During the Same Time Period, Poor RN Staffing Contributes to Thousands of Preventable Infections, Causing Patients to Suffer While Hospitals’ Coffers Grow
CANTON, Mass.— At a time when patient safety is being increasingly endangered by RN understaffing, the state’s hospitals continue to post record profits of nearly a half billion dollars for the first six months of 2007 – a 35 percent increase over the previous year’s second quarter profits. If the trend continues, the hospital industry is poised to record its third straight year of profits in excess of $1 billion.
According to the numbers posted recently by the Massachusetts Department of Health Care Finance and Policy (View Report), total hospital profits for the second quarter were $499,289,579, compared to $368,329,000 for the same period in 2006. As overall hospital profits grew, the number of hospitals reporting losses continued to decline, with more than 86 percent of the hospitals making gains. Click here to view a spread sheet detailing hospital profits for the last three years.
“These profits are shocking given the fact that they come at the same time that the Department of Public Health (DPH) has issued a report showing that an estimated 2,000 Massachusetts patients a year die needlessly from preventable hospital-acquired infections, infections that recent scientific studies link to poor RN staffing in hospitals,” said John McCormack, a patient safety advocate and co-chair of the Coalition to Protect Massachusetts Patients, an alliance of 124 leading health care and consumer organizations supporting legislation to set safe RN staffing limits. “According to DPH, six patients are dying every day in Massachusetts because of hospital-acquired infections, This year’s hospital-industry profits could pay for the staffing needed to protect patients many times over, yet the safety of patients is being sacrificed to high industry profits and seven-figure CEO salaries.”
The bill, The Patient Safety Act (H. 2059) will dramatically improve care by setting a safe limit on the number of patients assigned to a nurse. The measure, which is co-sponsored by State Rep. Christine Canavan (D-Brockton) and Senator Marc Pacheco (D-Taunton), calls upon the Department of Public Health to set a safe limit on the number of patients a nurse is assigned at one time. In addition, the bill calls for staffing ratios to be adjusted based on patient needs. It also bans mandatory overtime, and includes initiatives to increase nursing faculty and nurse recruitment. During the last legislative session, the Massachusetts House of Representatives passed a similar bill by a vote of 133-20. A public hearing on the bill before the Joint Public Health Committee is scheduled for Oct. 24.
Not surprisingly, the biggest profit margins were recorded by the state’s major Boston teaching hospitals. Children’s Hospital topped the list, posting a whopping $69 million profit for the first half of the 2007 fiscal year; Beth Israel Deaconess ranked second with $41.5 million and Massachusetts General Hospital came in third with $40.1 million. Not far behind were the Lahey Clinic Hospital at $40 million, Dana Farber Cancer Center at $39.9 million and Brigham & Women’s Hospital at $34.1 million.
In Central Massachusetts, UMass Medical Center led the region with a $13.7 million profit followed by St. Vincent Hospital in Worcester at $12.6 million. In Western Mass. Baystate Medical Center in Springfield topped $35 million and on the North Shore, Northeast Health Systems (Beverly Hospital and Addison Gilbert in Gloucester) recorded profits of $12.7 million. In Southeastern Mass, Southcoast Health Systems (St. Luke’s in New Bedford, Charlton Memorial in Fall River and Tobey Hospital in Wareham) posted a $17.1 million profit followed by Sturdy Memorial in Attleboro at $13.6 million.
On the South Shore, Good Samaritan Medical Center in Brockton and South Shore Hospital in Weymouth both led the region with profits of $3.9 million for the first six months of the fiscal year.
The $1 billion profit margin comes at a time when the industry is in the midst of a massive building boom, with expansion projects totaling more than $500 million either completed or in the works. Hospital CEOs have also reaped significant benefits, with most earning high six-figure, and a number receiving seven-figure salaries.
McCormack says now is clearly the time to act. “These profits show that the resources are available to hospital administrators to improve RN staffing levels to comply with the Patient Safety Act so that nurses can provide the safe, quality care our patients deserve. Every day we wait for this bill is another day patients suffer and perhaps die from the hospital industry’s focus on profits at the expense of patient safety” While Profits and CEO Salaries Grow, Hospitals Refuse to Invest in Safer Nursing Care While the hospital industry has been making enormous profits and spending lavishly on new projects, the quality of patient care in Massachusetts hospitals has been deteriorating because registered nurses are being forced to care for too many patients at once. Instead of investing in better staffing to protect patients, the industry has responded by spending hundreds of thousands of dollars to defeat the Patient Safety Act. Between 2004 and 2006, when the industry’s profits doubled, a study of actual RN staffing levels in the state’s hospitals conducted by the Massachusetts Nurses Association and Andover Economic Evaluation found:
- There was no statistically significant improvement in hospital staffing levels between 2004 and 2006.
- More than half of the hospitals reported regularly assigning more than five patients per nurse and every hospital reported an assignment of more than four patients per nurse on the medical/surgical floor. A study in the Journal of the American Medical Association finds that for each patient over four assigned to an RN there is a 7 percent increase in risk of injury, harm and death to patients.
