New Bill to Protect Patients Draws Strong Support from Legislators As Reports Show Mass. Patients Receiving Poor Patient Care
86 Lawmakers Sign on as Co-Sponsors for Measure to Require Safer Patient Limits for Nurses Working in Massachusetts Hospitals
CANTON, Mass. — In the wake of two recent reports showing Massachusetts hospitals rank near the bottom nationally for patient readmissions and certain types of preventable infections, 86 Massachusetts legislators have already signed on as co-sponsors to the Patient Safety Act, legislation filed by the Massachusetts Nurses Association that will dramatically improve patient safety by establishing a maximum limit on the number of patients assigned to a nurse at one time, while also requiring hospitals to adjust nurses’ patient assignments based on the specific needs of the patients. The announcement of this important patient safety measure comes as the National Patient Safety Foundation celebrates Patient Safety Awareness Week – March 8 - 14.
The filing of the Patient Safety Act (H 1958) follows the legislature’s unanimous passage of a landmark law last year to establish safe patient limits for nurses working in hospital intensive care units. The new law will extend appropriate, scientifically-based limits to all areas of the hospital. The lead sponsors for the bill are Senator Marc Pacheco (D-Taunton) and Representative Denise Garlick, RN (D-Needham). Editors/reporters note: to assist you in identifying co-sponsoring legislators in your coverage area, a complete list of all the co-sponsors can be found at the end of this release.
“I am proud of the work the Legislature has done on Healthcare in this decade,” Garlick stated. “We have said yes to access and we have said yes to cost containment, now we must say yes to safe quality care, not just in the ICUs of the all hospitals in the Commonwealth but in all units of all hospitals where patients need and deserve this quality care. The key is safe staffing limits. Erratic staffing decisions lead to medical errors, complications, readmissions, and death. This is unacceptable in the Commonwealth.”
Dozens of studies and reports have shown the need to set a maximum limit on the number of patients that can be assigned to each registered nurse if we are to avoid – medical errors, serious complications, hospital acquired infections and preventable readmissions.
In the last two months, two reports have been published which show Massachusetts hospitals rank near the bottom nationally in preventing these types of complications. For example, a Kaiser Health News report detailing the 2015 penalties for hospitals under the Medicare program for preventable readmissions found that Massachusetts has the fourth worst rate of preventable readmissions. Patient readmissions refer to instances where a patient has to be readmitted to the hospital within 30 days of discharge due to complications caused by poor care during the patient’s initial hospital stay. A second report, issued by CDC last month also found that Massachusetts ranks fourth worst nationally for incidents of Catheter Associated Urinary Tract Infections. Massachusetts hospitals’ incidence of these preventable infections is a shocking 58 percent above the national average. Again, there are several studies that clearly show that both readmissions and hospital acquired infections can be significantly reduced with safer patient limits for nurses.
In addition to these reports, a recent survey found that nearly 8 in 10 registered nurses in Massachusetts hospitals say that patient care is suffering because hospitals require nurses to care for too many patients at once, and nearly 9 in 10 nurses support the Patient Safety Act. A survey of physicians in Massachusetts found 6 in 10 report that hospital care is suffering because of excessive patient loads for nurses, and a majority support the law.
As legislators undertake consideration of this bill, conditions in Massachusetts hospitals continue to deteriorate as hospitals and hospital networks look to cut nurse staffing levels, increase patient assignments for nurses and implement a number of dangerous staffing practices, utilizing manufacturing-based management practices to cut costs and boost hospital profit margins, which surpassed a billion dollars in the last year.
In fact, in recent months, nurses working in hospitals from the Berkshires to Cape Cod have taken to the streets, conducting demonstrations, informational picketing, petition signings and community forums to warn their employers and the public about dangerous staffing cuts and increases to their patient assignment load. Last month, nurses at Newton Wellesley Hospital began leafleting patients outside their hospital to protest cuts to staffing in the hospital’s busy emergency Department. In December, nurses at Berkshire Medical Center, Cape Cod and Falmouth Hospitals, and Leominster Hospital held demonstrations outside their hospitals to protest unsafe conditions. In August, nurses at Brigham & Women’s Hospital held a press conference to alert the public of dangerous conditions for critical care patients due the hospitals refusal to follow the ICU law, and in July nurses from throughout the UMass Memorial Health Care system conducted a press conference to protest dangerous conditions at both campuses of UMass Memorial Medical Center in Worcester and at Marlborough and Leominster Hospitals.
