6.22.2002

Improving the RN-to-patient ratio
By Karen Higgins

EVERY DAY in Massachusetts, patients in our hospitals push a call button and wait ... and wait ... for a registered nurse to come to their aid. You could be one of those patients. You might be in severe pain, or frightened or disoriented. You need help, but you wait, sometimes for hours, to receive the care you need. Fortunately, in some cases the wait causes no serious harm. But with some frequency, the lack of a quick response from a nurse can trigger a downturn in a patient's condition, or lead to a serious and costly complication. And a two-day hospital stay could turn into a six-day stay.

This is why it is critical that legislation pending on Beacon Hill to set registered nurse-to-patient ratios and insure safe patient care be passed. The measure is vital to ending dangerous delays in attending to urgent patient needs.

Why is the patient waiting? Why isn't the nurse responding? The answer: insufficient RN staffing.

A groundbreaking study published in the New England Journal of Medicine in May made the consequences of RN understaffing all too clear. The study, which reviewed the records of more than 6 million patients in 11 states, including Massachusetts, showed that poor RN staffing leads to increased patient complications, while higher RN staffing results in better outcomes.

The cause of the poor staffing conditions in our hospitals is at the center of an intense debate being waged in hospital boardrooms, in the halls of Congress, and on Beacon Hill. Nurses on the frontlines - those who have been working in the system, those who actually answer those call lights, and struggle with increasing patient loads - know why: Patient care has fallen victim to short-sighted financial calculations.

Over the last decade the health care and insurance industries consciously created today's staffing shortages as a cost-cutting measure in implementing a market-driven managed care health care system. There is no shortage of nurses in Massachusetts. We have the highest per capita population of nurses in the nation.  What we really have is a shortage of nurses willing to work in the current risky environment.

In one national survey of nurses, one of five now working is seriously considering leaving the profession in the next five years. But three-quarters of the nurses said they would stay in nursing with better staffing ratios.

Policymakers miss the point if they focus on simply recruiting more nurses. Scholarship programs and incentives to entice students into nursing will help and should be supported. But unless we improve existing conditions, both the new recruits and more experienced nurses will continue to leave the profession.

The real and lasting solution lies in passing legislation similar to that enacted in California to regulate safe registered nurse-to-patient ratios in our hospitals. This is currently being considered by the Massachusetts Legislature.

The California law mandates ratios of one nurse to five patients on a typical hospital floor, and one nurse to two patients in an intensive-care unit. To account for changes in patients' needs and to allow for flexibility, it also mandates that staffing ratios be improved when the patient's condition warrants more nursing care. This is sound public policy that has been met with acceptance by the general public, by the nursing community, and even by California's health care industry.

Support among the public for this legislation is growing in Massachusetts. A recent poll found that more than 75 percent of the public supports legislation regulating nurse-to-patient ratios. Last month more than 80,000 Bay State residents signed petitions calling upon the Legislature to pass a measure requiring an improved RN-to-patient ratio.

If we are to preserve the quality of our health care and protect every patient in Massachusetts, we need to ensure that poor working conditions do not further reduce the supply of registered nurses. Passing RN-to-patient ratio legislation is the first and most important step toward making this a reality.

Sharing can be hazardous to your health if you are a hospital patient and it's your nurse who is being shared. 

Karen Higgins, RN, is president of the Massachusetts Nurses Association. 

This story ran on page A11 of the Boston Globe on 6/22/2002. © Copyright 2002 Globe Newspaper Company.