COMPROMISED COMPROMISE

One of the first acts of the Legislature early this year was the rejection of a bill that would have established nurse-patient ratios in Maine hospitals. Contrary to the negative connotation of an “ought-not-to-pass” vote by the Legislature’s Health and Human Services Committee, this was a positive development: The two sides in the staffing dispute – nurses’ organizations and hospital administrators – had worked out a compromise that made the legislation unnecessary.

Eight months later, that old negative feeling is back and this time it’s for real. The Maine State Nurses Association says the rules developed by the Maine Department of Human Services to flesh out the compromise fail to address the core issues of proper patient care and nurse burnout. The Maine Hospital Association says the nurses are backing away from the deal in order to advance the national organized labor agenda. One of the first acts of the Legislature early next year may well be starting over.

It would help, of course, if the hospitals took a more constructive approach than sounding the alarm at the approach of some imaginary card-carrying bogeyman. It will take a much stronger argument than that to trump the nurses’ position, backed by data, that there is a worsening shortage of direct-care nurses in Maine, throughout the United States and in much of the world and that it is caused not by low pay but by high stress. Direct-care nurses are overwhelmed by increasing workloads – staff downsizing, more patients with more complex conditions – which is why an estimated 18 percent of nurses nationally (it’s slightly higher in Maine) have chosen to work in other fields. The DHS rule that would allow hospitals to count supervisory nurses in calculating nurse-patient ratios merely masks the problem.

For an industry so concerned about costs and a public policy issue so thoroughly studied, one would think hospital administrators and state officials would make better use of the extensive research linking direct-care nursing – proper staffing levels and involvement in decision-making – with improved patient outcomes. And of the research linking improved patient outcomes – quicker recovery, the avoidance of complications, infections, readmissions and preventable death – with lower costs. This research has been accumulating since the mid-1980s, when the first signs of nurse burnout began to appear. The industry has responded with such fixes as importing Third World nurses and hiring temps through expensive staffing agencies.

The current projection is that the nursing shortage, already so acute that some hospitals in some states urge family members to keep watch at the patient’s bedside, will become a full-blown crisis by 2020, when current nurses have retired and no new nurses come along to replace them. Congress has responded, partially at least, with the Nurse Reinvestment Act, a bill that promises to boost nursing and stem the shortage. But federally funded scholarships, loan repayment plans and public-service campaigns can only get more people into the profession. Keeping them there will take better local efforts – cooperation and genuine compromise – than Maine has seen thus far. It may even take an act of the Legislature.