To the Editor:

Imagine that your loved one in an ambulance is forced to pass by the closest hospital Emergency Department because your local hospital is on “diversion,” sending ambulances and patients out of town to other facilities. Or, waiting in that same emergency room for not just hours, but days, until a regular hospital bed opens up.

We learned during the pandemic that these kinds of access issues can become all too real in a crisis. Our healthcare system today is stressed. The lingering effects of the pandemic – including patients who have put off care and are sicker on average than before as well as a workforce shortage that blossomed with the weight of the pandemic on the shoulders of caregivers – are still with us. And now, as we adjust and prepare for a post-pandemic future, another threat looms in the form of LD 1639, a bill in the Maine Legislature that would impose mandatory and inflexible nurse-to-patient staffing ratios in all Maine hospitals. At first glance, the idea of mandated staffing ratios may seem like a good idea. However, when you take a closer look at the issue, it becomes clear that this legislation could have serious negative consequences for Maine’s patients and communities.

For starters, there is no evidence to suggest that mandatory nurse-to-patient ratios will actually improve the quality of care that patients receive. Maine is already ranked in the top quartile for overall quality of care by the US Department of Health and Human Services. The Leapfrog Group, which monitors and rates hospital quality across the country, recently named Maine its “State of the Decade” for Hospital Quality. Meanwhile, the one state that does mandate nurse staffing ratios, California, ranks in the bottom half of states in terms of health care quality. But the real danger of LD 1639 lies in the fact that it would limit access to care for Maine people. Healthcare facilities that are unable to comply with the mandated ratios would be forced to close beds and divert ambulances. This would have a particularly devastating impact on rural communities, where access to healthcare is already a major concern. That’s because complying with the mandates will be impossible for many hospitals. Maine is already facing a nursing shortage, with 2250 positions currently unfilled and no relief in sight. Contrary to the claims of ratio proponents, the data make clear that the unemployment rate for Maine’s nurses is less than 2 percent. There is no supply of licensed nurses in Maine sitting on the sidelines waiting to be drawn back to work by an arbitrary staffing requirement. Mandated staffing ratios would do nothing to address this shortage and would actually make the problem worse by creating an even more restrictive environment for healthcare providers.

The fact is, there are already staffing guidelines in place at Maine Hospitals and our safety record testifies to their effectiveness. When nurses are able to work together to deploy resources to best meet the needs of their patients, it ensures that hospitals maximize access to care while maintaining our commitment to quality and safety. Mandatory ratios remove that authority from nurses, replacing skilled judgment with government-imposed and arbitrary numbers.

Even in a fantasy world where there is an unlimited supply of nurses, mandated staff ratios would raise costs – an estimated $105 million annually for Maine hospitals to comply – with, as California has shown, little impact on overall quality. As a healthcare organization dedicated to our community, we at Stephens Memorial Hospital are committed to ensuring that patients have access to the care they need when they need it. We believe that the best way to accomplish this is by focusing on efforts to increase the pool of qualified nurses with expanded education opportunities, loan forgiveness, and fair pay and benefits for those who choose to enter this rewarding but demanding profession.

Maine legislators should reject LD 1639 and instead focus on policies that will increase access to care and support our healthcare providers. By working together and exercising their best judgment, Maine nurses can ensure that every Mainer has access to the quality healthcare they deserve.

Christina Booth, RN, BSN, is Nurse Director of Emergency Services at Stephens Memorial Hospital.

Christina Booth, RN, BSN, Bethel Resident