Nursing Commission Issues Report on Nursing Crisis Echoes MNA Concerns, Calls for Legislation to Mandate Staffing and End to MOT

Click here to read the report.

The "Legislative Special Commission on Nursing and Nursing Practice" today issued its long-awaited official report on the nursing crisis in Massachusetts. It's key conclusions are startling and send a wakeup call to the health care system and those who depend on the system that there are serious problems with the quality of nursing care in the Commonwealth driven by a widespread deterioration of working conditions for nurses.

The report opens with a letter from the chairmen of the Commission, Brockton Senator Robert S. Creedon, Jr. and Brockton Representative Christine E. Canavan, RN, which clearly states the overriding message of the report: "Licensed nurses and the patients are inextricably linked. If the working conditions of the licensed nurse improve, direct patient care improves. If patients' concerns for quality care are met, the working conditions for the licensed nurses have been addressed. Their relationship is symbiotic."

The report contains findings on the current state of nursing practice and recommended legislative solutions to problems identified by the commission, which spent last year investigating concerns of nurses.

According to the report, "It is the unanimous consensus of licensed nurses, health care personnel and administrators that the short of nursing care in the Commonwealth is endangering the quality of care that our nurses can provide to the patient….The Commission is called upon to encourage the Commonwealth to take a leadership role; to commit her expertise and resources in support of quality patient care, to increase retention of experienced licensed nurses, to recruit prospective nursing students and to ensure safety for our sick and elderly, our school children and our nurses, with safe practice guidelines for staffing and caregiving."

The leadership of the Massachusetts Nurses Association (MNA), along with nurses from MNA working at facilities from throughout the Commonwealth were on hand at the State House today. A large delegation of nurses attended the briefing from Brockton Hospital, who are currently entering the 24th day of their strike over the very issues of concern highlighted in the report. The MNA applauded the report for its findings that echo and amplify the messages sent by MNA members to policy makers for the last six years. Many of those who testified before the Commission were MNA members.

The report cited the key nursing concerns "that consistently dominated each hearing" held by the Commission throughout 2000. They include:

• Staffing of licensed personnel and their ability to practice safely

• Mandatory overtime and its effect on the nursing personnel and their ability to practice safely

• Workplace violence as a result of inadequate staffing, licensed and non-licensed

• Changing preferences for nursing as a profession, and the ability of nurse education programs to meet the needs for nurses and nursing students

• Complaints (that are really systemic) are being filed at the Board of Registration in Nursing against the only licensed personnel, the nurse

• Specialty nursing and how this field is affected by the nursing shortage

• The report states that patients in our state have had their access to necessary professional nursing care limited by the following factors:

• Hospital stays are limited, so that patients maybe discharged in unstable conditions.

• Hospitals and hospital beds are closed.

• Insurers have limited nursing home care visits

• Unlicensed personnel have replaced nursing professionals

• Occupational related illness and injury have reduced nurses from the workforce.

Staffing and Mandatory Overtime Are Key Problems

The report singled out nurse staffing and the inadequacy of nurse staffing as a major problem. In fact, the report states, "short staffing of nurses combined with faulty systems is a ticking time bomb. Patients in understaffed environment are at risk for inadequate assessment of their condition, increased infection rates, skin breakdown, medication errors, inadequate pain management, falls and inadequate preparation for discharge. There is a positive correlation between an increase in licensed nursing staffing levels and reduction in medical errors and complications."

The report places the onus on hospital and health care administrators to address the issues of staffing head on. "Staffing must include factors such as the patient's acuity level. There are no staffing guidelines except for dialysis and Intensive Care Units. Instead of short staffing a unit and then spending all their time trying to catch nurses making mistakes, administrators must provide assistance to the nurses by providing the resources needed to delivery good patient care."

One of the key manifestations of short staffing identified in the report, and singled out for specific attention by policymakers was the issue of mandatory overtime. According to the report, "Mandatory overtime, which forces tired nurses to work extra hours beyond their scheduled shifts, is a negative working condition directly attributable to short staffing. Negative working conditions such as this contribute to the unattractiveness of the profession further exacerbating the nursing shortage. Because of nurses' concerns for patient safety, they have valid fears that understaffed and exhausting hours do contribute to increase medication errors, patient safety, infection and other poor patient outcomes."

The report concludes that poor working conditions is what is driving the nursing shortage and the problems identified by the report. It states, "Nurses licensed to practice in Massachusetts are working in a health care system that is hurting from personnel shortages and financial cutbacks. This system forces them to work in an environment that is not conducive to excellent quality care. Their working conditions are stressful for all and intolerable for many. They feel that there is little to no support for them and therefore there is no help forthcoming. They are leaving the profession in numbers that are alarming. Licensed nurses are scared of what the future holds for them. They want better working conditions so that they can practice safely and compassionately."

The report also cited the dramatic rise in workplace violence against nurses in recent years, which again, is being driven by poor staffing conditions. It also cites the rise in injuries to nurses due to unsafe conditions. The report states that nursing is among the most dangerous professions. "Safety issues include the health of nurses who lift patients and lack of adherence to OSHA Standards (ergonomics), latex allergy, the quality of indoor air that is found in our institutions, and serious back injuries.

The report urges the Commonwealth to take steps to recruit and retain nurses with an emphasis on retention. The most important step in retaining nurses is to improve the working conditions that are driving thousands of nurses out of practice, or keeping new nurses from coming into the profession.

To improve working conditions, the report offered six recommendations:

• Legislation to limit mandatory overtime to a level that would permit nurses to work in optimum physical and psychological condition.

• Legislation to establish patient/staff guidelines that are based in reality and based on patient acuity levels.

• Comprehensive legislation to improve the image of nursing as a profession and entice and retain women/men into the field.

• A legislative study of the constraints that nursing schools are under whether regulatory or financial and recommendations for relief.

• A legislative study of BORN's scope of power and whether it should be expanded to include licensing support services that take into account system failures that can lead to errors.

• Licensed nurses who are currently practicing must be included on all levels when studies are being done and legislation is being written. They the best judge of acuity they are the patient's first line of care.

Click here to read the report