Safe Staffing

Compromise Bill on RN Staffing in Hospitals is Approved by Public Health Committee, Clearing Hurdle for a House Vote on May 23rd

05.18.2006

Measure Calls for Safe Limits on Nurses’ Patient Assignments, Prohibits Mandatory Overtime and Includes Initiatives to Increase Nursing Faculty & Nursing Scholarships

MNA Applauds the Measure as a Balanced and Fair Solution that will Protect Patients While Addressing Every Concern Raised by the Hospital Industry

BOSTON, Mass. —T he Massachusetts Nurses Association and the 104-member Coalition to Protect Massachusetts Patients applaud the vote on Wednesday by the Public Health Committee to endorse and release for a vote a compromise bill to guarantee safe RN staffing in all Massachusetts hospitals. The measure, which was crafted after more than 15 hours of negotiations between legislative leaders, the Massachusetts Nurses Association and the Massachusetts Hospital Association, calls upon DPH to set safe limits on nurses’ patient assignments, prohibits mandatory overtime and includes initiatives to increase nursing faculty and nurse recruitment.

 The redrafted "Patient Safety Act, H. 2663," will now move to the floor of the House of Representatives for a debate and vote on Tuesday, May 23. Frontline nurses from across the Commonwealth, who have waited ten years for a vote on this measure, will be closely monitoring the debate and vote.

“We commend the Public Health Committee for their favorable vote on this bill and we look forward to a successful vote in the full House,” said Beth Piknick, president of the MNA.

According to Julie Pinkham, executive director of the MNA who sat in on all of the negotiations, the redrafted compromise addresses all of the objections expressed by the hospital industry.

The hospital industry had objected to having legislators set staffing levels. The compromise bill directs the DPH to set the staffing limits. The hospital industry opposes a rigid ratio. The compromise provides for staffing based on patients needs. The hospital industry said setting limits will cause financially strapped hospitals to close. This bill provides hospitals in legitimate financial distress an extension and oversight to reach compliance. The hospital industry said we need to focus on recruitment of nurses. This measure includes the recruitment initiatives put forth by their own bill, while giving hospitals time to prepare for the implementation of the staffing changes.

 A key addition to the final language released yesterday is a provision to protect valuable members of the patient care team who support nurses in caring for patients, which was the major sticking point identified by the hospital industry following the completion of negotiations on the compromise bill. The new provision prevents “understaffing of other critical health care workers, including licensed practical nurses and unlicensed assistive personnel.”

 “Everybody wins here; hospitals, nurses, and most important of all, the patients,” Pinkham said.

 Key components of the bill include: 

  • Directs the Massachusetts Department of Public Health to develop and implement specific minimum RN staffing standards for all units in the state’s acute care hospitals, which would include an optimum RN-to-patient assignment, as well as an enforceable limit on the number of patients assigned to each registered nurse.
  • The staffing standards would be developed within 12 months of the bill’s passage and be based on scientific research on nurse staffing levels/patient outcomes, expert testimony and standards of practice for each specialty area.
  • The bill calls for the safe staffing limits to be implemented in all teaching hospitals by 2008, with implementation in all community hospitals by 2010.
  • Provides flexibility in staffing and accounts for patients who require more care. The measure calls on DPH to create a standardized acuity-based patient classification system, which is a standardized formula for rating the illness level of patients. Based on the acuity of the patients assigned to a nurse, if those patients require more intensive care the nurse would be assigned fewer patients.
  • Prohibits the practice of assigning nurses mandatory overtime as a means of staffing the hospital.
  • Allows hospitals that can prove a financial inability to comply with the law to delay implementation of the staffing standards, with oversight provided by DPH.
  • Assures that institutions cannot delegate to unlicensed personnel duties which demand nursing expertise. Throughout the 1990s, the hospital industry attempted to cut costs by replacing nurses with unlicensed personnel, which led to deterioration in patient care and led to the exodus of nurses from bedside care.
  • Establishes a number of nurse recruitment initiatives sought by the hospital industry, and supported by MNA, to increase the supply of nurses, including nursing scholarships and mentorship programs, and support for increases in nursing faculty to educate new nurses. It also would create refresher programs to assist nurses in returning to practice at the hospital bedside. A survey of Massachusetts nurses found that more than 65 percent of those not practicing in hospitals would be likely to return if a law providing safe limits was passed.
  • Establishes strong consumer protections for safe RN staffing, including a prominent posting of the daily RN staffing standards on each unit.
  • Calls upon DPH to monitor compliance and to investigate violations, with the ability to impose fines.