- In a shocking 36 percent of observations, hospitals failed to meet the accepted minimum standard of no more than two patients per nurse in the intensive care unit, a standard recommended by the national Institute of Medicine.
- Most alarming of all, more than 45 percent of hospitals had, on occasion, assigned eight patients or more to their nurses, a staffing level that, according to research published in the Journal of the American Medical Association, placed those patients at a 31 percent increased risk of death.
During this time period, the rate of life-threatening hospital acquired infections continued to increase, causing hospitals to spend between $200 –$ 499 million annually to treat them, according to the DPH report. A study published in the June issue of the journal Medical Care found that limiting nurses’ patient assignments could reduce these costly infections by as much as 68%.
U.S. Department of Labor
Occupational Safety and Health Administration
639 Granite Street, 4th Floor
Braintree, MA 02184
Phone: 617.565.6924 Fax: 617.565.6923
July 13, 2007
Kimberly Walsh, VP of Patient Services
680 Centre Street
Brockton, MA 02302
Dear Ms Walsh:
During an inspection conducted beginning March 19, 2007 at your facility located at 380 Centre Street, Brockton, Massachusetts, conditions were observed, which although not violative of the standards, are considered significant enough to be brought to your attention.
Based on employee interviews and a review of incident reports of workplace violence during the previous six months, employees are suffering physical assaults from patients which can lead to serious injuries. The types of physical assaults include, but are not limited to, punching, kicking, biting, scratching and pulling hair. Resulting injuries include, but are not limited to bruising/contusions, cuts, hematomas, strains, and sprains. The majority of the cases involved patient care givers who were assaulted while assisting and/or caring for patients in the emergency department and psychiatric unit.
Since no OSHA standard applies and it is not considered appropriate at this time to invoke Section 5(a) (1), the general duty clause of the Occupational Safety and Health Act, this letter is being issued. In the interest of workplace safety and health, OSHA recommends that you take the following steps voluntarily to eliminate or reduce your employees’ exposure to hazards described above.
Section 21 of the Occupational Safety and Health Act authorizes OSHA to train employers and employees about workplace hazards and appropriate abatement methods. The following are recommendations to improve the existing workplace violence program. Although not exhaustive, the recommendations address employee involvement, worksite analysis, hazard prevention and control, and program evaluation.
a. Management Commitment and Employee Involvement: Develop a specific workplace violence safety committee whose focus is to minimize assaults and violence from patients and which includes as members: front-line workers, patient caregivers, doctors, security personnel, risk managers, facilities engineering, and administrators. Ensure that frontline workers have the time to attend the meetings so that can provide input on how to minimize the safety problems in the work place. Ensure there is adequate staffing so workers can attend meetings and be actively involved in hazard analysis and implementation of any corrective actions. Make the reduction of violence incidents a priority for management personnel. Responsibilities of the committee include performing continuous worksite analyses, conducting periodic walkthroughs of the hospital, reviewing case studies and guidelines, and making recommendations to reduce assaults.
b. Implementation of a Written Program: Put together all the existing hospital policies that address workplace violence into one cohesive workplace violence written program. The program should include existing site specific procedures to deal with different types of violence in your workplace. The workplace violence committee should annually review and update the program.
c. Worksite Analysis: This involves a step-by-step look at the facility to find existing or potential hazards for assaults and workplace violence. Continue to record analysis, tracking of injuries, and monitoring trends of injuries based on location, shift changes, and staffing levels. Workplace analysis also includes conducting a walkthrough of the facility to identify environmental risk factors. Another important tool is an annual anonymous employee survey to get employee’s ideas on the potential for violent incidents and to identify or confirm the need for improved security measures. Work analysis should also include a review of the security personnel’s ability to respond to unit crisis on all shifts. This analysis should be shared with the workplace violence safety committee so that the trends can be studies and acted upon.
d. Hazard Prevention and Control: This element includes engineering controls and workplace adaptations, administrative and work practice controls, and post incident responses. Evaluate the effectiveness of current security measures. Explore engineering controls such as installing metal detectors where appropriate, increasing the number of security cameras, placing curved mirrors in concealed areas, and enclosing the nurses’ station on the psychiatric unit C3. Also, utilize administrative controls such as increasing the number of “watchers” who watch overflow patients waiting in hallways in the emergency department psychiatric area, increasing the presence of security personnel in the emergency department, ensuring staffing levels of security personnel are adequate for each shift, developing a violence reporting program that identifies patients with a history of violence through a computerized database and establishing a liaison with local police and state prosecutors.
e. Training and Education: Continue to train all affected employees, (including but not limited to: patient caregivers, doctors, supervisors, security personnel, administrators, facilities engineering, managers and risk managers) on Management of Aggressive Behavior (MOAB) and/or Crisis Prevention Institute (CPI) training. The training session should include at a minimum (but is not limited to): a copy and discussion of the written violence prevention program; the person in charge of the program; the contacts for bringing up concerns (at local and corporate level): past assaults and follow-up actions taken by the facility; site specific hazards in your work area, site specific methods to reduce the risk in you work area; and policies and procedures for obtaining medical care, counseling, workers’ compensation, and legal assistance after a violent episode or injury.
f. Recordkeeping and Evaluation of the program: Continue maintaining records of all workplace violence incidents and continue analyzing the records. Continue keeping records of all follow-up actions following all workplace violence incidents. Ensure that the written workplace violence program and all of its elements are reviewed annually to ensure that it is working (i.e., downward trend in number of assaults and injuries and downward trend in severity of assaults), and make recommendations and updates for continuous improvement.
