News & Events

Legislative session ends in stalemate on safe staffing bill

From the Massachusetts Nurse Newsletter
July/August 2008 Edition

Executive Director’s Column
By Julie Pinkham

As the 2007-2008 session came to a close, legislation to finally set safe limits on nurses’ patient assignments failed to pass. The bill became the victim of a stalemate between the House and Senate, which passed dramatically different versions of the measure.

In May, the House once again passed (119-35) the Patient Safety Act, a carefully crafted compromise that was reached after input from all stakeholders. This legislation would have provided much-needed patient protections, as well as initiatives to improve the recruitment and retention of nurses. The measure was supported by 130 leading health care organizations, 80 percent of physicians, 90 percent of nurses and 80 percent of registered voters.

Unfortunately, on July 17 the Massachusetts State Senate voted 23-13 in support of Senate Bill 2816 (S.2816), a drastically amended version of the Patient Safety Act which would give even more power to hospital administrators and bean counters in making nurse staffing decisions, thereby codifying current unsafe staffing conditions in hospitals and continuing to place thousands of patients in jeopardy.

Bedside nurses have long sought regulatory assistance from the state legislature in curbing the dangerous practice of RN understaffing. The bill passed by the Senate would do nothing to curb this dangerous practice of stretching nurses beyond their limits and increasing their patient loads to unsafe levels.

It is hard to believe that language could be fashioned that would actually make the deteriorating situation worse for patients by giving hospital administrators more power over staffing care levels, but indeed the Senate bill does just that. In fact, it would place hospital administrators in charge of setting their own staffing—a practice that has led to a health care crisis in Massachusetts. Currently more than 45,000 Massachusetts patients a year are injured and more than 2,000 patients—six people a day—die from preventable infections and complications they get in the hospital.

Our deregulated, market-driven hospital industry forces nurses to care for patients when they can’t see straight, when they can’t make safe assessments and when they can’t provide safe care. The Senate bill endorses and empowers this status quo.

Undoing the compromise
We called the House bill that passed earlier in the legislative session a compromise because the stakeholders (hospitals and nurses) negotiated with House leaders for a week before forging new language that dealt with the issues of concern—hence, a compromise. The Senate language author(s) is/are unknown, and we were not part of the discussion.

During House negotiations we made 200 concessions to address a myriad of issues raised by the hospital industry. The new Senate bill removed all of these key compromise provisions. The House version called upon the Massachusetts Department of Public Health to create industry-wide staffing standards and patient limits to ensure safe patient care in all Massachusetts hospitals based on research, science and expert testimony. The Senate version hands hospital administrators more power to increase nurses’ patient loads.

Guts collective bargaining provisions
The Senate bill would have circumvented existing collective bargaining rights by creating “nursing care committees” of staff appointed by each individual hospital to develop nurse staffing plans. In other words, the fox would guard the henhouse.

The truth is, 80 percent of Massachusetts hospitals have a unionized RN workforce and, thus far, unionized nurses have been unable to make headway on safe staffing at the negotiating table. This approach certainly would not work with the management-dominated committees—similar to “company unions”—outlined in S.2816.

Continued deterioration in patient care
The Senate bill failed to recognize the overwhelming body of research that links safe patient outcomes directly to the number of patients a nurse is caring for at one time. It also greatly broadens the power of hospital administrators, who can cut corners and dangerously increase a nurse’s patient load.

Under the bill, there would be no uniform standard of care. Instead, the DPH would be required to enforce varying and inadequate standards created by hospital administrators. These are the same administrators who have spent the last two decades cutting corners and dangerously increasing nurses’ patient loads.

Simply put, this legislation is a hazardous step backward and it ensures that current unsafe conditions continue to deteriorate.

MNA strongly opposed Senate bill
When it became clear that the Senate was not going to alter its position, nurses and advocates tried to defeat the Senate bill. We are grateful to the thirteen senators who stood up against a bad bill. Among them, Sen. Michael Morrissey (D-Quincy) insisted on a roll call vote so that at least we could know who supports true patient-care legislation. Other senators worked hard to convince their colleagues to vote against this bill, and we are deeply grateful for their efforts. You can find a copy of the vote on this bill on the MNA’s Web site. If your senator voted no, call and thank her/him. If your senator voted yes, call and express your disappointment. If you don’t know who your senator is, you can find out at

The public trusts bedside nurses. They expect that if we believe a piece of legislation will enhance their safety, then it will do just that. They also trust that we will be honest with them about what is not safe. S.2816 would put more patients in jeopardy.

This year’s legislative session ended on July 31 with no further action. Going forward, we are meeting with various senators to determine what options are available, and we will announce plans for our next steps in the coming months.

Thanks to all who have fought so hard to ensure that hospital patients in the commonwealth are safe and that they receive the quality of nursing care they deserve.