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May 17, 2023

CT hospital staffing measure shifts away from mandated ratios

AFT CT / YOUTUBE Sherri Dayton, a registered nurse at the Plainfield Emergency Care Center, a standalone emergency department that is part of Backus Hospital, talks about the need for mandated staffing ratios and better recruitment and retention of health care workers at the state's Legislative Office Building.

Mandatory nurse staffing ratios in Connecticut’s hospitals, a lauded concept that proponents said is sorely needed as facilities face staffing shortages, will not move forward this legislative session.

Instead, lawmakers are shifting their focus to bolstering hospital staffing committees, which were formed to give workers a voice in staffing plans, and creating a statewide oversight panel that will act as a mediator if problems arise.

“I think we have to focus on solutions for today,” said Rep. Cristin McCarthy Vahey, a Fairfield Democrat who is co-chair of the Public Health Committee. “We want our nurses to feel heard and be heard.”

The proposal to create mandatory nurse staffing ratios was widely discussed early in the legislative session as advocates and employees turned a spotlight on staffing shortages in hospitals. But the high cost of the effort, along with pushback from stakeholders like the Connecticut Hospital Association, several hospital presidents and the Connecticut State Medical Society, prompted legislators to rethink the strategy this year.

Under the original bill, hospitals were directed to come up with employee-to-patient staffing ratios for registered nurses and assistive personnel, such as patient care techs, by 2028. The ratios would apply to staff in various departments, including the emergency department, operating room, intensive care unit, neonatal intensive care unit and psychiatry unit. As examples, the measure suggests there could be a 1-1 patient-per-nurse ratio in the operating room, while there could be a 6-1 ratio in the psychiatry unit.

But the cost to bring on additional staff would be substantial. The state’s nonpartisan Office of Fiscal Analysis estimated that it would cost the UConn Health Center, a state-owned complex that includes UConn John Dempsey Hospital, about $11.5 million more annually to meet the suggested ratios.

“The bill, which establishes requirements regarding nurse staffing and mandatory overtime in hospitals, results in a potentially significant fiscal impact to UConn Health Center and the Departments of Mental Health and Addiction Services and Children and Families,” officials wrote in the bill’s fiscal note.

They did not provide an estimate for costs to DCF or DMHAS. “The actual costs to the state, including those associated with DMHAS and DCF, will depend on the staffing levels at the time the bill’s provisions go into effect,” they noted.

“We don’t have $11.5 million. We didn’t have $11.5 million in our budget as it came out of the committee,” said Sen. Cathy Osten, D-Sprague, a co-chair of the Appropriations Committee.

Though many hospital workers, including registered nurses, testified in favor of the original proposal, others raised concerns. The head of the Connecticut Nurses Association asked lawmakers not to delay needed reforms and expressed support for “hospital-level decision-making” instead of creating the same standard for all.

“We ask that the legislature prioritize finding solutions that can be implemented without delay to create safe staffing environments,” Kim Sandor, the head of the association, wrote to legislators. “If steps are taken to strengthen the [hospital staffing] committees, including increased [public health] reporting and nurse retaliation protection, we agree with the current approach as it supports hospital-level decision making. [The original bill] is proposing a one-size-fits-all approach to nurse staffing ratios across the state.”

“I think the Connecticut Nurses Association felt that instead of having a top-down ratio strategy, we should actually give it to local power,” added Sen. Saud Anwar, D-South Windsor, a co-chair of the Public Health Committee. “And we said, ‘OK, if that is what many of the people are in agreement with, especially the nurses.’”

An amendment has been proposed that would instead require hospital administrators to get the approval of the hospital staffing committee before sending annual staffing plans to the state, which include nurse-to-patient ratios. The staffing committees are composed of bedside nurses and management nurses.

Each acute care hospital already has a committee, and members are supposed to have a say in staffing plans, though labor officials say it hasn’t always worked that way.

“Right now, because they’re not doing it collaboratively, management comes up with the staffing plans. And the staffing ratio could be, like, one nurse to five to nine patients. Five to nine is a big swing,” said John Brady, a retired registered nurse and vice president for AFT Connecticut. “And they’re showing it to the committee, and then saying, ‘We collaborated.’”

Under the latest proposal, he said, “the administration couldn’t just write up something, show it to the committee and submit it to the state. The administration would [have to] bring their ideas to the committee, the people on the committee could give their input, and then they would have to vote on the plan before it went to the state. So it would force it to be collaborative.”

Registered direct care nurses currently must make up 50% of the committee, but Brady said advocates are trying to nudge that number to 55%. The latest proposal would also require at least one registered nurse from each hospital unit to serve on the panel.

In addition, the bill would establish a statewide staffing oversight committee to help mediate disputes and resolve problems among hospital committees. If a hospital fails to submit its annual staffing plan on time, it must notify the statewide panel of an impasse.

“If the hospital staffing committee provides notification of impasse on a nurse staffing plan, representatives from the State-wide Staffing Oversight Committee shall meet with the committee not later than thirty calendar days after such notification to serve as mediators and assist the committee in reaching an agreement on such plan,” the proposal states.

If a plan still cannot be agreed upon, leaders of the hospital committees can appeal to the statewide group to request arbitration.

Negotiations over the bill’s language are ongoing.

“There is substantial common ground already,” said Nicole Rall, a spokeswoman for the Connecticut Hospital Association. “We agree nurses’ experiences and input are an integral part of how hospitals deliver high-quality, safe patient care.

“Government mandated staffing ratios are not the right direction to achieve these goals. As the legislation continues to take shape we will continue to advocate for solutions that support the work of hospitals’ nurse staffing committees.”

With three weeks left in the session, proponents are trying to push the measure over the finish line. It has not yet received a vote in the House or Senate.

“This is a priority,” Anwar said.

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