HAP Resource Center

Advocacy Correspondence: Joint Letter to PA General Assembly, House Bill 106

May 2, 2023

Honorable Elected Representatives
Pennsylvania General Assembly
Main Capitol Building
Harrisburg, PA 17120

Dear Elected Leader:

The Pennsylvania Provider Advocacy Coalition works to advance policy goals consistent with our shared commitment to promote coverage and improve health outcomes for the citizens of Pennsylvania. Every organization on this letter supports hard-working nurses and other medical professionals and dedicates its professional mission to ensuring safe, high-quality health care for all Pennsylvanians.

Today, Tuesday, May 2, the House Health Committee held a public hearing on a bill that has been introduced in previous legislative sessions as “The Patient Safety Act.” We urge you to focus on a careful and thorough review of the bill’s provisions and afford the opportunity for all affected stakeholders to provide feedback on its content before choosing whether to advance it.

While there are a number of problematic provisions in the bill, we reach out today to focus on one significant component centered on government-mandated nurse-to-patient staffing ratios across all units in acute care hospitals. Patient mix, acuity levels, provider experience, clinical setting, and a host of other factors require flexibility to ensure appropriate care. The American Nurses Association, for example, supports models that encourage flexible staffing levels and incorporate inter-professional teams.

As you know, there is a well-documented nationwide shortage in the health care workforce. The National Council of State Boards of Nursing recently published findings that reveal that approximately 100,000 registered nurses (RN) left the workforce during the pandemic and that more than half a million more report an “intent to leave” by 2027.

The commonwealth’s RN gap is expected to be the worst in the nation— requiring an additional 20,345 nurses within the next three years—and reaches through all environments that rely on nurses to deliver essential health care services.

Government-mandated ratios will not produce more nurses—which is what Pennsylvania needs. Instead, we believe that strict requirements will likely:

  • Strain non-hospital providers who also rely on RNs to provide essential care for Pennsylvanians
  • Decrease the availability of health care services from providers across the entire continuum of care
  • Exacerbate the behavioral health crisis and further intensify already alarming emergency department “boarding,” in which appropriate post-acute care placements cannot be found
  • Pressure ambulance services and emergency medical technicians, as more emergency departments are forced to “divert” when they cannot meet staffing ratios
  • Increase wait times for patients seeking emergency care and delay admittance for patients

There is no single solution that will solve Pennsylvania’s health care workforce crisis. 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. The commonwealth also should establish an infrastructure to coordinate all state agencies that oversee health care and workforce issues, and convene all stakeholders to identify immediate steps to address this crisis.

Pennsylvanians need their legislature to work with urgency to grow the number of nurses across the commonwealth, and we hope these policy suggestions provide a starting point for future conversations.

Thank you for your consideration, and we look forward to continued dialogue moving forward.


Pennsylvania Academy of Ophthalmology
Pennsylvania College of Emergency Physicians
Pennsylvania Rural Health Association
Pennsylvania Society of Health-System Pharmacists
Safety-Net Association of Pennsylvania
The Hospital and Healthsystem Association of Pennsylvania
The Urban Health Care Coalition of Pennsylvania


Topics: State Advocacy, Workforce

Revision Date: 5/2/2023

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