We gave a passing mention to Austin Rep. Donna Howard‘s House Bill 591 a couple of weeks ago because, enjoying the support of both the Texas Hospital Association and Texas Nurses Association, we didn’t foresee it having much opposition. Not so fast, says the National Nurses Organizing Committee. Howard’s bill (and the Senate twin authored by Sen. Jane Nelson of Flower Mound) “doesn’t have any teeth,” complains Jesse Romero, a lobbyist for the NNOC, a famously activist union.
The bill would elevate nurse staffing committees in Texas hospitals to standing committees that would report directly to the hospital’s governing body, require that hospitals implement and enforce policies to ensure that nurse staffing levels are adequate to patients’ needs, and in formulating those policies, “give significant consideration” to the recommendations of those committees. The bill is a response to the nationwide hospital nursing shortage.
However, “There is no nursing shortage,” counters Romero. “There’s a shortage of nurses willing to do adverse work, because their licenses are on the line.” The way to counter that, he says, is to legally mandate minimum nurse-patient ratios, which NNOC would do in proposed legislation it calls the Texas Hospital Patient Protection Act, for which they’ve picked up Sen. Mario Gallegos, D-Houston, as a sponsor.
The NNOC points to California, where the union successfully killed a 2005 attempt by Gov. Arnold Schwarzenegger to relax mandatory ratios. After Schwarzenegger relented, a spokeswoman for the California Health and Human Services Agency told the Los Angeles Times, “We had 10 months of experience with the court-mandated ratios and there seems to be no negative impact on the healthcare system. Our data shows that hospitals have been able to meet the lower ratios, and some hospitals have even signed it into their labor contracts.”
But Howard, herself a former nurse, doesn’t think that’s the way to go. “The whole point of this bill was to allow flexibility rather than one-size-fits-all, which is what NNOC has been recommending,” she says. “Just think about what happens in a hospital setting, and you realize there are unique patient needs, unique levels of acuity, regardless of the setting. There’s also different educational levels of the nurses – some have just gotten out of nursing school; some have 20 years of experience.”
The Texas Nurses Association and Texas Hospital Association echoed Howard’s sentiments. “We don’t believe in [mandatory ratios],” says Clair Jordan, TNA’s executive director. “The reason we don’t, what experience we’ve drawn from what California has done, California is the only state that has done mandatory ratios. The nine other states that have taken action have followed our lead, which is to set up a system whereby the hospital establishes and the nurses establish the actual staffing plans for the institution. … Obviously the skill level [differences among nurses] leads you to make false assignments. Because an experienced nurse may be able to handle five, while a brand-new nurse may be able to handle only two.”
But, also pointing to the California experience, Romero says that hospitals there actually reduced nurse turnover and raised profits with the ratios in place, drawing 80,000 licensed registered nurses back into the profession. “The empirical fact is, ratios work,” he says. (Howard says she asked NNOC to produce documentation of those statistics, and it had failed to do so.)
The bottom line for Romero: “Hospitals can already [lower the ratios] on their own, but for whatever reason, they choose not to.” Romero cited tragedies that prompted certain hospitals in Texas to lower their ratios, “but guess what happened after the media was gone? They went right back up.”
This article appears in February 6 • 2009.