New Jersey lawmakers are considering a measure to regulate the minimum "nurse-to-patient" ratio at hospitals in the state.
Nursing unions support the idea, and point to studies based on California's experience with ratios that find improved quality and lower mortality rates.
"The bill is important because there is not a consistent nurse-to-patient ratio that is applied in all the hospitals," said Ann Twomey, president of Health Professionals and Allied Employees union, which represent 12,000 nurses across New Jersey and Philadelphia.
"There needs to be a mandate that sets the standards, because every patient should expect and deserves to get a very consistent, safe level of care."
The bill calls for one registered nurse for every six patients on a surgical unit, and one for every four patients in the emergency department.
"Beyond that number, bad things happen to patients, whether they acquire infections, and even the death rate goes up. So this is clearly a safety issue," she said, pointing to a 2010 study from the University of Pennsylvania that found the lives of 222 patients would be saved each year in New Jersey if the state met California's staffing levels.
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But Aline Holmes with the New Jersey Hospital Association said the proposed regulations aren't based on hard evidence, and they would strip away the flexibility traditionally yielded to health facilities.
"There's no study that says 1:4 or 1:5 is the optimal ratio, and we need to take into [account] the education and experience of the nurses, and the acuity of the patients," said Holmes. "So I don't think we are going to get to the outcomes we want just by mandating ratios."
Opponents also point to studies that find New Jersey hospitals on average already perform well in national quality studies.
"Another concern is the added financial burden it would place on, not just our network system, but across the state," said Betty Sheridan, a chief operating officer for Inspira Health Network.
She said her own back-of-the-envelope calculation puts the price tag of adding RNs at Inspira at $5 million. Statewide, the NJHA estimates the measure could cost $159 million.
Unions, which have been backing similar measures in the state for nearly a decade, say improved patient quality reduces costs in the long run.
