Fact Sheets

H. 1186   An Act Relative To Sufficient Nurse Staffing 
To Ensure Safe Patient Care

This legislation proposes to create a process in which health care advocates, nurses, and hospitals will collaboratively craft a nurse staffing plan which is sufficient to care for the planned and unplanned needs of patients in health care facilities across the Commonwealth.

This legislation will help to ensure quality patient care at health care facilities.
Safe nurse staffing levels equals quality care for patients and reduces cost on our health care system by decreasing lengths of stay, reducing recidivism rates, and curbing other patient complications.

Research shows a direct correlation between the level of nurse staffing and patient outcomes. 
Studies over the past 2 decades have clearly shown that the level of care provided by registered nurses decreases the length of stay, decreases patient complications and increases patient satisfaction.  A recent study conducted through the Harvard School of Public Health of 5 million patient discharges found a "strong and consistent" link between nurse staffing levels and patient outcomes.  Adverse outcomes such as gastrointestinal bleeding, pneumonia, and length of stay in hospitals increased as nurse staffing levels decreased.
 
H. 1186 will help alleviate the current nursing shortage.
The working conditions that nurses are facing today are driving them out of the profession. Many of the shortage problems that exist today are directly related to the reluctance of licensed nurses not to practice in positions where they are inappropriately rushed through their patient care activities, assigned unsafe patient levels, and confronted by mandatory overtime.

There currently is no law in Massachusetts that protects patients from unsafe staffing levels in hospitals.
There is no current definition of “sufficient” staffing in Massachusetts’s law. H.1186 will facilitate a plan in which each health care facility will work to anticipate, design and adhere to a daily written staffing plan as required by patients or residents to maintain safety and to support nursing staff compliance with applicable professionally recognized standards of nursing practice.

H. 1186 will create a process that will represent the needs of patients, nurses, and hospitals.

The major provisions of the legislation include:

• The creation of a nurse staffing commission that must work collaboratively with the Department of Public Health (DPH) in relation to a nurse staffing plan;

• The promulgation of rules and regulations within one year of the passage of this act; 

• That the regulations shall be enforced by DPH and that they be based upon accepted standards of nursing practice, patient or resident classification system(s), patients’ or residents’ acuity level and functional capacity for self-care;
  

• The creation of specialty registered nurse positions which increase the quality of patient care including: Nurse Executive, Occupational Health and Safety Nurse, and Quality Assurance Nurse;

• Clear language related to the role of the licensed nurse and the inability for institutions to delegate to unlicensed personnel, duties which demand nursing expertise; 

• The utilization of research by the designated quality assurance registered nurse to evaluate nursing services and nurse staffing in relation to medical errors and patient outcomes;

• Strong consumer protections for “sufficient nurse staffing” including a “prominent posting of the daily written nurse staffing plan on each unit to reflect the nurse to patient ratio per each shift as a means of consumer information and protection; and

• That the facility will provide each patient and/or family member with a toll-free hotline number for the Division of Health Care Quality at DPH, which may be used to report inadequate nurse staffing. Such complaint shall cause investigation by DPH to determine whether any violation of law or regulation by the facility has occurred and fines for such substantiated violations. 

Fact Sheet

An Act To Ensure Safe Medication Administration

This legislation clarifies and strengthens the controlled substances act by ensuring safety in medication administration. 

This legislation:

• ensures that all persons in the Commonwealth are  administered medications safely especially when they cannot manage their own prescriptions;

• recognizes that family members, personal care attendants in true independent living situations, and emergency personnel may administer medications when needed,

• ensures that those who cannot self-administer, or who are at risk from side effects, have access to appropriate nursing/professional care. 

If a patient cannot self-administer a licensed professional is the reasonable and safe person to administer medications. 
This legislation would prohibit any misinterpretation of the Controlled Substances Act for the expedient use of unlicensed persons to deliver nursing services under the disguise of independent living.

The goal of this Act is to protect the public from unsafe medication administration, by those who are unqualified, and ill-prepared to make any assessment about the effects and side effects of medications. 
 

