Unionized nurses enter the Cross Building for a public hearing on safe staffing levels. | Courtesy of the Maine AFL-CIO
Originally published in the Maine Beacon on May 5, 2023
Understaffing at Maine hospitals has reached unsafe levels and that’s the fault of their executives, nurses say.
“We work in systems that set us up to fail,” said Mary Kate O’Sullivan, a registered nurse at Maine Medical Center in Portland, who said her unit recently went to a staffing ratio of one nurse to seven patients. “There were nine patient falls on the unit in the month of April. Two Wednesdays ago, a patient fell and broke their hip. Nurses know that when staffing isn’t safe, it’s not a question of whether patients will have falls, it’s when.”
O’Sullivan, a third-generation nurse, spoke at a public hearing in favor of the Maine Quality Care Act, a bill that would require safe nurse-to-patient ratios in the state’s healthcare facilities.
“Unsafe ratios are dehumanizing and degrading,” she said. “It looks like human beings sitting in their stool and urine, embarrassed and powerless.”
Sen. Stacy Brenner (D-Cumberland), the sponsor of the bill, explained that it’s not a worker shortage driving the problem, but the decisions of hospital executives, who refuse to pay for a robust pool of registered nurses from which to draw when scheduling shifts.
“Nationally, there are nearly one million licensed RNs who aren’t working in nursing. Maine has approximately 28,000 nurses licensed in the state, but only 56% of them are working,” said Brenner, who began her career as a nurse midwife attending to births at Mercy Hospital in Portland. “Maine does not have a shortage of nurses. We have a workplace culture where nurses aren’t interested in engaging in the available jobs.”
Brenner’s legislation is backed by the state’s largest nursing union, the Maine State Nurses Association, which hosted a press conference on Tuesday ahead of the hearing. Dozens of nurses clad in union red traveled to Augusta to speak in favor of Brenner’s bill.
California was the first state in 2004 to pass a law mandating nurse-to-patient ratios for acute care, but legislative efforts since then in other states have floundered under industry pressure, leaving the labor movement to revive the issue.
Resembling teacher unions across the country that in recent years have turned contract fights into platforms to address far bigger political problems like underfunded public schools, nurses unions have turned their attention to highlighting some of the biggest systemic failings of the for-profit hospital industry. Seven thousand nurses in New York City went on strike earlier this year for a new contract that included better nurse-to-patient ratios.
MSNA has also broadened its scope since scoring a major victory in 2021 by helping to unionize the state’s largest hospital, Maine Medical Center. As Beacon previously reported, Maine Med nurses joined last year with members of National Nurses United (NNU), the country’s largest nurses union, to put a spotlight on the issue of chronic understaffing.
Staffing problems in Maine came to the fore during the pandemic, most notably when Gov. Janet Mills deployed the National Guard to handle non-clinical jobs in hospitals to free up staff. But nurses insist it’s been a long growing problem brought about by an industry that is cutting corners on labor costs to remain profitable.
According to NNU, which conducted a survey of thousands of registered nurses across the country in 2021, 82.5% said at least half of their shifts were unsafely staffed. Sixty-eight percent of respondents said that they have considered leaving their position.
During Thursday’s hearing, nurses pushed back against the notion that staff shortages persist because not enough people are going into the profession. They pointed to the numerous measures passed by the Maine Legislature over the years to incentivize young people to enter the field through policies such as tuition forgiveness.
“Educating more nurses can’t be the only answer to this problem. Nurses are leaving at increasingly alarming rates,” said Lewiston resident Mariah Pfeiffer, a labor and delivery nurse. “The culture of efficiency and money saving in the healthcare industry is hurting us all. Hospitals may be saving money, but patients pay more and receive less care and nurses continue to suffer.”
Brenner’s legislation would establish minimum staffing requirements based on patient needs. The bill outlines numerous health conditions and proposes nurse-to-patient ratios for those conditions depending on how acute they are.
For example, one registered nurse could be assigned just one patient receiving critical care or intensive care, or just one patient who requires trauma services, or just one patient who is in active labor. The ratio increases for less acute conditions, such as one nurse could attend to two patients who are antepartum and require continuous fetal monitoring, or one nurse could monitor three patients who are antepartum and not in active labor.
The bill would protect nurses from retaliation for voicing concerns about staffing issues, such as being assigned patients they might not be qualified to attend to.
“Studies show that when registered nurses are forced to care for too many patients at one time patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure sores, increased length of stay, and readmissions,” Brenner said.
Brenner anticipated that the hospital industry would stand in strong opposition to her bill.
“They will tell you that hospitals will close down, go broke or never find enough nurses to fill necessary positions,” she said. “They will ask for studies and say they are already working hard to achieve quality care goals.”
As predicted, hospital industry groups, as well as some nursing associations and several Republican members of the legislature’s Labor and Housing Committee, held a press conference ahead of the hearing to argue that it would put a significant burden on an industry already struggling to fill nursing jobs.
Nurses said that hospital executives couldn’t be trusted to regulate themselves.
“We need legislation if we want to attract nurses back to the bedside,” O’Sullivan said. “We cannot simply trust hospital administrators to practice safe staffing without them being bound by law to do it. That is abundantly clear as they so fervently lobby against this bill.”
Dan Neumann studied journalism at Colorado State University before beginning his career as a community newspaper reporter in Denver. He reported on the Global North’s interventions in Africa, including documentaries on climate change, international asylum policy and U.S. militarization on the continent before returning to his home state of Illinois to teach community journalism on Chicago’s West Side. He now lives in Portland. Dan can be reached at firstname.lastname@example.org.