ALBANY — Unions for health care workers are waging a major push to enact nurse-to-patient ratios at hospitals and nursing homes across the state, contending the move would benefit patient care and address "burnout" among harried staffers.

But associations representing hospital management say staffing decisions should be left to supervisors. They warn the proposal could drive up hospital costs in New York by up to $3 billion annually.

The state Department of Health took testimony from all sides involved in the debate Tuesday, winding up what the agency called two days of stakeholder forums where the controversial proposal was detailed and analyzed by advocates and critics.

The New York Nurses Association, with some 43,000 members, has been highlighting its efforts to bring what it calls "safe staffing" regulations to the state's health care facilities in various organizing drives and contract disputes with hospitals in both the upstate and downstate region.

"Staffing is the Number One issue in all these campaigns," Carl Ginsburg, the association's spokesman, told CNHI. "Some of the nurses are running ragged, and this has been going on for years and years."

A legislative bill memo backing the proposal suggests the cost of adding nurses by hospitals and nursing homes could be alleviated through a reduction in staff turnover and a decrease in adverse patient outcomes. The memo cites data suggesting hospitals experience increased rates of pneumonia and cardiac arrests when they operate with lower staffing levels.

Hospital administrators, however, say mandatory staffing ratios would usurp the authority of supervisors to make decisions that result in the highest level of care.

They also cite experiences in California, the nation's only state to have mandated nursing staffing levels, contending there is no evidence its rules spawned improvements in patient care.

The New York legislation, Lorraine Ryan, senior vice president for legal, regulatory and professional affairs at the Greater New York Hospital Association told state officials, would eliminate the "invaluable expertise" of chief nursing officers and "replace it with the arbitrary staffing levels that must be maintained at all times, even during breaks."

Ryan also said the impacts from mandated staffing ratios could financially cripple some hospitals.

"Many of these financially struggling institutions would be forced to reduce services, lay off staff or even close their doors for good, impacting access to care for those with the most need," Ryan said.

The New York Nurses Association believes the staffing proposal has traction after Gov. Andrew Cuomo embraced the idea this year and called for state health officials to conduct a nurse staffing study.

A similar proposal to set nurse to patient ratios in Massachusetts was derailed by voter referendum last year, though union officials in the Bay State argue the hospitals "scared" the public into opposing it with a $30 million advertising campaign.

William Hammond, director of health policy at the Empire Center for Public Policy, an Albany think tank, said if staffing ratios are imposed on hospitals, it would likely lead to "vast amounts of overtime" paid to nurses as their employers struggle to comply with the mandate at a time when nurses are already in short supply in the labor market.

"The long term game plan here is to give nurses more leverage in their negotiations (with employers) over pay and benefits," Hammond said.

But advocates say the ratios are needed to address chronic understaffing.

Testifying before state officials last month, Nora Higgins, a veteran registered nurse assigned to the neonatal intensive care unit at SUNY Stonybrook Hospital and a coordinator for the Public Employees Federation, a state union, suggested many nurses face grueling conditions.

"Nurses work 12-hour shifts and are on their feet all day long," Higgins said. "They don't have anyone to cover for them while they take a break or try to sit down for a meal. Taking a bathroom break is a challenge. If they dont have to work overtime hours, they go home at the end of their tour with deep concern that something may have been missed."

The Department of Health expects to complete its study of the issue by Dec. 31, said an agency spokeswoman, Erin Hammond. Since the report has not been completed, she said it would be premature to comment on the agency's next steps.

Joe Mahoney covers the New York Statehouse for CNHI's newspapers and websites. Reach him at jmahoney@cnhi.com .

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