JUNE 18 TESTIMONY

TESTIMONY
JOINT COMMITTEE ON HEALTH CARE
HEARING ON AN ACT ENSURING QUALITY PATIENT CARE & SAFE REGISTERED NURSE STAFFING (H. 1282)
“RESEARCH MAKES CLEAR – SAFE STAFFING SAVES LIVES”
DOROTHY MCCABE, RN, MSN
WEDNESDAY, JUNE 5, 2003

Good morning. My name is Dorothy McCabe and I am the Director of the Nursing Department for the Massachusetts Nurses Association, as well as the staff person who works with our Congress on Nursing Practice, a membership body that specializes in monitoring and responding to issues impacting the clinical practice of nursing. I am also a former nursing administrator at a major Boston Teaching Hospital.

Since joining the MNA, I have watched this organization come before this body for the in an attempt to pass legislation, similar to that before you today, to regulate nurse staffing levels in Massachusetts hospitals. At hearings like this, I have heard the opposition, I listened to nursing and hospital administrators repeatedly claim that this legislation was not needed because there was no data to support what staff nurses were trying to tell you about the deteriorating quality of patient care caused by excessive patient loads.

It is my job today to share with you just some of the latest research that has come out in the last few years that clearly and unequivocally proves that what nurses have been telling you is the absolute and complete truth. It also shows that hospital staffing practices have and continue to harm, and, yes, kill patients in Massachusetts hospitals.

This research has appeared in the country’s most prestigious medical and nursing journals and has been conducted by some of our nation’s preeminent nursing researchers.

The most important and the most recent of these studies was published in the October 2002 issue of the Journal of the American Medical Association by Linda Aiken of the University of Pennsylvania School Nursing. It is important to note that her study was conducted in response to the passage of RN to patient ratio legislation in California, similar to the bill before you today. Dr. Aiken examined the records of 232,000 surgical patients and the relationship between nurse to patient ratios and patient mortality and complication rates.

The results were alarming. The study reported the higher the patient to nurse ratio, the more likely there will be a death or serious complication. Each additional patient above four that a nurse is caring for produced a 7% increase in mortality. If a nurse is caring for eight patients instead of four, there is a 31% increase in mortality. Allow me to put this in perspective.. Consider that according UNOS (the United Network for Organ Sharing), a liver transplant program is required to maintain an 80% survival rate, and failure to meet that survival rate would trigger an audit and subject that program to losing its Medicare funding. But here we have clear documentation that at many of our hospitals, we have nurses regularly assigned 8 patients or more, resulting in a deplorable 69% survival rate for those patients undergoing the most basic types of surgery, and nothing has been done about it.

In the conclusion of her study, the author stated that substantial decreases in mortality rates could result from increasing registered nurses staffing, especially for patients who develop complications. She further concluded that legislation, such as that passed in California and proposed by the MNA here today, is a credible approach to protecting patients. She further stated, in an article published in the New England Journal of Medicine, that “unless we create a floor for nurse staffing, we are not going to stop the flight of nurses from hospitals.”

Earlier in 2002, no less prestigious a medical journal than the New England Journal of Medicine published a study of 5 million patients in 11 states, including Massachusetts found a strong and consistent link between nurse staffing levels and patient outcomes.

As nurses staffing levels decreased; urinary tract infections, pneumonia, shock upper gastrointestinal bleeding and length of stay increased.

The study’s authors concluded that thousands of patients die every year due to understaffing, and that substantial improvements in patient care as well as cost savings could be realized by improving nurse staffing levels.

It is important to note that in both studies, the authors were clear that it was the registered nurse that was the important link. In fact, in one of the studies, complications and mortality increased when more LPNs were included in the skill mix. Keep this in mind, as you consider another piece of staffing legislation that has been filed that does not clearly delineate that only RNs should be included in the legislated ratio.

Finally, the Joint Commission on Accreditation of Healthcare Organizations, the body that inspects and provides accreditation of most hospitals, last year issued its own report stating that inadequate staffing levels have been a factor in nearly 25% of the most serious life-threatening events that have been reported to the Commission in the last five years. JCAHO found a link between poor staffing and 50% of ventilator related incidents, 42% of surgery-related incidents, 25% of transfusion incidents, 19% of medication errors and 14% of patient falls and patient suicides.

These are just three of the most recent studies. There are many more going back 20 years, including a Johns Hopkins study of ICU patients that found when an ICU nurse is given three patients instead of 2 (as recommended in our bill), there is a 14% risk in complications for those patients.

The data is clear, it is overwhelming, it cannot be ignored – save staffing saves lives, and the status quo for staffing in Massachusetts threatens to take many innocent lives.

The staff nurses have been right all along. The science is with them. I ask you today to pass H. 1282 in the name of science, in the interests of every patient in Massachusetts.

Thank you.