This story mentions suicide.
As Ron Smith flipped through a scrapbook in the middle of a Dayton living room, each page documents the life of his daughter, Tristin Kate Smith.
He pointed at a photo of Tristin Smith, smiling in scrubs.
“She was very much a patient advocate. She would question the doctors ‘Sure you want to do that?’,” he said. “She was a good nurse.”
But her profession took a toll. Tristan Smith died by suicide in 2023. Her parents later discovered a letter on her laptop addressing the nursing profession as if it were an abusive partner. She said it left her overwhelmed, juggling too many patients with little breaks.
She often called Ron Smith after particularly hard shifts.
“She said ‘Dad, I am so tired, [I] can almost fall asleep at the stoplight’,” Ron Smith recalled her telling him. “That is not how you want to treat your nurses.”
This sort of chronic overwork impacts nurses across the state. The Ohio Nursing Association (ONA), one of the state’s nursing unions, polled Ohio direct care nurses in 2024. More than half said they were considering changing jobs due to overwhelming patient loads.
Advocates across Ohio say it’s a sign that the state needs to revamp its staffing standards.
“Right now across the state, nurses show up to provide care in situations that are less than ideal,” said Rick Lucas, executive director of the ONA.
The nursing shortage
Nursing shortages have plagued hospitals for years.
Ohio University executive director of nursing Char Miller said many factors are at play: an aging workforce, lower enrollments in nursing, and, of course, COVID-19. She said the pandemic accelerated an already looming shortage.
“We're still losing people from the profession because of burnout,” she said.
Research shows the more patients a nurse takes on, the more likely those patients are to stay in the hospital longer or die in care.
“It's very unfair to put that expectation on nurses to just figure it out … when that is clearly not the pathway to safe and effective quality care,” she said.
The proposed fix
Legislators at the statehouse have proposed a number of measures to address overwhelming patient loads.
One proposed Democrat-sponsored bill, HB521, would assign each hospital unit a mandatory nurse-patient ratio. Another Republican measure, HB535, would give more authority to direct care nurses in crafting hospital staffing plans.
ONA director and nurse Lucas said they would work in tandem to prevent understaffing.
“When patients go into the hospital they're putting an incredible amount of trust in us, in the facility. So we need these facilities to be held accountable to the staffing standards,” he said.
So far, California has been the only state to implement mandatory staffing ratios. Miller, the nursing professor, said there’s one major roadblock preventing Ohio from following suit.
“The evidence certainly is there and has been there for a while, that nurse-patient ratios play a critical role in the quality of our healthcare,” she said. “I think we've struggled a bit with ‘Okay, how do we pay for that?’”
Skepticism from hospitals
Groups like the Ohio Hospital Association have also raised concerns. They have lobbied against similar legislation in previous sessions, arguing state law already requires Ohio hospitals to develop nursing service staffing plans in conjunction with direct care nurses.
“Mandated approaches to nurse staffing limit innovation, reduce the flexibility needed to respond to patients' changing care needs and increase stress on a health care system already facing an escalating workforce shortage,” a spokesperson said in an email to the Statehouse News Bureau.
Beth Kluding, chief nursing officer at Hocking Valley Community Hospital in southeast Ohio, is also worried about the proposed legislation’s impact.
She said it doesn't take into account other non-registered nurse positions that help meet patient demand, and it could create more administrative burden for hospitals with little resources to spare.
“Making any hard and fast rules for a rural hospital is not gonna be good,” she said. “A one size fits all for any region in Ohio or the nation for that matter is just kind of missing the mark.”
An uphill battle
Ron Smith disagrees.
He said understaffing – and the resistance to the bill – comes down to money. He believes hospitals have prioritized profits over the lives of nurses.
“The lawmakers have got to do the right thing. They have to live up to what's going on out here in the world. They can't bury their heads to it for so long,” he said.
Similar attempts to add staffing ratios have stalled in Ohio for the last three years. This legislative session, neither the Democrat or Republican-sponsored bill have had committee hearings.
Still, Smith is undeterred.
“I'll keep fighting this battle,” he said. “If there's air in my lungs, I'll fight it.”
