Nevada governor says ‘no’ to nursing mandates By HPN Staff Nevada’s governor has pushed back on a bill that would have made Nevada the second state to mandate maximum nurse-to-patient ratios in large hospitals. The governor vetoed the measure passed by the state legislature in June, which proponents said would improve patient safety and had the support of nursing groups. But hospitals pushed back on the measure, saying it wouldn't fix a long-running nursing shortage and would — in the state hospital association’s estimation— “do more harm than good to Nevada’s fragile health care delivery system.” Nursing unions were incensed by the veto, with SEIU Local 1107 saying the governor “chose to side with the health care CEOs and big corporations that lobbied hard against our bill." The union promised to remember come election season. Why it matters There are no federal mandates limiting the number of patients assigned to a registered nurse. California was the first state to pass a law along these lines, which went into effect about 21 years ago. Nevada’s Senate Bill 182 would have applied to hospitals with at least 70 beds in the state’s two largest counties: Clark and Washoe. Sen. Rochelle Nguyen, D-Las Vegas, sponsored the measure which passed Nevada’s legislative chambers in May and June. The vote was 27-15 in the Assembly and 13-8 in the Senate. Democrats hold the majority in both chambers; Gov. Joe Lombardo is a Republican. In his veto message, Lombardo said the bill “imposes a rigid, one-size-fits-all staffing mandate that fails to reflect the complex and ever-changing realities of health care delivery.” “Nevada is currently grappling with a significant shortage of nurses and other health care workers,” Lombardo said in his message. “Imposing fixed ratios without first addressing this workforce crisis could force hospitals into impossible decisions — such as reducing services or turning away patients simply because they cannot meet staffing quotas.” Bill advocates point to a number of studies that link staffing levels to nurse exhaustion and poorer patient outcomes, including a routinely cited study published in 2002. “In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction,” the study concluded. The bigger picture The Nevada Hospital Association said the bill would require hospitals to hire nearly 1,500 more nurses to meet the staffing ratios, increasing health care costs. Nursing groups said the bill could have been a turning point. Too many nursing positions are unfilled, they said, because unsustainable workloads make the jobs untenable. Multiple groups backed the bill, including the country’s largest nursing union, National Nurses Organizing Committee / National Nurses United, which said the bill would have improved patient care and safety. The veto is part of a wider rift between Lombardo and the state legislature. The governor set a new record this year for vetoes, besting one he set two years previously. Additional details This legislation has a federal companion bill — the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, which National Nurses Organizing Committee/National Nurses United also supports. That bill has been introduced before in Congress without moving forward.
