Maine’s safe staffing bill moves forward

Nurses speak out for enforceable RN-to-patient ratios

By Todd Ricker and Chuleenan Svetvilas

National Nurse Magazine - July | August | September 2023 Issue

Registered nurse members of the Maine State Nurses Association (MSNA) held a rally on May 4 in Augusta, Me., and testified at a hearing before the state Legislature’s Labor and Housing Committee in support of the Maine Quality Care Act (L.D. 1639), a bill that would create legally enforceable nurse-to-patient ratios. This legislation, sponsored by Sen. Stacy Brenner (D-Scarborough), will limit the number of patients that nurses can be given in their patient care assignments. Numerous studies show that placing limits on the number of patients a nurse is assigned improves patient health outcomes and protects the health and safety of nurses.

Lucy Dawson, an emergency department nurse at Maine Medical Center in Portland, said, “We cannot be the nurses that we want to be when our ratios are too high. I have seen the increase in stress and moral injury that occurs when nurses are stretched too thin. Many of my coworkers are leaving the bedside because they are unable to give the care that patients need and deserve.”

“Passing the Maine Quality Care Act is the only way we can make our working conditions better and the conditions for patients safer and therapeutic and also bring nurses back to the bedside,” said Dawson.

Later in May, the Joint Standing Committee on Labor and Housing of the Maine State Legislature voted to support L.D. 1639 and send it to the full Legislature. The Labor and Housing Committee voted to endorse this bill as “ought to pass.”

If passed by the full state Legislature, the Maine Quality Care Act will set enforceable nurse-to-patient ratios in Maine’s hospitals. The bill covers the following health care facilities: privately owned or privately operated hospitals (including acute-care, specialty, and psychiatric hospitals), freestanding emergency departments, and ambulatory surgical facilities.

“This is a historic victory for nurses and patients in the state of Maine,” said MSNA President Cokie Giles, RN. “We have never been so close to ensuring that our patients have the nursing care they need and deserve.”

L.D. 1639’s lead sponsor Sen. Brenner said, “I am so proud that my colleagues in the Labor and Housing Committee are standing with bedside nurses across the state of Maine. This bill will not only protect patients and nurses but will bring nurses back to the bedside where they are desperately needed.” Brenner is a registered nurse and a nurse midwife.

With its passage, the Maine Quality Care Act will make Maine the second state in the country to pass hospital-wide, legally enforceable nurse-to-patient ratios. In 1999, California enacted its safe staffing law. Studies show that mandated RN-to-patient ratios improve patient care and reduce patient mortality. When RNs are forced to care for too many patients at one time, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure ulcers, increased length of hospital stay, higher numbers of hospital readmissions, and death.

In her strong letter of support to the Maine Legislature, Linda Aiken, University of Pennsylvania professor and founding director of the Center for Health Outcomes and Policy Research, the leading research center on the nursing workforce and outcomes of hospital nurse staffing, stated that “a very large and rigorous research literature of more than 35 years consisting of hundreds of studies and multiple systematic reviews published in the most prestigious scientific journals in health care” show “that the more patients nurses in hospitals care for each, the worse the outcomes are, including preventable deaths, preventable hospital-acquired infections, poor patient satisfaction and worse financial outcomes for hospitals resulting from longer patient stays, Medicare penalties for excess readmissions, and high nurse turnover that costs hospitals many millions of dollars every year.”

Safe staffing helps recruit and retain registered nurses. When California’s law took effect in 2004, it attracted nurses back to direct-care nursing, and reduced nurse burnout, keeping experienced RNs at the patient bedside. 

“California’s example shows us what is possible,” said Giles. “By making conditions better for patients and nurses, we can have safe staffing and better patient outcomes. Now that we have made history in Maine by getting this bill voted out of committee, we are looking forward to passage of this bill by the full Maine State Legislature. From there, we look forward to our safe staffing bill getting to Governor Mills’ desk. We expect the next few weeks to be a lot of work, but we are used to hard work and perseverance when it comes to our patients’ lives.”

Todd Ricker is a labor rep at Maine State Nurses Association and Chuleenan Svetvilas is a communications specialist at National Nurses United.