MNA Reaction to the Health Policy Commission’s Vote to Approve Final Regulations Underpinning ICU Law Setting Safe Patient Limits for Nurses in Hospital ICUs
MNA Applauds Decision to Follow Law’s Intent by Ensuring Neonatal Intensive Care Units are Covered Under the Law
HPC Rejects Cynical Attempt by MHA to Exclude Safer Care Standards for the Most Vulnerable Newborns
The Health Policy Commission voted today to approve final regulations underpinning the ICU Safe Patient Limits Law, which was enacted last year to ensure patients in Mass hospital ICUs receive one-on-one care from their registered nurse, while allowing a nurse to take a second patient if and when it is deemed safe to do so. The regulations approved today put in place a process for hospitals to follow in developing a tool nurses can use, known as an acuity tool, to assist them in determining when patients are stable enough to allow a two-patient assignment.
The most important development coming out of today’s meeting was a decision by the HPC to follow the intent of the law, which calls for the law to apply to all ICUs, including neonatal intensive care units. The MNA applauds the HPC’s decision to follow the intent of the law, and to reject a cynical attempt the by Massachusetts Hospital Association to convince the HPC to exclude neonatal and pediatric intensive care units from coverage under the law.
“We couldn’t imagine how any responsible public official could support a policy that provides a lower standard of care for critically ill babies, and we are very pleased that the HPC came to the same conclusion and agreed to follow the law,” said MNA President Donna Kelly-Williams, RN, who is a maternity nurse at Cambridge Health Alliance.
While applauding the decision to include all ICUs, the MNA has serious concerns about these regulations, including:
The regulations fail to clearly state the law’s key intent, which was that there is a default one nurse to one patient standard of care for all patients in ALL ICUs. Our fear is that the industry will use the vague language in the regulation to avoid meeting the one-to-one standard for patients that clearly need that level of care – which is happening every day in most of our state’s hospitals.
- The regulations call for the committees formed at each hospital to create an acuity tool to support nurses in determining if and when they can take a second patient to be only “advisory” in nature, leaving management with the final say on what tool is submitted to DPH for certification. The committees formed under these regulations at each hospital are to include at least 50 percent ICU staff nurses. Senior management should not have the power to overrule or undermine the acuity tool ICU nurses at their hospital have developed to ensure the safety of their patients.
- The regulations appear to allow management to step in and guide staffing decisions when a nurses’ assessment is in conflict with the acuity tool (the intent of the law was for nurses on the unit to have sole discretion on determining patient stability, and the tool was there to augment that process, with management having a say only when the staff nurses on the unit couldn’t agree). As written, the nurse’s judgement and the tool appear to be given equal weight and again, management is given the authority to step into the decision making process when a nurse and the tool disagree. The failure of hospital administrators to provide nurses with safe patient assignments and the resources nurses need to deliver safe patient care was the driving force behind the law’s creation and passage. The clear intent of the law was to place decisions regarding the level of care for patients in the hands of those accountable for the patient’s care – the frontline staff nurse on the unit – specifically removing managers and administrators from that process.
- The regulations fail to ensure that notice of the law is posted in all ICUs so that patients and their families are informed of the standard of care called for under the law. The regulations also call for very limited and lax reporting. We believe that patients and their families have a right to know about this law and of their right to receive a safe standard of care. Providing patients with this information upon admission and the ability to report violations is key to ensuring the law is upheld and enforced.
Despite these concerns, the MNA intends to pursue any and all means to ensure that the true intent of the law and the safe standard of care it dictates for critically ill patients is followed to ensure patients in our hospitals are as safe as possible.
The MNA was shocked to learn at the meeting two weeks ago by the HPC’s Quality Improvement Patient Protection Committee that the committee had not made a final determination as to whether NICUs should be covered by the new law, despite the fact that this is what the law clearly stated and intended. They have left the question of inclusion of NICUs in the law up for a discussion and decision by the full Health Policy Commission.
The HPC Quality Improvement and Patient Protection (QIPP) Committee has held two listening sessions to collect general comment and testimony on issues related to implementation of the law, including the formulation of acuity tools, methods of public reporting, and relevant patient safety quality indicators.
Representatives from the Massachusetts Nurses Association, along with other health care and consumer advocacy groups and legislators who drafted this law, provided testimony at the public hearings on March 25 and April 2 to express our serious concerns about the initial “draft” regulations and where we advocated for needed changes to ensure the intent of the law is followed.