Dismantling the Arguments of the Hospital Industry Against a Minimum Safe Standard of Care

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		"It costs too much."			Minimum ratios are cost effective. A recent study in the Journal of Health Care Finance found that increasing RN staffing had no statistically significant impact on a hospital’s bottom line. The 1.8 percent costs associated with increasing RN staffing levels will be offset by the savings from reductions in patient complications, medical errors, and length of stay by providing better patient care and from reducing RN turnover rates. Turn to Page 7 of this document to review the findings of a recent research study detailing the tremendous cost savings achieved by improved staffing ratios.

		"Hospitals will close."			No hospital has or will close due to the passage and implementation of common sense minimum ratios. While hospitals have closed due to the competition ensuing from the deregulation of the industry, no hospital has or ever will close because it provided its patients with safe nursing care.

		"We can’t find the nurses."			Massachusetts has more RNs per capita than any state in the country. The Board of Registration in Nursing reports a 10 percent increase in the number of RNs in Massachusetts between 1992 and 2003, while the number of acute care beds required to be staffed by RNs has decreased by more than 33 percent. The fact is unsafe staffing has created a ‘shortage’ of nurses who are willing to work under the conditions created by the industry. Burned out by high patient loads just 47 percent of RNs are working at the bedside and nearly 60 percent of RNs working at the bedside are working just part-time or per diem. Safe ratios will keep RNs at the bedside and nearly 65 percent of those who have left bedside nursing say they will return if safe ratios are established—that’s a pool of 42,000 nurses.

		"We need flexibility."			What the industry administrators want is control – they don’t want any legislative or regulatory body telling them they must maintain a safe level of nursing care. The bill was purposefully drafted to provide maximum flexibility. The minimum ratios would vary for each unit and specialty area and ratios would constitute a staffing ‘floor.’ DPH would establish a patient acuity pool to allow for all the patient and care variables the industry says is necessary to determine appropriate staffing. Thus, it not only provides hospitals the flexibility they need to increase staff to meet patient needs, but gives greater weight to patient needs and the judgment of caregivers.

		"There's no evidence to support this bill."			Numerous prestigious medical and nursing journals have concluded the most important question a patient should ask when entering a hospital is, “How many patients will my nurse be caring for?” The answer can have life-or-death consequences. The Journal of the American Medical Association reports that the more patients a nurse has to care for, the more likely that serious complications or death will ensue. The study found that each additional patient above four that a nurse is caring for produces a 7 percent increase in mortality. If a nurse is caring for eight patients instead of four, that is a 31 percent increase in the risk of death. The conclusion of this study was that legislation to regulate RN-to-patient ratios was a “credible approach” to improving patient safety and ending the nursing shortage. Another study of 6 million patients published in the New England Journal of Medicine shows that patient without adequate nursing attention are more likely to die or suffer serious complications. The Institute of Medicine reported that . . . “nurse staffing levels affect patient outcomes and safety.” Insufficient monitoring of patients, caused by poor working conditions and the assignment of too few RNs, increases the likelihood of patient deaths and injuries at a time when avoidable medical errors kill up to 98,000 people in U.S. hospitals every year. JCAHO, the Joint Commission on Accreditation of Hospital Organizations, announced that inadequate nurse staffing precipitated 25 percent of all sentinel events - unexpected occurrences that led to patient deaths, injuries, or permanent loss of function - reported to JCAHO the past five years. A study of nurses in Massachusetts found more than 65 percent reported an increase in medical errors, more than half reported injury or harm to patient and one in three reported patient deaths directly attributable to poor ratios. The DPH in October reported a 76 percent increase in injuries, harm to patients, and complaints by patients in the last seven years, with the bulk of these problems attributed to nurse staffing issues. Conversely, there is no evidence to support the industry’s position.

		"We are cash-strapped."			The Boston Globe recently reported that Partners made more than $230 million in net profit last year, Boston Medical Center made $5.3 million, UMass Memorial Health Care made more than $52 million and North Shore Medical Center was on track to make $6.5 million. Lahey, MetroWest Medical Center, Milford Hospital, Jordan and Morton Hospitals all have hospital expansion plans underway in excess of $200 million. There is plenty of money in the system right now that hospitals can use to meet the 1.8 percent investment it would take to provide a safe standard of care. For example, Massachusetts hospitals spend 27.5 cents of every health care dollar to pay for health care administration, more than any other state. If administrators cut their spending on themselves—from 27 cents to a quarter of every dollar—and reinvested in nurses, the ratios could be met without any new spending and millions would be saved.

		"Patients sleep at night."			Ask any front-line registered nurse and they will tell you that patient needs and demands do not diminish at any time of the day. Two recent studies, one of newborns and the other of cardiac patients, clearly show that these patients are more likely to die at night, with understaffing of registered nurses as a major factor in those deaths.

		"We need clinical experts on the floor to make these decisions."			When a front-line registered nurse tells their nurse executive they need more staff, the nurse executive tells them to “make due with what you have.” Nurse executives have helped create and continue to perpetuate the deplorable conditions that caused the Legislature’s Nursing Commission to recommend ratios as a primary solution. In fact, the prestigious Institute of Medicine has recommended that decisions about staffing be placed in the hands of bedside nurses, calling for every staff nurse to have the right to refuse an unsafe assignment and stop admissions. And in 1998, the Legislature had to pass a whistle blower law to protect front-line nurses from being fired for even reporting unsafe conditions for their patients. If we could trust nursing executives and CEOs to make safe staffing decisions, we wouldn’t be in the crisis we are right now, and we wouldn’t need this bill.

		"This bill is driven by a nurses' union."			The Coalition to Protect Massachusetts Patients, an alliance of health care and consumer advocacy groups of 70 organizations, including the American Heart Association, the American Lung Association, Health Care for All, the Mass. Senior Action Council, and the Mass. Association of Older Americans, formed to fight for passage of this bill. A recent poll of Massachusetts voters found that 82 percent percent supports legislation regulating RN-to-patient ratios.

		"Hospitals are concerned quality care will be jeopardized if the bill passes."			Patients safety is in question now! Due to understaffing of registered nurses promoted by the industry, nearly 1 in 3 registered nurses in Massachusetts report a patient death, 64 percent report complications or other problems for a patient, 50 percent report longer hospital stays, 52 percent report injury or harm to patients, 54 percent report re-admission of a patient, 67 percent report medical errors, and 81 percent report patients having to wait for long periods of time for their medication and medical procedures. If the industry was truly concerned about the quality of care, they wouldn’t have cut nurse staffing by almost 30 percent during the last decade, promoted mandatory overtime as a staffing mechanism and attempted to replace nurses with unlicensed personnel.

		"If this bill passes, we will be forced to layoff ancillary staff, including LPNs and Aides."			The bill specifically prohibits such reductions in ancillary staff, including LPNs. The bill recognizes the value of ancillary staff and mandates that meeting the ratios cannot include a reduction in support staff.