Critical Care

The pandemic has added new fuel to the debate over how many patients NYC nurses should care for each shift

“Our feeling was that staffing was so tight, when this came to be, the system broke. It just broke,” she said.

The most recent bill about the issue proposed in the state Legislature is the Safe Staffing for Quality Care Act of the 2019–20 legislative session. It’s currently in committee. Some of the proposed ratios include one nurse to two patients in critical care and intensive care units, one nurse to four patients in medical-surgical units, and one nurse to six patients in well-baby nursery units. The union’s position is that mandatory nurse-to-patient staffing ratios would improve safety, quality of care and staff retention at a time when nurses are more essential than ever.

Hospitals, however, are steadfast in their belief in flexible staffing, which they say enabled them to handle the Covid-19 surge and save patients. Flexible staffing operates without mandated nurse-to-patient ratios and allows providers to adjust their number of nurses in real time based on how they view the needs of patients.

The hospitals also say meeting set staffing ratios is unachievable thanks to fiscal constraints arising from the current crisis, which resulted in a loss of revenue as most nonmandatory procedures were postponed or canceled.

Sean Clarke, a registered nurse and executive vice dean and professor at New York University’s Meyers College of Nursing, said he believes the pandemic could fan the flames of the staffing battle.

“We may see that debate continue,” Clarke said.

Feeling the strain

Tanisha Thompson, a registered nurse at Wyckoff Heights Medical Center and a member of the New York State Nurses Association, said the volume of Covid-19 patients that local nurses took on during the pandemic was incredibly difficult.

Thompson, a 20-year veteran, is trained in critical care and was redeployed from other work to that high-need area during the peak of the crisis in New York.

“Staffing is a huge issue,” she said. “The patients are getting sicker and sicker and sicker. They require more and more care, and you really need to have a manageable patient load.”

Thompson said she believes setting nurse-to-patient staffing ratios would aid facilities in retaining experienced nurses.

Last month the state Department of Health released a highly anticipated report that considered the logistics of implementing set staffing ratios. Researchers found that if the proposed legislation to do so were passed, hospitals would need to hire nearly 25,000 more nurses—at an annual cost of between $1.8 billion and $2.4 billion. And nursing homes would incur between $1.9 billion and $2.3 billion in annual costs.

The estimates reflect an increase in wage costs of between 40% and 53% for hospitals, and between 79% and 96% for nursing homes, at a time when local providers have been financially strained by Covid-19.

Aside from recruitment and costs, the department noted in its report that some stakeholders have voiced concerns that mandated nurse-to-patient ratios don’t take into consideration the differences in types of hospitals, patient populations and care practices.

It added that the evolution of clinical care and types of patients suggest providers need flexibility to implement staffing plans that best meet all needs.

A spokeswoman for the state Department of Health reiterated the need for adaptability in staffing, especially as a result of the current crisis.

“The staffing study concluded that maintaining a health care workforce that effectively meets the needs of patients requires a flexible and comprehensive approach to address today’s multifaceted and complex health care delivery challenges,” the spokeswoman said in a statement. “The department continues to support measures to improve quality of care and patient outcomes, and the pandemic has only underscored the need to maintain workforce flexibility.”

The Greater New York Hospital Association concurred.

“Nurses are indispensable professionals without whom there would be no patient care,” the association said in a statement. “Our hospitals are always looking for ways to better support them and the critical work they do.” However, it said, mandated nurse-to-patient ratios would have been “unworkable and unaffordable” even before the pandemic, and now such a requirement is unthinkable for hospitals.

“Every hospital in New York state will lose money this year,” the association said. “Some of our hospitals are contemplating layoffs—a terrible conundrum at a time when we are continuing to ask for heroism during the ongoing pandemic. And we fear, in a post-Covid era—if it ever comes—hospital revenues will not return to their pre-Covid levels due to consumer concerns about hospital care and out-migration of patients from New York City.”

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