JUNE 18 TESTIMONY

TESTIMONY
JOINT COMMITTEE ON HEALTH CARE
HEARING ON AN ACT ENSURING QUALITY PATIENT CARE & SAFE REGISTERED NURSE STAFFING (H. 1282)
“WHAT THE BILL DOES”
JULIE PINKHAM, RN, MNA EXECUTIVE DIRECTOR
WEDNESDAY, JUNE 18, 2003

Good morning members of the Health Care Committee, and thank you for the opportunity to testify on this critical public health issue. My name is Julie Pinkham, and I am the executive director of the Massachusetts Nurses Association. You’ve heard from Karen Higgins about what nurses do. You’ve heard the research that supports this bill. Now it is my job to explain what exactly this bill would do to protect patients and support nurses in providing quality patient care.

I will start by asking you to imagine you are out in the city somewhere when you suffer a serious injury that results in your being placed in an ambulance. Depending on where you are in the city, the ambulance driver can choose between a variety of hospitals. Because you happened to be closer, you end up at New England Medical Center where the ratio on a medical surgical floor is one nurse to four patients. Given what we have heard about the recent research, your nursing care and chances of recovery will be very good. However, should your ambulance end up at St. Elizabeth’s Medical Center, your nurse-to-patient ratio may be as high as one to eight, placing you at a 31 percent greater risk of suffering a serious complication or even dying. You had no real choice in this decision. Your insurance card was the same, but the standard of care and your potential outcome are vastly different. Does this make any sense to you?

We believe every patient in Massachusetts should be guaranteed a safe standard of nursing care, no matter where they receive that care. We believe any hospital licensed by the state, as a condition of holding that license, should be required to maintain a basic standard of quality patient care that is based on what patients actually need, not what a hospital administrator chooses to provide. That is what this bill will do for you and for all patients in the state.

House 1282 – An Act Ensuring Quality Patient Care and Safe RN Staffing – creates a safety net of minimum RN-to-patient ratios with a different ratio established for each and every unit of the hospital.

These ratios are based on nursing research, particularly the findings of the JAMA study as well as additional studies conducted in specialized areas, such as the Johns Hopkins study of ICU ratios. Further, it builds on more than two years of research conducted by the California Department of Health Services in the development of ratios based on that state’s staffing legislation, and finally, the ratios are based on the input of hundreds of staff nurses from across the Commonwealth working in each of these areas.

Our opposition claims this is a cookie-cutter approach that fails to provide flexibility to account for changing patient conditions. In crafting this bill, we have been careful to answer this concern. In addition to these baseline ratios, our bill also calls upon DPH to develop a standardized patient classification system, something most hospitals already use. But this patient classification system will be specifically designed to measure a number of factors to determine the severity of illness of the patients on a particular floor. Based on these criteria, when patients deserve more intense nursing care, the system will reflect the need to add nurses and decrease the number of patients assigned to each nurse.

We can only assume that this is the flexibility the hospital industry is looking for. We certainly wouldn’t think that they want have the right to implement ratios that research shows endangers patients.

We have also listened and worked to improve the bill based on the concerns of Senator Moore by including language that prohibits the use of mandatory overtime as a means of meeting the ratios.

The bill also prevents the movement of a nurse in one specialized area to another unless that nurse is qualified to practice in that area. Known as floating, this practice – for example moving a medical/surgical nurse to the ICU – has been abused over the last decade by the industry in an attempt to compensate for inadequate staffing. It’s akin to asking a French teacher to teach Spanish. It’s dangerous and goes against any standard of responsible nursing practice.

The bill prevents the replacement of registered nurses with unlicensed personnel, a practice known as “deskilling” that was employed throughout the 90’s, a practice that was one of the causes of the nursing shortage and, as Dorothy McCabe pointed out, contributed to the unsafe conditions we now face.

Finally, the bill provides patients and their families with a number of protections -- hospitals will be required to post the mandated ratios for all to see and the bill calls for the posting of a hot line number where calls can be made to DPH to report infractions.

In closing, House 1282 protects Massachusetts patients by guaranteeing a safe standard of staffing and by preventing those staffing practices – such as mandatory overtime, floating, and deskilling – that further erode their care and place them in jeopardy. It will also for the first time allow us to determine the actual need for nurses across the entire hospital industry.

Unlike other staffing measures proposed in the past, and those competing bills filed this year, House 1282 best reflects the science of nursing that exists and represents the best means of protecting patients. It is the only bill that follows the research and bases its ratios on registered nurses.

Thank you, and the MNA looks forward to working with the committee to move this resolution of this critical public health issue.