The above guidelines are taken from a publication entitled “Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers” – OSHA 3148, published in 1996, which is available on the OSHA website: www.osha.gov.
These methods are not meant to be the only ones available or feasible. OSHA makes available an on-site consultation service which may identify other measures or you may consider hiring outside consultants. The on-site consultations are free and do not in any way affect the enforcement activities of OSHA. On-site consultants may be contacted at:
The Commonwealth of Massachusetts
Dept. of Labor and Industries
1101 Watertown Street
West Newton, Ma 02465
OSHA request that progress reports on your specific effort to address this problem be provided to this office monthly (first progress report due August 15, 2007) until the above components have been fully implemented. The reports should include a management plan to address the workplace violence hazards and a timetable for implementation of the above elements. The plan should assign responsibility for the violence prevention plan, worksite analysis, hazard prevention and control, training and education of all employees, and recordkeeping/evaluation of the program implemented. The progress report should also include all new reports of assaults and follow-up actions taken as well as safety committee minutes. If you have any questions, please contact the supervisor in charge of this case, Maria Lisa Abundo 617.565.6924 extension 640.
Brenda J. Gordon
Fact Sheet on SB 1345
A Nurse is NOT a Punching Bag!
SB 1345 – An Act Requiring Health Care Employers to Develop and
Implement Programs to Prevent Workplace Violence
A hospital should be a haven where patients go to heal and nurses and other health care professionals provide care in a safe environment. Unfortunately, hospitals are increasingly violent workplaces, both for employees and for patients. Workplace violence against nurses and other health care workers, which can range from verbal and emotional abuse to physical assault and homicide, is not uncommon in hospitals and other health care settings. This violence can be perpetrated by patients, families, friends, visitors, and even co-workers. The statistics are sobering:
- 48 percent of all non-fatal assaults in the U.S. workplace are committed by health care patients.
- Nurses and other personal care workers suffer violent assaults at a rate 12 times higher than other industries.2
- In a 2004 survey of Massachusetts nurses, 50 percent indicated they had been punched at least once in the last two years, and 25 percent -30 percent were regularly pinched, scratched, spit on or had their hand/wrist twisted.3
- Between May 2006 and May 2007, there were over 1,000 phone calls to 911 from inside Brockton Hospital. That is over three emergency calls per day.
Like all violence, workplace violence has long-lasting traumatic effects on its victims. It always causes disruptions in the victim’s short and long term employment, and often permanently impairs the victim’s ability to return to work. We are already experiencing a shortage of nurses willing to work in the current hospital climate, and violence is driving still more nurses from the bedside. Workplace violence also makes quality patient care difficult to provide.
Right now, the implementation of procedures to prevent workplace violence in hospitals is completely dependent on the administration of each individual facility. Some hospitals are very aggressive in trying to prevent violence against nurses and other workers, while other hospitals are not.
SB 1345 would require all health care facilities to take significant steps to prevent violence in their facilities. SB 1345 would:
- Require that health care employers perform annual risk assessments relative to factors which may put employees at risk of workplace assaults and homicides.
- Direct these employers to develop written violence prevention plans and to implement programs to minimize the risks identified in the assessment.
- Share all of this information with employees.
- Direct the Commissioner of Labor to enforce these provisions.
- Reclassify all public sector licensed health care professionals who have worked ten years or more and who are responsible for the care of prisoners, persons who are forensically involved, mentally ill, mentally challenged, and psychologically impaired persons in group 4 of the state’s contributory retirement system.
A Nurse is NOT a Punching Bag!
SB1345 – An Act Requiring Health Care Employers to Develop and
Implement Programs to Prevent Workplace Violence
Workplace Violence Risk Factors
- Alcohol/Drug Abuse
- History of Violent Behavior
- Long Waiting Times
- Overcrowded or uncomfortable waiting rooms
- Inadequate staffing
- No visible security presence
- Unrestricted movement of general public throughout the facility
- Increased use of hospitals for holding individuals involved in the
- criminal-justice system
What Does A Strong Workplace Violence
Prevention Program Look Like:
- Make it clear to workers that a safe work environment is just as important as the quality of care given to patients.
- Work with employees to identify risks and create a plan to mitigate those risks.
- Distribute the plan throughout the facility.
- Provide training to employees that includes information on recognizing and responding to escalating behavior.
- Encourage police participation and a police presence.
- Establish counseling and debriefing for employees who experience violent incidents.
- Support employees who press criminal charges.