JUNE 18 TESTIMONY

TESTIMONY
JOINT COMMITTEE ON HEALTH CARE
HEARING ON AN ACT ENSURING QUALITY PATIENT CARE & SAFE REGISTERED NURSE STAFFING (H. 1282)
“THE ROLE OF THE REGISTERED NURSE”
KAREN HIGGINS, RN
WEDNESDAY, JUNE 18, 2003

Good morning. My name is Karen Higgins. I am here today as the president of the Massachusetts Nurses Association, an organization that represents more than 22,000 registered nurses and health professionals working in nearly every health care setting in the Commonwealth.

I am also here as a practicing staff nurse who has spent the last 25 of my 28 years working in the ICU at Boston Medical Center.

Before I begin I do want to note that we are very sensitive to the Committee’s time limits per testifier. If the Committee would allow, just my piece of the panel testimony may run over the 3 minute rule as I would like to provide you with the context for the rest of our testimony.

I am here, joined by all these nurses, consumers, doctors and advocates to testify in favor of House Bill 1282 -- a bill that we believe is crucial to protecting patients from cost-cutting measures and ensuring the safety of patients in our hospitals, as well as for addressing and ending the shortage of hospital bedside nurses in the Commonwealth. We are here because every day a patient in Massachusetts places his or her life in jeopardy as he or she is forced to share their nurse with too many other patients.

It is my hope to provide the context for this discussion by describing the role and function of the registered nurse in the care of hospitalized patients.

It is important to remember that the main reason patients are recovering in a hospital today is to receive around-the-clock care from a registered nurse and that it is the registered nurse who spends the most time and has the greatest impact on the quality of patient care.

Because of managed care, patients in our hospitals are sicker than ever, and they stay for a much shorter time. This means that the needs of patients are much greater, which means patients are in need of more nursing care than ever before.

Registered nurses are skilled professionals whose educated mind, eyes and ears are a vital link for the physician. Registered nurses monitor and evaluate a patient’s condition before, during and after high tech medical procedures. It is the registered nurse who adjusts medications, manages pain and side effects of treatments, acts instantly to intervene if there are life-threatening changes in a patient’s condition, or alerts physicians so that they can act to protect their patients.

Registered nurses are highly specialized, just like physicians. There are nurses who specialize, as I do, in intensive care, or those who specialize in emergency care, maternity care, oncology, pediatrics and psychiatric nursing. Each area of practice deals with different conditions, different types of patients, different medications, treatments and medical specialties.

Registered nurses are constantly using their knowledge of physical and social sciences to monitor, assess and protect their patients. For example, I was recently taking care of a patient who was brought into my intensive care unit with a serious infection who was suffering from a condition referred to as Acute Respiratory Distress Syndrome. In this situation, I’m assessing the function of every system in his body. The patient is placed on a respirator and may have at least 4 to 8 intravenous medication and fluid drips designed to maintain his blood pressure to prevent organ failure. These require my constant monitoring and assessment and I’ll need to assess respiratory status continuously. At the same time, I will be monitoring the electrolytes in his blood every few hours, as a slight change can signal a life threatening complication. In this case, because of kidney failure caused by the infection, I will be performing continuous dialysis on the patient. All the time I will be monitoring his heart rate for any changes that may signal a heart attack due to his other organs being affected. I’m prepared to intervene with emergency equipment if necessary. While all this is going on, I’ll have multiple conversations with physicians about the changes in the patient’s condition and will adjust treatments and medications as required.

I, and all nurses, am both legally and ethically responsible for the medications and treatments we administer. If a medication is ordered, I must know its proper dosage and side effects and I am legally obligated to raise a question if I believe it is the wrong drug or the wrong dose or if the medication is contraindicated, because, owing to side effects or other concerns, the drug is not appropriate. In this sense, nurses are the patient’s last line of defense in a system that is supposed to protect them from potentially harmful or lethal human errors.

A patient’s condition can change in an instant. A subtle change observed and acted upon, can prevent a more serious downturn in the patient’s condition. Every nurse in this room could tell you a story of how, while caring for a patient, they noticed something wasn’t right; it could be in the patient’s skin color, in the tone or timber of their voice, the size of their pupils, a slight variance in a lab value that made the nurse look deeper, something that made them take action, an action that ended up preventing a catastrophe. Conversely, because we may have too many other patients occupying our time, we may not be there to observe that change; we could miss that cue, which could trigger more serious complications. A four-day stay could turn into a two-week stay, or in the worst case, the patient may never leave the hospital alive. This process of failing to pick up on missing vital changes in a patient’s condition could lead to “failure to rescue,” and a number of prominent studies have made a clear link between poor RN staffing and this unfortunate outcome.

You also need to know that nurses are the teachers of patients and families in the health care system. We are trained to communicate with patients so that they understand what is happening and what they will need to do to support their own recovery. We are trained to be a compassionate sounding board for the inevitable fears patients and their families will experience. This is not fluff and this is not a luxury. If a nurse doesn’t have the time to properly teach the patient how to clean and protect their wound, or to manage their new medications, that patient is going to suffer an infection or a reaction that will land them right back in the hospital.

Given this understanding of the role of registered nurses, I’m sure you can begin to understand that the most important component of nursing is time -- time that a nurse has to use his or her educated mind, trained eyes and disciplined ears to monitor their patients. When you’re a patient, anything that diminishes the time your nurse has to spend in your care, the more likely something bad will happen to you. It’s that simple. And the most important determinant of how much time your nurse will have to devote to your care is the number of patients he or she is assigned.

It has been said that if you don’t listen to nurses, you will never hear the patient. I am here, we are here, screaming at the top of our lungs on behalf of those who suffer in silence – help us. Pass House Bill 1282. Safe Staffing Saves Lives. Thank you for your time and attentiveness.