Michigan lawmakers, nurses seek more efficient patient assignment limits with proposed bills

State lawmakers formally announced on Thursday a series of proposals designed to help nurses in Michigan provide better care for patients.

The bills call for limiting the number of patients hospitals assign to each nurse, reducing mandatory overtime and requiring health care facilities to publicly disclose staffing levels.

Michigan Nurses Association President Jamie Brown says chronic cost-cutting by hospital executives is overwhelming nurses with patients and driving many of them to leave the profession.

“There’s no nursing shortage. The state of Michigan has 50,000 nurses that currently hold an active nursing license that are not practicing at the bedside,” says Brown. “If these laws were to go into effect, it would effectively bring more nurses back to the bedside and there would be plenty of nurses to take care of the patients.”

The pandemic led to burnout among many nurses nationwide, but Brown states the problem goes far beyond difficulties created by COVID-19.

“The patient numbers that the nurses are taking care of has [sic] gotten worse since the pandemic because more nurses are not putting up with the bad working conditions the hospitals are forcing us to work under. And so they’re leaving the profession altogether.”

The Michigan Health and Hospital Association counters that a “one-size-fits-all” approach mandating nurse-to-patient ratios ignores the individual needs of both patients and hospitals.

Listen: Michigan Nurses Association presidents calls for better working conditions

The following interview was edited for clarity.

Quinn Klinefelter, WDET News: There has been for a long time talk that there’s been a lack of nurses in the industry. So if you limit the amount of patients that each nurse would be able to handle, could that exacerbate those shortages?

Jamie Brown: There’s no nursing shortage. The state of Michigan has 50,000 nurses that currently hold an active nursing license that are not practicing at the bedside. If these laws were to go into effect, it would effectively bring more nurses back to the bedside and there would be plenty of nurses to take care of the patients.

How would it lure them back?

Because they would be able to take care of the patients in the manner that they want to. If you think about it, if a nurse has six patients right now, that’s only 10 minutes per patient. And if you drop that number down to four, that gives you more time to spend with each patient and catch any changes that might need to be elevated so the patient can go to a higher level of care.

Since the pandemic began there was a lot of talk about situations being so dire that nurses were just getting burned out and leaving. Has that changed? Does that affect these proposed laws in any way?

The pandemic has put a focus on the number of nurses leaving the bedside. And the patient numbers that the nurses are taking care of has gotten worse since the pandemic because more nurses are not putting up with the bad working conditions the hospital are forcing us to work under. And so they’re leaving the profession altogether.

How does it work for you personally? Being a critical care nurse yourself, if you’re taking care of one patient, do others just have to wait because you’ve got to prioritize? And would that be different if they limited the amount of patients you had to care for?

Yes. Right now as a critical care nurse, I can be asked to take up to three patients and you absolutely have to prioritize. And if you aren’t prioritizing effectively, then harm could come to another patient and you hope that one of your teammates would be able to catch that if you’re caught up in a room with another sick patient. If I only had to take care of one patient, all my focus would be on that patient and I could better catch any minute changes that I need to let the doctor know about — so bad outcomes could be prevented.

The Michigan Health and Hospital Association put out a statement…[saying] they don’t support the legislation because it would institute government-mandated staffing ratios and a “one-size-fits-all” approach to mandating decisions about clinical care typically ignores the complexity of patient care or the diversity of healthcare environments. What’s your reaction to those statements?

I would challenge the hospital association that the one size that they’re using to staff the hospitals with right now isn’t working…bad outcomes are higher or infection rates are higher or falls are higher. And that’s simply because we do not have the number of nurses we need at the bedside. They’re asking nurses to take care of seven to eight patients on a med surg floor, which is double what the mandated levels would be. And it would give them more flexibility because we’re just asking for minimum patient ratios.

It all boils back to the money and how the hospitals are putting profits over patients’ lives.

One of the other things that some of the medical systems seem to argue is that they had nursing staffing levels set during collective bargaining and they say they’re sticking to the levels that were set. Did unions negotiate, in your view, for too few nurses to be on the job?

The collective bargaining affects only a small amount of nurses in Michigan. So that would not take care of every nurse in Michigan. And getting those ratios mandated into the contract is a really big ask and very few contracts have nursing ratios negotiated into their contracts.

It seems to make sense that if a nurse has fewer patients to take care of that they’d be able to provide better care. What has been the real sticking point? I mentioned the hospital association’s statements. But from your dealings with the proposed laws, why hasn’t this just gone through already?

I would put it on the corporatization of American healthcare. It all boils back to the money and how the hospitals are putting profits over patients’ lives.

Meaning if you have to limit how many patients a nurse takes care of then you have to hire more nurses to take care of fewer patients per nurse?

Absolutely. And nursing already is the highest labor cost in a hospital.