Proposed Hospital Nurse Staffing Bills Harm Public’s Access to Healthcare

82% of Michigan Voters Oppose Mandated Hospital Nurse Staffing Ratios

The Michigan Health & Hospital Association (MHA) released data today illustrating strong public opposition to legislation proposing one-size-fits-all state mandated hospital nurse-to-patient staffing ratios and hospital survey data on the severe impact of the legislation on access to care for Michiganders.

A survey of 600 Michigan voters conducted by EPIC-MRA in August shows 82% of Michigan voters do not believe the government should mandate one-size-fits-all nurse-to-patient staffing ratios in every hospital, which is currently proposed in Senate Bills 334 – 336 and House Bills 4550 – 4552.

If the bills were to become law, 83% of Michigan voters would be concerned about their ability to receive care, or the wait times, in a Michigan hospital emergency room.

“These survey results are abundantly clear; Michigan voters have no appetite to remove hospital staffing decisions from clinical nursing leaders to implement an arbitrary one-size-fits-all mandate by politicians,” said MHA CEO Brian Peters. “Such a decision would be harmful to patients and have dire consequences for healthcare throughout the state. Our hospitals and health systems are focused on proven solutions to address staffing shortages that address the talent pipeline and retain existing nurses.”

The MHA also released the results from a survey of 109 Michigan hospitals conducted in July and August on the potential impact of the proposed legislation. Implementing staffing ratios will either require hiring 12,954 registered nurses or the state risks closing up to 5,074 hospital beds to comply. These results follow a survey of 95% of the MHA membership in March 2023 which found Michigan hospitals had 8,438 immediate openings for nurses amid a nationwide nursing shortage. The loss in hospital bed capacity is roughly equivalent to Michigan closing its six largest hospitals determined by licensed hospital beds.

“The significant and devastating impacts these bills can have on patient care and patient access make these the top concern for hospitals and health systems throughout our state,” said Shannon Striebich, MHA Board Chair and Ministry President and Senior Vice President of Operations at Trinity Health Michigan. “We value our nurses and are working diligently to offer recruitment and retention options that do not come at the expense of access to care for Michiganders.”

Hospital staffing decisions and nurse-to-patient ratios are currently made by nursing leaders in each individual hospital based on years of clinical experience and a complex set of variables. These decisions weigh a multitude of factors which vary from each hospital and community and can include the number of patients in a hospital unit, how sick each patient is, the training and experience level of nurses and other members of the care delivery team, available technology and existing hospital data and metrics.

“The decades of experience I have serving as a bedside nurse, nursing supervisor and in other nursing leadership roles inform decisions I make every day when it comes to helping create the best possible environment for our patients and our clinical team,” said Kelli Sadler, MHA, BSN, RN, senior vice president and chief nursing executive of Corewell Health in Southeast Michigan. “We should be able to determine the staffing ratios that best fit our communities. This legislation doesn’t address the real problem, which is a lack of nurses statewide.”

Hospitals remain committed to identifying tangible solutions to recruit more workers to healthcare careers and to retain existing healthcare workers. The actions by the MHA include:

  • Launching a statewide public awareness campaign in June 2023 targeting high school students and professionals considering a career change to express the value of healthcare careers.
  • Distributing a total of $300 million in state funding to at least 69,000 healthcare workers for the purposes of the recruitment, retention and training through Public Act 9 of 2022 and Public Act 5 of 2023.
  • Successfully advocating for additional nurse training opportunities including funding to incentivize four-year Bachelor of Science in Nursing programs at community colleges and the expansion of Michigan Reconnect to allow funds to support Michiganders in their healthcare career pursuits.

The MHA has also identified several public policy solutions that can be enacted today to help solve nurse staffing shortages. Those solutions include:

  • Michigan joining the national Nurse Licensure Compact to reduce barriers for out-of-state nurses to move to and practice in Michigan immediately, which is supported by 67% of Michigan voters according to the August EPIC-MRA survey.
  • Increasing eligibility for Michigan Reconnect by lowering the age requirement to 18 and older.
  • Expanding Michigan Reconnect availability to include 4-year institutions.
  • Increasing penalties for violence committed against healthcare workers.

The data was released as part of Hospitals for Patient Access Advocacy Day, which brought more than 130 hospital and nursing leaders to Lansing to meet with state lawmakers about nurse staffing shortages and access to care for Michiganders. More information can be found on the MHA nurse staffing ratios webpage.

Headline Roundup: Prescription Drug Affordability & Healthcare Workforce

MHA CEO Brian Peters speaks with WOOD TV.
MHA CEO Brian Peters speaks with WOOD TV.
MHA CEO Brian Peters speaks with WOOD TV.

