Massachusetts Nurse :: October 2005

MNA continues opposing placement of patients in halls

The MNA is continuing its campaign to stop a new policy of the Massachusetts Department of Public Health that allows patients to be boarded and cared for in hallways and corridors of inpatient units as a means of dealing with the problem of emergency department overcrowding. Two meetings have been held with DPH to discuss the issue with a request that the policy be rescinded. The DPH has refused.

“While we are all concerned about the problem of emergency department overcrowding this is not the solution,” said Karen Higgins, RN, past president of the MNA and a practicing intensive care unit nurse at Boston Medical Center. “In fact, this policy is a recipe for disaster that would only place patients in greater danger.”

As of this printing, there have been no reports of the policy being implemented at any hospital represented by the MNA. However, we have received anecdotal reports of patients being boarded in hallways on inpatient units in non-union hospitals. There is also rumored to be a “gentleman’s agreement” among hospital CEOs to avoid ambulance diversion at all costs, thus placing tremendous stress on emergency departments across the state, which threatens to exacerbate the problem.

The policy to allow hallway patients on inpatient units was adopted by DPH last January. The MNA approved a position statement opposing the policy at its April 21 Board of Directors meeting, after it had received reports from its members at some hospitals that the policy might begin to be implemented in May. The MNA opposes the policy on the grounds that it:

• Endangers patients and results in degrading and substandard care
• Violates patients’ rights to dignity and privacy, including numerous HIPAA violations
• Violates fire safety codes
• Violates numerous infection control standards
• Violates the Nurse Practice Act, nursing standards of practice and professional ethics

As a result, the MNA has advised its members against accepting any assignment of patients placed in the hallway of an inpatient unit and believes that the current practice of allowing hallway patients in the emergency department should also be prohibited. The MNA has been working on the bargaining unit level and the state level to resolve ER overflow and diversion issues.

As stated in the MNA’s original position statement, “Nurses, both in the emergency department and inpatient units, are already working to their full capacity and, under the current unsafe staffing conditions in hospitals, are caring for far too many patients to provide appropriate care. Now we are asking those nurses to be assigned additional patients who must be cared for in an environment (hallways) that is not conducive to the delivery of any standard of appropriate care. In so doing, they not only jeopardize the safety of the new patients in the hallways, but would now be forced to provide their existing patients with substandard care as well.

“Unless all surrounding hospitals have no staffed beds available to admit patients, it is clearly safer for patients to be stabilized and transported to another facility than it is to place them in an environment that puts them and all other patients on that unit at such great risk.”

In fact, this was the expressed policy on how to handle ED overcrowding by the DPH, as outlined in 2001 report. That report also called upon DPH to initiate a number of changes in how they handle patient flow and discharge, which the industry has since failed to implement. “Now, at the industry’s urging, instead of fixing the problem, the DPH has joined with hospitals in condoning a policy that degrades the care of patients, as opposed to holding the hospital industry accountable for implementing the system-based changes required,” Higgins explained.

Immediately following the release of the position statement, the MNA began educating the leadership of local bargaining units about the problems with the DPH’s policy and the MNA’s position. The MNA, through the local leadership of its local bargaining units on the hospital level, has informed hospital administrators that we will not tolerate this practice and intend to educate local communities of the dangers of this practice should an attempt be made to implement it.

The MNA has also been reaching out to other interested parties regarding this dangerous policy to seek their support. To date, the Boston and Worcester firefighters associations have sent letters of support for the MNA position opposing the policy to DPH, citing serious fire safety concerns. In addition, the MNA is reaching out to a number of health advocacy organizations to alert them of the inherent dangers of this policy. The Greater Boston Diabetes Association has already endorsed the MNA’s position.

The Emergency Nurses Association has informed the MNA that it supports the DPH policy with the rationale that since emergency department nurses are forced to care for patients in hallways, it is acceptable for nurses on inpatient units to do the same.

In a response letter to ENA the MNA suggested a meeting between the two groups to discuss the situation, the MNA reiterated its position by stating, “The MNA is opposed to the placement of patients in hallways of emergency departments as well as for inpatient units. ED overcrowding is a system-wide problem that requires a system-wide solution, however, moving patients from one unsafe environment (an ED hallway) to an equally unsafe environment (inpatient hallway) is not a real solution—it’s a travesty and an abrogation of nurses’ role as patient advocates.”