09.15.2006

On the record positions of Democratic gubernatorial candidates on the safe RN staffing bill

HEALTHCARE LEDGER MAGAZINE
August 2006
http://www.healthcareledger.com/Augustarticlea.html
Democratic Candidates for Massachusetts Governor Sound Off on Healthcare
By Jeffrey Kelliher

On Tuesday, September 19, Massachusetts Democrats will choose one candidate among their party’s three gubernatorial hopefuls to compete in the November general election against the “likely” Republican nominee, Lt. Governor Kerry Healey. In this special cover story, the Healthcare Ledger interviews each of the three Democratic candidates for Massachusetts governor on a variety of healthcare topics. Each candidate has responded to the same 14 questions. The Healthcare Ledger wishes to thank Chris Gabrieli, Deval Patrick and Tom Reilly for their time and thoughtful attention to these interview questions.

HCL: What is your position on the nurse staffing bill (H. 4988) that was recently passed by the House? As governor, would you sign a bill that sets nurse patient ratios?
Chris Gabrieli: I support the compromise legislation that gives the Department of Public Health the authority to determine safe staffing levels. It is critical that DPH responsibly develop and implement these important regulations. I realize that this is a contentious issue, but the bottom line is that we need to have quality healthcare and take care of patients in the best possible way.

HCL: What is your position on the nurse staffing bill (H. 4988) that was recently passed by the House? As governor, would you sign a bill setting nurse patient ratios?
Deval Patrick: The goal of both healthcare professionals and their patients is assuring that patients receive safe and high quality care, and we can all agree that nurse staffing is a critical part of that equation. I am skeptical about whether this type of issue can be appropriately addressed by legislation. I understood that nurses and hospital administrators had worked out a compromise which assured the necessary flexibility, but do not know where that stands today. Our long-term interest lies in training more nurses to broaden the pool of available talent, and to this I am committed.

HCL: What is your position on the nurse staffing bill (H. 4988) that was recently passed by the House? As governor, would you sign a bill setting nurse patient ratios?
Tom Reilly: It is vital that our hospitals and other health facilities have safe and appropriate nurse staffing levels. This is essential to the safety of patients. I do not support setting nurse patient ratios in legislation. However, I believe that the Department of Public Health has an important role to play in assuring safe nurse staffing levels, with appropriate flexibility for hospitals—and I would sign legislation consistent with this approach.

Clearly, we face a shortage in the supply of nurses. A federal study has indicated that we could face a shortage of 25,000 registered nurses by 2020. As Governor, I would work with our colleges and universities, healthcare institutions and caregivers to expand the supply of nurses. For instance, I would work to build our capacity to graduate more nurses—expanding nursing faculty and classes. In my “Prescription for a Healthy Massachusetts,” I have proposed developing a state university program, in partnership with healthcare institutions and foundations, to provide a path to nursing school for students of color and students from lower-income backgrounds. I would support nursing scholarship and mentorship programs. And I would work to ensure that hospitals receive adequate reimbursements to be able to fund safe staffing levels.

New England Cable News Televised Debate
June 30, 2006

SAHL: Martha Bebinger.

Q: Mr. Reilly, there's been a heated debate on Beacon Hill for a number of years now about whether the state should

set limits on the number of patients assigned to each nurse. Right now, the nurse's union is pressing for that

legislation, because they say it would improve the quality of care for patients. The hospitals say it's unworkable and

the expense is not worth the results. When you weigh in on that, what would you do? Should the state be regulating

the number of nurses that each patient –

REILLY: First of all, making sure this adequate staffing is absolutely vital. Whether the state should be mandating that

through legislation is something I question. Public health can set standards and staffing standards, and I think that's the

appropriate role for government. But at the end of the day, what's missing here is we don't have enough nurses, and

that means particularly our public higher education, our community colleges, have to be aligned with the workforce

needs. If we need more nurses, then they're going to have to turn them out. And there are some encouraging things

that are happening. Northern Essex Community College is now undertaking and planning a new program that will

address the need for nurses. So we need more alignment throughout our economy with the workforce needs, and

that's how I would address it. I have problems with the legislature mandating particular staffing levels that public health

can set reasonable staffing levels, and I think that's the best way to do it, through regulation.

Q: So on the issue, though, of quality in health care, what should the state's role be? What should the state be doing

to make sure that the quality of care is improving?

REILLY: In terms of overall, I think there are quality control measures all the way through this system as part of my

health care plan. You need to focus on quality, performance standards. Government is the largest purchaser of health

care. Attaching performance standards and quality standards to things like Medicaid reimbursements and all the way

through is a role that government should play and a governor should play. A governor has to drive this kind of change,

addressing quality, and I would drive it through public health with administrative standards and goals and objectives,

and expect those to be met.

SAHL: Mandated nurse/patient ratios. Deval Patrick.

PATRICK: Very skeptical about this, although I will tell you that in talking with both folks from the hospital association

and the nurses, the compromise that they worked out sounded like it had appropriate flexibility. I think this is one of

these things where, it doesn't really allow it - lend itself to legislation. It's something that you want to expect will be

done well by successful managers in hospitals.

I will say, though, that measures of quality should be uniform in different providers, and as they are reviewed by

different companies, so that we're not having - different insurance companies, so that we're not having just new,

additional burdens to the whole administrative expense of having different measures of what quality outcomes are in

different settings.

SAHL: Chris Gabrieli.

GABRIELI: You know, the data's pretty clear that nurse, staffing ratios to correlate to outcomes. They correlate even to

fatalities. They certainly relate to errors in medications, to length of stay. There's some real benefits to lower staff

ratios, including certainly what patients have experienced, but also objectively on the data. I think the compromise that

was hammered out was a good compromise. It puts it in the department of public health to set the exact ranges, a

ceiling, as well as a target so that the ceiling would be significantly higher than the target. I think it's a good piece of

legislation. The details matter here, but I think it should be supported, and so I do.