A nurses union is supporting a bill that would establish minimum nurse-to-patient staffing ratios at Maine hospitals.

Supporters say it would provide relief for nurses who are spread too thin because of a hospital workforce shortage, while hospital officials oppose the bill and say such a mandate would reduce patients’ access to care.

The bill, sponsored by state Sen. Stacy Brenner, D-Scarborough, was released Wednesday and contains a lengthy list of nurse-to-patient ratios depending on conditions of patients. Averaged out, it would require roughly one nurse for every two patients.

If it is approved, Maine would become the second state, after California, to have a law mandating nurse-to-patient ratios.

Brenner, a former nurse, said she was compelled to introduce the bill because “the workplace conditions are really overwhelming right now for an inpatient hospital nurse.”

There are about 26,000 licensed nurses in Maine, according to state data.


Cokie Giles, president of the Maine State Nurses’ Association and a nurse at Northern Light Eastern Maine Medical Center in Bangor, said the problem is not an overall nursing shortage, but a shortage of those willing to work in hospitals under difficult conditions caused by high patient loads. The nurses are instead choosing primary care, outpatient clinics or other non-hospital jobs.

“Plenty of nurses are getting hired at hospitals. What’s happening is they’re not staying. We have a leaky bucket,” Giles said.

But Jeff Austin, vice president of governmental affairs for the Maine Hospital Association, disputed that characterization, arguing there’s an overall shortage of nurses, and that hospitals would be hampered by such an inflexible mandate. Austin said hospitals value nurses and want to hire more, but this bill is not the way to do it.

“This bill is the most significant threat to access to care and threat to hospitals that I’ve ever seen,” Austin said. “It will cost hospitals over $100 million, because we would have to hire 1,000 nurses. That assumes we first are able to fill all of the 1,500 positions we are currently trying to fill.”

A 2022 analysis prepared for the hospital association and the Maine Nursing Action Coalition says there was a shortage 2,250 registered nurses in 2021 and projects a shortage of 1,450 to 2,250 registered nurses by 2025. Because there has been an increase in nursing graduates in recent years, that projection is better than an earlier forecast, which predicted a shortage of 3,200 registered nurses over that time. Giles said colleges are focusing on graduating more nurses, which will help even more in the coming years.

Austin said hospitals have already blown through their personnel budgets because they have been forced to hire traveling nurses, who have been in higher demand since the pandemic but cost exponentially more. The difficult working conditions during the pandemic strained hospitals and led many nurses to leave, including many who were near retirement age.


Positions filled by traveling doctors, nurses and other medical staff have more than quadrupled because of the pandemic, from 535 traveling positions in 2019 to 5,138 in 2022, according to data from the Maine Hospital Association. The MHA did not have a breakdown of how many of those positions were nurses.

Brenner said if hospital nursing jobs become more attractive, hospitals won’t need to hire as many traveling nurses.

Austin said with hospital budgets already strained, a staffing-ratio mandate will lead to more waiting and reduced access to care for patients.

“If you don’t meet the rigid statute, you can’t see the patient,” Austin said.

Sharon Baughman, chief nursing officer for MaineHealth, the parent organization of Maine Medical Center and seven other Maine hospitals, said nurse-to-patient ratios can be good guidelines, but an inflexible mandate would reduce efficiency.

“If we have a patient ready to go home and just waiting for a few hours for family to come pick them up, that patient would still be part of the ratio,” Baughman said. “But now, a nurse might make a judgment call and could facilitate bringing in another patient. With the ratios, we would not be able to make that same level of independent decision-making.”


But Brenner said the bill is much more flexible than opponents are portraying. If a patient’s condition improves, for instance, the staffing ratio would be eased, she said.

And Giles said that if nurses know a state law requires adequate staffing for patent care, hospital jobs will be more attractive, also leading to better patient care.

“How many times have we heard patients say, ‘the nurses are so busy they can’t get to me,’ ” Giles said. “The patients’ needs are not being met. Nurses often don’t have time to break for lunch and we have nurses going home every night crying because they can’t help patients the way that they should be able to.”

Research on California’s ratio law is mixed. According to a 2010 study for Health Services Research, “hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California.”

But another 2013 study found “mixed effects” on quality and a 2014 analysis by the Health Economics journal found that “in spite of years of work to establish statewide staffing regulations, there is little evidence that the (California) law was effective in attracting more nurses to the hospital workforce or improving patient outcomes.”

The bill will go before the Legislature’s Joint Standing Committee on Labor and Housing in the coming weeks.

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