‘A Public Safety Issue’: PA Nurses on Why Safe Staffing Ratios Are Crucial

Nurses celebrating in the capitol rotunda after the PA. House passed Patient Safe Act on June 28, 2023 (Photo: Sean Kitchen)

By Sean Kitchen

July 24, 2023

Because of the lack of staffing ratios in hospitals, nurses are forced to care for too many patients at once, causing physical care to fall by the wayside. The Patient Safety Act would require hospital units to meet specific staffing ratios based on the level of care they provide, in order to improve patient safety and the level of care they receive.

Shannan Giambrone knew working in medicine would be hard, and for the 26 years she’s spent as a registered nurse, it has been. That was the deal though, and one she was happy to take.

But Giambrone, who’s spent most of her career inside the Intensive Care Unit (ICU) at the Suburban Community Hospital in Norristown, never expected to have to prioritize which patients to treat first and which to let anguish without care because she was stretched so thin.

That’s increasingly what being a nurse looks like, though, and that’s why Giambrone insists that having safe staffing ratios in hospitals across the commonwealth is a public safety issue.

“This is about the care that people get,” Giambrone said. “And when I say people, I mean me and you and my parents and my children. All of the people who go in. This is a public safety issue. It’s not a labor issue.”

Some nurses around the commonwealth have spent their whole careers advocating for safe staffing ratios in their hospitals, but this was an issue Giambrone became more familiar with when she became the president of her local union with Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP) about 10 years ago. Giambrone still serves in that role today and has spent much of the past decade fighting for safe staffing ratios.

All those years of advocacy are on the verge of paying off.

The Pennsylvania House passed House Bill 106, the Patient Safety Act, in a bipartisan vote, 119 to 84, at the end of June. The bill would require hospital units to meet specific staffing ratios based on the level of care they provide.

The bill states that emergency room nurses could be assigned to no more than four patients or one trauma patient at a time, while nurses in intensive care units could only care for up to two patients at a time.

During her interview, Giambrone talked about what a typical day in the ICU may look like and how she has to prioritize which patients she sees first.

“This is going to sound dramatic but it’s the sort of thing you think. You look at your patients and you think, ‘okay, who’s dying first?’ Giambrone said. “And maybe nobody. Maybe you have got an assignment and everybody’s doing well and they’re responding, but maybe you’ve got some other, sicker patients on a different day that you need to pay attention to.”

Those sorts of decisions are complicated by staffing shortages that have become increasingly common in some hospitals.

“If I go into the ICU and maybe we don’t have the staffing that we need, and I have three patients, now I have to start looking at these patients, which one gets my attention first? And what of the things that they need am I going to prioritize?” Giambrone said.

Because of the lack of staffing ratios in hospitals, physical care tends to fall by the wayside.

When the Patient Safety Act was passed out of the House Health Committee in June, State Rep. Kathy Rapp (R-Warren), who is the minority chair of the committee, listed over 40 hospitals and organizations in the healthcare industry that opposed the Patient Safety Act.

To Giambrone, this opposition isn’t a reason not to pass the bill—it highlights what’s wrong with the system.

“It is a fight against a corporate model in healthcare—whether it’s a for-profit hospital— They’ve all taken a corporate model,” said Giambrone. “They have to understand they’ve chosen a business that is not a good to be traded. It’s not something that people can choose to have or not have when you’re having a heart attack. You have to go to the hospital. You don’t get a choice.”

The bill passed the Democratic-led House despite the opposition from industry groups and hospitals, and according to Maureen May, the President of PASNAP and a nurse of 37 years, that’s largely because of the advocacy work of nurses and family members of nurses.

“We believe the bill got to where it got because we had nurses involved,” said May.

Some of those nurses include State Reps. Bridget Koiserowski (D-Lackawanna) and Tarik Khan (D-Philadelphia). State Rep. K.C. Tomlinson (R-Bucks), whose sister is a nurse, also supported the bill , State Sen. Maria Collett (D-Montgomery), who is also a former nurse, is the prime sponsor of the Senate’s version of the bill.

The Senate has not yet taken up the bill, and nurses are planning out their next steps to meet with their legislators and make sure the legislation is sent to Gov. Josh Shapiro’s desk. Pennsylvania would become the second state in the country to require safe staffing ratios in hospitals if the bill were to become law.

May, who was in the capitol the day the House passed HB 106, described her emotions after it passed.

“There are very important moments in your career, but publicly and politically, I would say organizationally for me it was overwhelming,” said May. “We were tearful because it’s when you fight a good fight and you’ve been doing it for so long and it comes to you, we were elated.”



  • Sean Kitchen

    Sean Kitchen is the Keystone’s political correspondent, based in Harrisburg. Sean is originally from Philadelphia and spent five years working as a writer and researcher for Pennsylvania Spotlight.

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