White told the Senate Health, Human Services and Senior Citizens Committee.
“Nursing care is simply a line item in a budget that can be cut to its lowest number to maximize profits. Unfortunately, this is what we can always expect hospitals to do,” she added, eliciting applause from the hundreds of nurses who packed the largest hearing room in the capitol. “So we need New Jersey policy makers to take a stand and pass laws to mandate safe staffing.”
The committee did not vote on the safe staffing bill (S304) at the conclusion of the nearly two-hour hearing. But the measure’s proponents have a friend in Sen. Joseph Vitale, D-Middlesex, the committee’s chairman, who has introduced a hospital safe staffing bill every legislative session since 2002. After the hearing, Vitale said he would rewrite the bill and find common ground between nurses and hospital leaders in the next several months.
Vitale said he remains convinced 20 years after he first sponsored the bill that patient limits are necessary to retaining the nursing workforce necessary to keep patients safe. Countless nurses have told him “the conditions are untenable. It’s not sustainable,” Vitale said. “Something is wrong.”
Vitale asked Judy Danella, president of United Steel Workers Union 4-200, which represents Robert Wood Johnson University Hospital’s 1,700 nurses, whether the recently inked contract could serve as a template for the legislation.
Danella called the terms of the contract “a start — but it’s not where we want to be.”
The contract, for instance, sets a 5-to-1 patient-nurse ratio in the inpatient and surgery units, but the hospital is permitted to miss that target 18% of the time in each quarter before it would be obligated to pay a penalty, Danella said. The fines, ranging from $500,000 to $2 million, would later be paid to the nurses who had to work on the understaffed shifts, she said.
In the emergency room, the ratio is 6-to-1. If it involves a trauma patient, the nurse-patient ratio would be 1-to-1, Danella said.
“In the end it is the right thing to do. One day, every one of us will be a patient in a hospital, and we want to give the same care — whether it’s Sen. Vitale, Judy Danella or somebody who was picked up on the street,” said Danella, a bedside nurse for 28 years.
Lisa Ruiz, a registered nurse who got her start at Atlantic City Medical Center in 1992, said she recalled thinking “something was seriously wrong when she was assigned 11 patients on her first day as a brand-new nurse.”
“Now let’s fast-forward to today. I work for the New York State Nurses Association, representing nurses in New York and in our one bargaining unit in south Jersey at Shore Medical Center in Somers Point,” Ruiz said. “Nurses still have 11 patients — sometimes more, sometimes a little less.”
She said the mass exodus of bedside nurses, especially since the pandemic, “is because they are not going to be part of a system that puts patients at risk every day.” Nurses will return if the job is made safer, she said.
“This bill will absolutely save lives,” Ruiz said.
Hospital executives have successfully fought the proposal, saying it would cost millions of dollars and undermine the judgment of medical professionals on a daily basis. In 2015, the New Jersey Hospital Association estimated it would cost hospitals $159 million to hire an estimated 2,100 nurses to meet the bill’s nursing quotas.
The hospital association ranked sixth for the amount of money it spent lobbying lawmakers and the governor’s office on various issues from 2000-2022, according to an analysis by the state Election Law Enforcement Commission last year. It spent $13.5 million over that period.
Hospital Association President and CEO Cathy Bennett told the committee there would be unintended consequences that would harm patients if the law passed.
“Mandated ratios may lead to a hospital temporarily or permanently halting necessary healthcare services, such as obstetrics, dialysis, cancer, or pediatric care. This directly impacts patients, and may at times be life-threatening,” Bennett said.
Stephanie Pollack, a neonatal and pediatric intensive care nurse and patient care manager from St. Luke’s University Health, a system serving Warren, Hunterdon and central-eastern Pennsylvania, reinforced that message.
“If hospitals are not able to have the flexibility in determining nurse-to-patient ratios, the number of patients who have access to health care services will shrink without the immediate injection of thousands of new RNs that simply do not exist,” Pollack said. More than 1,000 nurses have been hired by St. Luke’s over the last 18 months, “and we would have hired more if they were available,” she added.
Pollack predicted that if hospitals cannot decide which professionals they need to hire to best handle patient care, people will be spending more time in the emergency room or be diverted to other hospitals, resulting in unreasonably long wait times.”
Hospitals are increasingly relying on a broader team to administer care, said Leslie Hirsch, president and CEO of Saint Peter’s University Health in New Brunswick. Nurses are an integral part of that team, but there are others, including skilled support staff, like respiratory therapists, and new technology that hospitals also must invest in, he said.
“Legislatively mandated nurse staffing ratios do not consider all of these factors,” Hirsch said.
Hirsch asked lawmakers to consider focusing on what else can be done to recruit and retain nurses and develop more nursing educators. “There simply aren’t enough educators to educate all those who might want to pursue a career in nursing.”
New Jersey would be the second state, behind Oregon, to enact a nurse-patient staffing law. Oregon Gov. Tina Kotek signed a 1:4 staffing ratio law for nurses in medical and surgical units in August that will take effect in 2026. California was the first to enact staffing ratios by state regulation 20 years ago. The New York Department of Health enacted rules setting a 1:2 nurse-patient ratio in the intensive care unit last year.