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WILKES-BARRE — If Heidi Stempien’s children decide to follow her into nursing, she hopes the issue of staffing will be resolved by then — not just here, but across the state.
After more than a year of negotiations, Stempien and others in the Wyoming Valley Nurses Association last week ratified a new contract that averted a strike at Wilkes-Barre General Hospital and made progress on addressing their concern of being assigned too many patients.
But Stempien, secretary of the union affiliated with the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP), described the three-year deal as another stepping stone on the path toward a larger goal: A law setting nurse-to-patient ratios in Pennsylvania.
She hopes to see it before her children enter the working world.
“I don’t want them to fight the same fight,” Stempien, a registered nurse in the WBGH emergency room, said of her daughter Lena, 1, and 3-year-old son Chance.
She is not alone.
Patty Eakin, past president of PASNAP and its political consultant, said staffing is front and center for the union and will remain that way until limits are the law.
Union representatives pointed to California’s mandated minimum limits as an example of what works, and advocated for Pennsylvania to follow the lead of the Golden State, where a law implemented in 2004 determines how many patients a nurse may treat at any given time.
“We will fight on every front,” Eakin vowed.
Opponents of such measures question whether their inflexibility would pose problems for hospital operations and finances.
In Harrisburg, two registered nurses-turned state senators have taken up the issue in the legislature, but from different approaches.
“Around our state, nurses are feeling overburdened,” said Maria Collett, D-Bucks/Montgomery, who plans to introduce a ratio bill.
They’re not able to adequately attend to patients, resulting in falls, infections and higher rehospitalization rates that all have costs, she said.
On the other hand, Senate Bill 63, introduced last month by state Sen. Judy Ward, R-Blair, aims to give the hospitals a place at the table with nurses, with committees working to determine staffing in the units providing various levels of care.
“I think it allows more flexibility,” Ward said of a collaborative effort between staff nurses and hospital administrators.
Local issues
Staffing and ratios were at the heart of the differences between the union and WBGH. Even after last week’s deal, however, the community at large doesn’t know much more about the numbers because specific details have not been released.
During a public presentation prior to the agreement, WGBH operating room nurse Jamie Fleming cited a ratio of six or seven patients per nurse at the hospital, which she and her colleagues say is not safe for anyone.
In a response to the Times Leader following that presentation, a WBGH spokeswoman said the hospital has not downsized nursing staff, either through attrition or otherwise, and continuously posts all nursing positions.
Asked about ratios, the spokeswoman added only that the hospital’s staffing plans “… are reviewed and deemed appropriate” by the Pennsylvania Department of Health and The Joint Commission, a non-profit health care accrediting agency.
The new contract agreed to by Community Health Systems, the hospital’s Tennessee-based, for-profit owner, includes a patient care council that’s scheduled to meet regularly and have a federal mediator present if necessary.
Stempien argues that the time will come when they will have to move beyond discussions and set ratios. The issue is one of common sense, she says: it’s safer for patients and reduces nurse burnout from overrationing.
She is eager for the state to do the same.
“I just want it to be a law,” Stempien said.
Collett supports ratios
Collett’s intent is to reintroduce legislation similar to Senate Bill 214 from the previous session.
That bill, which languished in committee, set a wide range of nurse-to-patient ratios for specific care circumstances, such as one-to-four for general emergency department visits, one-to-one for critical trauma patients in an emergency department, one-to-two in a burn unit, one-to-three for pediatrics, and so on.
That’s what language in California’s Title 22 regulations does.
Collett said the new bill hasn’t been numbered and still has to work out specific ratios.
There are still financial lessons to be learned from California’s law, Collett acknowledged. But there have been benefits, she said. “It results in better patient outcomes,” she said.
To the argument that ratios will be too restrictive and eliminates hospitals’ autonomy to address staffing, Collett responded, “It’s not working now.”
Ward: Ratios too rigid
Ward offered a frank assessment of the effect of a California-type law on the small community hospitals in her Senate District 30, which stretches from the Altoona area south to the Maryland border.
“It would put them right out of business,” she said.
Ward did not dispute staffing has to be addressed and said her bill, that she first introduced as HB 2092 when she was in the state House, arrives at a solution suitable for all parties.
It’s not as rigid as a mandated ratio and would not hamper the teamwork Ward said she experienced working in a coronary care unit and was able to provide a coworker assistance.
“There’s no incentive to help your neighbor,” Ward said when a rigid ratio is in place.
The Pennsylvania State Nurses Association (PSNA) prefers Ward’s bill, CEO Betsy Snook said, as nurses would have a voice on the committee and take part in a dialogue to determine what works.
“One size doesn’t fit all,” Snook said of the other soon-to-be introduced legislation on mandated ratios. “Their bill is looking at one size fits all and it never does.”
A flyer distributed by PSNA argues that ratios are unnecessarily expensive, inflexible and do not take into account important differentials such as the needs of individual patients or the impacts of unpredictable events on staff levels.
“It’s different for every hospital, every unit, every season,” Snook said.
Back in Wilkes-Barre, however, Stempien insisted there needs to be a mechanism protecting nurses and patients from the pattern of understaffing that has resulted in many facilities even when there is no shortage of nurses.
“Nurses are just people who make it work,” Stempien said. “Corporations prey on our altruistic ways.”