HAP, Hospital Community Address Health Care Workforce Shortages

May 02, 2023

Pennsylvania needs comprehensive policy solutions that bring more nurses to the bedside, not government-mandated staffing ratios that won’t produce more nurses, HAP and Pennsylvania nurse leaders told state lawmakers today.

This morning, the House Health Committee hosted a hearing about House Bill 106, which would mandate nurse staffing ratios for Pennsylvania hospitals. HAP President and CEO Andy Carter testified—along with Michele Szkolnicki, RN, FACHE, CMPE, senior vice president and chief nursing officer, Penn State Health Milton S. Hershey Medical Center, and Stephanie Pollock, BSN, RN, CCRN, pediatric intensive care unit, patient care manager, St. Luke’s University Health Network—about the extraordinary efforts hospitals are making to recruit and retain nurses and how government-mandated ratios would affect patient care.

“There are very real concerns that statewide ratio mandates will diminish Pennsylvanians’ access to care,” Carter said. “If hospitals are unable to meet mandated ratios due to the scarcity of available RNs, they will have no choice but to close beds and reduce other health care services in order to comply with state law.”

Among the key takeaways:

• Core issue:  Mandated ratios do not address the state’s shortage of registered nurses, which is projected to be worst in the nation, with a shortfall of more than 20,000 nurses within the next three years.
• Rural challenges:  Mandated hospital staffing ratios will especially challenge rural facilities that already struggle to recruit staff, subjecting them to penalties and risking the closure of some hospital service lines.
• Weaknesses:  This legislation does not consider the certifications nurses need to work in certain hospital units and care settings. It also does not account for real-time adjustments that hospitals need to make in response to crises that can happen at any time.
• Workforce solutions:  HAP and the hospital community are focused on comprehensive solutions to address the health care workforce crisis and relieve strain on health care teams. This includes growing the number of nurse educators and preceptors; supporting nurses through scholarships, tuition discounts, loan relief, and other incentives; implementing interstate licensing compacts; reforming the state’s licensing and enrollment processes; and promoting health care worker wellness and safety.
• Quotable:  “The staffing challenges we face today are reflective of a supply issue, not the absence of mandated staffing ratios. In the past 15 months, St. Luke’s University Health Network has hired over 1,000 nurses and would have hired more if they were available,” Pollock said.

Szkolnicki noted that Pennsylvania hospitals need the flexibility to react quickly to changing needs within their communities, such as mass casualty incidents. Ratios do not address several important factors in health care, such as patient acuity, comorbidities, experience and training across staff, and the high-risk nature of work.

“If we are going to change, we need to change the right things,” Szkolnicki said.

HAP's testimony is available online.

Also today, a coalition of Pennsylvania health care provider organizations, including HAP, raised concerns about government-mandated ratios in a letter to the General Assembly. The coalition urged lawmakers to focus on solutions that grow the nursing workforce.

“There is no single solution that will solve Pennsylvania’s health care workforce crisis,” the coalition wrote. “We urge you to very carefully scrutinize potentially overly simplistic or ineffective proposals. Alternative—and more promising—policy efforts could include investing in nurse educators, expanding nursing education programs and apprenticeships, supporting nursing students, and forgiving the educational debt of currently practicing bedside nurses.”

For additional information, contact Jeffrey Bechtel, senior vice president, health economics and policy, or Heather Tyler, vice president for state legislative advocacy.