National Survey Underscores Growing Crisis in Nurse Staffing/Patient Safety
MNA Points to Results in Pushing Safe Staffing Legislation on Beacon Hill.

MNA Takes Issue with ANA's Response to Staffing Crisis. Opposes ANA's Industry- Friendly Model Staffing Legislation

A national survey of registered nurses released today has revealed a growing crisis and continued deterioration of the quality of patient care in our health care system, driven by deplorable working conditions and unsafe staffing levels for nurses.

According to the survey of more than 7,000 nurses conducted by the American Nurses Association over the internet, 75 percent of nurses surveyed feel the quality of nursing care at the facility in which they work has declined over the past two years, while an alarming 40 percent said they would not feel comfortable having a family member cared for in the facility where they worked. Nearly 70 percent identified inadequate staffing as the cause of the declining care at their facility. Even more discouraging in light of the growing nursing shortage is the finding that over 54 percent of nurse respondents would not recommend their profession to their children or their friends.

"This information is nothing new to the nurses of Massachusetts, who have been reporting similar data and advocating for legislative reforms to improve these conditions since 1995," said Denise Garlick, RN, President of the Massachusetts Nurses Association. "It is not uncommon for medical/surgical nurses at a Massachusetts hospital to be assigned between 9 - 12 patients on a shift, or nurses working in long term care to be assigned 30 - 40 patients. Home care nurses, who a few years ago were seeing 5-6 patients in a day, are now being asked to see between 7 - 9 patients. In all of these settings, patients are more acutely ill and in need of more nursing care."

Garlick and the MNA point to such data as evidence for the need for immediate and comprehensive staffing legislation; specifically, the need for passage of legislation to mandate safe nurse-to-patient ratios in all health care settings, similar to landmark legislation passed in California in 1999.

In December, the MNA filed an impressive package of bills to provide unprecedented protection for nurses and patients in Massachusetts. The centerpiece of that package is "An Act Relative to Sufficient Nurse Staffing to Ensure Safe Care," which is a safe staffing bill sponsored by State Representative Christine Canavan, RN (D-Brockton) and State Senator Robert Creedon(D-Brockton) who both served as co-chairs of the Nursing Commission, a legislative committee that spent the last year investigating the current nursing crisis.

Since filing the bill, MNA has won widespread attention from both state and local industry watchers and policymakers, including the state's Governor. At the last meeting of the Governor's Task Force on Health Care Reform, MNA Executive Director Julie Pinkham raised the issue of the current nursing shortage, and the need for passage of safe staffing legislation as a means of creating working conditions that will allow for the recruitment and retention of nurses. Governor Paul Cellucci agreed with Pinkham, citing the nursing shortage as equal to, if not surpassing the shortage of teachers in Massachusetts. He further expressed his desire to work with the MNA on solutions.

In addition to its staffing bill, the MNA has also teamed up with the California Nurses Association to draft and file federal legislation to ban mandatory overtime, a practice being utilized by health care managers to compensate for a lack of adequate staffing. The bill, which was filed last fall by U.S. Congressmen James McGovern (D-Mass.) and Tom Lantos (D-Calif.), has already garnered broad support in Congress.

The Lantos-McGovern bill, entitled the "RN and Patient Protection Act," amends the Fair Labor Standards Act to bar mandatory overtime beyond 8 hours in a work day or 80 hours in any 14 day work period, except in the case of a natural disaster or in the event of a declaration of emergency by federal, state or local government officials. Voluntary overtime is permitted under the legislation.

MNA Takes Issue With ANA’s Response to Crisis
Opposes ANA’s Industry-Friendly Staffing Legislation

The MNA is concerned about model legislation that was unveiled by the American Nurses Association in conjunction with the release of its survey data. Specifically, the MNA is concerned that the ANA has not joined them in calling for legislation mandating safe staffing levels and nurse-to-patient ratios, similar to what has been proposed on the state level in Massachusetts and passed in California. Instead, the ANA is proposing that its member states file a staffing bill that not only is very weak, but that also contains a provision that could accelerate the current staffing crisis.

First, the ANA-proposed staffing bill merely calls for health care facilities to establish their own patient classification systems, with no mandate to adhere to the standards they create. The bill appears to codify into law requirements similar to those already made of hospitals by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO).

"This is a weak and totally ineffective approach to the problem their own survey so poignantly demonstrated," said Garlick. "Their suggested staffing legislation only calls upon the industry to develop their own standards for measuring staffing. This approach amounts to putting the fox in charge of the hen house. If we could trust the industry to staff safely and appropriately, we wouldn’t be in the crisis we are in. Hospital staffing must be regulated."

The MNA is joined in their position by Dr. Lucien Leape, the nation’s leading authority on preventable medication errors, and one of the authors of the Institute of Medicine’s groundbreaking report on medication errors. Leape has stated his support for regulation of staffing ratios to prevent medical errors, and has called for a legal ban on mandatory overtime.

Even more concerning to the MNA is the inclusion of a clause in the proposed ANA staffing bill that would allow hospitals to experiment with "alternative methods of assuring adequate staffing." The MNA is appalled that such language has been included as it is specifically designed to allow hospitals to reintroduce workplace redesign "schemes" that result in the replacement of licensed nurses with lesser qualified unlicensed aides and technicians.

It was the introduction of these types of "alternative methods" of staffing that caused the deskilling (replacing licensed nurses with unlicensed personnel) and the subsequent speed up of the RN workforce, which has created this unprecedented shortage of nurses throughout the U.S.

The MNA has spent more than a decade successfully fighting against these plans, which have been proven to have disastrous results for nurses and, more importantly, for patients.

"If passed into law, this could be the most dangerous piece of nursing legislation in the history of our profession," said Julie Pinkham, RN, MNA Executive Director who is a nationally recognized expert and speaker on the dangers of so called "alternative models of care. "We are talking about sanctioning by law the health care industry’s right to experiment with patient care models that do away with nurses. This legislation is so objectionable and anti-nurse, one would have thought it was written by the American Hospital Association, not the American Nurses Association.

The nurses of Massachusetts, like the nurses in California, who have led the nation in combating these dangerous trends, believe the only real solution to this problem is the development and enforcement of strict nurse to patient ratios that are based on the standards of nursing practice and the acuity level of the patient.

It is precisely because of these differences in philosophy and the ANA's moderate approaches to the problems of nurses that the MNA is now seeking to disaffiliate from the American Nurses Association and pursue affiliations with more like-minded, progressive nursing organizations whose actions match their rhetoric when it comes to defending nurses and their patients.