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.

MHA & MONL Issues Joint Statement on Harmful Nursing Legislation Introduced in the Michigan Legislature

Kim Meeker, RN, BSN, MBA, president of the Michigan Organization of Nurse Leaders.

The following joint statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association, and Kim Meeker, RN, BSN, MBA, president of the Michigan Organization for Nursing Leadership (MONL).

Kim Meeker, RN, BSN, MBA, president of the Michigan Organization of Nurse Leaders.
Kim Meeker, RN, BSN, MBA, president of the Michigan Organization of Nurse Leaders.

A package of bills announced today in the Michigan Legislature has the potential to severely harm hospitals and access to important services for patients, if ultimately passed. Proponents of the legislation falsely claim this will address nursing shortages in Michigan, but those claims couldn’t be further from the truth. Michigan hospitals are trying to fill 8,500 job openings for nurses. Instituting a one-size-fits-all mandate requiring hospitals hire more nurses who do not currently exist will limit the services hospitals can offer to their communities, prolong the time it takes for a patient to receive care and hinder the ability of hospitals to respond to a crisis in fear of violating Michigan law.

Tangible, proven steps are needed to attract more nurses to Michigan. Those include passing legislation that allows Michigan to join the Nurse Licensure Compact, expanding Michigan Reconnect eligibility and increasing penalties for those who commit acts of violence against healthcare workers.

Brian Peters
MHA CEO Brian Peters.

Michigan hospitals and health systems have been hard at work addressing nursing shortages over recent years. Those efforts include:

  • Obtaining a total of $300 million in state funding that has benefitted 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.
  • Securing additional nurse training opportunities including expanded state policy allowing four-year BSN programs at community colleges.
  • Expanding Michigan Reconnect to allow funds to support Michiganders moving from a licensed practice nurse (LPN) to a registered nurse, or from a patient care technician certificate to a LPN.
  • Modernizing the scope of practice for certified registered nurse anesthetists which allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources under Public Act 53 of 2021.
  • Providing emotional well-being support to healthcare workers through a partnership with the Duke Center for Healthcare Safety and Quality that has so far assisted 5,000 healthcare workers from 144 organizations throughout Michigan.

Nursing careers not only provide stable, well compensated jobs with a set of transferrable skills that rarely become obsolete, but in a rewarding environment that truly make a difference in the lives of the patients they serve. The MHA and our member hospitals and health systems, together with MONL, remain committed to focusing on effective solutions that support Michigan nurses and ensure safe patient care.

MHA CEO Report — Attracting Healthcare Talent

MHA Rounds Report - Brian Peters, MHA CEO

“Individual commitment to a group effort – that is what makes a team work, a company work, a society work, a civilization work.” Vince Lombardi

MHA Rounds Report - Brian Peters, MHA CEOTalent acquisition is always top of mind for all business leaders. Demand for workers now outpaces supply throughout the U.S., but particularly here in Michigan due to our demographic realities, including an aging baby-boom generation entering retirement in significant numbers. A recent presentation by Michigan Senate Fiscal Agency Chief Economist David Zin summarizes these challenges, as Michigan has the eleventh highest median age in the country, a metric which has been increasing rapidly in recent years.

This challenge is clearly felt by Michigan hospitals and health systems, as many retirement decisions made by healthcare workers accelerated during and because of the pandemic. The use of contract agencies for nurses exploded while hospitals also reduced the number of staffed beds in their facilities due to worker shortages. The financial repercussions of these shortages had Michigan hospitals spending more than $1 billion more on contract labor and recruitment and retention expenses in 2022 than in 2020, according to a MHA workforce report.

Although current staffing levels have stabilized somewhat in the state, the demand remains high. According to a March 2023 survey of 95% of the MHA membership, there were over 27,000 job openings in Michigan hospitals, including nearly 8,500 open nursing positions.

While the number of open positions may be surprising, healthcare is historically the largest private-sector employer in Michigan. The next iteration of the Economic Impact of Healthcare in Michigan report publishes May 2, which demonstrates the massive role healthcare plays in the state. Michigan healthcare organizations provided nearly 568,000 direct healthcare jobs in fiscal year 2021, with Michigan hospitals providing roughly 219,000 – or nearly 40% – of those jobs. Once wages, salaries and benefits and tax revenue are factored in, healthcare contributes nearly $100 billion to the state’s economy each year.

The value that our hospitals provide to the health and wellness of a community is obvious and is reason enough to warrant our strong support. But in addition, the magnitude to which our Michigan economy depends on healthcare can easily be overlooked. Hospitals are often the largest employer in their respective communities and serve as critical lynchpins of economic vibrancy. This is why it is so important for hospitals to engage with business and policy leaders to ensure alignment across the state in our efforts to attract and retain talent.

Healthcare careers are not only stable and well compensated, but also provide a set of transferrable skills which rarely become obsolete. We recognize that healthcare careers, particularly clinical positions, can be stressful and emotionally draining. We can’t sugarcoat the challenges associated with caring for all types of patients in organizations that operate 24/7/365.

But the MHA is here to help. In an effort to support the emotional well-being of healthcare workers, in 2021 the MHA Keystone Center launched a partnership with the Duke Center for Healthcare Safety and Quality team led by Bryan Sexton, PhD. More than 5,000 clinical and non-clinical staff from 144 organizations joined in the first 10-week Well-being Essentials for Learning Life-Balance cohort, and our work here is ongoing. We are also advocating for policy change at the state and federal level that would increase the penalties for those who commit acts of violence against our caregivers.