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Fact Sheet

An Act Relative To Improvements In Private Duty Nursing Care
For Developmentally Disabled Children

There are currently about 500 severely disabled children in Massachusetts, most of them are ventilator dependent and require nearly 24-hour private duty nursing care in order to avoid institutionalization.  The Division Health Care Finance and Policy is the agency responsible for funding the provision of this care through a system of utilizing private nursing agencies to “bid” on state contracts to provide for the care of these patients. This program is over 10 years old and was created under the authority of the Division without a statute.   In December 1998, the Division held a hearing regarding the rates of payment to providers.  What became clear at the hearing was that families struggle every day because the agencies are not required to supply adequately trained nurses for the intensity of the needs of these patients.  Further, low salary, lack of benefits and lack of control over working conditions lead to frequent turnovers in nursing care such that families are often left without coverage for extended periods of time.  These patients have complex needs and require skilled and specialized nursing care. 

The MNA bill contends that financial changes in the rate paid to agencies alone are an insufficient measure to adequately provide the skilled services needed by these patients.  This law fundamentally changes the program from a private sector to a public sector provision of care.  All nurses shall be employed by the state and would be certified with the appropriate skills to care for this population of patients.  An "adequate pool” of nurses shall be recruited and retained in an attempt to better fulfill the Commonwealth’s obligation to care for these disabled children.  This approach will significantly mitigate the tremendous burden experienced by the families.
 

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Fact Sheet

An Act Relative To A Nurse Deputy Commissioner At The Department Of Public Health

This legislation would create a Nurse Deputy Commissioner in the Department of Public Health.  The qualified nurse would have the responsibility, as directed by the Commissioner of Public Health for statewide planning, policy development, coordination of clinical decision-making, communication and resource management for district health officers and programs within divisions of the Department.  These divisions would include but not be limited to; the division of family and community health, the division of health care quality, the division of communicable and venereal diseases, the division of alcoholism, the division of drug rehabilitation and the division of food and drugs.
 

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Fact Sheet

An Act Relative To A Registered Nurse Seat 
On The Public Health Council

The Public Health Council has existed for decades.  The current primary role of the Council is to approve certificates of need for health care facilities and to approve new Department of Public Health regulations that frequently relate to health care delivery.  There has never been a nursing position on this consumer-oriented board.  There are a number of physician positions.  This bill would create a nursing seat on this important council. 
 

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Fact Sheet

An Act Requiring Health Care Employers To Develop And Implement Programs To Prevent Workplace Violence

Backgrounder

Violence in the workplace has been a growing trend among many businesses and health care facilities are no exception.  Working as an employee in a health care facility is considered to be the third most dangerous job in the United States.  In fact, according to the Centers for Disease Control and NIOSH, nursing is one of the most dangerous occupations.  For example, 73% of psychiatric nurses have been assaulted at least once.  Colonial Insurance Company, the disability insurance carrier for the commonwealth reports actuarial data suggesting that the state employee nurses in Unit 7 have the highest incidence of traumatic injury in the workplace of all occupational groups covered. 

Risk factors that put nurses at risk of workplace assault and injury include, but are not limited to:  working alone or in small numbers; working late night or early morning hours; being a predominantly female occupation, uncontrolled public access to the workplace; working in high-crime areas (as a visiting nurse, for instance); guarding or maintaining property or possessions; working in public areas where people are in crisis; working in areas with known security problems; insufficient staffing and working in areas where a patient may exhibit violent behavior is a reasonably foreseeable matter, such as caring on a specialty unit for a patient who is an incarcerated criminal, requiring continued criminal security measures.

Nonetheless, many workers and employers remain unaware of the severity of the problem and its profound negative impact on the well being of workers and their efficiency.  Cooperative efforts by employers and employees to evaluate the hazards of workplace violence in their setting and efforts to implement a worker protection program have proved to be highly effective in reducing the incidence of injury from workplace violence.  OSHA has developed guidelines and recommendations to reduce worker exposures to this hazard but has not initiated any rulemaking at this time.  In the year 2000, 12 states filed 17 bills to address the issue of workplace violence and two, so far, have become law. (See WA & VA).

This bill requires private and public health care employer(s) of five or more employees, to evaluate, in cooperation with its employees and any labor organization representing its employees, all factors which may put any of the employees at risk of workplace assaults and violence. The employer is required to develop and implement a program to minimize the danger of workplace violence to the employees, including employee training and a system for the ongoing reporting and monitoring of incidents and situations involving violence or the risk of violence. The bill requires that the program be described in a written violence prevention plan made available to affected employees and any labor organization representing them. The plan shall include a list of factors endangering the employees, a description of the methods that the employer will use regarding each factor, such as the use of security, equipment, changes in job design, staffing, and employee training; and a description of the reporting and monitoring system. 

