Illinois this week is the latest state to take a run at legislation setting a limit on how many patients a nurse can care for at once, part of union efforts to find relief from what they call dangerous conditions.
State assemblies in New York, Pennsylvania and Michigan have also discussed bills in recent weeks to mandate the number of patients assigned to one nurse at any given time.
National Nurses United is "more optimistic than ever about these bills," union official Gerard Brogan told Healthcare Dive, describing recent events as a "grand swelling."
"Every nursing union has been active in promoting other states to pass a safe staffing law," Paul Clark, director of labor employment relations at Penn State, told Healthcare Dive. "And the issue of a national safe staffing law has been going on for years."
Democratic Illinois Rep. Jan Schakowsky reintroduced a bill this week that would set mandatory nurse-to-patient staffing levels in hospitals.
Either way, hospitals are pushing back. Lobbying associations frequently peg California's staffing law, the first in the country to enforce nurse-patient ratios, as a failed experiment with unproven benefits.
"Studies indicate that one-size-fits-all nursing staffing ratios do NOT improve quality of care or patient outcomes," the Illinois Hospital Association argues.
Linda Aiken, founder of the University of Pennsylvania's Center for Health Outcomes and Policy Research, has helped build the majority of what is now the entire body of work on safe staffing. She rejects those claims.
"There is absolutely no evidence that anything with negative consequences for the public happened in California as a result of ratios or would happen in other states if ratios were adopted," Aiken told Healthcare Dive. "No hospitals or services closed because they could not recruit enough nurses, neither patients nor taxpayers were charged more for nursing."
Here's a roundup of the latest action in the states:
The state hospital association in Illinois is using many of the same tactics used by its peer association in Massachusetts in November, according to nurses in the state.
"They used fear with the general public and intimidation with nurses," Illinois nurse Marti Smith told Healthcare Dive. In public, both hospital associations argue hospitals will close if staffing laws are enacted. Internally, Smith claims nurses have their "clinical autonomy" threatened if they don't side with their employers.
The Safe Patient Limit Act, a bill gaining steam in state, may have the best chance of becoming law. The legislation is moving at a rapid clip and is due for a vote in the Democratic-majority state house before the end of the month. Supporters are optimistic about the bill's odds of moving to the state Senate and eventually the governor's desk.
Modeled after California's law (with a few exceptions), the Illinois staffing mandate would be the second of its kind. It does, however, contain at least one difference: codified ratios, which California's bill did not have.
Massachusetts Nurse Association is is keeping its push up for a staffing law despite a failed attempt in November to pass on the legislative process for a ballot referendum. Massachusetts voters rejected the measure.
"That is not a state that does a lot of propositions," Joanne Spetz, a researcher at Healthforce Center at UC San Francisco, told Healthcare Dive, adding that voters may have been confused by the question. "It's hard to say what voters were thinking about that."
Prospects for approval seemed positive leading up to the election until, just days before the vote, the state's Health Policy Commission published a report claiming the law would cost the state as much as $949 million a year.
Union nurses argue the study's timing and methodologies warrant skepticism. Union and non-union nurses recently surveyed by MNA largely agreed that the hospital industry's campaign strategy last fall was "inappropriate."
New York State has now commissioned a study to analyze staffing ratios. The research is designed to inform a future vote on safe staffing legislation. New York's state assembly is majority-Democrat and its governor has expressed interest in signing safe staffing into law.
Under the proposed legislation, nurses are authorized to refuse work assignments if the assignment exceeds their abilities and establishes "private right of action for nurses discriminated against for refusing any illegal work assignment."
While nurse staffing bills have largely garnered support from Democrats, they've also found champions among a small sect of Republicans across the country.
In Michigan, Republican state senator Ed McBroom recently re-introduced for the third time mandatory staffing legislation, along with a twin bill in the House. And, similar to Michigan, where the state houses are dominated by conservatives, Pennsylvania nurses are continuing their fight for mandatory staffing legislation.
Democratic Pennsylvania Gov. Tom Wolf has promised to sign any such bill to make it to his desk, but judging by a union coalition's legislation tracker, the bill has a long way to go before it reaches the governor.
Hospitals prefer to address staffing levels themselves — a handful have done so in recent days.
In Tennessee this week, Ballad Health announced $10 million in pay increases for nurses while a 326-bed hospital in Pennsylvania announced improved staffing limits. Both follow last month's standoff between 10,000 nurses and New York's three largest hospitals, a contest that ended with a promise to improve staffing ratios and spend $100 million hiring new nurses.
While it’s too early to be called a trend, it seems some hospitals have begun rethinking their strategy. Patients are flocking to outpatient settings, payment mixes are increasingly Medicare-heavy and fears of the coming workforce shortage still linger. The need for healthcare workers — even unionized ones with demands — is not going away.