Michigan Voters, Healthcare and Business Leaders Agree: One-Size-Fits-All Ratios Will Harm Patients

Michigan coalition opposing mandated nurse staffing ratios.

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:

  1. 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.
  2. Expand Michigan Reconnect Eligibility: Lower the age requirement to 18 and older, encouraging more individuals to pursue nursing careers.
  3. 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.

The coalition includes the following organizations, and joins nursing organizations such as the American Nurses Association – Michigan and Michigan Organization for Nursing Leadership in opposing legislatively mandated nurse staffing ratios:

  • Business Leaders for Michigan
  • Community Mental Health Association of Michigan
  • Detroit Regional Chamber
  • Grand Rapids Chamber
  • Health Care Association of Michigan
  • Michigan Ambulatory Surgery Association
  • Michigan Association of Ambulance Services
  • Michigan Association of Colleges of Nursing
  • Michigan Association of Health Plans
  • Michigan Chamber of Commerce
  • Michigan College of Emergency Physicians
  • Michigan County Medical Care Facilities Council
  • Michigan Health & Hospital Association
  • Michigan HomeCare & Hospice Association
  • Michigan Manufacturers Association
  • Michigan Osteopathic Association
  • Small Business Association of Michigan
  • Traverse Connect

To learn more about the impact of the proposed legislation on care in Michigan, visit www.mha.org/issues-advocacy/key-issues/nurse-staffing-ratios.

Michigan Community Colleges, Universities and Hospitals Team Up to Solve the Nursing Shortage

Logos of supporting organizations for the legislative nurse staffing proposal.

Logos of supporting organizations for the legislative nurse staffing proposal.

Leaders ask Legislature for $56 million to get more nurses in the field

Michigan higher education and healthcare leaders today unveiled a collaborative plan to increase educational options to produce more highly-qualified nurses and address the nursing shortage across the state.

“Michigan’s community colleges and 4-year colleges and universities have come together to combat the nursing shortage, creating an innovative and affordable way to earn bachelor’s degrees in nursing at 28 new locations across the state,” said Brandy Johnson, Michigan Community College Association President.

The plan was developed by the Michigan Community College Association, the Michigan Association of State Universities, Michigan Independent Colleges and Universities, and the Michigan Health & Hospital Association. It is also backed by the Michigan Works! Association, Michigan Association of Colleges of Nursing and the Michigan Council of Nursing Education Administrators.

“Michigan’s public universities are pleased to have worked with our higher education partners to craft this common-sense and innovative approach to creating a more highly-skilled nursing workforce capable of fulfilling the critical role nurses play within the state’s healthcare community,” said Dr. Daniel Hurley, CEO of Michigan Association of State Universities.

It would create seamless opportunities for nurses with associate degrees to complete their Bachelor of Science in nursing (BSN) on community college campuses. Through this program, community colleges would partner with a four-year college or university and design a BSN completion program with input from local employers and local workforce development agencies.

“This plan ensures that Michigan nursing students have every option possible to get high-quality education and training on nearly every college, university or community college campus in this state,” said Robert LeFevre, president of Michigan Independent Colleges and Universities. “

The group is seeking a $56 million state budget investment to increase access and affordability of Bachelor of Science in Nursing programs for students who completed their Associate Degree in Nursing at a Michigan community college. Under the plan, grants would be administered by the Department of Labor and Economic Opportunity (LEO) and be awarded to Michigan community colleges. Each community college would be eligible for a $2 million grant for administering the program.

“We are proud to work in partnership with colleagues to develop an innovative strategy to strengthen Michigan’s nursing workforce by ensuring students throughout our state have access to a high-quality baccalaureate nursing education,” said Laurie Lauzon Clabo, PhD, RN, FAAN, Michigan Association of Colleges of Nursing president-elect.

This program would significantly increase the number of nurses with bachelor’s degrees that are in-demand at Michigan’s hospitals.

“Staffing shortages are impacting Michigan hospitals throughout the state, particularly in the areas of nursing,” said Brian Peters, Michigan Health & Hospital Association CEO. “This plan will help us get more highly-skilled professionals into the field quickly and increase access to nursing education in more communities across the state.”


The Michigan Community College Association fosters collaboration, connection, and partnerships among the 28 Michigan public community colleges and their stakeholders.  The MCCA provides strong legislative and public advocacy in Lansing and throughout Michigan, works to improve the image and credibility of community colleges, and advances numerous shared initiatives through the Michigan Center for Student Success, Michigan Colleges Online, and the Michigan New Jobs Training Program.


The Michigan Association of State Universities serves as the coordinating board for Michigan’s 15 public universities, providing advocacy and fostering policy to maximize the collective value these institutions provide in serving the public interest and the State of Michigan.

Michigan Independent Colleges & Universities represent the state’s not-for-profit independent colleges and universities. Our goal is to increase awareness of the impact MICU members have on higher education in Michigan. With over 125,000 students at our institutions, Michigan independent colleges educate approximately 25 percent of all college students in the state.

MICU serves its members through government relations, public policy development and advocacy. For more information and data related to Michigan’s independent colleges and universities, please visit www.micolleges.org.

Based in greater Lansing, the MHA advocates in Michigan and Washington, DC, on behalf of healthcare providers and the communities and patients they serve. The MHA is a nationally recognized leader on initiatives that protect and promote quality, cost-effective and accessible healthcare. To learn more, visit www.mha.org or follow the MHA on Facebook and Twitter.