Is nurse shortage myth or reality? Question drives Pa. hospital staffing debate

Is a shortage of nurses preventing hospitals from hiring enough? Or is there a sufficient supply of nurses, but not enough willing to work in hospitals?

That’s a central question in the debate over a proposed Pennsylvania law that would require hospitals to provide a minimum number of nurses for every patient.

Backers of the law say the latter is true, arguing the problem is that too many Pennsylvania nurses are unwilling to work in hospitals because they fear being stretched too thinly and unable to adequately care for their patients.

Hospitals, meanwhile, argue that even as they dangle generous pay and bonuses in front of nurses, they can’t find enough.

The competing claims were aired repeatedly at the state Capitol on Tuesday, which featured a hearing on the proposed staffing law, and the presence of scores of nurses who rallied in support of the law and spoke directly to lawmakers in an effort to persuade them.

Only one other state, California, has a law similar to the one proposed for Pennsylvania, although about 15 have laws intended to ensure sufficient staffing. Meanwhile, the issue has been around for years in Pennsylvania, with previous bills failing as they faced opposition from hospitals.

But supporters have new cause for optimism: The state House version of the law has an unusually high number of sponsors, including about 20 Republicans, who often oppose such mandates.

That’s similar to the number of sponsors of a similar bill discussed last year — which also had enough sponsors to pass the bill, if only it came up for a vote. But Republicans were in control last year, with state Rep. Kathy Rapp, R-Warren, controlling the health committee and unwilling to allow a vote needed for the bill to advance to a vote by the full House.

This time, Democrats control the House, with the new health committee chairman Dan Frankel, a Democrat, one of the backers of the bill.

Rapp has opposed the bill out of fear hospitals in her rural district will find it impossible to hire enough nurses, and be forced to shut down units because of inability to meet the law’s staffing requirements.

One of the speakers who tried to shoot down that claim Tuesday was Linda Aiken, a nurse and professor and researcher at the University of Pennsylvania School of Nursing.

Aiken said Pennsylvania has the sixth-highest rate of nurses per resident in the United States. She further said Pennsylvania has 100 nursing schools turning out 9,000 nurses per year.

Aiken cited that as cause to expect there will be enough nurses to meet hospitals’ increased staffing needs resulting from the law.

She further argued that prior to the covid-19 pandemic, there was a “glut” of nurses, with some new graduates unable to find jobs. She further argued that hospitals’ survey-based claims of high percentages of nurses planning to leave their job within a year are “exaggerated.”

Aiken was among assorted backers of the law who argued the staffing levels required by the law will make more nurses want to work in hospitals, because they’ll no longer fear being overworked and unable to sufficiently care for patients.

Andy Carter, the CEO of the Hospital and Healthsystem Association of Pennsylvania, disputed Aiken’s portrayal of the supply situation.

He said hospitals have worked “tirelessly to try to recruit and retain nurses,” offering signing and retention bonuses, loan forgiveness and expanded benefits.

Still, hospitals report an average vacancy of 30% for direct care nurses, with research forecasting a statewide shortage of 20,000 nurses within three years, according to Carter.

“Regardless of the total population of nurses that may be in Pennsylvania, we are not succeeding despite all these efforts to attract them,” he said.

Another opponent of the staffing law, Michele Szkolnicki, the chief nursing officer at Penn State Health Milton S. Hershey Medical Center, argued the law would take away the flexibility needed to deal with unique circumstances such as mass casualties.

Nurses in support of the law, however, argued that hospitals are simply unwilling to spend the money to provide sufficient staffing, and history has proven that a law is the only way to make them change.

The day featured assorted horror stories from nurses about being unable to provide safe care for patients because of short-staffing, and others recounting harm to loved ones caused by low staffing.

Aiken attempted to quantify the consequences via research, citing a “conservative estimate” that 1,155 lives per year would be saved if Pennsylvania imposes the staffing levels contained in the bill.

The bill requires minimum nurse-patient staffing levels that vary based on the needs of patients in a given unit. For example, it would require one nurse per patient giving birth; at least one nurse for every two patients in intensive care; at least one nurse for every three patients in intermediate care; and at least one nurse for every five patients in rehabilitation units.

The prime sponsor is state Rep. Tom Mehaffie, a Republican from Dauphin County, who rallied with nurses on Tuesday.

“I’m listening to what the nurses are saying, because they are the only ones that can tell you the trials and tribulations of every day, and what an every day problem [staffing] is in some of the hospitals across the state,” he said.

A Senate version of the bill was drafted by state Sen. Maria Collett, a Democrat. If a version passes both the House and the Senate, supporters expect Democratic Gov. Josh Shapiro will sign it.