Nurses unions have a bad idea for better healthcare

By | February 10, 2020

Last week, a union representing nearly 8,000 nurses and other medical service providers went on strike in Seattle. Members had many demands, such as higher pay and more authority over staffing decisions. But it appeared their main gripe was with understaffing and too-flexible nurse-to-patient ratios, citing nurse burnout and low patient satisfaction. The voices behind these cries for help are often driven by the best of intentions, but they should probably rethink their demands.

After all, a lower ratio won’t necessarily give them what they want.

This isn’t the first time that nursing unions and associations have made pushes to get mandatory nurse-to-patient ratios. Right now, California is the only state with laws mandating specific nurse-to-patient ratios, but 14 other states have laws that address “safe staffing.” There have even been efforts to pass a federal law mandating a national ratio.

Proponents of increased nursing staff numbers insist that nurses wouldn’t be as fatigued and would have more time and energy to provide patients with better service. That may be true, but it’s by no means guaranteed. And mandatory ratios are likely to yield a bevy of unintended negative consequences.

During a time of panic over healthcare spending, putting more money toward more nurses is ill-advised. We tend to forget that hospitals are actually behind much of the growth in U.S. healthcare spending over the last decade, and nurses’ salaries make up a hefty portion of that spending. Since 1960, their real income increased by 300% — compared to an average of 50% across all professions. All things kept equal, mandatory nursing ratios would drive up healthcare costs even more.

The idea of enforced ratios is based on the assumption that there are even enough nurses to meet the requirements necessary to take care of a growing patient base. But soon, there won’t be.

By 2030, all baby boomers will have reached retirement age, adding 18 million patients to Medicare — an incoming aged population that dwarfs the already-insufficient body of nursing professionals. Certainly, large hospitals may be able to attract enough nurses and meet the ratio requirements, but small hospitals will struggle and ultimately consolidate, which isn’t a good thing. Consolidation drives up prices without improving quality and puts smaller hospitals out of business in rural areas, where they’re badly needed.

By creating an artificial demand for traditional labor at the expense of emerging technology, these nurse ratios also squash innovation that can save lives. If hospitals are forced to hire and staff a certain number of nurses no matter what, why would they invest in technological developments? Heavy-duty delivery robots, for instance, could make the provision of medical services more efficient, but if hospitals are forced to allocate funds toward staffing, they won’t have any reason to develop these types of labor-saving technologies.

Mandates aren’t even necessary for hospitals to staff their units appropriately. Renowned hospitals consistently deliver high-quality care without them.

Sure, a mandated ratio might benefit some nurses, but it would likely be bad for hospitals, patients, and the taxpayers that have to foot the bill. At the end of the day, though the nation is rather divided on what healthcare reform should look like, we can all agree on one thing: We need better care, for more people, at a lower cost. Unfortunately, mandatory nursing ratios just won’t be what gets us there.

Trace Mitchell (@whatthehayek) and Elise Amez-Droz (@EliseAmezDroz) are Young Voices contributors. Mitchell is a research assistant with the Liberty and Law Center at George Mason University, and Amez-Droz is a healthcare policy associate in the D.C. metro area.