Nursing ratios: Rigid staffing rules boost costs, limit care

Elected Democrats see themselves as champions of health care policy that improves patient access to treatment while keeping medical costs down. Yet they continually push for legislation that would accomplish precisely the opposite.

The latest incarnation of this disconnect is Senate Bill 362, which would impose mandatory nurse-to-patient staffing ratios at urban health care facilities in Nevada. The bill, sponsored by Sen. Patricia Spearman, D-North Las Vegas, and Sen. Tick Segerblom, D-Las Vegas, has its initial hearing today before the Health and Human Services Committee.

Everyone wants the best care they can get when hospitalized. Nurses are at the front lines of that care. The less critical the nature of the care, the more patients a nurse can look after. The fluid and unpredictable nature of hospital admissions means nurses in less-emergent specialties will care for different numbers of patients day to day, hour to hour. Such environments call for maximum staffing flexibility.

Rigid staffing ratios, as proposed in SB 362, are idealistic, one-size-fits-all impositions that ignore the laws of economics. In a perfect world, everyone would have their own nurse. But every nurse comes at a cost. And no one — especially not private and public health insurers — has unlimited resources. Compounding the problem in Nevada and other states is the ongoing shortage of nurses. Hospitals and care facilities must constantly balance rising nurse salaries — a result of a lack of supply — with flat to declining reimbursements. Requiring hospitals to double staffing in some departments doesn’t mean they’ll have the resources or the pool of qualified applicants to do it.

If SB 362 became law, Nevada’s experiences would mirror those of California, the first and only state to impose minimum nurse-to-patient ratios. The law increased demand for nurses, boosting their salaries further, increasing overall health care costs. Hospitals that couldn’t afford to meet statutory staffing ratios closed emergency rooms and other money-losing departments, or shut down altogether. Ambulance diversions and emergency room wait times increased. Most hospitals still can’t comply with the ratios.

Higher costs, less access to care. Nobody wants that.

This is a union bill, pushed in Nevada by the Service Employees International Union, which represents nurses at several local hospitals. It just so happens that the SEIU, working with other liberal organizations, got Sen. Spearman elected last year in a low-turnout primary against incumbent John Lee. Her co-sponsorship of this bill is a classic quid pro quo.

The union says the bill is about patient safety, but minimum staffing ratios offer no guarantee of improved patient outcomes. They ignore the fact that some nurses are more skilled than others, and that some patients are sicker than others. Besides, the bill provides exemptions if a bargaining group agrees to less-stringent staffing ratios, meaning nonunion hospitals suddenly would have a powerful incentive to unionize. How convenient.

SB 362 is the wrong medicine for Nevada. It should die.