The Maine Senate voted Wednesday in favor of mandatory nurse staffing ratios for the state’s hospitals, bringing back a controversial issue that has divided hospital officials and the state nurses’ union.

The Mills administration opposed the bill when it was introduced last year, arguing that the measure could have the unintended consequence of reducing services in the health care industry at a time when there are acute nursing shortages in some areas. Unable to meet mandated ratios, the hospitals would need to cut services and reduce patient counts to comply, state officials have said.

The bill was tabled and never received a vote in 2023, but Democratic lawmakers brought it back for a vote on Wednesday.

Senators voted 22-13 in favor of the bill, which now goes to the Maine House for an initial vote.

“Maine does not have a shortage of nurses,” said Sen. Stacy Brenner, D-Scarborough, a former nurse and the bill’s sponsor. “We have workplace conditions that are unacceptable to nurses. Let’s change those conditions so nurses will come back to bedsides.”

She and other supporters said the strain placed on nurses is harming the quality of care they can give to patients.


The number of registered nurses has increased slightly, from 14,490 in 2019 to 14,610 in 2022, the latest year statistics are available, according to the U.S. Bureau of Labor. Maine’s higher education system has graduated increasing numbers of nurses in recent years, in an attempt to meet demand.

But Maine’s overall health care practitioner workforce – including doctors, nurse practitioners, nurses and other health professions – has shrunk form 42,390 in 2019 to 41,110 in 2022, while Maine’s population has grown and aged.

And while the number of nurses has increased, there are areas of acute shortages, including direct care nurses and in some hospital departments. Hospitals have had to rely on expensive traveling nurses for years, straining budgets.

State Sen. Eric Brakey, R-Auburn, said that strict ratios are not a solution.

“We certainly have a nursing shortage in our state, but we can’t mandate it away,” Brakey said.

The bill would set minimum nurse-to-patient staffing ratios that would vary depending on the service, so, for instance, emergency department ratios would be different than oncology. The ratios would also vary depending on the type of patients and severity of a patient’s condition. The bill sets ratios depending on patient needs, ranging from one-on-one care up to one nurse caring for four patients.


There are national guidelines for safe nursing staff levels, although there is no standard nurse-to-patient ratio. The American Nurses Association does not recommend specific ratios, but advises that each hospital develop safe staffing plans with input from nurses.

If signed into law, Maine would join California and Oregon as the only states that mandate nurse ratios, although several states have considered adopting ratios. Oregon passed its staffing ratio bill last year, while California’s has been on the books for about 20 years.

Jeff Austin, vice president of government affairs for the Maine Hospital Association, said in a written statement that the “Senate voted to support government control of staffing decisions at hospitals.”

“We firmly believe the Legislature should not substitute its judgment for that of experienced nurse leaders,” Austin said. “The bill deviates from recommendations of the leading national care organizations and will harm patients and communities.”

Austin said over half of Maine’s hospitals are losing money.

“They can’t hire 1,000 nurses that don’t exist, with $100 million they don’t have,” Austin said.

But Cokie Giles, president of the Maine State Nurses Association union, which represents nurse unions at Eastern Maine Medical Center in Bangor and Maine Medical Center in Portland, said that the bill would “protect nurses and their patients.”

The nurses’ union contends that the bill would stop unsafe practices, such as eliminating breaks for hospital workers and mandating overtime.

“We are ecstatic that this bill has taken another important step forward to becoming law in our great state,” Giles said. “Nurses know that safe staffing saves lives.”

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