News & Events

MNA information request for acute care nurses regarding impact of DPH’s ‘No Diversion Policy’ and hospitals’ response on the patients you care for

From the Massachusetts Nurse Newsletter
February 2009 Edition

On Jan. 1, the Department of Public Health instituted a “no diversion” policy for patients accessing care in hospital emergency departments. The MNA is investigating how the hospital industry is responding to this directive and how these activities are affecting the patients you care for.

The initial investigation and anecdotal reports that MNA has received reveal a potentially dangerous situation for patients and for nurses. We are circulating this message in an attempt to hear from nurses across the commonwealth regarding what they are experiencing in their practice. For example, we would like to know:

  • How has this change affected waiting times in your emergency departments?
  • How has this change affected your ability to move patients from the ED to floors/units?
  • What policy changes has your hospital implemented to deal with this situation? For example, has the hospital beefed up staffing in the ED to compensate for the no-diversion mandate? Have they opened up a holding area for patients waiting for admission and, if so, have they staffed it with dedicated nurses? Are hospitals floating nurses to the ED to help care for waiting patients? If patients are held in ED hallways, are there additional nurses added to care for them?
  • Has the hospital opened new beds and added staff for those beds to account for increases in patient volume?
  • Has your hospital changed staffing patterns to accommodate the DPH policy of no diversion, (i.e. staffing for bed capacity or peak census vs. their common practice of staffing for average daily census)?
  • If they have not done so, have patient assignments increased?
  • We have learned that in some hospitals patients are sent from the ED to floors without orders. Is this happening at your hospital?
  • In a few hospitals, we have heard that hospitals are, or are contemplating, placing patients in hallways of in-patient units. This is a practice the MNA strongly opposes. Is this happening at your hospital?
  • Are hospitals implementing patient flow strategies? What are they?
  • In 2000, to deal with this crisis, the DPH recommended that hospitals implement policies to control and regulate elective admissions and surgeries, which are admissions over which they have control. Is your hospital working with physicians to regulate patient flow?
  • Whatever the hospital is doing or not doing, we need to know what it means for your patients. Have you seen an increase in injuries or complications as a result?

To adequately and effectively address this situation, we need to hear from you about what is really happening on the front lines. Please tell us what you are seeing by sending an email message to David Schildmeier, the MNA’s director of communications, at