Two days after the State Legislature adjourned without acting on a bill to require nurse-staffing minimums in state hospitals and nursing homes, Governor Cuomo June 22 pledged his support for such standards and said he would have state Department of Labor officials ensure that nurses were not improperly burdened.
Less than six weeks earlier, the New York State Nurses Association, the prime champion of the stalled legislation, had endorsed his re-election, putting yet another left-leaning union in his corner even as Democratic primary challenger Cynthia Nixon seeks to make the case that Mr. Cuomo is not a true progressive.
Won't Wait on Lawmakers
While the NYSNA-backed bill was opposed by the lobbying arm for hospital operators, the Greater New York Hospital Association, the Governor said in a statement, “We know that quality of care is directly linked to appropriate staffing levels.” He pledged to “introduce legislation allowing the Department of Health to set safe staffing levels by regulation, as legislative solutions have not been forthcoming.”
With the Legislature not scheduled to reconvene until next January, Mr. Cuomo continued, “In the meantime, I have directed the Department of Labor to vigorously enforce workforce protections. Reports of nurses being forced to work through lunch breaks, additional hours and without fair compensation are not only unwise, as it diminishes the quality of care, but they violate state law, which will result in penalty-pay to each nurse, and which I am directing the Department of Labor to aggressively pursue.”
“Governor Cuomo understands the critical importance of safe staffing standards and RNs thank him for taking this very significant action,” Judith Cutchin, president of NYSNA’s Health and Hospitals Executive Council, said in a statement. “The proposed legislation and regulations will give us the protection we need and, in turn, give patients the safety and quality care they deserve. This is truly a breakthrough for nurses and the patients and communities we serve.”
“Governor Cuomo has demonstrated outstanding leadership in behalf of the public’s health that protects nurses and other caregivers on the job in very important ways,” Anne Bové, NYSNA secretary, said in a statement. “His initiative is two-fold: it provides for a process to establish safe staffing standards essential to quality patient care; second, his immediate enforcement of laws governing overtime pay, meal breaks, rest periods and mandated overtime protects both nurses and patients.”
So far, California is the only state to pass such a legislatively mandated staffing requirement. NYSNA’s executive director, Jill Furillo, was one of the key architects of that measure in 2004.
“This has been a top priority since Jill came here,” Carl Ginsburg, NYSNA’s communications director, said in a phone interview. “In a majority of the hospitals we staff, understaffing is a significant issue for workers, and it was central to our winning the vote to represent the nurses at the Albany Medical Center.”
Close to a third of the state’s hospital nurses are represented by NYSNA, the union said. NYSNA endorsed Mr. Cuomo for re-election on May 15.
George Arzt, a political consultant and former Press Secretary for Mayor Ed Koch, said in a phone interview that NYSNA was the beneficiary of Mr. Cuomo’s primary battle with Ms. Nixon.
One Eye on 2020
“He’s pulling out all the stops,” said Mr. Arzt. “The buzz over Nixon has subsided but it is still a long time between now and September. And this move is a sign not just to the nurses but to all unions, and it is the unions that provide that critical network you need for the get-out-the-vote operation.”
Mr. Arzt contended that for Mr. Cuomo’s 2020 national aspirations to flourish, the incumbent “has to at the very minimum win his primary by 10 points, but ideally, he would want to see a 20- or 30-point margin.”
In 2010 medical researchers conducted a survey that looked at patient outcome and workplace experience for 22,336 hospital nurses in California, Pennsylvania, and New Jersey. Published in the journal Health Services Research, under the title “Implications of the California Nursing Staffing Mandate for Other States,” it documented that the lower the nurse-to-patient ratio, the better the health outcome was for both patients and nurses.
The researchers concluded, “California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses’ workloads were in line with California-mandated ratios in all three states, nurses’ burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care.”
Helped in Retention
In addition to California’s staffing ratios being associated with lower mortality for patients, the regulations helped promote better nurse retention, according to findings published in the Health Services Research journal.
A 2002 study published in the Journal of the America Medical Association that looked at the performance of nurses and patient outcomes at 168 hospitals in Pennsylvania over an eight-month period produced similar findings.
Under California’s law, a minimum of one nurse for every five patients was required, with Intensive Care Units using a one-to-two ratio.
In 2015 the Economic Policy Institute analyzed the Bureau of Labor Statistics data for the occupational injuries and illnesses experienced by nurses in all 50 states between 1999 and 2009 and found that for California nurses, “occupational injury and illness rates dropped over 30 percent” after the 2004 law took effect.
GNYHA, however, opposes NYSNA’s proposal as unnecessary and too expensive. The trade group also claims California’s law has not lived up to expectations.
“There’s a reason why so many of New York’s hospitals are an international destination for patients in need of world-class care,” GNYHA said in a statement. “There’s also a reason why 49 states don’t have extremely costly, inflexible nurse staffing ratios—the patient care improvements that were promised in California simply haven’t happened.”
It noted, “Let’s look at the facts. New York’s patient-mortality rates are lower than California’s—the only state with mandatory nurse-staffing ratios. New York’s hospitals are among the finest in the world. They have achieved this through the skill, dedication, and tireless work of their nurses, doctors, and other members of their health care teams.”
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