The MHA received media coverage the weeks of August 28 and Sept. 4 regarding prescription drug affordability, the healthcare workforce and COVID-19.

MHA CEO Brian Peters spoke with a variety of news outlets regarding these topics.

Below is a collection of headline from around the state.

Thursday, Sept. 7

Wednesday, Sept. 6

Wednesday, August 30

Members with any questions regarding media requests should contact John Karasinski at the MHA.

MHA CEO Report — Preserving Patient Access to Care

MHA Rounds Report - Brian Peters, MHA CEO

“For every complex problem, there is an answer that is clear, simple and wrong.”  – H.L. Mencken

MHA Rounds Report - Brian Peters, MHA CEONurses are the heart and soul of our healthcare ecosystem. They were heroes long before the COVID-19 pandemic, they stepped up in extraordinary ways during the darkest days of that chapter in our history and they remain heroes today. Anyone who has spent time as a patient – or the family member of a patient – knows how impactful nurses can be, and how they truly become the face of our healthcare experience. In short, they deserve our admiration and support.

Our Michigan hospitals are proud to employ more than 62,000 nurses and the reality is that we are desperately trying to hire thousands more in every corner of the state. In terms of the supply of nurses, Michigan is confronting the same dynamics as the rest of the country. First, the significant number of baby boomers reaching senior status in recent years has translated to a growing exodus of nurses to normal retirement, while the unprecedented stress of the pandemic and its aftermath led many more to leave the field earlier than planned. As we engage with our leaders throughout the state, there is no question that the day-to-day work of our nurses has never been more challenging, and the rise in self-reported burnout rates is real and palpable.

On the first day of graduate school, one of my professors said something that I have subsequently heard many times throughout my career, and it is unequivocally true: “healthcare is not rocket science…. it’s much more complex than that.” This complexity is not limited to the incredible science behind our medical diagnoses and interventions, but extends to the organization and financing of that care as well. In practical terms, what this means is that absolutely nothing in healthcare happens in a vacuum – every potential lever to be pulled in the operational or public policy realm is impacted by a complex set of interwoven realities.

A case in point: recently-introduced state legislation (Senate Bills 334–336 and House Bills 4550–4552) would create mandatory minimum nurse-to-patient staffing ratios for Michigan hospitals. On the surface, such a mandate would seemingly ensure that we will have more nurses on the hospital floor, simultaneously alleviating their stress and creating better, safer care for patients. I would like to explain why this clear and simple proposal is flat out wrong.

Every single day in every single Michigan hospital, nursing leaders determine appropriate staffing levels in the emergency department, the labor and delivery unit, and in every other corner of the facility. These decisions take into account a complex set of variables, including the volume and acuity level of patients in house at that time, the training level and experience of not only the nurses, but all other members of the care delivery team, the various technologies that may or may not be available for deployment, and a wealth of in-house data and metrics that are updated multiple times per day. Seasoned nurse leaders have developed a good sense of the unique dynamics in a given community and in a given hospital, and they use their long experience to ensure the safest possible staffing models accordingly.

Here is the bottom line: even if there was a robust, immediately available supply of nurses to meet the proposed minimum staffing ratio mandate (there is objectively not), and even if there was an unlimited supply of available funding to pay for this new staffing (there is objectively not), there is simply no way on earth that it makes sense to replace the expert judgment of nurse leaders at the local level with a one-size-fits-all, inflexible model developed by politicians in Lansing. 

There is a good reason why the Michigan Organization of Nurse Leaders (MONL) is adamantly opposed to this legislation, and good reason why many nurse leaders I have spoken with in recent months have said they are personally offended by the premise behind it. Such a mandate would create an untenable situation for hospitals when a patient shows up and the facility is already at the mandated ratio: willingly ignore the law and risk penalties, fines and reputational damage, or follow the law and essentially tell the prospective patient “There is no room at the inn” and send them down the road. Of course, the hospital down the road will be in precisely the same boat. Without question, more hospitals will go on diversion, more hospitals will temporarily or permanently take beds offline, and more hospitals will make the difficult decision to eliminate entire service lines. In other words, the real losers here are patients and communities, who will lose access to care. This will be a reality in every corner of the state, and particularly alarming as we consider winters in rural Michigan and the distance between providers. Access reductions will become very serious, very quickly.

