News & Events

Nurses press for patient limits

By Jen Judson and Matthew Kaplan/Daily News correspondents

MetroWest Daily News

Posted Nov 04, 2009 @ 01:36 AM


Renewing a long-standing lobbying effort, nurses implored legislators yesterday to pass a bill that would set nurse-to-patient ratios for the state’s hospitals.

"Hospitals can truly not continue their unsafe practices," Donna Kelly-Williams, Massachusetts Nursing Association president, said in testimony to the Joint Committee on Public Health. "There is no limit to the number of patients that I, as a nurse, can see. There is none."

The bill supported by the Massachusetts Nursing Association would require the state Department of Public Health to set nurse-to-patient ratio standards for each hospital department. The hospital could then alter the ratio based on specific needs. Once the health department determined the ratios, hospitals would have two to four years to determine needs and to implement ratios.

Different versions of the legislation have made it to the House and Senate floors over the past 15 years but have never successfully passed through both chambers.

Many of the nurses and other hospital staff, some dressed in scrubs or white lab coats, added their own emotional stories to testimony before a packed hearing room, complaining about over-extended nurses unable to deliver appropriate care for their patients.

Bed sores and other infections are a direct cause of under-staffing nurses, according to peer reviewed research, said scrub-clad Kelly-Williams. To treat just one patient with a urinary tract infection costs $44,000, driving up health care inflation.

"Bedside nursing today is akin to a MASH unit – keep rolling in the patients and do the best you can," said Kelly-Williams. She said that it is standard for a nurse to have about six patients and some nurses can have up to 12 patients at any given time.

Angelena DeLima of Fall River testified about the circumstances surrounding the death of her grandmother a few years ago at Charlton Memorial Hospital in Fall River.

"I watched day after day, as my grandma’s nurses struggled to provide the care she needed and deserved," said DeLima, "I watched mistakes being made, not because these nurses didn’t care, but because they were running themselves ragged, caring for far too many patients."

But, while she said she sympathized with such stories, Karen Nelson, senior vice president of clinical affairs with the Massachusetts Hospital Association, said, "Legislation should be about fact, not emotion."

In an interview after the hearing, Nelson said that in order to meet the bill’s ratio requirements, the cost of hiring and retaining enough nurses could cost at least $250 million in Massachusetts.

The average annual salary for a Massachusetts hospital-employed registered nurse is approximately $80,000, not including overtime and differential pay, according to the MHA. This is the second highest pay rate in the country behind California.

California is the only state to have a required set nurse-to-patient ratio, which is five-to-one in general medical or post-surgical care units.

Nelson said there is no factual evidence from the state to show that such an arrangement actually works.

Nelson said she preferred a bill sponsored by state Sen. Richard Moore, D-Uxbridge, that would offer more flexibility in assigning nurses to patients and eliminates the controversial ratio requirement.

"In Massachusetts we put patients first. We don’t practice cookie cutter patient care and one-size doesn’t fit all," said Christine Schuster, president and CEO of Emerson Hospital in Concord.

"Mandating nursing staff ratios was a bad idea yesterday and it’s a bad idea today, she said."

The newer version of the bill requiring nurse-to-patient ratios allows for more flexibility. Ratios would be determined through a study of hospitals and units based on such factors as nursing experience, the facility and patient needs. A four-to-one ratio was removed from the bill.

But having established ratios, if they vary, is still too rigid a requirement for some hospitals. MetroWest Medical Center supports Moore’s bill according to the center’s spokeswoman Beth Donnelly.

The chief nursing officer at the Framingham-based hospital was unavailable for comment.

Moore, in a letter to the committee, said, all sides of the issue agree that, "having more nurses to serve the increasingly complex patient case load is a desirable goal."