Opinion | Forced nurse staffing ratios will shutter Michigan hospital beds

For anyone who has been a patient or a family member of one, you know the profound impact nurses have on the healthcare experience. They save lives, hold hands, encourage and comfort patients and families during their hospital stay.

They deserve our full support — including the freedom to make decisions that work best for their patients.

Michigan hospitals employ more than 62,000 nurses, and the truth is, we're desperately trying to hire thousands more. Michigan, like every state, is facing a nursing shortage. The retirement of many baby boomer nurses, coupled with the unprecedented stress of the pandemic, has resulted in a significant loss of nursing staff. The daily work of nurses has never been more challenging, and the rise in self-reported burnout rates is noticeable.

Health care is not rocket science. In fact, it's far more complex. This complexity includes not only the science behind medical diagnoses and treatments but also the organization and payment of health care. Everything in health care is interconnected, including how hospitals operate and the impact of public policy decisions.

With that in mind, it’s important to know the impact of the proposed Senate Bills 334–336 and House Bills 4550–4552, which would mandate a one-size-fits-all nurse-to-patient staffing ratio for Michigan hospitals. On the surface, it may seem like this would ensure more nurses on hospital floors, reducing their stress and providing safer care for patients. However, this assumption is fundamentally flawed.

Every day, in every Michigan hospital, nurses who are leaders in their facilities make critical decisions about staffing levels in various units. These decisions account for many variables, such as how many patients are getting care, how sick they are, the skillset of the care team, available technologies, and real-time data and metrics. These nurses, with decades of experience including at the bedside, understand the unique dynamics of their communities and hospitals, using their knowledge to create the safest staffing models for their patients.

The bottom line is, even if there was an endless supply of nurses available to meet the proposed staffing ratio mandate (which there is not), and even if there were unlimited funds to pay for these new staff (which there are not), it simply does not make sense to replace the expert judgment of local nurses with a one-size-fits-all model dictated by politicians in Lansing.

The Michigan Organization of Nurse Leaders (MONL) strongly opposes this legislation, and many nurses are personally offended by its premise. Implementing such a mandate would put hospitals in an impossible situation: either break the law and risk their ability to stay open and deliver care, follow the law and turn away patients, or shut down beds and service lines entirely to move nurses into other units. A survey of Michigan hospitals earlier this year estimates the state is at risk of losing up to 5,100 hospital beds across the state if this legislation is implemented, which is comparable to every hospital north of Grand Rapids and Flint closing. This situation would also lead to more hospitals diverting patients to another facility, ultimately harming patients and communities, particularly in rural areas during harsh Michigan winters.

We can learn from other states that have implemented similar policies. California was the first to adopt mandated nurse staffing ratios about two decades ago. Despite these ratios, they still face a shortage of 40,000 RNs, showing that mandated staffing ratios haven't attracted nurses to that state or solved the workforce issue, and in the years following the mandate, California had multiple hospitals close.

In contrast, Michigan performs better in hospital quality, with a higher percentage of top-rated hospitals compared to California — hospitals with the local authority to know what is best for their community.

Similar legislation was recently discussed and ultimately failed in Minnesota, as every hospital's leadership raised grave concerns about its consequences. Even the Mayo Clinic, renowned for its quality of care, felt so strongly about the negative consequences of this concept that it considered reallocating resources to other states because of the threat the legislation posed to its viability in Minnesota.

The mission of the MHA is to advance the health of individuals and communities. When we see proposals that jeopardize this mission, no matter how well-intentioned, we will stand united to tell our story to elected officials. Healthcare is indeed complex, and Michiganders deserve better than mandates that may not consider the unique local challenges our hospitals face.

Let’s work together to support new and existing solutions that support our nurses at the bedside and maintain access to quality healthcare for all Michiganders. By taking away the expertise of local nurses and replacing it with a government ratio imposed on every community across our state, this proposed legislation does not accomplish either.