In public policy and politics, it is often instructive to examine other states that have already implemented a policy that is under consideration. To that end, California was the first state to adopt legislatively mandated nurse staffing ratios, some two decades ago. According to data from the Bureau of Labor Statistics, Michigan has a greater number of nurses per capita today than California. Despite having staffing ratios, California continues to have a shortage of 40,000 RNs, demonstrating they are suffering from the same problem as all other states in the country and the presence of legislatively mandated staffing ratios has done virtually nothing to improve the size of the workforce. Meanwhile, Michigan outperforms California in hospital quality, as Michigan has both a higher percentage of 4- and 5-star hospitals than California (49% to 35.3%) and a lower percentage of 1- and 2-star hospitals (18.4% to 38.7%), according to CMS Care Compare Hospital Overall Star Ratings.

Legislation similar to what is now being proposed here in Michigan was recently defeated in Minnesota, after the leadership of every single hospital in the state raised grave concerns about the severe negative consequences of its passage. The Mayo Clinic – world-renowned for its quality of care – publicly threatened to withdraw billions of dollars in planned investment in the state should the bill be adopted. The fact that an organization of their reputation and credibility felt so strongly about the negative ramifications of this concept should be a major red flag for policymakers in all states.

The mission of the MHA is to advance the health of individuals and communities. When we see public policy proposals that jeopardize our ability to achieve this mission, no matter how well-intended, we will do everything in our power to stand strong, to stand united and tell our story to our elected officials. Healthcare is complex, and Michiganders deserve better than ham-handed mandates coming from Lansing.

As always, I welcome your thoughts.

What’s Next Address Focuses on Healthcare Access

Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association following Gov. Whitmer’s What’s Next address.

Brian PetersOn behalf of Michigan hospitals and health systems, the MHA is very pleased to see Gov. Whitmer prioritize healthcare and improving access to care for Michiganders. Prescription drug costs continue to grow at alarming rates. Addressing prescription drug affordability will help improve access to important medication for residents throughout Michigan, leading to improved health outcomes.

Our association looks forward to working with the administration and lawmakers to support efforts to reduce costs for lifesaving drugs, remove barriers to prescription drug access and protect existing solutions such as the 340B drug pricing program to increase affordable prescription drug access for Michigan residents.

Media Recap: Cybersecurity and Rural Emergency Hospitals

Brian Peters

Brian PetersThe MHA received media coverage the week of August 7 on hospital cybersecurity, the first Michigan hospital receiving a rural emergency hospital designation and COVID-19 cases and hospitalizations.

MHA CEO Brian Peters spoke with WJR Newsradio 760 host Chris Renwick August 7 about how Michigan hospitals are responding to cyberattacks. Peters discussed the factors that make healthcare the top target for cybercriminals, what hospitals are doing to protect their data and networks and how patients can protect themselves from cyberattacks.

Becker’s Hospital Review published an article August 8 on Sturgis Hospital becoming the first hospital in Michigan to receive the new rural emergency hospital designation. The article recaps a story from the Sturgis Journal that references the MHA’s involvement in the process.

Bridge Michigan also published a story August 8 on the slight growth in COVID-19 cases and hospitalizations, which follows a national trend. The MHA provided comment, referencing overall rates of COVID hospitalizations continue to be at all-time lows.

Members with any questions regarding media requests should contact John Karasinski at the MHA.

Headline Roundup: Andary No-Fault Decision

Brian Peters

Brian PetersThe MHA received media coverage the week of July 31 regarding Michigan Supreme Court decision in Andary v. USAA, which the MHA published a media statement on following the opinion release. The MHA is also mentioned in several stories regarding price transparency and healthcare workforce shortages.

MHA CEO Brian Peters is quoted in multiple stories. Below is a collection of headlines from around the state.

Thursday, August 3

Wednesday, August 2

Monday, July 31

Friday, July 28

Members with any questions regarding media requests should contact John Karasinski at the MHA.

MHA CEO Report — Added Association Value

MHA Rounds Report - Brian Peters, MHA CEO

“It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently.” – Warren Buffet

MHA Rounds Report - Brian Peters, MHA CEOThe healthcare industry is a vital cornerstone of any community, providing essential medical services to people in times of need – not to mention our role as economic engines. Behind the scenes, there’s a complex network of organizations and associations dedicated to supporting healthcare providers and ensuring their success. Among these is the Michigan Health & Hospital Association (MHA), the leading advocate for hospitals and health systems throughout the state of Michigan.

While most people recognize the MHA’s visible and impactful role in the public policy arena, many are unaware of the comprehensive business services we also provide to our member organizations. Housed within our MHA Service Corporation, these services not only help hospitals and health systems to achieve their missions of providing high quality, cost-effective care to their communities, but they also generate revenue for our association – which in turn allows us to moderate the need for membership dues increases over the years.