“In Massachusetts, outside of the ICUs, there is no law that states the maximum number of patients a nurse can safely care for at any one time, nor is there any requirement for hospitals to adjust their staffing levels based on the actual needs of the patients,” said MNA President Donna Kelly-Williams. “As a result, hospitals are forcing nurses to ration care, placing patients’ health in jeopardy. The Patient Safety Act will ensure patients receive the care they need and deserve, when they need it, preventing thousands of patient complications, saving hundreds of lives, and yes, saving millions of dollars that are being wasted now because patients aren’t receiving adequate, timely care from their nurse.”
Massachusetts is one of several states and the District of Columbia to have filed legislation in the last two years to create a maximum limit on the number of patients that can be assigned to nurse at one time. California passed its landmark bill in 1999, with full implementation in 2004. Since then, the law has proven to be a resounding success, with studies showing improved patient outcomes and safety. And contrary to industry claims, not a single hospital has closed as a result of the law, and in fact, hospital profits dramatically increased since the law’s passage.
Last year, Boston College Researcher Judith Shindul Rothschild presented groundbreaking findings of two recently published studies that for the first time provide concrete, peer-reviewed data comparing standards of nursing care and patient outcomes for hospitals in Massachusetts, where there is no limit on nurses’ patient assignments, and California, where such a law has been in place for nearly a decade. Rothschild’s study provides conclusive evidence that Massachusetts hospital nurses are caring for significantly more patients than their counterparts in California and that patients in Massachusetts are receiving over three hours less care per day from registered nurses than patients on the West Coast (just over six hours of care for patients in our hospitals vs. over nine hours of care per day in California).
“From the public’s perspective, it is absolutely in their interests to support this legislation so that when they’re in the hospital or a loved one is in the hospital, there is no doubt there will be an adequate number of registered nurses to care for them to assure they get safe, quality nursing care,” says Shindul-Rothschild, whose article in the Journal of Nursing Care Quality showed an association between nurse staffing in Massachusetts and a higher rate of readmissions for heart failure. She points out that heart failure is the most common and the most expensive condition for which patients are admitted to hospitals, and the number one cause of death in America.
“The research is clear and unequivocal, the most important factor contributing to the health and safety of patients while they are in the hospital is the number of patients your nurse is assigned to care for during his or her shift,” explained Kelly-Williams. “The fact is patients in our hospitals are at greater risk because they are being forced to share their nurse with too many other patients at the same time.”
Fact Sheet on the Patient Safety Act – What it Does
Outside the intensive care unit, there is no law and there are no standards in existence for the number of patients that can be assigned to a nurse at one time in Massachusetts hospitals, and there are no requirements for hospitals to provide an adequate level of nursing care. It is not uncommon for nurses in Massachusetts to have six, seven or even eight patients at a time, when a safe limit would be no more than four patients for a nurse on a typical medical/surgical floor. This legislation attempts to reverse these trends by setting safe patient assignment limits that are sufficient to care for the planned and unplanned needs of patients. It is based upon significant nursing research and experience. The major provisions of the legislation include:
- Maximum safe patient limits for nurses will be established for different types of units/departments in a hospital. The proposed law calls for one nurse for every four patients in medical/surgical units, where most patient care takes place. In emergency departments, the proposed regulations require nurses to care for between one and four patients depending on the severity of the patient conditions, and there are specific maximum limits for all other areas of the hospital based on scientific research and accepted professional standards.
- To provide flexibility in staffing and to account for patients who require more care, the bill calls upon a state agency to establish an “acuity” system, which is a standardized formula for rating the illness level of patients (a tool to measure how sick the patients are on a particular unit). Based on the acuity of the patients assigned to a nurse, the maximum safe patient assignment will be reduced if those patients require more intensive care. Right now, there is no law or regulation that requires hospitals to adjust RN staffing based on patients’ needs, and as a result, most hospitals rarely make such improvements.
- All acute care hospitals will be required to adhere to these safe patient assignment standards and the acuity scale.
- Hospitals will not be allowed to meet the necessary RN staffing standards for the safe patient assignment limits by diminishing other members of the health care team.
