Canton, Mass.— While we are pleased that the Massachusetts Hospital Association has now acknowledged that a crisis exists for the safety of patients in our state’s hospitals, legislation filed by the MHA and sponsored by Senator Richard Moore misses the mark on patient safety and maintains the dangers of the status quo.
All parties agree that we have a disturbing crisis in Massachusetts — nurses are being forced to care for too many patients at once, and patients are suffering the consequences in the form of preventable errors, avoidable complications, increased lengths of stay and readmissions. Studies by the most respected scientific and medical researchers affirm the significance of safe minimum RN-to-patient ratios for patient safety.
Unfortunately, the MHA bill is written by hospital administrators for hospital administrators and fails to provide any minimum standards that will protect hospital patients from the current dangerous practice of understaffing of registered nurses. It gives only the allusion of accountability. Nearly every requirement called for in this bill is already called for under the industry’s accreditation process, a process that has proved totally ineffective in guaranteeing patients safe care.
The primary problem with the bill is it fails to heed the key findings of the scientific research and the legislature’s own 2001 Nursing Commission report, which called for the implementation of a minimum standard for nurse staffing ratios. Instead of addressing this crisis and protecting patients with a minimum standard, this measure protects an industry that has endorsed the practice of understaffing of registered nurses to the detriment of patient care.
Other problems with the measure include:
- Merely allows the hospital industry to file a report about its staffing "plan", with no requirement that they meet any minimum standard of safety.
- Approval of the staffing "plan" by the Board of Directors of the hospital allows those responsible for the current practice of understaffing of registered nurses to continue to approve similar staffing plans.
- Fails to address the root cause of the nursing crisis: nurses burned out with high patient loads leaving the bedside. This is the number one reason why RNs continue to leave the bedside. Years of experience with recruitment incentives has proven that they just don¹t work; the crisis is with retention.
- Calls for yet another commission to study this issue. When the legislature conducted such a study in 2001, it recommended the establishment of minimum RN-to-patient ratios.
However, on the issues of recruitment for future nursing needs, the bill does include important recruitment initiatives for nursing faculty that should be acted upon immediately. Nursing school enrollments are now full and, as a result, our state’s nursing programs have waiting lists. We must increase our supply of nursing faculty to meet the demand for nurses to care for an aging population in the coming decade. Massachusetts is fortunate to have more RNs per capita than any state in the nation. While we don’t currently have a nursing shortage, we do have a shortage of nurses willing to work in the acute care hospital setting under current staffing levels. While continuing to work to increase the long-term supply of RNs is important, addressing the issue of retention to stem the exodus of both new and more experienced RNs from the bedside is more critical.
The nurses of Massachusetts and the 70 health care and consumer organizations that are part of the Coalition to Protect Massachusetts Patients say the evidence is clear that legislation to set minimum RN-to-patient ratios in hospitals is the only way to truly protect patients.
State Rep. Christine Canavan (D-Brockton), who is a registered nurse and vice chair of the Joint Committee on Health Care, is the lead sponsor for the bill, which is entitled "An Act Ensuring Patient Safety." Canavan was also the chair of a special legislative commission which was formed in 2001 to study the crisis in nursing in Massachusetts.
The bill would protect Massachusetts patients by ensuring that they receive nursing care appropriate to the severity of their medical conditions. To ensure maximum flexibility, the bill also requires that the Department of Public Health develop an objective system for monitoring patient medical conditions so that staffing levels can be adjusted and improved to meet patient needs. The bill would set minimum staffing standards specific to every unit and department in a hospital to ensure that major disparities in care levels do not exist in the commonwealth’s hospitals, and specifically provides that nothing in the bill "shall be deemed to preclude any facility from increasing the number of direct-care registered nurses."
The House Ways and Means Committee is in the process of creating a subcommittee to address this bill. We made a commitment to work with all parties in this debate to craft a bill to address this crisis. The Coalition to Protect Massachusetts Patients and the MNA await the opportunity to work with the Committee and all stakeholders to create a "real" solution to the staffing crisis in our hospitals that guarantees safe patient care and true accountability.