Our business services include in-house offerings and carefully vetted and selected partnerships. All services have been curated to give hospitals and healthcare providers robust solutions and options. Examples of services available to hospitals and other providers include the MHA’s data services, unemployment compensation program, a robust endorsed business partner program and graphic design and print services.

The MHA first began work to develop a data bank in 1975, establishing our association as a credible resource for industry data. Data-driven decision-making is essential for healthcare organizations to deliver high-quality services efficiently. More than 500 healthcare entities nationwide now use MHA data products for a variety of purposes, including strategy development, community benefit tracking and improving safety and quality of care. By harnessing the power of data, hospitals and health systems can enhance patient outcomes, optimize workflows and ultimately reduce costs.

Our unemployment compensation program has an even longer history, having existed since 1972. Much like data services, it not only serves existing MHA members in Michigan, but nationally. Collectively, it processes thousands of unemployment claims for over 700 clients every year, saving clients millions of dollars annually. By participating in this program, member organizations can navigate the complexities of unemployment compensation more effectively, saving valuable time and resources. I’m pleased to share the program was once again recognized by the National Association of State Workforce Agencies (NASWA) for the program’s commitment to utilizing the NASWA’s nationwide, web-based system for receiving new claims and responding to state unemployment agencies.

The MHA Graphic Design & Print Services division offers specialized print services, as we recognized the need to offer our members cost-effective printing solutions. The healthcare industry has a constant need for marketing materials, patient information brochures and administrative documents. This program has grown and now offers services for many organizations even outside of healthcare.

Our association has also expanded our ability to connect our member hospitals and health systems to companies that offer products and services tailored to the healthcare industry. Within the MHA Endorsed Business Partner Program, we rigorously review each potential company before endorsing a partner to ensure that they provide quality and valuable services to our membership. The MHA has the opportunity to be a liaison between our members and endorsed business partners, leveraging our events and relationships to make the right connections at the right time.

As you can see, our commitment to supporting hospitals and health systems goes well beyond advocacy and policy. By offering diverse business services, we empower healthcare organizations to thrive in an ever-evolving industry. These additional services complement our existing efforts to improve the health and wellness of individuals and communities. Together, these initiatives contribute to the enhancement of healthcare excellence in Michigan, ensuring that the state’s healthcare providers can deliver the best possible care to their patients.

I can tell you that over the years, I have heard from countless clients of our various business services, who consistently praise the outstanding customer service and value-added work provided by our exceptional team. From my perspective, our success can be largely attributed to a commitment to build genuine, trusting relationships for the long haul.  And we will not allow those relationships – or our reputation – to be compromised in any way. If you are affiliated with a healthcare-related organization (and perhaps even if not), I would strongly encourage you to reach out and explore our ability to serve you and see this difference first-hand.

As always, I welcome your thoughts.

MHA Issues Statement on Andary v. USAA Decision

Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association following the Michigan Supreme Court decision on Andary v. USAA.

Brian PetersThe MHA, on behalf of our member hospitals and health systems, are pleased with the Michigan Supreme Court decision that will provide greater access to care for auto accident survivors. It will make a positive impact on the lives of those survivors seriously injured prior to the recent changes to Michigan’s auto no-fault law who continue to have significant ongoing care needs.

In addition to this decision, the MHA remains engaged with lawmakers on identifying and supporting reforms to the auto no-fault law to improve access to care and support healthcare providers.

Headline Roundup: Healthy Michigan Plan & Healthcare Workforce

Brian Peters

Brian PetersThe MHA received media coverage the week of July 17 regarding the healthcare workforce, federal legislation to address drug shortages and bills signed by Gov. Whitmer eliminating burdensome provisions in the Healthy Michigan Plan and making changes to help ensure the program’s long-term success.

MHA CEO Brian Peters is quoted in multiple stories. Below is a collection of headlines from around the state.

Thursday, June 20

Wednesday, July 19

Tuesday, July 18

Members with any questions regarding media requests should contact John Karasinski at the MHA.

Headline Roundup: State Budget, Healthcare Workforce and More

Brian Peters

The MHA received media coverage the week of June 26 regarding the state budget, the healthcare workforce and auto no-fault utilization review.

MHA CEO Brian Peters is quoted in multiple stories. Below is a collection of headlines from around the state.

Friday, June 30

Thursday, June 29

Wednesday, June 28

Monday, June 26

Members with any questions regarding media requests should contact John Karasinski at the MHA.