- Hospitals found by the state to have violated the law will be subject to a $25,000 fine for each day they fail to be in compliance.
Listing of Legislative Sponsors
LEAD SPONSOR: Marc R. Pacheco (D-Taunton)
Thomas M. McGee (D-Lynn)
Thomas P. Kennedy (D-Brockton)
Sal N. DiDomenico (D-Everett)
James E. Timilty (D-Arlington)
James B. Eldridge (D- Acton)
Jennifer L. Flanagan (D-Leominster)
Michael O. Moore (D-Millbury)
Patricia D. Jehlen (D-Somerville)
Barbara L'Italien (D-Andover)
John F. Keenan (D-Quincy)
Linda Dorcena Forry (D-Dorchester)
Michael F. Rush (D-West Roxbury)
Robert L. Hedlund (R-Weymouth)
Daniel A. Wolf (D-Harwich)
LEAD SPONSOR: Denise C. Garlick (D-Needham)
Paul W. Mark (D-Peru)
Michael J. Finn (D-West Springfield)
Gailanne M. Cariddi (D-North Adams)
Ann-Margaret Ferrante (D-Gloucester)
Brian M. Ashe (D-Longmeadow)
Sarah K. Peake (D-Provincetown)
Chris Walsh (D-Framingham)
Claire D. Cronin (D-Easton)
Benjamin Swan (D-Springfield)
Louis L. Kafka (D-Stoughton)
Denise Provost (D-Somerville)
Marjorie C. Decker (D-Cambridge)
John J. Lawn, Jr. (D-Watertown)
Tackey Chan (D-Quincy)
Daniel Hunt (D-Dorchester)
Aaron Vega (D-Holyoke)
Robert M. Koczera (D-New Bedford)
Geoff Diehl (R-Whitman)
Sean Garballey (D-Arlington)
James J. Dwyer (D-Woburn)
Michael D. Brady (D-Brockton)
William C. Galvin (D-Canton)
Lori A. Ehrlich (D-Marblehead)
David Paul Linsky (D-Natick)
John Velis (D-Westfield)
Angelo J. Puppolo, Jr. (D-Springfield)
David M. Rogers (D-Cambridge)
Peter V. Kocot (D-Florence)
Diana DiZoglio (D-Methuen)
Carmine Gentile (D-Sudbury)
RoseLee Vincent (D-Revere)
Edward F. Coppinger(D-Boston)
James J. O'Day (D-West Boylston)
Ruth B. Balser (D-Newton)
Danielle W. Gregoire (D-Marlborough)
Brian R. Mannal (D-Barnstable)
Mary S. Keefe (D-Worcester)
Kevin G. Honan (D-Brighton)
John J. Mahoney (D-Worcester)
Tom Sannicandro (D-Ashland)
Timothy J. Toomey, Jr. (D-Cambridge)
Brendan P. Crighton (D-Lynn)
Aaron Michlewitz (D-Boston)
Timothy R. Madden (D-Nantucket)
Jeffrey N. Roy (D-Franklin)
Daniel Cullinane (D-Dorchester)
Michael D. Brady (D-Brockton)
Thomas M. Stanley (D-Waltham)
Christine P. Barber (D-Somerville)
Walter F. Timilty (D-Milton)
Daniel M. Donahue (D-Worcester)
Josh S. Cutler (D-Duxbury)
Stephen L. DiNatale (D-Fitchburg)
Nick Collins (D-Boston)
Paul McMurtry (D-Dedham)
Harold P. Naughton, Jr. (D-Clinton)
Frank I. Smizik (D-Brookline)
Daniel J. Ryan (D-Charlestown)
Kimberly N. Ferguson (R-Holden)
Michelle M. DuBois (D-Brockton)
Thomas A. Golden, Jr. (D-Lowell)
Antonio F. D. Cabral (D- New Bedford)
Ellen Story (D-Amherst)
Jonathan D. Zlotnick (D-Gardner)
Mark J. Cusack (D-Braintree)
Michelle M. DuBois (D-Brockton)
Elizabeth A. Malia (D-Jamaica Plain)
Marcos A. Devers (D-Lawrence)
Dennis A. Rosa (D-Leominster)
Thomas M. Stanley (D-Waltham)