NY Considers 1:2 Nurse Staffing Ratio For Critical Care

A new rule drafted by the New York State Department of Health (NYS DOH) would require hospitals to assign at least one nurse for every two patients in critical care units. The mandated increased nurse-to-patient ratio for critical care patients is part of the revised "Safe Staffing Act" passed by the legislature in 2021. 

The proposed rule states:

“The registered professional nursing ratio shall be at least one registered professional nurse for every two patients (1:2) in the ICU/PACU level setting, increased as appropriate for the acuity level of the patients.”

The regulation was on the agenda for NYS DOH Public Health and Health Planning Council's Codes Committee meeting on June 15, 2023. According to state officials, the entire council will gather on June 29, 2023, and the proposed regulation may be considered for adoption. 

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Details of the New York “Safe Staffing Act” 

The “Safe Staffing Act” is part of Public Health Law Section 2805-t. The regulation requires one professional registered nurse for every two intensive care or critical care patients.

According to the act, “ensuring sufficient staffing of general hospital personnel, including registered nurses, is an urgent public policy priority in order to protect patients and support greater retention of registered nurses and safer working conditions.”

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Notably, the NY Safe Staffing Act is a compromise. It allows the state to set staffing ratios for critical care units while limiting its oversight of other units and settings. 

The initial version of New York's staffing statute, brought to the Health Committee in January of 2021, included statewide minimum staffing ratios for all settings. However, the proposal was subsequently changed at New York's healthcare unions' request. Statewide staffing mandates were replaced with individual staffing committees at each hospital. The recommendation for committee-based staffing ratios came from a series of talks between the Hospital Association of New York and the state's three main healthcare unions—CWA, 1199SEIU, and the New York State Nurses Association (NYSNA). 

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The revised bill compels each hospital to organize a staffing committee, half nurses and half hospital executives. Staffing committees would be required to convene annually to set minimum staffing ratios for the facility. 

“Staffing ratios are negotiated between clinical nursing staff and high-level executives, who are effectively their employers,” Karen Lasater, assistant professor at the University of Pennsylvania Nursing Center for Health Outcomes and Policy Research, told NY Focus. “So it becomes a very lopsided table to sit around.” 

If a committee could not agree on a set of ratios, hospital management would devise a plan, which it must make public and file with the state health department.

The Committee’s report suggests that allowing each hospital to develop a plan collaboratively will allow for the best staffing outcomes at each site. With a hospital-by-hospital approach, facilities can balance what is best for the patient and workforce while considering each hospital’s varying needs.

Hospital clinical staffing committees will be responsible for the following functions:

• Establish and oversee the clinical staffing plan annually, including specific criteria or ratios, matrices or grids used to determine staffing requirements.

• Review the staffing plan semiannually.

• Review, assess, and respond to violation complaints, staffing variances, and concerns about the plan’s implementation.

Under the proposed rule, each hospital must adopt and submit its staffing plan to the NYS DOH. In addition, they must post staffing plans for each unit with the actual daily staffing for that shift in a publicly visible area in each patient care unit. 

The health department will investigate complaints of potential infractions, which will levy civil penalties for noncompliance. Retaliation and intimidation against any employee, patient, or other person who raises concerns about rule infractions are prohibited.

“The proposed clinical staffing requirement codifies standard industry practice and places patient health and safety first,” state Health Department spokesman Cort Ruddy told the New York Post.

Impact of the New York Safe Staffing Act

The NYSHD estimates that the rule change will cost the Department of Health around $1.8 million annually. Regulation implementation will require 75 additional onsite hospital surveys per year — the equivalent of one survey per hospital over a three-year period.

Nancy Hagans, president of the New York State Nurses Association, told Healthcare Dive the law will improve “safety and working conditions for nurses at the bedside” and will help “to recruit and retain enough nurses for quality care everywhere.” However, she added the law is a single step in the right direction. “We would like to see safe patient ratios extended to all patients in New York’s hospitals,” Hagans said.

Recently, researchers showed that New York’s average ratio is about one nurse for six patients, far below federal recommendations.