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2003-2004 MNA Legislative Agenda

The Massachusetts Nurses Association engages in a comprehensive membership driven process to file and work towards passage of legislation that addresses the concerns of its members. This included a Blue Ribbon Commission that conducted statewide hearings, and an outreach program through the MassNurse. The following is a compilation of bills approved by the MNA's Congress on Health Policy and Legislation and the MNA Board of Directors.

The Following Bills Address Safe Staffing/Quality of Nursing Care/Patient Safety Issues.

An Act Relative to Quality Patient Care and Safe Registered Nurse Staffing – This legislation would require all Massachusetts hospitals to adhere to Department of Public Health (DPH)-established minimum registered nurses (RN)-to-patient ratios as a condition of licensure by DPH. The filing of the legislation follows the recent release of prominent research studies and reports that clearly demonstrate that safe RN staffing produces dramatic cuts in patient mortality and is a key element in stemming the flood of RNs from Massachusetts hospitals.

The most recent study in the Journal of the American Medical Association (JAMA) shows that for each additional patient assigned to an RN, there is a 7% increase in the likelihood of death within 30 days from a complication not present upon admission to the hospital. The difference between 4 to 6 and 4 to 8 patients per nurse is accompanied by 14% and 31% increases in mortality respectively. It is common for RNs in Massachusetts to be assigned 6, 8, and even up to 10 patients on a given shift, placing thousands of patients at risk for serious complications and death.

The scientific evidence is clear and overwhelming: when nurses have too many patients, patients' lives are in jeopardy. The evidence also makes clear that poor staffing conditions in Massachusetts hospitals have caused and are exacerbated by a growing shortage of nurses willing to work in hospitals," said MNA President Karen Higgins, RN. "Passage of this legislation is key to improving care for our patients and to creating conditions that will retain and recruit the nurses we need to provide safe patient care."

Nurses are not alone in their desire for minimum RN-to-patient ratios. Support among the public for this legislation is strong in Massachusetts. A poll of Massachusetts residents found that more than 75% of the public supports legislation regulating RN-to-patient ratios. And last May, more than 80,000 Bay State residents signed petitions calling upon the legislature to pass a measure requiring an improved RN-to-patient ratio. Lead Sponsor Rep. Christine Canavan, RN.

An Act Relative to A Patient's Report Card of Nursing - When nurses advocate for improvements in staffing and changes in skill mix ratios to improve patient care, the industry claims there is not data to support these claims. If this data is collected, facilities have no legal obligation to share it with policy makers or the public. This bill would mandate that all hospitals, clinics, long term care facilities and HMOs track and report to the public annual data regarding staffing levels and skill mix ratios; as well as nurse-sensitive patient outcomes, such as patient falls, nosocomio infections, bedsores, patient satisfaction and medical errors, readmission rates and length of stay. Lead Sponsor Rep. Cory Atkins.

An Act To Ensure Safe Medication Administration - This bill would amend the Controlled Substances Act (Chapter 94C) by mandating that only licensed professionals may administer Schedule II - VI medications, thus clarifying and strengthening Chapter 94C. It would reverse regulatory changes which teach and mandate unlicensed direct care personnel to administer all schedules of medications in group home settings, after only a 16 hour course and state certification. Those who can self administer, have family or have personal care attendants to aid with self administration are exempt from the requirements of this legislation. It will also be structured to capture medication errors along with other systems, which collect this information. Lead Sponsor Sen. Marc Pacheco.

An Act Relative To Improvements in Private Duty Nursing Care for Developmentally Disabled Children – Because of poor compensation, and lack of appropriate training, there is serious shortage of nurses to provide home care to developmentally disabled children in the Commonwealth. This bill would improve the care of children who are developmentally disabled and in need of home care services by creating a training program for the care of these children and a stable pool of qualified nurses. Further, the nurses would be employed by the state and would also be granted benefits and commensurate salaries in an attempt to decrease the rapid turnover of providers experienced by these families. Lead Sponsor Sen. Steven Tolman.

An Act Relative To A Nurse Deputy Commissioner At the Department of Public Health – Nursing plays an essential and distinct role in the safe delivery of health care in the Commonwealth. This bill would raise the profile of nurses in the health care policymaking apparatus, by establishing a Director of Nursing position, responsible for working with the Commissioner to ensure that nursing-related issues are adequately monitored and considered as the department carries out its mandate to protect the public health. Lead Sponsor Sen. Pam Resor.

An Act Relative To A Registered Nurse Seat On The Public Health Council (new) – The Public Health Council has existed for decades. The role of the council currently is primarily to approve certificates of needs for health care facilities and new regulations in relation to health care delivery. There has never been a nursing position on the mostly consumer board. There are a number of physician positions. This bill would create a nursing position on this important council. Lead Sponsor Sen. Richard Moore.

The Following Bills Protect the Economic and General Welfare of Nurses

An Act Requiring Health Care Employers To Develop And Implement Programs To Prevent Workplace Violence – This bill would mandate a comprehensive workplace violence prevention program, along with counseling program for victims of workplace violence who work in the delivery of health care. It would also address the risk of violence and the appropriate retirement compensation for those professionals who care for these populations in public sector settings. Lead Sponsor Sen. Guy Glodis.

An Act Relative to Assault and Battery on Health Care Providers - The bills amends Massachusetts law to declare it a felony to assault any health care worker while such person is treating or transporting another. The crime shall be punished by imprisonment in the house of correction for not more than two and one-half years or by imprisonment in the state prison for not more than five years, or by a fine of not more then $5,000, or by both such fine and imprisonment. Lead Sponsor Rep. Michael Rodriques.

An Act Relative to Group 4 for Health Care Professionals – This legislation would place those state employed health care professionals who work with violent or potentially violent populations in Group 4 for the purpose s of their retirement. Group 4 recognizes state employees who work in dangerous situations. Lead Sponsor Sen. Brian Joyce.

An Act Relative to Group 2 Employees - Elevates registered nurses and other health care professionals that are state employees to a "professional status" for the purposes of their retirement. They are currently considered "technical status" in the state system. Lead Sponsor Rep. Edward Connolly.

An Act Related To Interest Arbitration for Health Care Professionals – Provides for the use of binding interest arbitration in the case of a collective bargaining impasse with the State. The purpose is to expedite the process, ensuring a fair and objective settlement to contract negotiations. Sen. Thomas McGee.

An Act to Include Certain Municipal Employees of the Commonwealth in Group 2 of the Contributory Retirement System for Public Employees – elevates nurses in municipal employment from a technical position to a professional position for the purposes of retirement. Lead Sponsor Rep. Timothy Toomey.

An Act Regarding Insurance Equity For Registered Nurse First Assistants - Filed with the Association of Operating Room Nurses, Massachusetts Chapter One, this bill creates equity for RN First Assistants with other paid providers of first assistant services. It prevents insurance companies from discriminating and refusing payment for first assistant services when they are provided by a Registered Nurse. Lead Sponsor Sen. Charles Shannon.

An Act Authorizing The Sale Of "RN" Distinctive Registration Plates – This bill would create an RN Vanity License Plate with directed funding to provide scholarships for nursing with an emphasis on attracting a diverse population to enter and advance in the nursing profession. Lead Sponsor Rep. Brian Knuuttila.

An Act Relative to Creating a Difficult to Manage Unit Within the Department of Mental Health – This legislation creates a Difficult to Manage Unit for women within the Department of Mental Health. The Department currently has such a unit for men. Lead Sponsor Rep. Patricia Haddad.

Latex Gloves – The MNA is working with Representative Vincent Pedone on legislation relative to latex gloves.