Nursing Shortage Solutions: States Propose New Measures to Support Nurses
- Nurses have responded to the nursing shortage by planning and executing union-led strikes nationwide.
- Due to the growing need for nurses, states are proposing and passing legislation to support nurses and their concerns about unfair wages, unsafe working conditions, and unsafe staffing.
- Nurses are responding favorably to the proposed measures.
In 2022, just over one-third of strikes in the U.S. occurred in the hospital sector. This includes the largest strike in history. In September 2022, more than 15,000 nurses employed by the Twin Cities Hospitals Group in Minnesota went on a three-day strike.
Nurses' outcry for fair wages, better working conditions, and fair contracts from hospital employers are receiving national attention. States are now proposing laws to protect nurses. Discover what new measures states are putting in place to support nurses.
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How Nurses Have Responded to the Nursing Shortage
Nurses have responded to the nursing shortage in various states by planning and executing strikes. In the past few years, union-led strikes have occurred nationally and globally. Many are due to the 2020 pandemic that had nurses either leaving the profession, retiring earlier than expected, or dying from COVID-19.
Nurses are also walking off the job to protest, citing:
- Unfair wages
- Unsafe staffing
- Unfair health benefits
- Lack of respect
- Nursing shortages
There are consequences to striking. One is how nursing strikes impact patient care. Leaving the bedside where staffing is already short disrupts the continuation of care. But nurses are demanding change and a fair contract from hospital administrators. One way to get it is through a strike.
Luckily, many hospitals and union leaders reach tentative agreements to avoid strikes. Nurses can ratify new contracts — at least for the next three years — without having to leave their patients or the profession.
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States Propose New Measures to Support Nurses
States have proposed new measures to address the nursing shortage and support nurses. For example, states like Arizona, Idaho, and Utah used coronavirus relief funds to increase hospital staffing.
Last October, the U.S. Department of Labor announced an $80 million nursing grant program to expand "bottlenecks in training" and increase diversity in the nursing workforce.
More recent measures are aimed at nurses rather than institutions. Here are a few bills/proposals that speak to nurses.
The federal government reports healthcare workers are five times more likely to experience workplace violence at healthcare facilities than any other industry. In Texas, according to the Texas Hospital Association, 98% of Texas hospitals report that violence in the workplace has increased dramatically or stayed the same since the start of the pandemic.
Texas State Rep. Donna Howard (D-Austin), a former nurse, supports the need for hospitals to have a workplace violence protection plan. HB 112 would require hospitals to have this plan in place and make it easier for healthcare workers to report violent incidents to the police.
Mental Health Support
Nurses, doctors, and other healthcare workers experience the burden of suicide greater than the general public. Nurses report feelings of anxiety, depression, and suicidal thoughts because of the stress that comes with their role.
Legislative sessions in Washington State recognize nurses still feel the aftershock of the COVID-19 pandemic. Sen. Annette Cleveland, D-Vancouver, sponsors Bill 5454. She believes services need to be put in place for the mental health of nurses, specifically those with post-traumatic stress disorder (PTSD). The bill would provide workers' compensation insurance coverage for nurses with PTSD.
Safe Staffing Ratios
In February, Keeping Nurses at the Bedside Act (SF1561) was proposed by Minnesota nurses and legislators as a way to combat the nursing shortage, retain nurses, and keep them safe at the bedside. On March 8, nurses, administrators, and the public testified in the first hearing supporting the bill.
The bill would create two new hospital committees consisting of nurses, managers, and other direct care workers. They would be in charge of creating requirements for:
- Nurse staffing
- Patient care
The bill mirrors many nurse-to-patient staffing ratio laws and regulations that are in effect.
The nursing staff shortage continues to reveal the growing need to train and retain nurses. In Mississippi, there are about nine nurses per 1,000 population. Legislature proposed Senate Bill 2373. This bill offers a loan repayment program for $6,000 per student for up to three years. In exchange, nurses must work in a Mississippi hospital or nursing home. Mississippi Governor Tate Reeves signed the bill, and it will go into effect.
Limits on Mandatory Overtime
On May 3, the Michigan Nurses Association proposed The Safe Patient Care Act to state representatives. With bipartisan support, The Safe Patient Care Act plans to improve patient safety in hospitals.
According to the Michigan Nurses Association, nurses can be fired if they refuse to work long hours. If passed, the Safe Patient Care Act would hold hospitals responsible for three House and Senate Bills. This legislation seeks to:
- Limit the rampant use of forced RN overtime so that care isn’t compromised by an exhausted or sleep-deprived nurse. (House Bill 4483, Senate Bill 205).
- Follow evidence-based RN-to-patient ratios by unit so that everyone can get safe, quality care no matter where they go. (House Bill 4482, Senate Bill 204).
- Tell the public what their RN-to-patient staffing is, so that crucial data can be examined and consumers can make informed choices. (House Bill 4484, Senate Bill 206) Safe RN staffing.
No law limits the number of patients a nurse can care for in hospitals. There is also no law limiting the hours nurses can work. Passing The Safe Patient Care Act will help ensure nurses are providing safe care and patients are on the receiving end of this care.
How Nurses Respond to Proposed Measures
Nurses have responded favorably to the proposed measures. The effective bills and those pending show promise for the nursing profession.
Tammy Stafford, DNP, assistant clinical professor and graduate program coordinator at Angelo State University in Texas, believes the Texas House bill to protect nurses regarding workplace violence is a step in the right direction.
"Nurses should not have to worry about being assaulted when they are doing their job," Stafford says. "This would not be acceptable in another environment, and healthcare should be no different."
But Stafford believes the bill should extend to all healthcare workers and the entire organization as violence can occur in any department, she points out.
Karen Chung, FNP-BC, also agrees with the proposed measures to support nurses. Nurses are a vital piece of the healthcare puzzle, she points out.
"At this critical time of extreme nursing shortages throughout the country, it is imperative new legislation is passed that will protect and empower nurses to give the best care to our patients," Chung says.
Chung is looking forward to more sweeping changes in the healthcare system.
She says, "Change to the nursing profession gives more merit and safety measures to a rewarding but tough career."
Meet Our Contributors
Tammy K. Stafford, DNP, MSN, MBA, RN, NEA-BC
Tammy Stafford has 29 years of experience in both inpatient and outpatient settings caring for end-stage renal disease patients with 18 years of leadership experience. In fall 2018, Stafford joined the Department of Nursing at Angelo State University as an assistant clinical professor and graduate program coordinator. Stafford is proud to have the opportunity to teach nurses and prepare them for advanced practice.
Karen Chung, RN, FNP-BC
Karen Chung worked as an emergency room nurse for six years before becoming a nurse practitioner. She has been an NP for the past six years and currently works in the retail health industry.
HB 112. (2023). Texas Legislature Online
Health and care worker deaths during COVID-19. (2021). World Health Organization
Keeping Nurses at the Bedside Act will solve retention and care crisis in Minnesota hospitals. (2023). Minnesota Nurses Association
Major strike activity increased nearly 50% in 2022. (2023) Economic Policy Institute
Original research: Suicidal ideation and attitudes toward help seeking in U.S. nurses relative to the general working population. (2021). American Journal of Nursing
SB 5454. (2023). Washington State Legislature
Senate bill 2373. (2023). Mississippi Legislature
THA white papers & reports. (2023). Texas Hospital Association
The Bipartisan Michigan Safe Patient Care Act. (2022). Michigan Nurses Association
US department of labor announces $80M funding opportunity to help train, expand, diversify nursing workforce; address shortage of nurses. (2022). U.S. Department of Labor
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