In addition, each employer must appoint a senior manager responsible for the development of a crisis response team that shall implement an assaulted staff action program.  Research has shown that such acute action plans reduce staff-turnover, sustain productivity and reduce sick leave utilization.  Flannery, Raymond “The Assaulted Staff Action Program: Coping with the psychological aftermath of violence in health care settings,” Journal of Healthcare Safety, Compliance & Infection Control p.322-324. (1999).  Services under the program shall include the provision of crisis counseling and support services for any employee affected by violence in the work setting.  Professional referrals shall also be made available.

The commissioner of the Department of Labor shall adopt rules and regulations necessary to implement the act and shall include guidelines regarding appropriate programs, reporting and monitoring systems and employee training.  Any employer violating this section may be fined for each offense and the Department of Labor, the person aggrieved or a labor union officer may file a written complaint of such violation in the district court.  In the event the attorney general deems that a violation of this standard exists, a cease and desist order may be sought by him to close said work site.  Further, no employee shall be penalized for providing notice of an employer violation of this section. 

Lastly, the bill acknowledges those health care professionals who have worked as state employees for more than ten years in settings where workplace violence and risk is very high.  On behalf of their exposure to violence in the work setting and their contributions, these employees are classified as group 4 professionals for purposes of the state retirement system.
 

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Fact Sheet

An Act Relative To Group Four 
For Health Care Professionals

Within our public system of health care delivery, there are professionals who risk their own personal safety every day.  These professionals work with violent or potentially violent populations.  Currently, there is no system for recognizing this commitment among health care providers who work in these settings.

Under this legislation, for those public health care professionals who risk their own personal safety and work with violent or potentially violent populations for ten years or more, their retirement would be elevated to Group 4 under the Contributory Retirement System for Public Employees. 
 

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Fact Sheet

An Act Regarding Insurance Equity 
For Registered Nurse First Assistants, “RNFAs”

SEEKING EQUITY: This bill was filed to ensure parity of treatment among the RNFA and other surgical first assistants, whose valuable contributions to patient care have been measured and documented by past billing mechanisms.  Managed care contract negotiations rely on the availability of competitive health care providers.  Massachusetts RNFAs respectfully request that equitable value be attributed to services provided to surgical patients within the lawful scope of RNFA practice.  This is not an additional insurance mandate, but a mandate that all certified providers of this service be acknowledged as providers.   The Maine legislature surveyed commercial insurers regarding the anticipated cost of passing this legislation.  That survey indicated that commercial insurers unanimously agreed that “no cost increase” would be incurred by passage of RNFA legislation.

A law which values the RNFA equitably with any other health care provider who provides this service avoids the discriminatory billing practice of favoring one practitioner over another.  In addition to assisting in surgery, the RNFA may also be involved in pre and post operative assessment and teaching.  Through patient education and counseling, RNFAs aid in decreasing the frequency and length of costly hospital stays.

QUALITY CARE Registered nurses have been practicing as surgical assistants since the late 1800’s.  In fact, 27 out of 56 Massachusetts Hospitals surveyed in February 1997 utilize RNFAs.  Physicians and institutional employers in all surgical settings and specialties recognize the quality and value of services rendered by RNFAs.  RNFAs meet national certification standards as established by the Association of Operating Room Nurses and are nationally recognized by the American College of Surgeons, the American Nurses Association and all 50 State Boards of Nursing.

COMPETENT PROFESSIONALS RNFAs are highly experienced professional nurses who function in an expanded role as first assistants in surgery.  Through post-basic education, the RN acquires technical skills, knowledge and judgment necessary to assist the surgeon in performing a safe operation, which yields optimal results for the patient.  They hold certification in both the specialty of “perioperative nursing” and cardiac life support, and are graduates of an accredited RNFA program.
 

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Fact Sheet

An Act Authorizing The Sale Of  "RN" Distinctive Registration Plates
 

In response to the shortage of registered nurses, the Massachusetts Nurses Association has filed the following legislation.  The bill would establish a separate fund, titled “For the Future of Nursing”.  Revenue would be collected in this fund from the sale of distinctive RN license registration plates and through the any appropriations, gifts or donations made to such fund.  The additional cost of purchasing an RN license plate shall be $25.  The Massachusetts Nurses Foundation, Inc. would be given authority to expend these funds for the purpose of recruiting and retaining a core of registered nurses in Massachusetts.  Scholarships and grants would be awarded to students of registered nursing programs and to registered nurses seeking academic advancement.  Consideration will be given to applicants from culturally diverse backgrounds.

The registrar shall make these distinctive RN license registration plates available to the public for purchase, no later than June 1, 2002.