Through our successful advocacy work, the Michigan Legislature appropriated $75 million in funding for the recruitment, retention and training of hospital workers in Public Act 5 of 2023. This funding supplements an earlier $225 million appropriation made in Public Act 9 of 2022 and has played a large part in minimizing further losses to the healthcare workforce. The MHA was named as the fiduciary for both of these funding pools – evidence of the strong bipartisan trust in our association.

Allowing clinicians to work at the top of their license and removing administrative work is another tactic that can help attract healthcare talent. Enacting policy change that reduces rates of healthcare worker violence and expands access to behavioral health treatment are others. The work of the MHA and our members is to make sure healthcare workers have all the tools available to do their work improving and saving lives without unnecessary mandates and other interference that contributes to the challenges healthcare professionals experience.

These workforce challenges and the need for more workers also illustrates the need for local control for hospitals to determine staffing models that best represent the needs of their patients and communities. A one-size-fits-all approach doesn’t work when comparing a rural critical access hospital to an urban Level I trauma center. Successful staffing models incorporate input and feedback from nursing teams and the unique needs of the local community.

There are also a variety of other approaches the MHA and our partners at the American Hospital Association are advocating for to attract healthcare talent. This ranges from increased investment in nursing schools, nurse faculty salaries and hospital training time; enacting protections for healthcare workers against violence and intimidation; supporting apprenticeship programs for nursing assistants; and supporting expedition of visas for foreign-trained nurses.

There is no silver bullet that will fix workforce shortages. The current issue facing hospitals, as well as many other industries, is the reality that the available supply of workers simply doesn’t meet the demand. Michigan continues to be aggressive in efforts to attract businesses to the state. We must recognize our state is in competition with others for a finite amount of available healthcare workers.

Yet things can be done to grow the pie and attract more students into the healthcare talent pipeline. For example, the MHA will be focused this summer on raising awareness about the variety of jobs and career pathways that exist within health systems, and encouraging future and existing workers to consider a career in healthcare where they can truly change lives, whether they’re at the bedside or behind a computer screen.

Healthcare is the ultimate team sport, with the utmost objective – saving lives, and preserving the health and welfare of people. I hope you will join us in this endeavor and invite as many people as you can to the party.

As always, I welcome your thoughts.

Crain’s Grand Rapids Business: Healthcare Jobs In-demand Across West Michigan

Brian Peters

Brian PetersCrain’s Grand Rapids Business published a story April 20 on the annual release of the West Michigan Works! list of “hot jobs,” with nearly half of the 100 high-demand careers being in health-related professions. MHA CEO Brian Peters is quoted in the story in relation to hospital workforce funding grants signed earlier this year.

The $75 million for the recruitment, retention and training of healthcare workers is part of Public Act 5 of 2023. The article also cited a March 2023 workforce survey of 95% of the MHA membership that indicated Michigan has more than 27,000 job openings in hospitals, including nearly 8,500 open nursing positions.

“Maintaining the sustainability of our healthcare workforce is a universal priority for all Michigan hospitals and health systems,” said Peters. The quote is originally from a MHA press release published March 8 following the signing of the supplemental appropriation bill.

Media Recap: Pandemic Preparedness and Hospital Mergers

Brian Peters

Brian PetersThe MHA received media coverage the week of April 3 regarding the preparedness of hospital for another pandemic and how hospital and health system merger and acquisition activity impacts healthcare.

ABC News published a story April 1 that reviewed how chronic staffing shortages and new threats to funding may undermine the ability of hospitals to respond to a future pandemic. ABC News spoke to 11 hospital associations, including MHA CEO Brian Peters. A quote from Peters is included in the story regarding staffing challenges.

“Now, nurses and others are leaving health care altogether, to companies that have signing bonuses and very high hourly rates. And so all of a sudden, hospitals are in a position where the only way we’re going to have an adequate nursing force is to work with the nurse traveler agencies,” said Peters.

Bridge published an article April 3 on the finalized partnership between Michigan Medicine and Sparrow Health System. A section of the article reviews hospital acquisitions and mergers within healthcare. Peters spoke to the general reasons why a hospital or health system may determine merging with another organization is the best decision for their community.

“We have hospitals right now in Michigan … that are struggling mightily from a financial perspective,” said Peters. They’re struggling with supply chain issues. They’re struggling with the workforce.”

“I’ve heard it said more than once and I really think this summarizes the situation well: ‘We value our independence, but we’re not going to ride our independence to our grave.’ The ultimate goal of any organization — whether it’s a hospital system or any other entity in the community — is not about maintaining your independence. It’s about maintaining your viability.”

The Detroit Free Press and Michigan Radio also published stories on a recent nursing workforce survey released April 6. A portion of a statement Peters issued in March following the appropriation of $75 million for healthcare recruitment and retention as part of Public Act 5 of 2023 was published in the Detroit Free Press story. Meanwhile, the MHA provided a statement to Michigan Radio sharing the study incorrectly identifies mandated nurse-to-patient staffing ratios as a solution to the problem of inadequate nurse supply.  Portions of the statement are included in the Michigan Radio article.

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