The number of patients assigned to nurses would be limited and nurses’ mandatory overtime reduced, under legislation reintroduced in the House and Senate with Michigan Nurses Association (MNA) support.

The package, called the Safe Patient Care Act, was intended to improve nursing retention. It was immediately opposed by the Michigan Health and Hospital Association.

Sen. Sylvia Santana (D-Detroit)’s SB 334 , and Rep. Stephanie Young (D-Detroit)’S HB 4550 limit the number of patients a nurse can be assigned.

The bills establish a one-to-one ratio in intensive care units, during trauma or critical care for triage duties, in operating rooms, during conscious sedation and post-anesthesia, during active labor and birth, immediately postpartum and in cases of an unstable newborn.

In pregnancy cases before labor, the ratio would be one nurse to three pregnant patients, not including cases of continuous fetal monitoring.

Non-trauma emergency departments and pediatrics would each be required to staff one nurse for every three patients, while postpartum care, behavioral health and acute rehabilitation cases would require one nurse for every four patients.

Sen. Stephanie Chang (D-Detroit)’s SB 335 and Rep. Betsy Coffia (D-Traverse City)’s HB 4551  prohibit hospitals from punishing nurses who refuse to accept overtime requests outside of a declared state of emergency, with a $1,000 fine for violation.

Sen. Jeremy Moss (D-Southfield)’s SB 336 and Rep. Carrie A. Rheingans (D-Ann Arbor)’ HB 4552 require hospitals to release their staffing ratios for each shift, maintaining a record for at least three years.

The package was supported by the MNA as a way to address years of hospital understaffing that have taken a toll on nurses, said Jamie Brown, a critical care nurse and MNA president.

“We have reached the point now where almost 40% of current nurses say that they are planning to leave within the next year,” Brown said.

But the bills have garnered opposition from the Michigan Health and Hospital Association and Michigan Organization of Nurse Leaders (MONL), according to Health and Hospital Association CEO Brian Peters and MONL President Kim Meeker.

In their joint statement, the pair said the bill package could harm hospitals and reduce access to important patient services by sending nurses home during a staffing shortage.

Michigan hospitals are trying to fill 8,500 job openings for nurses, according to their statement, and “instituting a one-size-fits-all mandate requiring hospitals to hire more nurses who do not currently exist will limit the services hospitals can offer to their communities, prolong the time it takes for a patient to receive care and hinder the ability of hospitals to respond to a crisis in fear of violating Michigan law.”

Instead, the groups suggested legislation that would allow Michigan to join the Nurse Licensure Compact, expand eligibility for tuition assistance programs like Michigan Reconnect and increase penalties for those committing acts of violence against healthcare workers.

The pair added that hospitals and health systems are already working to address the shortage by obtaining more state funding and partnering with healthcare safety organizations to provide more emotional well-being outlets for nurses and other healthcare workers.

But Brown and the MNA disagreed. According to the association, it’s not a lack of qualified registered nurses (RNs) resulting in the shortage, but instead poor working conditions.

The MNA cited statistics from the Department of Licensing and Regulatory Affairs (LARA) that reported there were 154,758 RNs holding active Michigan licenses as of January, yet only 102,480 people employed as RNs in the state of Michigan, according to the U.S. Bureau of Labor Statistics.

The difference is about one-third of licensed RNs in the state.

A Feb. 1 poll conducted by the MNA earlier in the year found that nine in 10 registered nurses say requiring nurses to care for too many patients at once is affecting the quality of patient care, and the number of nurses who said they knew of a patient death due to nurses being overassigned jumped from 22% in 2016 to 42% in 2023.

The poll was conducted by Emma White Research with a +/-4.9% margin of error.

Coffia referenced the statistics, adding that she believes it’s time to end the cycle and the burden placed on nurses.

“We cannot keep asking nurses to do more with less. Nurses have repeatedly shared the exhaustion and moral fatigue they are experiencing,” Coffia said. “Research has shown that requiring nurses to work too many hours is both unsafe for patients and increases the likelihood of RNs leaving the profession entirely.”

Santana asked, “How many more nurses have to leave the profession before we start listening to RNs about the problems they are facing? How many more studies have to come out showing that out-of-control staffing levels are creating a downward spiral in healthcare?

“As elected officials, we have a responsibility to act to keep patients safe and help nurses stay at the bedside,” she said.

The House and Senate bills were introduced today following a press conference with legislators and the MNA. The House versions are headed to the House Health Policy Committee, while the Senate bills will go to Regulatory Affairs for further consideration.

The package received a Republican co-sponsor in the form of Rep. Jamie Thompson (R-Brownstown), and Rep. John Roth (R-Interlochen) also signed on to HB 4551 and HB 4552 .

Thompson said the package has the potential for bipartisanship with a little more work on the bills.

At the moment, they only address hospitals, she said.

This story courtesy of MIRS, a Lansing-based news and information service.