Portland Press Herald / Maine Sunday Telegram
Bill sets ratios for nurse staffing
Portland Press Herald Thursday, May 3, 2007

By ANN S. KIM
Staff Writer
AUGUSTA - Cecile Martin has seen how her fellow nurses work more than 14 hours at a time in order to finish their paperwork after a full shift. She says 12 hours without lunch breaks is not uncommon in her emergency room and that many times nurses do not even get a chance to use the restroom.
"We have to take care of these patients. It's an ER," said Martin, who works at Millinocket Regional Hospital.
Martin said nurses' workloads are growing heavier because patients in hospitals are sicker and because there are fewer nurses to care for them. She and other members of the Maine State Nurses Association are pushing for a law that would impose nurse-to-patient staffing ratios in hospitals. The bill includes whistle-blower protection and would punish violations with fines of up to $25,000.
The bill, similar to a California law, spells out ratios for different hospital units and situations. One nurse would be required for every two patients in intensive care units, burn units and post-anesthesia recovery units. One nurse would be required for every four patients in emergency departments and one would be needed for every five patients in a rehabilitation unit.
Bill proponents say the ratios would lead to better patient care, but critics say the approach is inflexible and could force hospitals to shut down beds.
The two sides will get a chance to make their cases before the Legislature's Labor Committee on Friday. The committee plans to hold a public hearing on the bill at 10 a.m. in Room 220 of the Cross State Office Building.
A similar proposal failed four years ago. The sponsor, House Majority Whip Sean Faircloth, D-Bangor, wants to revisit the issue.
"Nurses are the frontline workers in the effort to protect public health. And what I'm hearing from them is a real concern about safety in Maine," he said.
After the previous legislation failed, a study by the advisory council of the Maine Quality Forum, a division of the state's Dirigo Health reform effort, found that while adequate nursing resources are essential to medical care, no evidence shows that mandated staffing ratios guarantee quality or safety.
In the past 10 years, hospital patients have been in poorer health than they were in the past, said Vanessa Sylvester of the Maine State Nurses Association. Fewer nurses are willing to work under such stress, she said, and are leaving direct care for other areas of nursing, such as home health.
The Maine Hospital Association opposes the bill. Mary Mayhew, vice president of governmental affairs, said state regulations already address staffing in a more comprehensive way that avoids the bill's "cookie-cutter approach."
"The rigid approach it takes to providing patient care, it would force hospitals potentially to shut beds down, to have to transfer patients if they couldn't meet these artificial ratios," Mayhew said.
A better solution, she said, is to increase the number of nursing student slots at community colleges. Nursing is among the programs that have wait lists.
At least one Labor Committee member has decided to oppose the bill. Sen. Dana Dow, R-Waldoboro, fears the measure would drive up health care costs.
The Maine Medical Association also is fighting the bill. Gordon Smith, executive vice president, said while the organization is sympathetic to staffing concerns, mandated ratios are not the answer.
"It's overregulation. It's micromanagement at a time when the hospitals have enough to worry about," Smith said.
Staff Writer Ann S. Kim can be contacted at 623-1031 or at:


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edmac of Benedicta, ME
May 5, 2007 4:56 PM
Obviously the oponents of this bill are thinking only of money and not of people. This is what got us here in the first place. There are nurses in Maine several of them not wroking because of the working conditions. I became a nurse to take care of patients but a 6-8 patient assignment makes that almost impossible. The patients are lucky to get their meds at all never mind on time. I think you should all read this bill from start to finish before you make judgements about the people that are pushing for patient safety. Someday I can almost guarantee each and every one of you will need a nurse at your bedside. Lets hope it's on a good day when the nurse has a light load. If acuity was always taken into consideration we wouldn't need this legislation, but it is not. Management teams tell you that it is. They sound pretty convincing but we've heard it all before and the only way to change it is with mandation. report abuse
parker66 of South Portland, ME
May 4, 2007 11:28 AM
You'll notice that the top complaint among all the (union) nurses in favor of this bill is money ... and how much administrators make. That's the real motivation here - patient safety is just the cloak they wrap it in to make it sound less selfish. This bill does nothing to address salaries, so if that's the REAL problem, why not address that?

Check out the website of any hospital in Maine and you will see that they are ALL looking for nurses. York Hospital recently offered $10k sign-on bonuses. Money isn't the issue, it is a definite nusing shortage - fewer people are entering this profession.

For those who don't think hospitals or units within hospitals will close, go ahead and pass this bill and see what happens. If there aren't enough nurses now to fill the slots, they aren't going to magically appear with passage of this bill. Closures will HAVE to occur.

