The MHA published a letter today on behalf of all Michigan hospitals and health systems signifying their unified opposition to proposed House Bills 4550-4552, which threaten to put patient care at risk across Michigan. MHA CEO Brian Peters announced the letter during his testimony in the House Health Policy Committee, which contains the names of leaders from all Michigan hospitals and health systems.
“Our hospitals are prepared to serve you and your loved ones on your worst day with high-quality, safe care,” said Peters. “We can’t risk losing experienced clinical judgment and local access to care. It is for these reasons that our membership is publishing a letter today signed by every hospital leader indicating our complete unified opposition to these bills.”
The proposed bills would mandate one-size-fits-all nurse staffing ratios for all Michigan hospitals, which do not create more nurses nor solve staffing shortages, as evidenced in other states that have tried this policy. California has a shortage of 40,000 registered nurses, despite the presence of mandated staffing ratios for 25 years. Michigan hospitals are currently trying to hire more than 8,400 nurses for vacant positions despite a national staffing shortage. Data from the Michigan Public Health Institute and the Bureau of Labor Statistics show that 85% of all licensed Michigan registered nurses currently living in the state below the age of 65 continue to work as nurses from a pool of 119,714 RNs.
Peters was joined for testimony by Beth Charlton, president and CEO, Covenant HealthCare; Doug Dascenzo, DNP, RN, chief nursing officer, Trinity Health Michigan; and Bonnie Kruszka, DNP, FNP-C, ENP-BC, RN, VP & chief nursing officer ambulatory services, Munson Healthcare.
A representative from American Nurses Association – Michigan also testified in opposition. The committee hearing included approximately 60 hospital representatives in attendance.
The testimony opposition follows the announcement earlier this week of a comprehensive coalition of healthcare, business and advocacy organizations opposing the bills.
A diverse coalition of healthcare, business and advocacy organizations published a letter to members of the Michigan Legislature today opposing the proposed House Bills 4550-4552 and Senate Bills 334-336, which threaten to put patient care at risk across Michigan.
“These partners from a broad collection of industries all agree imposing a one-size-fits-all legislative mandate to hospital nurse staffing will harm patients and severely restrict access to care in Michigan communities,” said Brian Peters, CEO of the Michigan Health & Hospital Association. “Our nurses, patients and communities deserve more than political posturing that puts healthcare access at risk.”
The proposed bills would mandate one-size-fits-all nurse staffing ratios for all Michigan hospitals, which would not solve existing staffing shortages, as evidenced in other states that have tried this policy. In California, which has had legislatively mandated staffing ratios for over two decades, the state still faces a shortage of 40,000 RNs. Additionally, 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.
The United States is facing a national nurse shortage issue, exacerbated by the aging nursing workforce, as many experienced nurses approach retirement. Currently, 32.3% of licensed RNs in Michigan are 55 years of age or older and nearly 8,500 open nursing positions exist statewide. A survey of 109 Michigan hospitals conducted in July 2023 shows Michigan is at risk of losing up to 5,100 hospital beds across the state if this legislation is implemented. This total represents 23% of Michigan’s overall statewide hospital bed capacity and is equivalent to closing all hospitals north of Grand Rapids and Flint.
The coalition emphasizes that mandatory nurse staffing ratios have a broader impact beyond hospitals alone, affecting all healthcare providers’ ability to hire nurses. With a finite pool of available RNs, nursing homes, rehabilitation facilities, physician practices and other healthcare settings will experience increased difficulty in recruiting and hiring nurses, especially as hospitals compete for the same talent pool.
“The entire healthcare sector is facing historic workforce shortages,” said Melissa Samuel, Health Care Association of Michigan President/CEO. “We all need more nurses. Unfortunately, these bills exacerbate the problem and fail to offer meaningful solutions.”
The potential impact to the business community is significant. Data collected from hospitals indicates the proposed ratios could increase healthcare costs by over $1 billion, impacting economic development and employers.
Recent EPIC-MRA polling of Michigan voters indicates that 82% do not believe the government should mandate one-size-fits-all nurse-to-patient staffing ratios in every hospital, and 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.
The coalition supports the following alternative solutions to address the nurse staffing shortages:
Join the Nurse Licensure Compact: Bring Michigan into the national Nurse Licensure Compact to reduce barriers for out-of-state nurses to practice in Michigan immediately, joining 41 other jurisdictions across the country.
Expand Michigan Reconnect Eligibility: Lower the age requirement to 18 and older, encouraging more individuals to pursue nursing careers.
Funding Innovative Approaches to Workplace Violence Prevention in Healthcare Settings: This complements the passage of House Bills 4520 and 4521 that increase penalties for violence committed against healthcare workers and would make the nursing profession more attractive by addressing safety concerns.
To date, Michigan hospitals, health systems and other healthcare providers have focused on addressing staffing shortages by implementing various measures, including increased compensation, partnerships with post-secondary education institutions, emotional well-being support, modernizing scope of practice rules and recruitment awareness campaigns such as MI Hospital Careers.
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.
