Ohio bill to address nurse mistreatment, understaffing in state hospitals

Ohio House Bill 521 — known as the “Ohio Nurse Workforce and Safe Patient Act” — was introduced in the Ohio House of Representatives by State Reps. Crystal Lett (D-Columbus) and Christine Cockley (D-Columbus). The bill was proposed by the Ohio Nurses Association(ONA) and addresses ongoing issues of understaffing and mistreatment of nurses in Ohio hospitals.

The ONA introduced a similar bill by the same name (House Bill 285) in the 2023-2024 session of the 135th General Assembly, but the earlier bill did not pass initial committee review.

Rick Lucas, president and executive director of ONA and registered nurse at The Ohio State University Wexner Medical Center, says House Bill 521 has a better chance of passing in the current 136th General Assembly as working conditions for nurses have only gotten worse. “I don’t know how a member of congress could look at the state of healthcare and deny the bill with a straight face,” he said.

Lucas stated that many hospitals are putting profit over nurse and patient safety, often by disregarding safe patient ratios. A patient ratio states how many nurses are required per number of patients in a unit.

“There is a 30% increased risk of mortality in any acute [short-term] care unit where nurses have over four patients,” Lucas said. “A lot of nurses are being asked to take up to seven patients at a time.”

The ONA collects data, reports on and surveys Ohio nurses about hospital staffing annually. The organization claims high patient ratios are limiting nurses’ ability to provide timely and attentive care to patients. They also connect high patient ratios to increased nurse burnout and patient on nurse violence.`

“Nurses are placed in harrowing situations on the job every single day,” said Ohio Rep. Crystal Lett (D-Columbus), one of the bill’s primary sponsors. “Constituents who are nurses have told me that guns have been pulled on them, that they have been pushed, grabbed, had things thrown at them and more. Although these issues affect nursing universally, some nurses are at significant risk, such as ER nurses, rehabilitation nurses and patient mental health nurses.”

To address this mistreatment, the bill would require Ohio hospitals to create nurse staffing plans that adhere to safe patient ratios defined in the bill and that must be approved by a nurse staffing committee composed of at least 60% registered direct care nurses employed by the hospital.

The bill also protects nurses who refuse orders from hospital staff if the nurses themselves believe they are not qualified to fulfill the order, fulfilling the order will harm the patient or the order doesn’t fall in line with established safe patient ratios.

Additionally, the bill would block hospitals from directly or indirectly limiting what nurses can publicly say about their place of employment — through intimidation or otherwise. 

According to Lucas, reports of violence, harassment and abuse in the healthcare industry are often disregarded or suppressed by hospital management.

“I am not aware of Ohio’s hospitals silencing nurses’ speech through intimidation,” Lett said. “In fact, hospitals are pretty explicit in their policies that nurses can report without fear of retaliation. This section just adds protection to that existing standard.”

The bill would not only impact registered nurses but nursing students as well. “As a person entering a nursing field, I do feel there is talk about mistreatment of nurses regarding safe patient ratios, pay and so on,” said Mia Dowdy, a second-year nursing student at the University of Cincinnati. “I haven't seen it with my own eyes yet and I hope I don't have to.”

The bill also allocates money from the Ohio Treasury into a newly established loan-to-grant nurse education assistance program. If the bill passes, prelicensure nursing students will be able to apply for repayable loans with a requirement of five years of nursing service. After completing five years of service, the loans will be converted into grants that no longer need to be repaid.

Lucas and Lett encourage Ohioans to reach out to the bill’s sponsors with any questions or comments regarding the bill. “Everybody knows somebody who has received healthcare,” Lucas said. “I suggest just having an honest conversation with Ohio representatives about your experience.”