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Unionized nurses are calling on state health officials to do a better job of enforcing a 2021 law that aims to ensure hospitals have enough nurses on duty to safely care for patients.

The majority of New York hospitals are not posting their staffing plans publicly on every unit, as required under the law, and some are also falling short of the minimum nurse-to-patient ratios the state mandates for intensive and critical care patients, according to a new report by the New York State Nurses Association, or NYSNA, which represents 42,000 members statewide.

“I hear from our members in every part of the state that staffing continues to be a problem and the hospitals are not following the law,” said NYSNA President Nancy Hagans. “As nurses, we have to continue to advocate to increase implementation and enforcement.”

NYSNA and other New York health care unions fought for legislation to establish statewide hospital staffing standards for years and finally got a version of it through after the COVID-19 pandemic brought increased attention to the dangers of understaffed facilities.

After the law’s passage, the state health commissioner set a statewide minimum of one nurse for every two intensive or critical care patients. But otherwise, hospitals were able to establish their own staffing levels for each unit, determined by committees made up of management and employees.

Hospitals were supposed to start following their individual staffing plans at the start of 2023. But by the end of that year, union leaders with NYSNA and CWA District 1 said thousands of complaints about violations of the law had been filed and most had gone unresolved.

The state Department of Health has now resolved 1,992 complaints about violations of the staffing law, agency spokesperson Cadence Acquaviva said. The department has issued 40 statements of deficiencies and four hospitals have received fines. Probes into several other staffing complaints are ongoing, Acquaviva said.

“The department will continue to enforce the law as necessary to ensure compliance, including enforcement against hospitals found to be in violation of the law,” Acquaviva said. “It is important we also recognize the health care worker shortages in our state, which underscore the importance of expanding common sense scope of practice changes” to expand the types of care different clinicians can provide.

An independent commission convened to evaluate how the law is being implemented and make recommendations for improvements to the state Legislature was supposed to release a report at the end of October, but that report has yet to materialize. Acquaviva said the state cannot comment on the status of that report because the commission is independent.

NYSNA says the report it released this week is intended to help “fill the gap” in evaluating how the staffing law is working.

To gather data, NYSNA conducted surveys on staffing at more than 60 hospitals across the state. Union members working with intensive and critical care patients at 20 hospitals across the state also reported on staffing levels in their units during a total of 532 shifts between Jan. 1 and Oct. 31 of this year. Surveyed hospitals failed to meet the minimum staffing requirements for those patients more than half the time, the union found.

In its report, NYSNA also called on the state to offer more transparency by posting hospitals’ actual staffing levels rather than just their staffing plans. Acquaviva said the health department is working on a process to collect and publish that information.

“ Nurses do not want to come to work everyday and put their license in jeopardy and put their life patient’s lives in jeopardy,” NYSNA’s Hagans said.

A 2021 University of Pennsylvania study of New York hospitals found that more robust nurse staffing was associated with lower in-hospital mortality rates among Medicare patients as well as shorter stays and less likelihood that they would end up back in the hospital within 30 days.

But recruiting and holding onto nursing staff can be a challenge. Many New York hospitals struggled with nurses leaving full-time positions in the wake of COVID-19 and had to pay premiums for temporary contract workers. That led to unions like NYSNA negotiating big pay bumps for their members in post-pandemic contracts, cementing higher labor costs.

“Our hospitals are committed to complying with the hospital staffing law and will continue to develop clinical staffing plans in collaboration with frontline staff,” said Brian Conway, a spokesperson for the Greater New York Hospital Association.

NYSNA and other New York unions representing nurses are not just waiting on the state to hold hospitals accountable. In recent years, unions have used provisions in their contracts with individual hospitals to bring management to arbitration over understaffing. Major hospital networks such as Mount Sinai and NewYork-Presbyterian have even been ordered to make hefty payments to nurses who worked on understaffed shifts — although NewYork-Presbyterian has pushed back on those remedies in court.

Still, Hagans said, even those payouts don’t always lead to better staffing.