On the same morning that 400 nurses were at the State House for Nurse Lobby Day pushing for safe staffing legislation, another group of MNA members was providing testimony at a hearing held by the Joint Committee on Health Care to look into the growing problem of emergency room diversions. 

The MNA was invited by the committee to provide a panel of nurses to offer a nursing perspective on the problem, as well as to offer the organization's solution to the problem. Not only did MNA members make a strong case to the committee, but they also reached hundreds of thousands more Massachusetts citizens through extensive media coverage of the testimony, which was reported in news stories throughout the state. The solution to the problem? Pass legislation to mandate safe staffing levels in all health care facilities, which will attract and retain the staff needed to address the nursing shortage and the underlying cause of ER Diversions. 

Below are excerpts of testimony provided by Edith Harrigan, an ER nurse at Worcester Medical Center, who provided an excellent picture of both the problem of diversions, and the most important solution, and Jeanine Hickey, an emergency room nurse from Hale Hospital. Also testifying was Janet Gale, an ER nurse from Carney Hospital
 

Excerpts from Hickey testimony 

Hickey testified to her experience at Hale Hospital, where the administration is looking to use cross training of ICU and ER staff as a solution to the problem. Hickey  condemned this approach, which calls for providing ICU nurses with all of three weeks training to assume a role in the ER.

"Their attempt to provide patients with the "highest level" of care will be little realized by a plan that falls short in providing the affected nurses the necessary skills and competencies to maintain the safety of the patients and in protecting the licenses and livelihoods of the RNs who will have to participate in this ill advised plan. The result will be a partially prepared RN providing less than the highest level of care.

"These types of quick fixes to the shortage of qualified nurses will be the impetus for more nurses to leave the profession. We are not generic nurses to be utilized to fill any void in the hospital roster! We have all chosen areas that are special to us and have availed ourselves of the necessary education and training needed to provide specialized care to our patients. Mandating nurses to participate in these plans makes it a negative learning environment and adds to the already high level of stress and anxiety!

Whether it is cross training or mandatory overtime it is important for all of us to continue to fight for the right to work in an environment that provides patients with highly skilled nurses who deliver the care they need and to protect the employment rights of all of our staff members who may find themselves in these or similar circumstances. The individual nurse has a professional responsibility to accept only those assignments for which she/he is qualified and consumers have a right to expect that nurses will provide care and services in accordance with the standards of the nursing profession. As the nursing shortage continues we will find ourselves in more positions that compromise the integrity of the professional nurse and we must remain committed to fight each and every one of them. Fortunately for us the MNA has been pro-active in their agenda for safe staffing legislation and is well ahead of any national movement to address these same issues. We need your help to get this legislation passed. If we don't take this opportunity now the future of nursing will be forever changed and not for the better and patient care and safety will remain compromised. 
 

From the testimony of Edith Harrigan

The overcrowding of facilities and over extension of personnel not only results in diversion but also in the decreased ability to deliver safe quality care to patients whose needs are urgent or emergent.

At St. Vincent Hospital/Worcester Medical Center, we have a brand new facility. The main ER has 18 beds and the prompt care area has five beds. There is also an observation area with 12 beds for patients awaiting disposition or admission to inpatient beds, but often no staff is available to utilize this area to it's full potential…we routinely have 7-9 patients on stretchers in the hallways and 5-10 people waiting in the waiting room to be brought into the treatment area.

This overcrowding results in the inability of nurses to provide quality care to patients. Nurses have no control over the number of patients they are asked to care for, often feeling frustrated and unsafe. The system now puts them and their patients in peril. Closure and diversion is seen as a relief, a chance to catch up and regain some control. Closure and diversion however, only diverts ambulances, patients continue to arrive by car and via the waiting area. 

In my career I have seen great change from a time when the ER was a place to treat emergencies and decide which patients could be treated and released and which patients needed to be admitted. Once the decision was made to admit the patient was sent to a room where there was a nurse ready to accept and care for them. 

Today the ER is a place of long waits for non-urgent patients, admitted patients waiting so long for inpatient beds that the work-up is done and treatment begun. Families are angry and frustrated by the uncertainty of where and how their loved ones will be cared for.

ER nurses are asked not only to care for emergency patients, but also to monitor admitted patients, as well as those on cardiac monitors, those awaiting admission to the ICU and the CCU, those going to the OR, on ventilators and receiving critical interventions.

ER nurses are administering medications with such potency that, theoretically, still require a one nurse to two patient ratio and critical care equipment to safely monitor their effectiveness and outcome. 

Nurses in the inpatient area are also being asked to care for more and more patients. Years ago there were patients in the hospital for non-urgent care, some receiving tests and others having lengthy stays for treatment. Today, patients are in the hospital only when acutely ill and for a short period of time before being sent to skill nursing facilities, rehab centers, or home with home care services. Nurses in inpatient units are over-extended with the number of patients they have making them reluctant to take more patients even when beds are available, just shifting the unsafe conditions from one place to another.

Patients who need intensive care should receive intensive care whether in the ICU or waiting in the ER. Patients who need cardiac monitoring should be in a place where nurses are able to see that monitor and are provided the time to interpret the information from that monitor and evaluate their patients conditions.

As long as hospitals must use their inpatient beds for revenue producing patients, such as elective surgery, the availability of beds for patients entering the hospital via the emergency department will be limited.

As long as nursing is not given the opportunity to practice safely and not given the time to provide quality care with pride in their practice we will not attract or retain people in this profession.

We in nursing need to have safe staffing ratios for both inpatients and outpatients. The current system jeopardizes nursing as we know it, and as we know it should be. It threatens us personally and it threatens those we care for. We are asking to be able to practice nursing safely and to be given time to care for patients as they should be cared for.