News & Events

House Passes Landmark Bill on RN Staffing in Massachusetts Hospitals

Measure Calls for Safe Limits on Nurses’ Patient Assignments, Prohibits Mandatory Overtime and Includes Initiatives to Increase Nursing Faculty & Nursing Scholarships

BOSTON, Mass.—The state House of Representatives voted 133 – 20 yesterday to approve a landmark bill to guarantee safe RN staffing in all Massachusetts hospitals. The measure calls upon the Massachusetts Department of Public Health to set safe limits on nurses’ patient assignments, prohibits mandatory overtime and includes initiatives to increase nursing faculty and nurse recruitment.

The “Patient Safety Act” will now move to the Senate for consideration. The measure was crafted by House leadership after days of negotiations between legislative leaders, the Massachusetts Nurses Association (MNA) and the Massachusetts Hospital Association.

“This is a bill about patient safety; it’s about saving lives, from Boston to the Berkshires. It’s fundamentally about guaranteeing a baseline of quality care that all citizens can depend on,” said Rep. Peter Koutoujian, co-chair of the Joint Committee on Public Health, who co-authored the redraft of the bill with House leadership. “While drafting this legislation we made every effort to address the concerns of the hospitals, while also addressing the real concern that some units in some hospitals are dangerously understaffed.”

“We are very pleased with this vote for patient safety,” said Beth Piknick, RN and president of the Massachusetts Nurses Association—one of 104 of the state’s leading health care and consumer groups supporting the bill. The MNA had filed the original version of the patient safety bill.

The law, when enacted, will make Massachusetts only the second state in the nation to set safe staffing limits in hospitals. A similar law was passed in California in 1999, and 14 other states currently have similar legislation pending.

The approval of the bill by the House follows years of scientific research and reports by health policy experts that show the safety of patients in hospitals, including those in Massachusetts, is suffering due to understaffing of registered nurses. Last year, a survey of recent patients in Massachusetts hospitals conducted by Opinion Dynamics Corp. found one in four (an estimated 235,000 patients each year) reported their safety was compromised during their hospital stay due to the understaffing of registered nurses. A survey of Massachusetts physicians found that one in five reported patient deaths attributable to nurses having too many patients. The scientific research clearly shows that when nurses have fewer patients, patients get better care, medical errors are reduced and millions of dollars are saved.

Key components of the bill include:

  • Directs the Massachusetts Department of Public Health (DPH) to develop and implement specific minimum RN staffing standards for all units in the state’s acute care hospitals, which would include an optimum RN-to-patient assignment, as well as an enforceable limit on the number of patients assigned to each registered nurse.
  • The staffing standards would be developed within 12 months of the bill’s passage and be based on scientific research on nurse staffing levels/patient outcomes, expert testimony and standards of practice for each specialty area.
  • The bill calls for the safe staffing limits to be implemented in all teaching hospitals by 2008, with implementation in all community hospitals by 2010.
  • Provides flexibility in staffing and accounts for patients who require more care. The measure calls on DPH to create a standardized acuity-based patient classification system, which is a standardized formula for rating the illness level of patients. Based on the acuity of the patients
    assigned to a nurse, if those patients require more intensive care the nurse would be assigned fewer patients.
  • Protects valuable members of the patient care team who support nurses in caring for patients, which was the major sticking point identified by the hospital industry. The new provision prevents “understaffing of other critical health care workers, including licensed practical nurses and unlicensed assistive personnel.” It also includes consideration of ancillary staff in the criteria created by DPH for the standardized acuity-based patient classification system.
  • Prohibits the practice of assigning nurses mandatory overtime as a means of staffing the hospital.
  • Allows hospitals that can prove a financial inability to comply with the law to delay implementation of the staffing standards, with oversight provided by DPH.
  • Assures that institutions cannot delegate to unlicensed personnel duties which demand nursing expertise. Throughout the 1990s, the hospital industry attempted to cut costs by replacing nurses with unlicensed personnel, which led to a deterioration in patient care and to the exodus of nurses from the bedside.
  • Establishes a number of nurse recruitment initiatives sought by the hospital industry, and supported by MNA, to increase the supply of nurses, including nursing scholarships and mentorship programs, and support for increases in nursing faculty to educate new nurses. It also would create refresher programs to assist nurses in returning to practice at the hospital bedside. A survey of Massachusetts nurses found that more than 65 percent of those not practicing in hospitals would be likely to return if a law providing safe limits was passed.
  • Establishes strong consumer protections for safe RN staffing, including a prominent posting of the daily RN staffing standards on each unit.
  • Calls upon DPH to monitor compliance and to investigate violations, with the ability to impose fines.