Ohio lawmakers push plan to set nurse staffing requirements in hospitals

The Ohio Nurses Association declared “code red” earlier this year due to understaffing in Ohio hospitals, now state lawmakers are looking to do something about it.

House Bill 285, the “Workforce and Safe Patient Care Act,” co-sponsored by state Reps. Haraz Ghanbari, R-Perrysburg, and Elgin Rogers, Jr., D-Toledo, would create minimum staffing ratios in hospitals, among other requirements.

“Ohio’s nurses and healthcare workers are tired and fed up with hospital administrators turning a blind eye to the unsafe staffing conditions and this bill is a step in the right direction. We are in  a patient care crisis, but this legislation will guarantee safety for patients and healthcare workers in Ohio’s hospitals,” Robert Weitzel, Ohio Nurses Association president, said in a press release.

The bill creates a $20 million “loan-to-grant” program for nurses that commit to five years of service, whether at the bedside or in nurse education, in Ohio post-graduation. Nurses would be eligible for $3,000 a year for up to four years.

“This is about safety and about supporting our workforce,” Ghanbari said. “It will be a better opportunity that will translate into a better work environment for nurses in Ohio’s hospitals.”

ONA ran a survey of nurses throughout Ohio from May to June. It found seven out of every 10 direct-care nurses are considering leaving bedside nursing due to current conditions, but 89% of direct-care nurses said minimum staffing standards in Ohio would increase their likelihood of remaining in a direct-care role.

“This is a pro-patient piece of legislation asking for reasonable staffing levels for our nurses,” Rogers said.

How would it work?

A nurse staffing committee would be created in Ohio hospitals to give meaningful representation in setting safe, working staffing levels, Ghanbari said.

The committee would comprise half direct-care registered nurses, with at least one registered nurse serving as a member from each of the hospital's patient care units, and all or part of the remainder would be made up of non-management staff.

“We believe that those that are in the front lines of patient care should have a voice in determining those appropriate staffing ratios,” Ghanbari said.

Hospitals would develop and implement a nurse staffing plan, which will be based on the recommendations the hospital receives from its nurse staffing committee.

Minimum staffing ratios of registered nurse-to-patient would be between 1-to-1 and 1-to-6. The Ohio Department of Health can establish stricter ratios if deemed necessary.

The ratios have to be in place within two years, four years for rural areas, after the effective dates. There are provisions that prohibit the use of video or overtime to meet ratios.

However, there would be exceptions to the ratio requirements. The exceptions are:

• State of emergency.

• Emergency room patient diversion.

• Inability to obtain staff, but the hospital must have made reasonable efforts to obtain staff but couldn’t, which would be in consultation with the staffing committee.

• Unforeseeable clinical care needs where a nurse is willing to accept assignment of additional patients because of life threatening adverse effects.

• Deviations for not more than 12 hours, no more than six in a 30 day period, so long as the hospital doesn’t deny meal breaks, the staffing committee has to be notified.

• Use of innovative care models.

• Transfers from another hospital if the patient is in critical care.

• Certain patient circumstances like waiting to discharge, or any other provisions as determined by the staffing committee.

How would nurse-to-patient ratios be enforced?

In order to check for violations, hospitals would be audited to ensure compliance at least once every two years. Hospitals will be required to do a corrective action plan if there are any violations.

If the violation is not resolved, the hospital will owe $25,000 for a first offense and $50,000 for any offense following. The money collected from violations would go into the Ohio Department of Education’s existing nurse education assistance loan program.

Other requirements include public transparency, including a description of the staffing ratio and the information of the nurses on shift. There would also be a patient safety telephone line for reporting staffing violations. Provisions would also ban discriminating, interfering with or intimidating a registered nurse, hospital patient or any other person who, in good faith, files a complaint.

Concerns with the legislation

John Palmer, the Ohio Hospital Association's director of media and public relations, said OHA is currently opposed to the introduced version of the bill.

OHA was not a part of developing the legislation and is hoping to meet with the bill's sponsors to discuss its concerns.

When the legislation was introduced in September, OHA released a statement supporting hospitals' commitment to safe staffing to ensure quality care for patients.

The statement says there is currently a law that says Ohio hospitals develop nursing service staffing plans by organizing internal committees of caregivers, including nurses, to make recommendations for staffing levels that provide both a safe working environment for employees and quality health care for patients.

"We just feel that mandated approaches to nurse staffing, they limit innovation, reduce flexibility needed to respond to patients changing care needs, because at any point we can have an influx of patients requiring us to staff appropriately to make sure that we're trying to get some care addressed," Palmer said.

Palmer said right now nurses are seeing a significant staffing shortage, and the National Organization for Nursing Colleges is estimating 1 million nurses will retire by 2030, and there are more than 8,000 job listings on the Ohio Means Jobs website for nurses in Ohio.

"The pipeline has always been an issue, even before the pandemic, of trying to figure out how we can either build on classroom capacity, bringing in more faculty, get more hospitals involved with establishing educational programs to help that nurses through the pipeline," Palmer said.

Palmer said funding student programs for nurses could also cause other professions to gravitate toward that, which could set a precedent.

"When you go and try to get things like this from the state, and then there's state funding, we just are curious to see how that might ultimately play out," Palmer said.

Kayla Bennett is a fellow in the E.W. Scripps School of Journalism's Statehouse News Bureau.

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This article originally appeared on The Columbus Dispatch: Ohio lawmakers want to set minimum nurse staffing requirements