Advocates For Patient Safety Urge Legislature To Act
Understaffing of RNs Leads to Preventable Medical Errors That Cause Needless Suffering for Patients; Passage of Safe RN Staffing Legislation will Improve Care & Reduce Costs
Public Hearing on The Patient Safety Act To Be Held Sept 20 at the State House
BOSTON, Mass. — Advocates for patient safety from Greater Boston gathered today outside Tufts Medical Center to urge lawmakers to swiftly pass legislation to set limits on the number of patients a hospital nurse must care for at one time along with a companion bill to prohibit the dangerous practice of using mandatory overtime as a means of staffing acute care hospitals. Both measures come before the Legislature’s Joint Committee on Health Care tomorrow, Sept. 20 at 10 a.m. at the Massachusetts State House. Similar events were held outside Cooley Dickinson Hospital in Northampton, UMass Memorial Medical Center in Worcester, North Shore Medical Center in Salem and Cape Cod Hospital in Hyannis.
Holding signs that read “patients deserve safe care” and “safe staffing saves lives,” advocates from the Coalition to Protect Massachusetts Patients (CPMP) spoke out about the dangers of understaffing at area hospitals, and called on elected leaders to pass the two bills, which the best medical research demonstrates will improve the quality of patient care, save millions of health care dollars and prevent thousands of preventable infections and medical errors caused by poor RN staffing in the state’s acute care hospitals.
The Patient Safety Act (HB. 1469), calls upon the Massachusetts Department of Public Health to set safe limits on the number of hospital patients a nurse is forced to care for at one time. The limits would be based on scientific research and testimony from public hearings and, once established, could be adjusted in accordance with patient needs and requirements using a standardized, DPH-approved system. The Bill would also protect against the reduction in the number of other members of the health-care team including LPNs, aides, and technicians. Patients would have the right to know and demand safe limits.
A second bill (HB. 1506) would prohibit the dangerous practice of utilizing mandatory overtime as a means of staffing hospitals such as forcing exhausted RNs to work extra hours or double shifts. Under this bill, a hospital could not, except in the case of a declared state or national emergency, require or permit a nurse (or other hospital worker, such as a nurse’s aide) to work more than 12 hours in any given shift or to exceed 16 hours in a 24 hour period. A nurse who works 12 consecutive hours in a shift must be given at least eight hours off from any work between shifts.
Marilyn Hicks, a member of the Boston Chapter of the Massachusetts Senior Action Council, underscored the importance of the Patient Safety Act for the state’s elderly residents. “I have been an advocate for a number of family and friends who have been hospitalized over the years. I have watched their care deteriorate. And not because their nurses haven’t cared or aren’t working hard, but rather because they are working too hard, running from patient-to-patient to do what they need to do. I have watched my friends and neighbors wait in pain for their nurse to come to administer medications. I have witnessed the suffering caused when nurses have too many patients to care for at the same time…and this practice is unacceptable. The seniors of Massachusetts support The Patient Safety Act because we understand that the issue of safe staffing limits for registered nurses is a senior issue.”
Rich Rogers, executive secretary-treasurer of the Greater Boston Labor Council, also spoke in favor of establishing safe staffing limits as a means of protecting the health of working families throughout Greater Boston.
“When our sons, daughters, husband, wives, grandmothers and grandfthers enter a hospital, we want to know that when they push the call button, their nurse is ready to respond to do whatever is necessary to keep them safe and sound,” said Rogers. “However, when I speak to my members about this issue, they all agree that something needs to be done to stop the stories they hear about what has happened to their friends and loved ones because their nurse had too many patients to care for at one time. In this state, which bills itself as a Medical Mecca, this level of care is unacceptable.”
Barbara Tiller, RN, a resource nurse at Tufts Medical Center highlighted how poor staffing conditions impacted nurses’ ability to deliver the care patients deserve and how those conditions drove more than 1,100 nurses to the brink of strike last May to finally address the problem. Such job actions have become commonplace across the state and the nation as hospitals continue to cut nursing staff, and the legislature fails to act to establish a safe standard of care for hospitals.
“It should not take months of contentious negotiations and near strikes to achieve something as common sense as making sure a nurse has enough time to provide the highest quality of care to each of their patients,” Tiller explained. “It’s time for the legislature to act on this issue so that every patient in every hospital is guaranteed a safe level of care.”
Karen Higgins, RN, a critical care nurse at Boston Medical Center and co-chair of the Coalition to Protect Massachusetts Patients, pointed to numerous studies showing that understaffing of registered nurses leads to many cases of hospital-acquired infections, preventable errors, and avoidable complications. One of those sources, the Massachusetts Coalition for the Prevention of Medical Errors, reports that 2,000 patients — or six people per day — are dying in Massachusetts every year because of preventable infections. Higgins said, “More patients will continue to suffer unless Massachusetts provides nurses with safe patient limits.”
Preventing these and other preventable medical errors would reduce loss of life and could reduce health care costs in Massachusetts by as much as 30 percent, according to a report by William E. Encinosa and Fred J. Hellinger in the July 2008 issue of the journal Health Services Research.
Referring to previous research that looked at the business case for setting a limit on the number of patients a registered nurse is assigned at any given time, the researchers concluded: "It is quite possible that the post-discharge costs savings achieved by reducing adverse events might just be enough for the hospital to break-even on the investment in nursing."
Other studies have found that nurses working mandatory overtime are three times more likely to make a medication error, and when nurses work more than 12 hours hospitals see an increase in patient mortality. The Institute of Medicine has recommended that no nurse ever be required to work more than 12 hours.
“Every day that Massachusetts doesn’t act to fix the dangerous understaffing in our hospitals we are exacerbating a crisis that has led to the squandering of millions of valuable health care dollars,” Higgins concluded. “With all the talk of lowering the cost of health care in Massachusetts, it is more important than ever to protect the quality of care by ensuring that hospital patients have adequate access to registered nurses.
To date, more than 125 of the state’s leading health care and consumer advocacy groups have endorsed the safe staffing bills and have joined the CPMP to push for passage in both the House and Senate.
For more than a decade, the hospital industry has fought furiously to defeat any regulatory measure that would limit their ability to engage in unsafe staffing practices. Different versions of the safe staffing legislation have made it to the House and Senate floors over the past 15 years but have never successfully passed through both chambers.
Key components of the Patient Safety Act include the following:
- The bill directs the Massachusetts Department of Public Health to develop and implement staffing standards and enforceable limits on the number of hospital patients assigned to a registered nurse at any one time.
- 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 2013, with implementation in all community hospitals by 2015.
- The bill allows DPH to grant waivers to hospitals in financial distress.
- The bill provides flexibility in staffing and accounts for patients who require more care. Once established, the staffing levels will be adjusted up or down based on patients needs using a standardized, DPH-approved system for measuring patient needs.
- The Act will reduce errors caused by fatigue and overwork by prohibiting hospitals from forcing nurses into mandatory overtime. It will also prevent hospital administrators from moving nurses into unfamiliar assignments without proper orientation.
- The Act prevents the reduction of support services, including services provided by licensed practical nurses, aides, and technicians.
- The bill establishes strong consumer protections for safe RN staffing, including a prominent posting of the daily RN staffing standards in each unit.