We talk a lot about how healthcare workers could use a break after watching their colleagues flee the profession during the pandemic. Even the seemingly settled Kaiser Permanente upheaval recently came out of remission, and this month, 60,000 Kaiser workers authorized strikes in Oregon, Washington, and California.
Yet there is light at the end of the tunnel, albeit with monetary pain in the process. Mandated patient-to-caregiver ratios are coming after intense lobbying by SEIU and other unions, and there’s no stopping these ratios. Yet they can help facilitate opportunities to improve the workplace, too.
First, it’s worth looking back at what led to U.S. history’s largest mental healthcare strike at Kaiser in 2022. The biggest grievance, believe it or not, was not wages but high patient-to-therapist ratios. It’s also worth a journey to 1999 when the labor laboratory of California became the first state to mandate highly specific patient-to-nursing ratios in acute-care hospital settings. That law went into effect in 2004 with the goal of easing burnout and increasing nurse retention and recruitment.
Pandemic-fueled job vacancies are now motivating states to increasingly look toward California to improve healthcare workplace practices:
Oregon: The state’s hospitals officially “shifted into crisis standards of care” for the first time in 2022 when ICUs were forced to operate on high nurse-to-patient ratios due to influxes of COVID-19, RSV, and flu patients. In Jan. 2023, lawmakers codified minimum nurse-to-patient ratios with wiggle room to handle mass-casualty events. The legislation officially passed in September, and the phasing-in period begins in June 2024.
Michigan: Similar pending legislation has received a mixed response. Industry leaders hope to convince some of the 50,000 statewide nurses who departed during the pandemic to return. After all, those staffing gaps are creating more frustration and inspiring more nurses to exit.
Pennsylvania: This state has looked to address 30%+ turnover in nursing homes. A bipartisan agreement of legislators propelled the Patient Safety Act, and facilities recently began implementing staffing ratios projected to cost $200 million. The law went into effect on July 1, with nursing homes required to meet ratios for CNAs, LPNs, and RNs
A National Mandate? The Biden administration wants to roll out national ratios that would require at least one-third of facilities to hire more RNs and about two-thirds to employ more CNAs. A Sept. 1 proposal received pushback from industry groups due to a lack of funding and skepticism about a one-size-fits-all approach.
Only Part Of the Solution: Mandated ratios, despite their financial burdens, can be viewed as part of an intermediary solution for an industry in desperate need of a cure. They are not magic bullets and cannot address the complexity of the nursing shortage, and clearly, more work needs to be done for a long-term solution.
More optimal ratios will at least encourage nurses to return to the field. From there, employer focus upon caregiver retention and workplace satisfaction will be part of a long-term treatment to insulate hospitals from the next big healthcare crisis.
