Maine Senate Passes Nurse-to-Patient Ratios Bill

In a huge victory for patient safety, the Maine Senate voted 22-13 on Wednesday to pass LD 1639, The Maine Quality Care Act, which will limit the number of patients that nurses must take on their daily assignments, based on patient need and the severity of a patient’s condition. 

“This is the most significant legislation for patient safety that has ever been proposed or passed in our state,” said MSNA President Cokie Giles, RN. “Our membership from Portland to Fort Kent has worked tirelessly to educate the public and our legislators about how important this bill is to protect nurses and their patients. We are ecstatic that this bill has taken another important step forward to becoming law in our great state. Nurses know that safe staffing saves lives.”

The bill’s sponsor, Sen. Stacy Brenner (D-Scarborough) is a nurse and midwife with many years of nursing experience. She stated in her floor speech before the vote, “Colleagues, I tell you with humility, that being in the Legislature feels like a relaxing hobby in comparison to working as a bedside nurse. The fear of near misses and possibly devastating errors from working over capacity builds a sense of moral injury, one shift at a time.”

The working conditions of direct-care nurses often include short-staffing, unsafe patient loads, lack of breaks and meal periods, and forced overtime. These ongoing, stressful conditions create moral distress and moral injury, often resulting in nurses leaving bedside care for good. This is why members of MSNA decided to partner with Sen. Brenner to bring this bill forward.

“All of us nurses know other nurses who have left bedside care because of the conditions we and our patients face in hospitals today,” said Kelli Brennan, an RN at Maine Medical Center. “There is no ‘nursing shortage,’ only a shortage of nurses who are willing to work in these conditions. If we want to fix Maine hospitals and our statewide health care system, we must enact reasonable and enforceable nurse-to-patient ratios. RN-to-patient ratios will bring nurses back to the bedside, keep the nurses we have, and protect the patients we are all committed to serve.”

LD 1639 does the following to help secure safe staffing ratios in Maine:

• Establishes mandated minimum RN staffing ratios that require additional staffing based on individual patient care needs.
• Safeguards nurses’ right to advocate in exclusive interests of the patients under their care.
• Protects nurse whistleblowers who speak out about assignments that are unsafe for the patient or nurse.
• Requires hospitals to post notices on minimum ratios and maintain records on staffing.
• Authorizes the Maine Department of Health and Human Services to enforce RN-to-patient limits.

Decades of studies have shown that more nurses result in lives saved and fewer complications. Studies show that when RNs are forced to care for too many patients at one time, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, pressure ulcers, increased length of hospital stay, higher numbers of hospital readmissions, and death. A 2021 study found that each additional patient per nurse is associated with 12 percent higher odds of in-hospital mortality, 7 percent higher odds of 60-day mortality, 7 percent higher odds of 60-day readmission, and longer lengths of stay, even after accounting for patient and hospital covariates including hospital adherence to sepsis bundles. 

The bill faces further votes in the Maine House and Senate.