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What the Bill Does

Currently, there are no legal or regulatory mandates to ensure patients receive a level of nursing care that is based upon accepted standards of nursing practice or on their actual need for care. As the health care system has moved to a deregulated, free-market system, where competition and cost drive the industry, the pressures to cut nurse staffing, and the resources allocated to nursing have escalated. This has resulted in dramatic cuts in nurse staffing levels and an increase in the number of patients each nurse is expected to care for.

State Rep. Chrisitine Canavan, RN, in conjunction with the Massachusetts Nurses Association and the Coalition to Protect Massachusetts Patients, has filed An Act Ensuring Patient Safety to reverse these trends by mandating nurse staffing which is sufficient to care for the planned and unplanned needs of patients. It is based upon significant nursing research and experience. The major provisions of the legislation include:

• Establishes minimum "safety net" ratios. (See specific ratios at left.) The ratios are the same for all three shifts.
• Provides flexibility to improve ratios based on acuity. To provide flexibility in staffing, and to account for patients who require more care, the bill calls upon DPH to create an acuity based patient classification system (or acuity scale) that will be used by all hospitals to measure acuity and, when necessary, require hospitals to reduce a nurse's assignment based on the needs of those patients. This provision answers a key objection of the hospital industry, which has argued that establishing minimum ratios is too rigid.
• Prohibits the reduction of ancillary staff, including aides, technicians and LPNs. The bill specifically states that hospitals cannot justify meeting these ratios by reducing valuable ancillary support staff.
• Prohibits mandatory overtime and mandatory on-call. The bill prohibits the practice of assigning nurses mandatory overtime or mandatory “on-call” policies as a means of meeting the ratios.
• Prohibits floating without proper orientation.
• Prohibits unlicensed personnel from performing nursing tasks.
• Requires collection and reporting of nurse-sensitive patient out come data to evaluate patient care and nurse staffing.
• Provides patients the right to know and demand safe ratios. The bill provides strong consumer protections, including prominent posting of the daily RN-to-patient ratio on each unit, as well as a toll free hotline number, which may be used to report inadequate nurse staffing to DPH. Violations would be investigatged by DPH with the potential for fines.