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Bill Imposing Government-Mandated Staffing Ratios Advances

June 06, 2023

The state House Health Committee today advanced legislation that would mandate one-size-fits-all nurse-to-patient ratios across Pennsylvania hospitals, a move hospitals and nursing leaders have warned would force facilities to close beds and reduce services amid a historic health care workforce shortage.

In a 12–9 vote, the committee sent House Bill 106 to the full chamber for consideration.

“We all agree that there is a nursing shortage in this commonwealth and that solutions must be found,” committee Minority Chair Kathy Rapp (R-Warren) said, urging members to vote no. “But this bill will decrease care, not increase it.”

During a hearing last month, HAP and nurse leaders emphasized that Pennsylvania hospitals are aggressively working to fill existing vacancies and actively deploying strategies to reduce strain on current bedside nurses. They cautioned that government-mandated ratios are not universally supported by nursing organizations, do nothing to increase the number of bedside nurses, would reverse innovations in care, and do not actually achieve many of the key outcomes supported by the bill’s advocates. Instead, they urged the committee to focus on strategies to bring more nurses to the bedside.

Despite extraordinary efforts to hire and support nurses—including signing and referral bonuses, pay increases, schedule flexibility, retention incentives, loan forgiveness, wellness initiatives, investments in staff who want to advance their careers, and investments that prioritize staff safety—Pennsylvania hospitals reported a nearly 31 percent vacancy rate for bedside registered nurses late last year.

In a letter to the committee last week, HAP President and CEO Andy Carter voiced hospitals’ opposition to the bill and raised concerns that mandating staffing ratios would hurt Pennsylvanians’ access to health care.

“Given the well-documented, nationwide shortage of bedside nurses, this bill will put Pennsylvania hospitals in the impossible position of having to choose between turning patients away or breaking the law at the risk of losing their licenses,” Carter wrote.

The committee voted to amend the legislation before reporting it out to the full House. The changes remove some additional provisions that were separate from the ratios mandate but also added language that could limit hospitals’ ability to adjust their staffing models to accommodate the ratios.

HAP continues to urge the General Assembly to focus on solutions that grow the health care workforce, not mandating staffing ratios that will hurt access to care. For information, contact Heather Tyler, HAP’s vice president, state legislative advocacy.



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