Senator Skindell Reintroduces Bill Reducing Nurses' Workload

COLUMBUS, OH — Democratic State Sen. Mike Skindell on Tuesday reintroduced the Ohio Patient Protection Act, or Senate Bill 55 (previously Senate Bill 324), which would regulate the nurse-to-patient ratio. According to the bill, a one-to-one nurse-to-patient ration would be required for visitors to the operating room, trauma or critical care, and for unstable newborns and patients requiring resuscitation.

The bill was originally introduced at the end of last year's General Assembly, in May 2016. A spokesperson for Skindell said he thinks that the late introduction contributed to the bill effectively going nowhere. The spokesperson added that the Ohio Patient Protection Act is an important bill for Skindell, and he felt it was crucial to get it reintroduced early.

Besides mandating a one-to-one nurse-to-patient ratio for certain departments, the legislation is broadly aimed at preventing nurses becoming overworked and overloaded with patients. That's why Senate Bill 55 also mandates a 3-to-1 nurse-patient ratio for pediatrics and pregnant patients. More departments are then broken down into various nurse-to-patient ratios, and for any department not listed, a hospital's nursing care committee would assign nurses to the department based off its characteristics.

The legislation also mandates that hospitals post the required ratios in a public, visible space and forbids hospitals from issuing mandatory overtime to fulfill the ratios. The bill also prohibits layoffs of practical nurses or supporting personnel to help meet the ratio. Hospitals would also be forbidden from using video surveillance of a patient as a substitute for in-room care.

The legislation also gives nurses the right to refuse to perform a medical act if they feel it is not in the patient's best interest.

There's much more to the legislation, and you can find the full text of the bill here.

However, with a Republican-controlled Congress, a bill instituting regulations of any industry seems, at least on the surface, unlikely to pass. The bill does enjoy the support of a majority of the state's (and some national) nursing groups.

Additionally, the bill does not have the support of the Ohio Nurses Association. A spokesperson for the group said, "While ONA respects any group’s attempt to address staffing concerns, our members feel strongly that a meaningful staffing solution goes beyond mandated and non-negotiable nurse-to-patient ratios. Many ratio bills like this one have been introduced across the country and none passed besides California."

In crafting the bill, Skindell worked with National Nurses United. The NNU helped craft a similar bill in California that it says has helped save patient lives.

“NNU nurses have witnessed first hand the dramatic improvements in patient care conditions that resulted from the implementation of the California staffing legislation. This life-saving measure should be extended to Ohio patients as well," said Michelle Mahon, an NNU representative, in a statement. "Unfortunately, hospital corporations continue to place an emphasis on the bottom line, and care suffers. As patient advocates, Ohio nurses fight daily battles with hospital management to ensure that there are enough nurses to care for patients. Our patients deserve the guarantee that when they are most vulnerable they will have the constant vigilance of a skilled registered nurse to protect them.”

In a press release announcing the reintroduction of Senate Bill 55, Skindell touts the money-saving possibilities of the legislation. While that may seem initially contradictory (with hospitals likely having to hire more nurses and being unable to layoff staff or mandate overtime), a spokesperson for Skindell says nurse burnout has been contributing to longer stays and more frequent trips to hospitals.

There's evidence to back that claim up. A 2015 study on the National Institute of Health's website says that nurse burnout has been negatively impacting patient outcomes. That study found that happy, supported nurses helped patients recover better and faster.

"Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care," the study says.

However, how the practice plays out in the real world may be different than the studies.

A spokesperson for the Cleveland Clinic emailed Patch a statement saying, "We staff by specialty and needs of the patients. We are at or below the ratios for our nursing levels and if a patient requires more nursing care than we adjust accordingly based on the needs of the patient."

“With no limit on the number of patients we care for, we have a safety crisis on our hands in Ohio. Hospital administrators are free to cut corners on staffing and put their bottom line over patient safety. We need a mandatory, non-negotiable limit to the number of patients each nurse cares for in order to protect our patients from harm—and also to protect nurses and other healthcare staff," Debra McKinney, a registered nurse at Affinity Medical Center in Massillon, Ohio, says in a statement.

MetroHealth and University Hospitals did not respond to a request for information on their respective nurse-to-patient ratios.

Photo from Rick Uldricks, Patch