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State nurses rail against bill requiring minimum nurse-to-patient ratios

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The New Jersey State Nurses Association, a trade group that represents roughly 125,000 registered nurses in the state, is arguing against a new bill that would require medical care facilities and hospitals to establish minimum nurse-to-patient ratios.

The bill, S-989, sponsored by state Sen. Joseph Vitale, D-19th District, states that “minimum nurse-to-patient ratios will vary depending on the type of unit, and will range from one registered professional nurse for every five patients in a behavioral health or psychiatric or a medical/surgical unit, to one registered professional nurse for every patient under anesthesia in an operating room. The regulations adopted by the Commissioner of Health are not to decrease any nurse-to-patient staffing ratios that are already in effect on the bill’s effective date.”

Judith Schmidt, NJSNA’s CEO, argues the new bill could decrease the quality of care for patients because it could set up situations in which an inexperienced nurses would have to handle emergency situations. She added “ratios are rigid and dictate a set number of staff, which is not the best model for optimal patient care, which constantly changes. We need to give the nurses at the bedside the authority and the accountability for staffing their units as needed.”

Instead, nurse managers need to be held more accountable for staffing based on the patient needs and nurse skill levels, Schmidt said in a statement.

“This bill does not address some of the key issues that occur with staffing, such as the constantly changing needs of patients,” said Schmidt in a public statement. “Staffing is not about a specific number, but the appropriate mix of how sick the patients are, which dictates how much care they need, plus the level of experience of the nurse.”

Schmidt also said that the bill does not address the availability of assistive personnel such as nursing assistants, transporters and technicians. 

“With healthcare economics the way they are, hospitals are going to have to eliminate some of the assistive positions,” she said. “Nurses and their assistants have the most contact, one-on-one time and direct care of patients within the healthcare system.”

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Vince Calio

Vince Calio

Vince Calio covers healthcare and manufacturing for NJBIZ. You can contact him at vcalio@njbiz.com.

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Kasia February 28, 2018 12:32 am

In a perfect world, yes "Staffing is not about a specific number, but the appropriate mix of how sick the patients are, which dictates how much care they need, plus the level of experience of the nurse" But any nurse that works in acute care settings knows that this is not the case. Nurses work shortstaffed all the time and this bill would at least prevent that from happening. I am yet to see an assignment when there is an uneven number of patients assigned to different nurses based on acuity and the experience of the nurse. New nurses off the orientation are expected to "hit the ground running" and good luck to the charge nurse who makes an uneven assignment. I worked in many different specialties, one of them being psychiatry, and I often had 14 (!!) patients on an involuntary unit. do you think anyone looked at the acuity or the experience of the staff when they staffed the unit with 2 RNs for 28 involuntary, often psychotic and violent patients? No, they did not. And this seems to be the trend everywhere I work. Not to mention nursing homes that have a ratio of 1 RN to 60 resident at night. NJ needs this bill for both nurses and patients safety!!

Kasia February 28, 2018 12:45 am

I also just wanted to add that Judith Smith is so far removed form the reality of nursing its not even funny. reality check Judith, those staffing conditions ALREADY EXIST where an inexperienced nurse is given 8 patients because hospitals are chronically short staffed. I cant believe anyone would be against this legislation!!

Patricia February 7, 2018 5:05 pm

Why would minimum staffing ratios take away the ability to staff based on acuity? Im tired of hearing that as an excuse to not support safe nurse-to-patient ratios. The bill would mandate a maximum amount of patients allowed to be assigned to a nurse depending on their type of unit, meaning that the nurse can take on an assignment less than that mandated number. The way things are right now there is nothing protecting the nurse or the patients from nurses being given inappropriate assignments.

Assignments should absolutely be based on acuity, however, there needs to be a law in place to protect the nurse from being pushed beyond a safe ratio.

Megan February 7, 2018 4:41 pm

This is ridiculous? Their criticisms don’t even make sense. Nurse managers can be responsible for assigning patients based on acuity and experience within the parameters of the ratios. Perhaps there should be a provision addressing emergency/disaster situations but the hospitals should be required to have adequate staff on hand to handle their patients.

Jan in Ohio February 9, 2018 5:46 pm

The NJSNU’s claim is that they “represent the interests of” 125,000 nurses. This is a subtle but meaningfully different thing than actually “representing” them, which is what your article says. I’m pretty sure not ALL the New Jersey nurses have authorized NJSNU to speak on their behalf - by actually joining the NJSNU.

