Lawmakers in Minnesota and Washington have passed laws in recent weeks limiting the amount of overtime nurses can be required to work. But Kentucky won't do the same just yet, as lawmakers have turned aside two nurse-staffing bills.
Louisville Courier-Journal, March 29, 2002
http://www.courier-journal.com/business/news2002/03/29/bu032902s177679.htm
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Kentucky won't set nursing ratios - at least for now
Legislators let two bills die for this session
By Patrick Howington
[email protected]
The Courier-Journal
''We already have a nurse shortage. . . . Where are the people going to come from?''
Carol Ormay, Kentucky Hospital Association
FRANKFORT -- How many hours can a hospital nurse work and still treat patients safely? And how many patients can one nurse safely care for?
Those have traditionally been matters for hospital officials to determine. But that is changing, as state governments become more concerned about patients tended by tired or overworked nurses.
This year, California became the first state to set minimum nurse-to-patient ratios for hospitals; other state legislatures are considering similar measures.
In the past two weeks, Minnesota and Washington became the fourth and fifth states to enact laws limiting the amount of overtime nurses can be required to work, and protecting them if they refuse.
Kentucky won't join those states, however -- at least not this year. Legislators turned aside two nurse-staffing bills during this session of the General Assembly, which ends soon.
The bills, backed by nursing groups, would have required hospitals and nursing homes to set and post their minimum staffing levels and be held accountable for them. It also would have restricted mandatory overtime if a nurse felt too tired to care for patients.
While the measures may have the laudable goals of protecting patients and easing nurses' burdens, they are seemingly undercut by the shortage of nurses.
Overstretched nurses are ''a serious problem, there's no question about it,'' Rep. Steve Nunn, a Glasgow Republican, said yesterday at a legislative hearing. ''But . . . if you don't work overtime, then who's going to be at the health-care facility to take care of people if we've got this shortage?''
Nunn was addressing four nurses and a nursing-union organizer who had spoken to the House Health and Welfare Committee in support of House Bill 91, a broad nurse-staffing measure. It was sponsored by Rep. Joni Jenkins, D-Shively, at the urging of the Nurses Professional Organization.
The committee took up the measure for discussion only and did not vote on it yesterday, which means it's dead for this session. But legislators indicated the subject of nurse staffing might deserve study before the next session.
A more narrow measure to limit mandatory overtime, sponsored by Rep. Mary Lou Marzian, D-Louisville, herself a registered nurse, also did not win approval. However, it was replaced with a measure directing an interim legislative committee to study the length of work shifts of nurses and other health-facility employees. That measure is pending.
Nurses and advocates for staffing requirements and overtime limits say they are needed because of sweeping changes in health care in recent years. Those changes include staff downsizing by some hospitals and movement by many nurses away from hospital duty to less stressful work, such as in doctors' offices and home health care.
Combined with greater opportunities for young women in careers other than nursing, the result has been fewer and older hospital nurses. And they are coping with a sicker population because less severe cases increasingly are handled as outpatients.
Today hospital nurses ''find ourselves frustrated, overworked and abused,'' including by being forced to work extra hours, Patty Clark, a longtime nurse at Norton Audubon Hospital and president of the NPO union, told legislators yesterday.
Such feelings are widespread. A survey conducted last year for the American Nurses Association found that more than 40 percent of nurses would not feel comfortable having a family member cared for where they work, and 54 percent would not recommend nursing as a profession. More than two-thirds cited inadequate staffing as a chief cause in the decline of care.
The Kentucky Nurses Association ''gets at least five to 10 calls a week from nurses who feel like they don't have the staff to cover'' a unit's patients safely, said Maureen Keenan, the association's executive director.
One of the nurses who addressed legislators yesterday, Suzette Sewell, said she was fired from Audubon in 1998 for refusing to work overtime. Now a nursing Ph.D. candidate at the University of Kentucky, she said the profession needs safeguards similar to those of the airline and trucking industries, in which pilots and drivers' travel time is limited to protect the public.
But hospital officials and business leaders oppose requiring hospitals and nursing homes to meet rigid staffing ratios.
''We already have a nurse shortage -- a total health-care worker shortage,'' said Carol Ormay, a vice president of the Kentucky Hospital Association. ''Where are the people going to come from?''
''Hospital administrators don't need a bill to tell us what to do, because we do what's right anyway,'' said Teresa Parker, chief administrator of Norton Southwest Hospital and a registered nurse.
Parker said her hospital has guidelines for nurse-to-patient ratios for different units -- such as intensive care, where a nurse might handle two patients, or a medical-surgical floor, where six patients to a nurse might be normal.
But flexibility is needed, she said. If patients are sicker, or healthier, a different ratio might be appropriate. And without the ability to make nurses work overtime, she said, there might not be enough staff for the patients on hand.
Another concern is that staffing requirements could boost the cost of hospital care and thus health-insurance premiums.
Health insurance is such a large portion of employee-benefit costs today that anything that would boost premiums raises concerns, said Tony Sholar, lobbyist for the Kentucky Chamber of Commerce.
''Somewhere, there's a balance between the highest quality of care that we can get and what we can afford to pay for,'' he said.
Jenkins' measure does not go as far as the California law, which calls for state health authorities to set staffing minimums for different types of hospital units.
The staffing requirements -- for example, one nurse per eight babies in a well-baby nursery, one nurse per two burn-unit patients, and so on -- are not as stringent as the state nursing association wanted, but more strict than hospitals favored.
