No Limits: In 49 States, Nurses Have No Cap on How Many Patients They’re Assigned

Ohio Latest State to Stand up and Fight Back.

In an old episode of “I Love Lucy,” Lucy and Ethyl find jobs wrapping candy in a chocolate factory. As the candy comes down the conveyor belt, the joke is that there is a rate at which they can keep up—which is soon crossed. The franticness of their motions, as the belt speeds up, causes them to fumble and flail, hiding unwrapped chocolates in their hats, trying to do a good job even when that’s no longer possible.

It’s good comedy to watch the transition into the impossible—on TV. When it comes to caring for sick and injured people, however, a shift beyond one’s capacity is not funny. It’s dangerous. Unfortunately, 49 out of 50 states in America still allow healthcare corporations to speed up the belt on nurses—overloading us with too many patients, having no set limit to how many sick or injured people we can care for at once.

I have heard patients describe their nurses as a “blur”—a flash of hospital scrubs running from room to room. It breaks my heart to hear that because every nurse knows it’s a symptom of short staffing. It happens when hospitals cut corners to save costs, saddling one nurse with 9 or 10 patients at once—or with too many patients who are “highly acute” (severely injured or ill) at once.

Nurses also know all too well—and studies have shown again and again—that overloading us with too many patients is detrimental to the health of patients—and also to nurses (who experience higher rates of injury and job burnout). A 2016 study (Aiken et. al) found that with each 10 percentage point reduction in the proportion of professional nurses, there was an 11 percent increase in the odds of patient death.

I’ll repeat that one more time to let the gravity sink in, given that everyone in America is a potential patient: an 11 percent increase in the odds of patient death.

Many Americans may be surprised to know that California is the only state in the country with mandatory limits on the number of patients a nurse can be assigned at one time. The regulations were enacted in 2004, after nurses with the California Nurses Association/National Nurses United fought for years to achieve them.  Patients in every other state do not have the same safety protections—although nurses in other states have been fighting for similar legislation. NNU is fighting to ensure that all patients and nurses in America have the high level of protection they deserve.

On February 14, for example, NNU registered nurses in Ohio and elected officials gathered at the Ohio Statehouse, in Columbus, to mark the reintroduction by Senator Michael Skindell of the Ohio Patient Protection Act—a bill which sets specific limits on how many patients nurses can care for at once in hospitals throughout Ohio.

“With no limit on the number of patients we care for, we have a safety crisis on our hands in Ohio,” said Debra McKinney, RN, of Affinity Medical Center in Massillon, Ohio. “Hospital administrators are free to cut corners on staffing and put their bottom line over patient safety. We need a mandatory, non-negotiable limit to the number of patients each nurse cares for in order to protect our patients from harm—and also to protect nurses and other healthcare staff.”

The Ohio Patient Protection Act also provides whistleblower protection to assure that nurses are free to speak out for enforcement of safe staffing standards.

These fights can be a long game. Hospital corporations have a lot of money to fight against these bills. But the facts are on our side. In California, for over a decade, safe staffing ratio laws have been working.

A September 2012 report by the U.S. Agency for Healthcare Research and Quality titled “State Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction,” concluded that California’s nurse ratio law works and that higher nurse workloads are associated with more patient deaths, complications, and medical errors.

A 2015 study in the International Archives of Occupational and Environmental Health showed that the California safe staffing law was associated with 55.57 fewer occupational injuries and illnesses per 10,000 RNs per year, a value 31.6 % lower than the expected rate without the law.

Registered nurses will continue to fight, in Ohio and nationally, until every state has the same protections California has achieved.  We vow to advocate for our patients’ health and safety—and when we are pushed beyond our own limits by hospital corporations putting profits over people, the law must advocate for us, in turn. Nurses must be protected from patient overload as if lives depended on it. Because they do.

Bonnie CastilloDirector of Health & Safety at @NationalNurses, Director of RN Response Network; I’m an RN & healthcare champion who believes healthcare is a human right!