This union activity, driven by zealots in California, will destroy Maine's rural hospital system. Don't let a handful of lazy, selfish nurses speak for the volumes who see the foolishness of this bill. If I'm ever in the hospital, I pray to God that I'm treated by a nurse who understands his/her profession and didn't get into the field for what some union rep promises. report abuse
berged of Portland, ME
May 4, 2007 10:09 AM
Anactual nurse is probably a member of the nurses' union trying to push this bill. Yes, Bangor is a hub of nurse union actiivty AND Representative Sean Faircloth. As many have pointed out, this legislation is not needed.
Being 'an actual nurse' for 25 years, I have seen the quality of nursing care improve with other, less costly measures. Posting patient satisfaction scores and quality measures has driven and continues to drive hospitals to improve. The Magnet Hospital certification program, sponsored by the American Nurses' Association, has hospitals striving for improved care and professional nursing practice. Maine has two such hospitals, with many others applying for this honor. Not one "ratio" is cited as a requirement, yet these hospitals demonstrate quality care that is in the top 3% of the WORLD.
Nurse-patient ratios are not the primary or solitary contributor to adverse events in a hospital. One need only read the Institute of Medicine's report "To errr is human" to realize that systemic failures are the root causes. I'm sorry. I'm not buying this labor union propaganda. I'm saddened that nurses want to reduce their profession to the equivalent of a working trade. report abuse
Sandra1950 of Thomaston, ME
May 4, 2007 9:19 AM
Having patient ratios will not cause hospitals to close, it will create a safer environment for patient care. Everyone keeps saying all we need are more nursing students slots, but the newer nurses are often the ones who opt out of working in hospitals because of the stress involved with caring for such sick patients. With all the opportunities for nurses, why would they want to put themselves through that day after day?
The people who say we are just complainers, that they work overtime too, obviously haven't stopped to think about the difference in our jobs. Do they have to keep someone breathing? Or give dangerous medications? Or stop someone from bleeding to death, when they are overworked and unable to think straight? I think NOT!
There is NOT a shortage of nurses in Maine! There is a shortage of nurses who are willing to work under these conditions. If things are to get any better, ratios need to be addressed. The hospitals don't seem to be willing to do this voluntarily, what other choice is there.
As for the people who keep saying we nurses are so overpaid, they should take a look at what the hospital administrators make! Hospitals are being run like businesses now, and the administrators get pay raises for keeping costs down, NOT for providing better patient care. I know, because our administrator at Penobscot Bay Medical Center got a $47,000 RAISE this year when the nurses hadn't recieved a raise for 2 years. He now makes $288,000 a year....report abuse
AnActualRN of Bangor, ME
May 3, 2007 11:31 PM
As an actual bedside Nurse working at a busy hospital, I feel I can speak on this issue with some insight.
I have read many comments by well-meaning people opining that this Bill is unfounded, ridiculous and, at the very least, unnecessary. Yet, it is BECAUSE of the nursing shortage that this Bill becomes increasingly necessary. A safely-regulated patient/Nurse ratio is an idea whose time has come.
Because health care has become a multi-billion dollar business, it is in the hospitals' best interest to be concerned about their bottom line--they cannot stay open and provide a service to the community if that were not the case. Unfortunately, there has been no tangible measure to maintain patients' safety in this business model. I can attest first-hand that many mistakes happen because Nurses are expected to work beyond a reasonably safe working condition. Medications cannot be given on time, patients fall out of bed, patients wait in pain, patients cannot be taken to the bathroom in time, patients do not get adequately bathed, patients are becoming infected by these easily-spread "superbugs". This Bill offers a viable solution to the reality of hospital care today.
The ratios would mandate the maximum number of patients that one Nurse would be expected to provide safe care for during her shift. Currently, there is nothing to prevent Nurses from working beyond what is safe.
I would encourage those strongly opposed to this Bill to look through the eyes of a Health care provider and reconsider its importance.
report abuse
Eileen Dunn of Bayville, NY
May 3, 2007 11:01 PM
I love it,compare Nurses who save lives to supermarket checkout clerks. In case you don't understand Nurses save lives everytime they go to work.Of course the Maine Hospital Assoc. is against the bill, it will cost money. Ask the administrators at the hospitals what their salaries are! When they tell you, make sure you call on them next time you're in pain or can't breathe at 3am in the hospital. We all need a good Nurse at some time. Hopefully all of you out there that are against the life savers working under safe conditions, where they have time to give the kind of care that people want for their loved ones, I hope you are the one that has to wait for the call bell to be answered in a timely fashion maybe then you will understand.
Thanks a very tired overworked Nurse.report abuse
J LV of PORTLAND, ME
May 3, 2007 9:43 PM
I COMPLETELY AND WHOLE HEARTEDLY SUPPORT THIS LEGISLATION. THE HOSPITAL LOBBY IS TRYING TO SCARE EVERYBODY INTO KEEPING THINGS STATUS QUO. BUT THEY DON'T SCARE ME. THE FACT IS, ASK THE HOSPITALS WHY THEY'RE SPENDING SO MUCH MONEY TO FIGHT THIS BILL, MONEY PATIENTS ARE PAYING OUT OUR WALLETS.

THE BOTTOM LINE IS THIS: OUR HEALTH IS ON THE LINE HERE. PATIENTS ARE SUFFERING AND NURSES ARE SUFFERING. THIS IS ABOUT SAFETY. PERIOD!!! report abuse
Joey of Falmouth, ME
May 3, 2007 7:41 PM
Studies by nurse researchers have been done. They found the ratio of nurses to patients is correlated to the number of patients that die after surgery from complications. Basically, too few nurses result in very busy nurses, who fail to recognize in time when patients hearts are are about to stop. The more nurses, the fewer needless deaths in hospitals. The same studies also show that nurses quit much more often at hospitals where staffing is insufficient-thereby making the staffing shortage even more of a problem.. Faircloth has it right. The public needs to be protected.report abuse
ISPortland of Portland, ME
May 3, 2007 7:13 PM
I waited with my son in the ER last winter for over six hours and can't help but think, if there were more nurses there, he'd get help sooner.report abuse
woof of Portland, ME
May 3, 2007 6:46 PM
Now aren't we touchy? I would like to know how many of the negative comments about this bill were made by people in hospital management positions. As usual control is a scary thing to lose but patient safety is even scarier to lose and much more dangerous! report abuse

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