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Nurse staff ratio proposal fails to pass in Maine, but supporters say they aren't giving up

Nurses demonstrate outside the Maine Medical Center in Portland on Thursday in support of the Maine Quality Care Act. Organized by Maine State Nurses Association (MSNA), the group asks for Governor Mills' support on the bill (LD 1639).
Nick Song
Maine Public
Nurses demonstrate outside the Maine Medical Center in Portland on Thursday in support of the Maine Quality Care Act. Organized by Maine State Nurses Association (MSNA), the group asks for Governor Mills' support on the bill (LD 1639).

Nurses in Maine who said they're under-staffed and overworked are expressing disappointment that a bill that would have established minimum staff ratios was rejected by state lawmakers.

Kelli Brennan is a registered nurse in the neuro trauma unit at Maine Medical Center. She said she loves to help people when they need it most. But Brennan often oversees so many patients, that she doesn't have time to provide the level of care they need, she said.

"You know, if we have five patients, and they all have to walk three times a day, and they all have to take pain meds on time, and they all have to do this, we simply cannot be in every room at the same time," Brennan said. "So somebody's care is delayed, or they go without. And it's hard, because we know that it doesn't have to be that way."

Brennan said bare minimum staffing is leaving nurses over-stretched and exhausted. And when someone calls out sick, it exacerbates the problem. She remembers a day this winter when her unit was so short-staffed, she called a patient's family to see if they could help.

"We were at that point, let's just you know, call family to see if they can come in and sit with their loved ones because we don't have the staff to do it," she said. "We usually say, you know, this is not an emergency, however, are you coming by to visit so and so today? Will you be able to stay? We don't have the staff to put a companion or a nurse, you know, one to one. We don't want them to fall. If you're going to be able to come in today, that would be super helpful."

Some nurses have been so frustrated by staffing levels, they've quit. Sadie Tirrell said she left her job at Maine Medical Center last year.

"When I was at work I just was constantly asked to do so much more work than I could and just watch the patient suffering that was happening because of it," she said.

Twelve hour shifts often grew to 14 hours, with little to no time for meals or bathroom breaks, Tirrell said.

Both Tirrell and Brennan said the situation will only get better if the state steps in. They're among nurses in the Maine State Nurses Association who want to establish minimum nurse staff ratios under state law. Advocates said it would improve nurse retention as well as patient care. But Sharon Baughman, the chief nursing officer for MaineHealth, pushed back against the assertion that patient care is being compromised because of inadequate nurse staffing.

"Our nurses do a fabulous job of taking care of our patients" she said. "I get compliments from patients all the time."

Baughman also points out that MaineHealth's hospital quality ratings - and Maine Medical Center's in particular - get high marks. She said state-mandated ratios would make nurses' jobs harder because it would take away flexibility to make staffing decisions. And some nurses agree. Jana Drake is a nurse director at Maine Med.

"First of all, there aren't enough nurses for this mandated ratio," Drake said. "But it's also more about the nurse's autonomy and the nurse's ability to look at, 'what is this patient? What do they need? What are the resources that we have? and how do we use our resources?' So some of that is just about our decision-making."

The Maine Hospital Association paints a more dire scenario.

"It is literally - and not exaggerating- the quickest way to ration care in the state of Maine," President Steven Michaud said.

He said mandated ratios would be impossible to meet because of a nationwide nursing shortage, including a shortage of 2,200in Maine.

"If the state steps in and says, you now have to have a certain number of nurses in order to keep your services open, there isn't a state, there isn't a hospital in the country that could comply with that," Michaud said. "So there's only one answer to that. You'd have to shut down beds. You'd have to shut down services. And that's why we oppose it."

But in California, a nurse staff ratio law has been in effect for 20 years. And Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, said it has not caused hospitals to shut down services.

"We heard anecdotally that there were increases in emergency room diversions in the short term," she said. "But we found no evidence that that was systematic, or that it was persistent."

And Spetz said California's law has reduced nurse stress and boosted overall job satisfaction. But when it comes to improving patient outcomes, Spetz said staffing ratios aren't a silver bullet.

"I think there's some indication that in the long term, they might be beneficial," she said. "There's a lot of theoretical reason to think that they should be beneficial. But the evidence is not entirely clear that they benefit patients."

That doesn't mean they shouldn't be considered, Spetz said. And she encourages hospitals to explore the underlying reasons why some nurses support them.

"They really are reflecting real concerns of their staff, and regardless of whether the legislation passes, they should be attentive to those concerns."

Even though the nurse staffing ratio bill didn't pass this session, it received initial approval from the Senate. The Maine State Nurses Association views that as an indication that ratios are gaining momentum — and not just here. Several other states have also considered bills, and Oregon passed a nurse ratio law last year.

The Association said they're not giving up on trying to pass a law in Maine.