Lawmakers mull bill to limit nurse-to-patient ratios in Maine hospitals

May 4—A legislative committee on Thursday heard impassioned public testimony on a bill that would force hospitals to hire more nurses to meet limits on how many patients they can serve.

Mandating minimum staffing levels, the bill's supporters said, would provide relief for nurses who are stretched to the breaking point by a hospital workforce shortage. But hospital officials said the requirement would be costly, reduce patients' access to care and not address the pervasive nursing shortage.

The bill, sponsored by Sen. Stacy Brenner, D-Scarborough, contains a lengthy list of nurse-to-patient ratios for various types of care. Averaged out, the legislation would require roughly one nurse for every two patients.

The Joint Committee on Labor and Housing heard sharply divided opinions both for and against the bill, but those who spoke agreed on one thing: We need more nurses.

If the bill is approved, Maine would become the second state, after California, to have a law setting allowable nurse-to-patient ratios. Research on California's law has yielded mixed results.

There are about 26,000 nurses in Maine, according to state data, but more are desperately needed.

A 2022 analysis prepared for the Maine Hospital Association and the Maine Nursing Action Coalition said there was a shortage of 2,250 registered nurses in 2021 and projects a shortage of 1,450 to 2,250 registered nurses by 2025. Because there has been an increase in nursing graduates in recent years, that projection is better than an earlier forecast, which predicted a shortage of 3,200 registered nurses over that time. The state's community colleges are trying to train more nurses, which would help even more in the coming years.

Proponents of the bill argue that an overall nursing shortage isn't the problem. Rather, it's the shortage of nurses willing to work in hospitals under difficult conditions caused by high patient loads. The bill's supporters said that if anything, adequate staffing requirements will only help make the state more attractive to nurses, helping to boost and retain their numbers.

"We simply must have enough nurses to do our jobs safely and well," said Jackie Fournier, a registered nurse at Maine Medical Center. "When you leave shift after shift with the feeling that you couldn't do enough because you were too overextended, it takes a toll on even the strongest of nurses."

Ashley Schumacher left her bedside nursing career last year after more than a decade at Northern Light Mercy Hospital. Then a labor, delivery, and postpartum nurse, she said she was exhausted and stressed by high patient acuity, low ratios of one nurse to three parent-and-baby couplets, and seemingly endless menial tasks that pulled her away from direct patient care.

Schumacher said in written testimony that safe staffing levels will improve care for patients and give nurses more time for both continuing training and certifications, as well as an improved work-life balance.

"All of these factors will serve to establish Maine not only as a place to receive excellent medical care but also as an attractive place to work for new nurses and prevent burn-out in experienced nurses like me who are considering leaving the profession altogether," she said.

But bill opponents, including many hospital personnel and officials, say the nursing shortage is widespread and caused by multiple factors, including a clogged student-to-nursing pipeline. Both sides agree that the current low staffing levels desperately need to be remedied, but several people on Thursday argued that the bill is not the way to do it.

'THIS BILL DOES NOT PRODUCE ONE NURSE'

The bill carries an estimated $100 million price tag, and hospitals already have largely blown through their personnel budgets by hiring traveling nurses to fill the gaps caused by the shortage. The difficult working conditions during the pandemic strained hospitals and led many nurses to leave, including many who were near retirement age.

If passed, Maine hospitals would have to hire 2,500 new nurses — 1,000 nurses on top of the 1,500 positions they are already trying to fill, according to Lisa Harvey-McPherson, vice president of government relations at Northern Light Health and a board member with the Maine Nursing Action Coalition.

"We do not have that nursing capacity available and we are not projected to have that capacity available," she said. "This bill does not produce one nurse."

Other opponents of the bill said that while reduced staffing ratios are good in theory, the parameters set by the bill are too rigid. They would strip nurses of their ability to exercise their professional judgment and the flexibility to meet the individual needs of their patients.

Megan Lowell, a nurse manager at Maine Medical Center, said in written testimony that the bill does not take the severity of a patient's illness into account.

"This bill attempts to give a one-size fits all approach to nursing care which is neither a realistic nor an achievable goal," she said.

Harvey-McPherson and others suggested time would be better spent improving and expanding training programs.

If staffing ratios solved the problem, she said, nursing homes, which do have mandated staff ratios, wouldn't have needed to close 25% of the state's nursing home beds in the last few years.

Rep. Michael Soboleski, R-Phillips, repeatedly said that the bill seemed like a "collective bargaining agreement that went wrong," and suggested that the ratio question should be hashed out at the bargaining table rather than in the State House.

But not all of Maine's hospitals are unionized, and Fournier noted that the nurse's union at Maine Medical Center only ratified its first contract in September. Typically, that's an issue discussed in second contracts, she said.

The committee will discuss the bill further at an upcoming work session.