To put this story in clearer context, you should find out what proportion of the nurses in the state are actually dues-paying members of the organization. It would also be illuminating to find out what type of work those nurse members do.

Only about 5% of the Registered Nurses in the United States belong to the American Nurses Association (ANA) and that number has been in decline for years. That 5% proportion holds true in Ohio, where the nurse members of the Ohio Nurses Association are largely hands-off managers (or as they like to be called “Nurse Executives”) academics or members by virtue of being in one of the ONA’s collective bargaining agreements, where membership is mandatory for employment. 

95% of nurses do not authorize the ANA, or any of it’s affiliates, to speak for them. That 95% includes the vast majority of nurses who actually care for you in your hospital or nursing home bed. 

Whenever you hear Ms. Schmidt, or ANA, or some cadre of “Nurse Executives” say they are speaking for nurses, remember they really only speak for a very small minority.

Susan February 7, 2018 4:35 pm

Wait a minute…I know a lot of NJ nurses who are in favor of A1470/S989, just not the nurse executives. If you ask a bedside nurse, he or she will tell you that our work has gotten harder, the patients are sicker and the paperwork is endless. I’m not exaggerating. I’ve been a nurse for 20 years, 10 of those in various emergency departments around the state. Never have I been asked to juggle so much, with so little. We have little to no ancillary help. We go 12, 14, sometimes 16 hours with no break. And everything rests on our shoulders, it seems: patient outcomes, patient satisfaction scores, a dozen National Patient Safety Goals.

Ms. Schmidt wants an nursing assignment algorithm that will change frequently based on acuity and experience. My job already has that. We adjust staffing every 4 hours based on collected data. For example, we have more staff come at 3p because 3p to 7p are usually our busiest times. But there’s no “usual” in medicine. I can’t tell you home many times we’ve sent people home because 3pm was slow and then, in the next hour, 37 patients came. Now you’re short staffed. You think that nurse you sent home is coming back? No way. Every unit I’ve ever worked is staffed like this every day. God forbid someone should sit around for 5 minutes and take a breath.

There’s also the things that can’t be measured by scores and algorithms, but patients expect nurses to provide them. The doctor isn’t very communicative, they want the nurse to explain what’s going on with their family member. You have a dementia patient who is constantly calling you into the room because they don’t remember you were just there. The patient who is dying: under acuity staffing, they shouldn’t need a lot of “care”, but often that’s when the patient and their family needs you the most. Am I supposed to wait until 7pm when more staff comes in before I go and provide my non-acute emotional support?

For those of you who count the beans, nurses are worth every cent you spend on them. We are the biggest group of hospital representatives at any institution. When you have enough of us Press Gainey scores improve, outcomes improve, morale improves. These things are proven. Why, then, is it so hard to get a staffing bill passed? Because the nurses who are supposed to be our advocates in government and business are busy trying to divide us.

Is this staffing bill perfect? No, but it’s a damn good place to start.

Suzan Shinazy February 8, 2018 1:22 am

This is the obvious problem with what Schmit wants: Medical errors are the #3 cause of death in the US, with 440,000 deaths and millions more left disabled, and these numbers are increasing. Study after study proves patient outcomes are much worse when nurses are given too many patients, as is happening now. Do you want your loved one safe in a well staffed hospital? I do, and that is why I stand for safe nurse:patients staffing ratios. I do agree the aides and ancillary staff should also have mandated ratios because when Califonia implemented safe staffing ratios for RN's, the hospital laid off ancillary staff and gave the RN's more jobs to do that way.

Andrew Lopez, RN February 8, 2018 4:19 am

Which state nurses exactly? Did the NJSNA poll it's nurses? Exactly what percentage of NJ nurses are members? Seems the NJSNA,is quite out of touch with the daily grind, needs of bedside nurses.

Michelle February 8, 2018 1:20 pm

I am a registered nurse in the State of New Jersey. The NJSNA does not speak for me. We need patient ratios. Healthcare is a business and all the hospitals want to make money. This type of Bill has been law in California for years and all the studies have shown increased care and benefits for patients since it was enacted. Nurse's save lives, but only if they have the necessary time to spend with their patients.

Nurse M February 8, 2018 1:49 pm

Do you have any idea what nurses face? Too few nurses, too many patients. We don’t even get the resource staff they say will be taken away. Nurse managers load us up with absolutely unsafe assignments. We have NO input into staffing. ANA is nothing but suits, long removed from bedside care. This all boils down to money. It’s disgraceful.