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MASSACHUSETTS NURSE NEWSLETTER ::
October 2007
A special message for ED nurses
Why H.2059, the Patient Safety Act, will improve both patient
care and your working conditions
The goal H.0259, the Patient Safety Act, is to resolve the nursing
staffing crisis in the commonwealth’s hospitals, not to simply move
the problem from one area of the hospital to another.
Accordingly, all major units in a hospital are included in the bill.
To meet the requirements a hospital will not be able to reduce patient
loads on med/surg floors by boarding more patients in the ED. There
must be enough nurses in all of the major units of the hospital, thereby
improving the working environment for all nurses in the hospital—including
ED nurses.
Different limits required for the ED, emergency critical care
and emergency trauma units
This means that the hospital will have to anticipate and staff appropriately
for a rapid influx of patients without resorting to internal disaster
status and diverting patients to another already overburdened ED.
For example, in California—where safe staffing is the law—an ED nurse
can only be assigned four patients at a time. For critical patients
however, a nurse can only be assigned two patients, and a nurse can
only be assigned one trauma patient at a time. The Massachusetts law
will be implemented similarly, with different limits required depending
on the acuity of the patient.
In addition, the triage, radio or charge nurse cannot be included/counted
when meeting the staffing levels, and the bill will prohibit both
mandatory overtime and the “floating” of nurses without
adequate orientation.
Hospitals will be required to make RN staffing plans public
Hospitals will no longer be able to keep their staffing plans secret,
or worse, non-existent. This means that if the hospital has nurses
on call you will know about it and be able to insist that they call
those nurses in when necessary.
How does H.2059 provide for enforcement of the limits?
- Confidential Reporting: If a hospital exceeds the staffing limits,
you can report it to the DPH as can a patient, a family member,
a reporter or anybody else. Reporting is confidential, so you
don’t have to fear reprisal.
- Mandatory investigation: The DPH will be required to investigate
the complaint.
- Penalties: Where facilities routinely violate the limits, DPH
can impose a range of penalties, including fines and even pulling
a facility’s license.
In California, despite the predictions of disaster when their safe
staffing bill passed, hospital administrators now understand that
it’s just easier to comply with the law … so they comply. Hospitals
in Massachusetts will too.
Ancillary services are protected
The bill requires the DPH to incorporate the availability of support
services into setting patient limits. This means that hospitals cannot
meet the requirements by simply eliminating support services. Adequate
numbers of RNs and support staff are essential in order to keep patients
safe, and H.2059 requires DPH to account for this.
Limits throughout the hospital will improve patient care everywhere
Because the bill requires better staffing throughout the hospital—including
the ICU, med/surg, and other floors—inadequate staffing on the floors
cannot prevent admitted patients from being moved to other units.
There will be more RNs throughout the hospital, thereby improving
patient flow and efficiency throughout the facility.
What’s the bottom line?
Right now, you are powerless to improve staffing in the ED or anywhere
else. With H.2059, you will have a tool with some teeth in it that
you can use to enforce safe staffing limits. H.2059 will not solve
all the problems in the emergency department. The challenges faced
by ED nurses are complex and require multi-pronged solutions, but
with this legislation you will have many more protections and tools
at your disposal than you have now.
To look at the language in H.2059 for yourself, go to http://www.mass.gov/legis/bills/house/185/ht02pdf/ht02059.pdf
If you have any questions, call the MNA at 781.821.4625.
Over 85 percent of acute care hospital nurses in Mass.
support H.2059
“In the emergency department it is fast paced and inadequate
staffing is the leading cause of medication errors, patient falls
and staff injuries. The ED is a chaotic environment and our job
is stressful enough with having to make life saving decisions
every minute of our shift while simultaneously dealing with the
crisis of inadequate staffing. Passage of H.2059, beyond any reasonable
doubt, is in the best interest of patient safety and it will create
a safe environment for both patients and nurses!” — Traci
Mather, RN, BSN and an ED nurse Northeast Hospital
“I work in the ED at Brockton Hospital and I support H.2059,
The Patient Safety Act, because it will help improve patient care.
H.2059 is an all-encompassing bill—it attacks the problem of staffing
at every unit in the hospital, including the ED.” — Doug
Dell, RN
“Right now, when management tries to understaff the ED
there is very little we can do. We have tried just about every
form of protest at my facility with some improvement in staffing,
but still no coverage for our pediatric, psych and ICU boarders.
There is no guarantee of adequate staffing for our boarders in
the future. If H.2059 were law, we would be able to report violations
to DPH confidentially, and they would have to investigate and
impose penalties if the hospital refused to comply. That is a
much more powerful option than anything we have at our disposal
now.” — Barbara Broussard, RN, NEMC
This is not an experiment— safe staffing already works
in California
Four years ago, California implemented a law similar to H.2059,
and that law is improving patient care and nurses’ working conditions
in hospitals throughout the Golden State. But don’t take our word
for it.
“I used to take care of six to eight patients a day, with
30 patients in the waiting room before the ratios. It was hectic
and stressful, and as a result, I went part time and stopped doing
charge. Now we have no more than four patients and even fewer
if there is an intensive care level patient. I can provide care
in a more timely manner, do ongoing assessments as needed and
provide patient teaching. We hired more ED techs, we no longer
have hall beds and we actually see more patients.”
— Pam Gilbert, an ED RN for 13 years Good Samaritan Medical
Center, San Jose, Calif.
“Staffing limits in California provided improved retention
and recruitment for nurses and safer and more effective care for
patients.”
— Michael Jackson, RN University of California San Diego
Medical Center
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