L.D. 1639: Nurse-to-patient ratios

An Act to Address Unsafe Staffing of Nurses and Improve Patient Care.
A decorative graphic with the Maine State Legislature, overlayed with text that says what bill is being highlighted.
Maine’s nursing union and labor allies favored the bill, while hospital administrators, nursing directors, medical trade organizations and local chambers of commerce warned of negative consequences.
The Maine Monitor is recapping the 131st Legislature by highlighting legislative bills you should know about. View all of our recaps.

In March, the Maine Senate passed a bill to set limits on the nurse-to-patient ratios in Maine hospitals. The House did not pick up the legislation before the end of the session, effectively killing it.

But the arguments over the bill illustrate the tension between quality and access that is inherent in many health care debates. 

Maine is facing a shortage of available nurses. Proponents of the bill argued reducing the patient load for each nurse would help address the shortage by preventing burnout, increasing retention and reducing turnover. They also argued that fewer patients for each nurse would improve patient safety.

But opponents said requiring nurses to have fewer patients wouldn’t increase the number of available nurses, it would simply reduce the number of patients who could access care while stripping nurses and hospitals of autonomy. 

Maine’s nursing union and labor allies favored the bill, while hospital administrators, nursing directors, medical trade organizations and local chambers of commerce warned of negative consequences.

Testimony from nurses was overwhelmingly against the legislation. Representatives from some of Maine’s nursing homes and long-term care facilities also said hospitals would have to hire their nurses to meet the new ratios, putting their operations at risk. 

Both sides pointed to California, which mandated nursing ratios in 1999, as an example of the legislation’s potential impact. Proponents said the move improved nurse retention and recruitment.

Opponents argued that Maine has a higher quality of care than California and the policy’s failures are why no other state has passed similar legislation. 

Read the full bill on the legislature’s website.

Some excerpts from submitted testimony illustrate the debate: 

For: 

“Nurse retention rates increase with safe staffing ratios. Nationally there are nearly 1 million licensed RNs who aren’t working in nursing. Maine has 28,526 nurses licensed in the state but only 56 percent are working. Maine does not have a shortage of nurses. We have a workplace culture where nurses aren’t interested in engaging in the available jobs.” ~ Sen.Stacy Brenner (D-Cumberland), bill sponsor and former nurse

“It is important for you all to know that we aren’t hoping and wishing for better working conditions and lower patient ratios to bring nurses back to the bedside. We have data to show this will happen. As you may know, California passed a safe staffing law, much like what we’re proposing here, back in 1999. After that law was implemented, nurse applications to hospitals shot up by 60 percent.” ~ Cokie Giles, Maine State Nurses Association

“The failure by hospital employees to staff appropriately and provide needed resources make it impossible for nurses to meet their ethical and professional obligations to provide safe, effective and therapeutic nursing care.” ~ Michelle Mahon, National Nurses United

Against:

“This legislation, if enacted, will decrease access to care. Without an increased supply of nurses, we will be forced to close beds and our emergency department may go on diversion, which means we ask ambulances not to bring patients to our hospital.” ~ Kristin Anthony, Mid Coast Parkview Health 

“Without the ability to flex ratios when appropriate or when absolutely necessary, we will be forced to limit capacity. Where will our community, our loved ones, and your constituents get the care they need? As nurses, we are trained in evidence-based practice. I have seen no evidence that patient care and safety are increased due to mandated ratios. Research in the literature does not support mandated nursing ratios.” ~ Victoria Quinlan, Maine Medical Center

“The bill before you would require hospitals to comply with mandatory staffing requirements for nurses. While we believe the intent of this bill is honorable, the ripple effect would devastate the home care industry, which is already struggling to recruit and retain nurses.” ~ Laurie Belden, Home Care & Hospice Alliance of Maine

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Josh Keefe

Josh Keefe is a government accountability reporter with The Maine Monitor. He joined The Monitor in March 2024. Previously, he worked as an investigative reporter for The Tennessean in Nashville and the Bangor Daily News. Originally from the Bangor area, he is a graduate of Skidmore College and the Craig Newmark Graduate School of Journalism at CUNY. He lives in Portland.
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