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As NYC Nurses Threaten to Strike, the Healthcare World Debates Staffing Ratios

The New York State Nurses Association is making a big push for “safe staffing” — mandatory nurse to patient ratios in every hospital. In Albany, it’s backing legislation. In New York City, members are negotiating with New York Presbyterian, Montefiore, and Mount Sinai — and threatening to go on strike if ratios aren’t put in place. But as Camille Petersen finds, not everyone in the world of healthcare agrees ratios are a good idea.

PETERSEN 1: Julia Symborski is 34. And she’s an operating room nurse at New York Presbyterian.

When she shows up for her 12-hour shift, she picks up scrubs.


They recently changed from a nice pale blue color to kind of an offensive

cranberry color. (0:05)

PETERSEN 2: Then, she puts on a hair cover and goggles. And she gets her assignment for the day.


It’s always a surprise every morning. What surgeon am I working with. What

surgery am I doing. (0:04)

PETERSEN 3: But sometimes, there aren’t enough nurses to go around. Symborski has been a nurse for more than a decade. And she says, as a nurse, this is her worst nightmare.


Because you’re having to make decisions that no one should be forced to

make. (0:04)

PETERSEN 4: Check on a patient who had surgery OR prep blood for a transfusion? She says these choices aren’t just hard for nurses — they affect patient care. And they’re why nurses need staffing ratios.

Hospitals don’t publish data on staffing levels. But the New York State Nurses Association says concerns like Symborski’s make up two-thirds of complaints from nurses at New York Presbyterian and Montefiore.

The New York City Hospital Alliance, which represents those hospitals and Mt. Sinai, says current staffing levels are safe. And mandatory ratios would worsen patient care.

Sean Clarke researches how to improve hospital care at NYU’s College of Nursing. He agrees nurses are put in a tough place when hospitals are understaffed.


They don’t want to feel one as if they’re being forced to cut corners on patient

care. And two, they don’t want to feel as if they’re putting themselves out there.

You know sometimes they say they’re even putting their professional reputations

and their licenses on the line. (0:14)

PETERSEN 6: But Clarke says the research on nurse staffing RATIOS is murky.


In terms of what research says, we just don’t know. (0:04)

PETERSEN 7: Mandatory ratios only exist in California and two states in Australia. So Clarke says it’s hard to draw big conclusions. He says researchers have studied how staffing levels affect patient outcomes. And the risk of bad outcomes is consistently lower in hospitals with more staff. But not by much.


Jumping from there to saying that we can draw some lines in the sand about

conditions that should never be permitted…that’s a big leap. (0:08)

PETERSEN 8: Plus, Clarke says ratios could have unintended consequences. Say one nurse has a patient who needs a lot of care so they want to hand off one of their other patients to a different nurse. If Nurse #2 has already hit their ratio, they can’t take on another patient.

That’s why when ratios were on the ballot in Massachusetts last year, some nursing organizations opposed them. They were worried about losing flexibility.

Carri Chan teaches hospital operations at Columbia Business School. She says with fixed ratios…


You don’t have the flexibility to re-allocate and utilize your resources in the most

efficient manner. (0:07)

PETERSEN 9: Chan says ratios are a good idea. But as guidelines. Not rigid rules.


My fear is that it could tie your hands where you’re too reliant on each patient

needs half of a nurse’s time. (0:06)

PETERSEN 10: Ratios can also be a tough financial sell for hospitals. Ashley Swanson is a health economist at the University of Pennsylvania.


So what hospital leaders are going to argue is that they’re already adequately

staffed given their resources. (0:05)

PETERSEN 11: Staffing ratios could mean higher payroll costs without a guaranteed improvement in care.

But Julia Symborski, the OR nurse, says ratios should be a no-brainer for hospitals.


If they have to pay a bill to ConEd, they would pay it. If they had to pay a bill for

their water they would pay it. But when it comes to paying a bill for safe staffing

for patients through nurses? (0:09)

PETERSEN 12: She says hospitals are reluctant.

Nurses at New York Presbyterian, Montefiore, and Mt. Sinai voted this week to authorize a strike if ratios aren’t put in place.

Their next meeting with hospital management is less than a week away.

Camille Petersen, Columbia Radio News.


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