Nurses groups split over mandate

By Emma Dumain

Two major nurses advocacy groups have split over whether, and how, Congress should mandate how many nurses work at each hospital.
National Nurses United, the largest registered nurses' union in the country, is pushing for legislation that would mandate the same nurse-to-patient ratio in every hospital around the country.
The American Nurses Association, a professional organization that represents registered nurses, opposes a set ratio and prefers a move to require hospitals seek input from nurses about staffing ratios in various units.
Thousands of registered nurses with National Nurses United came to Washington last week to lobby for the National Nursing Shortage and Patient Advocacy Act, which is modeled on a California law the nurses union helped pass in 1999.
"This is the most comprehensive bill to address nursing shortage and the quality of care, one that has been actually proven to have a huge impact on patient safety and keep the right number of nurses at the bedside," said Chuck Idelson, National Nurses United's communications director. "Nurses can have more time to help patients, and the ratios will also decrease burnout, a huge cause of nursing shortage."
Advocates were emboldened by a recent study out of the University of Pennsylvania showing that the ratios proposed by this bill would have accounted for 14 percent fewer surgical deaths in New Jersey and more than 10 percent fewer in Pennsylvania.
They can also boast that their bill already has powerful champions in the House and Senate.
But the American Nurses Association is skeptical that mandating the same ratios at every hospital will necessarily help.
"A 'one size fits all' will not get to the heart of the problem," said Michelle Artz, the association's chief associate director of government affairs. "We worry about a lack of flexibility."
Instead, the Nurses Association backs the Registered Nurse Safe Staffing Act. Rather than set across-the-board ratio requirements, that bill would require each hospital to work with registered nurses to determine how many are needed on each shift and in each medical unit.
Though the Nurses Association's bill has been introduced in a number of Congresses over the past several years, it has never gained much momentum. While the organization tweaks the current language for reintroduction next year, National Nurses United moved ahead on a push for its own legislation.
The union is gearing up for a fight.
"The American Nurses Association is working with the hospital industry on an issue that will not solve the problem," said National Nurses United policy director Michael Lighty. "They believe that hospitals, on their own, will implement safer staffing. That's not a formula or a solution to staffing that will be nurse driven."
The American Nurses Association objected to those remarks.
"We are certainly not in any hospital association's pocket," Artz said in response. "And most hospitals would tell you that they would not want to be told how to staff, period."

After a bitter yearlong struggle to pass health care reform, it seems unlikely that Congress will have the appetite to take up another piece of legislation from either group that would dramatically change the way hospitals are staffed and run.

It's also unclear which bill would have more success on the House or Senate floor and which would have more support not just from Members of Congress, but from related industry groups as well.

The influential American Hospital Association, which represents hospitals and patients, is not standing behind either bill, which could further complicate either's chances for passage.
"We do not believe that these decisions are needed at the federal level," said Carla Luggiero, the senior associate director for federal relations for the hospital association. She argued that the legislation does not account for the real problem at hand, which is the national shortage of registered nurses.

"All staffing decisions have to be made in individual hospitals, at the unit level," Luggiero said. "All health care is local."
Emma Dumain covers health care for Congress.org.