Opinion | Revisiting failed policies isn't the answer to Michigan’s nursing shortage

Peter Allen’s song “Everything Old Is New Again” touches on the importance of reflecting on the past to guide how to navigate current challenges. It was a simple musical earworm at the time, but the idea that everything old becomes new again seems more prophetic the longer I’m around. 

During my first term as the director of the Michigan Department of Community Health in the ‘90s (now the Michigan Department of Health and Human Services) our state, like many others, faced a shortage of skilled health-care workers. During conversations about what policies might help, the idea of a one-size-fits-all, government-mandated nurse staffing ratio was raised as a possible solution.

We find ourselves with a similar workforce shortage today — one we anticipated before the pandemic and was only exacerbated by it — in which this same discussion has come back around. As our policymakers explore the options before us today, I implore them to heed the advice from past leaders: The proposed government-mandated nurse-to-patient ratio solution in Michigan House bills 4550-4552 and Senate bills 334–336 will only set health care back and pose serious risks to patient care. We recognized it in the ‘90s, and it still rings true today.

Let me be clear: when implemented locally to address the unique patient care and resource needs of a community, nurse staffing ratios can work. They are not a bad one-off option in the toolbox of a health-care leader. The issue lies in the use of them as a one-size-fits-all government mandate that treats the needs of patients in densely populated southeast Michigan the same as those in rural northern Michigan. 

States like California that implemented statewide nurse staffing ratios 25 years ago have experienced negative outcomes as a result. Despite having these ratios in place for decades, California still faces a shortage of 40,000 nurses and employs fewer nurses per capita than Michigan. Additionally, hospitals in California reported increased operating expenditures and decreased margins, leading to reduced services and even the closure of hospitals altogether. These consequences further restrict access to care and result in delays in treatment. When Massachusetts tried this mandate, there was no improvement on patient care outcomes.

If Michigan were to implement this flawed policy, it would have dire consequences for patients. Our state would stand to lose 5,100 hospital beds, which is the equivalent to losing our six largest hospitals, or all hospitals north of Grand Rapids and Flint. In short, the medical services Michiganders rely on every day would be jeopardized. 

Mandating a statewide staffing ratio will not address the nursing shortage in Michigan. Instead, we must focus on solutions that support the expertise of local health-care experts and their efforts to recruit, retain and support nurses. The good news is that there are several actions policymakers can take to support the workforce and improve care. Michigan has already begun taking steps towards common-sense solutions, such as the signing of bipartisan legislation to increase penalties for those who commit violence against health-care workers. Solutions that support local experts while building the pipeline are key.

First, Michigan should pass legislation to join the national Nurse Licensure Compact, supported by 67% of Michigan voters according to an August 2023 poll. This compact would reduce barriers for out-of-state nurses to move to and practice in Michigan immediately, helping to alleviate staffing shortages. 

Second, we must support the retention and recruitment of nursing professionals. Post-secondary education programs such as the Michigan Achievement Scholarship and Michigan Reconnect help individuals pursue careers in nursing by providing financial assistance and access to educational opportunities. 

For current nurses, support is needed on efforts to make clinical opportunities more robust. For example, nurse preceptorships provide hands-on experience for students and help prepare them for the challenges of clinical practice. A new state tax credit could decrease the costs associated with career advancement. And most importantly, we must listen and react more quickly when healthcare workers, especially nurses, express concerns about workplace issues. 

Policymakers must learn from the wisdom of leaders before them and refocus their efforts on implementing initiatives that will actually build a stronger workforce and ultimately, a healthier future for our state.