Op-Ed: New Jersey Should Adopt Safe Nurse-To-Patient Limit

By Ann Twomey, John Brady and Donna Kelly-Williams
July 24, 2018

Having too few nurses working in healthcare facilities is to the detriment of patients and staff. Legislation to set reasonable ratio is proposed for NJ. It could save lives.

The direct link between safe patient care and safe nurse staffing limits is clear. More than a decade of studies and almost 15 years of experience in California make clear that having too few nurses increases patient complications, infection rates and rates of readmission, and leads to even higher mortality rates. Short staffing also sends nurses from the bedside, into other jobs, or into retirement, something we cannot afford as our population ages.

Nevertheless, hospital management and even some nurse executives continue to argue against setting safe patient limits, ignoring not only the evidence but the voices of nurses everywhere, who overwhelmingly support laws setting safe patient limits out of their own experiences of working “short-staffed.”

The argument against setting patient limits (sometimes called nurse-to-patient ratios), is that setting ratios makes nurses a number. Bedside nurses know better, and they know that when hospitals set nurse staffing limits by budget, they make patients a number, and a budget line.

A proposed New Jersey law establishes a base-line safe limit on the number of patients one nurse can care for — with adjustments for a patient’s illness and his or her need for nursing care. This fall, Massachusetts voters will also get the chance to vote for setting safe patient limits by law — an initiative driven by the state’s largest organization of nurses, the Massachusetts Nurses Association.

New Jersey hospitals already must comply with long standing regulations setting ratios, or limits, in specialized hospital units, like Intensive Care Units (ICUs). Those limits save lives every day. But even the current limits (one registered nurse to three patients, for example) are outdated and inadequate for today’s more critically ill patients. In many unionized hospitals, staffing limits work well, and nurses have a voice in decisions concerning patient care.

Fighting for safe regulations

Nursing unions like ours — from New Jersey, Pennsylvania, Massachusetts, New York, Connecticut and Rhode Island — are leading the way in fighting to save lives and to keep nurses at the bedside. That’s why we are fighting for legislation and initiatives that would put safe patient limits into law. The New Jersey bill, sponsored by Sen. Vitale and Assemblyman Benson reflects both the science and experience of bedside nurses who day in and day out take care of the sickest among us. We believe every patient, in every hospital, deserves the same high level of care their illness demands — just as nurses should know that when they come to work, they will be able to deliver quality care to all their patients.

This long drawn-out fight over safe staffing levels has chased many nurses away from our profession. The argument against safe patient limits pushed by hospital CEOs diminishes the voice and value of nurses.

If hospitals respected and valued their nurses, they would listen to the voices of nurses — and they would hear loud and clear: The problem is understaffing, and the solution is safe patient limits. It’s time for the Legislature to move forward with legislation setting safe patient limits that give nurses the tools they need to keep their patients safe.

Ann Twomey is president of Health Professionals and Allied Employees (HPAE), the largest union of registered nurses and healthcare professionals in New Jersey representing 13,000 nurses, social workers, therapists, technicians, medical researchers, and other healthcare professionals in hospitals, nursing homes, home care agencies, blood banks, and university research facilities. HPAE is affiliated with the American Federation of Teachers, AFL-CIO. John Brady, RN, is vice president of AFT Connecticut. Donna Kelly-Williams, RN, is president of the Massachusetts Nurses Association.