Remove Barriers that Prevent Nurses from Addressing Public and Private Health Crises

Nurses have been on the front line of the COVID-19 pandemic as they have been for every public health crisis from the Spanish influenza to the AIDS epidemic. Yet state governments have made it harder for nurses to help victims of this and other diseases.

In 2004, California enacted a law that restricts the ability of hospitals to assign nurses to where patients need them, which increases the cost of care. In that year, California became the first state to mandate inpatient facilities adhere to predetermined nurse‐​to‐​patient ratios. The law restricts the number of patients each nurse can care for in the hospital. The idea is that more nurses equals better care and increased safety.

Nurses unions have a financial incentive to support such laws because they require hospitals to hire more nurses, which creates more jobs for nurses and increases revenues for nurses unions, just as hospitals oppose them because they cost hospitals money. Even so, Kaiser Health News reports, “nursing and hospital advocates say there is scant research on what the ideal ratios should be, and there are conflicting studies about whether mandating a ratio by law ultimately improves patients’ health.”

The “right” nurse‐​to‐​patient ratio depends on the needs of individual patients, the skills of each particular nurse, and the ever‐​changing technologies available to monitor hospital patients. Letting politicians make those decisions assumes they have better information and incentives than hospitals and nurses themselves. It will inevitably harm consumers by making health care less affordable and accessible, and hamper the health sector’s ability to respond to public health crises, such as by increasing the cost of investing in new hospital capacity.

In response to the COVID-19 outbreak, New York Gov. Andrew Cuomo suspended regulations that make it harder for qualified nurses to practice in the state in an effort to encourage as many nurses as possible to care for the state’s COVID-19 patients.

Yet Cuomo himself has enacted such restrictions. In 2017, he signed a law that made New York the first and only state to require all new registered nurses (RNs) to obtain four years of nursing education instead of just two years. All newly licensed RNs must obtain a bachelor of science in nursing (BSN) degree within 10 years if they want to keep practicing in the state.

As with nurse‐​to‐​patient ratios, the “right” number of years of nursing education varies depending on the particular job a nurse performs. Not every RN job requires a four‐​year degree. There is likewise no reason to think politicians have better information or incentives when it comes to setting these standards than do nursing schools and employers.

Like California’s nurse‐​to‐​patient ratio law, New York’s “BSN‐​in‐​10” law will unnecessarily restrict access to care. It will raise the cost of acquiring and retaining a nursing license, reduce the supply of nurses, increase the price of nursing services, and make health care less affordable and accessible—again, hampering the health sector’s ability to respond to future public health crises.

The COVID-19 pandemic has highlighted how regulation of health care professionals impairs the health care sector’s ability to adapt to public health emergencies. Policymakers should forswear such restrictions on the nursing workforce both now, and after the pandemic ends.

The author thanks Jacqueline M. Pohida, BSN, for her research assistance.