DOH Issues Long-Awaited Report on Nurse Staffing
On Aug. 15th, the Department of Health (DOH) released its long-awaited report on nurse staffing requirements in hospitals and nursing homes. Entitled Study of Nurse Caregiver Minimum Staffing Levels and Other Staffing Enhancement Strategies and Patient Quality Improvement Initiatives, the report concludes that proposed staffing ratios legislation would require hospitals and nursing homes to hire 50,000 more nurses and 20,000 additional certified nurse aides (CNAs) over current staffing levels at a combined cost of between $3.7 and $4.7 billion. While the report makes various recommendations, importantly it does not advocate for the staffing ratios proposed in the Safe Staffing for Quality Care Act [A.2954 (Gunther)/S.1032(Rivera)] or other nurse staffing ratios.
DOH had been expected to issue the report by Dec. 31, 2019, and on Aug. 3rd, Health Commissioner Dr. Howard Zucker assured the Legislature during a joint Senate-Assembly hearing on nursing homes and COVID-19 that the report would be issued by Aug. 15th. The report focuses on registered nurses (RNs), licensed practical nurses (LPNs), and CNAs and considers the advisability of nurse minimum staffing levels, other nurse staffing enhancement strategies, and patient quality improvement initiatives. Cornell University was retained to analyze the potential fiscal and economic impact of these strategies.
DOH reviewed public reports, academic literature, and news publications on nurse-to-patient staffing ratios and strategies aimed at enhancing nurse staff and improving patient care. The Department also solicited input from various stakeholders through one-on-one meetings and public forums, which produced comments both in support of and in opposition to mandated minimum staffing ratios. As part of this process, LeadingAge NY met with DOH officials on staffing ratios last August and provided formal testimony in September reiterating our strong opposition to government-mandated nurse staffing ratios requiring inflexible nurse/aide-to-resident ratios in nursing homes, which would override the professional judgment of clinicians and potentially limit access to care. We also provided several alternative financial and programmatic recommendations to support the direct care workforce.
The Safe Staffing for Quality Care Act would require hospitals and nursing homes to meet specific staffing ratios for nurses and other direct care staff. Nursing homes would be required to staff direct care time of 2.8 hours of CNA care per resident day and 1.3 hours per resident day of RN or LPN care, of which at least 0.75 hours must be RN time. Further, nursing homes would need to staff at least one nurse for every five subacute care patients (i.e., 1.6 hours per patient day). According to Cornell’s analysis, the state’s nursing homes would need an additional 10,181 RN full-time equivalents (FTEs), 15,007 LPN FTEs, and 19,970 CNA FTEs if the proposed legislation were implemented. Cornell projects that the total cost of employing these 45,000 additional staff would range between $1.9 and $2.3 billion, assuming the added demand created by the requirements would also increase prevailing wages across the board by between 5 and 15 percent. Added total costs to hospitals were estimated at between $1.8 and $2.4 billion.
The report reviews the experience of California and other states that had implemented nurse staffing ratios and summarizes arguments for and against the use of ratios in New York. It concludes by not espousing staffing ratios: “[w]hile the Department supports measures to improve quality of care and patient outcomes, the COVID-19 pandemic has only highlighted the need to maintain workforce flexibility. The team-based approach to healthcare that fundamentally requires flexible staffing solutions is essential to a sustainable system that can support an effective pandemic response.” According to the report, all of the factors studied suggest that an effective workforce development approach should include strategies to ensure that nursing continues to be an attractive career path, ensure that there is enough capacity to educate and train a future workforce, and create a safe work environment for nurses to work in, among other initiatives.
The New York State Nurses Association, New York State AFL-CIO, New York State Public Employees Federation, Citizen Action of New York, New York State Trial Lawyers Association, League of Women Voters, and New York Public Interest Research Group are among the supporters of the Safe Staffing for Quality Care Act. While we expect their support and advocacy to continue, this report provides support for LeadingAge NY’s longstanding position on nurse staffing ratios. We appreciate the continued advocacy of the LeadingAge NY membership on this vitally important issue.
Contact: Dan Heim, dheim@leadingageny.org, 518-461-2934