A plan to implement mandatory nurse staffing ratios in Connecticut hospitals was scrapped this legislative session, but an overhaul of hospital staffing committees survived, along with a requirement that hospitals produce staffing reports more often.
Under changes included in the state budget, direct care nurses will now get majority representation on special staffing committees in each hospital. The committees are formed to give workers a voice in each hospital’s staffing plans for the year.
The budget that gained final approval in the Senate on Tuesday requires direct care nurses to have one more spot than non-direct care employees on the committees. When developing staffing plans, the panels must evaluate the most recent research on patient outcomes, share with hospital workers the procedure for relaying concerns about staffing plans and assignments, and review all concerns brought to the committee.
By law, hospitals already are required to submit staffing plans once a year to the state health department that provide “adequate and appropriate patient health care services.” The measure adopted Tuesday increases the submissions to twice a year, in January and July. Hospitals must now also post their staffing plans on each patient care unit in an area that is “visible and accessible” to the public.
Hospitals that fail to comply with the new requirements must file a corrective action plan with the state and may be fined $3,500 for the first violation and $5,000 for subsequent lapses.
“This is going to be a big step in the right direction to help address staffing,” said Sen. Saud Anwar, D-South Windsor, a co-chair of the Public Health Committee. “This bill requires that there are staffing committees in every hospital, and in such a manner that the direct care nurses are going to be in the driver’s seat to help make sure the staffing ratios determined will be representative of their needs.”
A 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 have applied 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 suggested 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 have been substantial. The state’s nonpartisan Office of Fiscal Analysis estimated it would cost the UConn Health Center, which includes UConn John Dempsey Hospital, about $11.5 million more annually to meet the suggested ratios.
Leaders of unions representing hospital workers signaled support for the final proposal.
“It’s a really good effort,” said John Brady, a retired registered nurse and vice president for AFT Connecticut. “The local staffing committees have to come up with staffing plans, and the plans have to include ratios. And right now that happens, but it’s the management that makes the staffing plan. They show it to the staffing committee, but the committee doesn’t have to approve it. Now it has to be a collaborative process. The committee is going to have to approve the plan, including the ratios.”
The Connecticut Hospital Association praised the deal.
“CHA supports strengthening the nurse staffing committees, enhancing the role of direct care nurses in those committees, and ensuring that their voices are heard, without imposing bureaucratic remedies that would disrupt patient care,” said Nicole Rall, a spokeswoman for the association. “The language contained in the budget supports the work of hospitals’ nurse staffing committees and maintains nurses’ ability to use their professional judgment in providing care.”