There’s been much commentary recently on the increasing stress that nurses are suffering. A number of remedies have been suggested, including legislation mandating nurse-patient ratios in hospitals in 32 specific clinical scenarios. How, I’ve wondered, would this issue be dealt with in a publicly funded universal health care system (“single-payer”)?

One example of such a system is the Medicare for All Act of 2023, which specifies that individual institutions, like hospitals, would annually negotiate with the Secretary of Health and Human Services a global budget to cover their operating expenses.

These operating expenses would include “wages and salary costs for physicians, nurses … including mandatory minimum safe registered nurse-to-patient staffing ratios.” Along with hospital administrators and other professionals, nurses would no doubt be involved in these negotiations, which would arrive at pay and staffing ratio figures appropriate for the particular hospital, its patients and its nursing staff.

Modifications would be made if there were “unanticipated increases in complex or high-cost patients or care needs.” Capital expenses, such as for building projects, would be negotiated separately and not affect the nursing staff. In addition, to deal with the problem of limited numbers of nurses, “the director of the Office of Primary Health Care shall … develop, coordinate, and promote policies that expand the number of … registered nurses.”

That sounds like a more comprehensive approach. Indeed, though the Maine State Nurses Association does support the legislation setting nurse-patient ratios, the website of their parent union, National Nurses United, states: “It’s time we have a Medicare for all, single-payer health care system.”

Daniel Bryant
Cape Elizabeth

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