Colorado is the latest state to pass some form of legislation addressing nurse staffing in light of the pandemic.

New York passed a staffing law last summer that stipulates hospitals form clinical staffing committees that include front-line nurses and other direct care staff when setting annual staffing standards for units, similar to Colorado’s.

California, though, is still the only state with mandated nurse to patient ratios specified for certain units.

Colorado’s new law grants rule-making authority to the state’s department of health. Hospitals must report the baseline number of beds they can staff and their current bed capacity. If staffed-bed capacity falls below 80% of the baseline, facilities can face fines of $1,000 per day if they don't take corrective action.

Fines of up to $10,000 may also be levied on hospitals that fail to scale up to 125% of staffed-bed capacity to meet surge requirements in an emergency event, and if they fail to have enough COVID-19 vaccines available or have inadequate COVID-19 testing abilities at their facilities.

Pushback from rural providers though led Polis to write a letter to state lawmakers outlining exceptions for some hospitals.

All hospitals can submit requests for a hardship waiver if they’re unable to meet the required staffed bed capacity of 80% of their baseline, with the waivers accounting for local factors like a hospital’s size and geography, according to the letter.

“If they are granted a waiver, they will not be fined. It is not the intent of this bill to fine hospitals that are struggling to hire staff or have increased costs and small margins,” Polis wrote in the letter.

Hospitals also won't be fined for lacking vaccine and testing capacity if supplies are unavailable, according to the letter. And they won’t be fined in fiscal years 2022 to 2023, with fee implementation authority coming from the board of health.

The law also addresses another issue for nursing staff that the pandemic highlighted   — workplace violence.

Clinical nursing staff members must make up 60% of the hospital's nurse staffing committee members under Colorado’s new law, and committees must designate a leader of workplace violence prevention and reduction efforts.

An April survey of 2,500 nurses from National Nurses United, the country’s largest nursing union, found 48% of nurses working in hospitals reported an increase in workplace violence , up from 31% in September 2021.

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The eye-popping variations demonstrate "the total insanity of American healthcare pricing," Niall Brennan, CEO of the Health Care Cost Institute, said.

The FTC is looking to get more aggressive with anticompetitive tie-ups while states eye ways to beef up oversight. And if handed the reins of HHS, Xavier Becerra would likely put an antitrust lens to potential rules.

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