The Health Policy Commission’s Quality Improvement and Patient Protection (QIPP) committee held the first of two public hearings regarding the proposed regulations surrounding M.G.L. Ch. 111 Section 231 — the new ICU safe staffing law.
Representative Denise Garlick, RN (D-Needham) (view a portion of her testimony below) was the lead house sponsor of the bill and was given the honor of signing her name on the bill on behalf of the Massachusetts House of Representatives. The bill passed unanimously in both the house and senate, was signed into law by Governor Patrick and became effective September 28th, 2014. It establishes a default standard of care for ALL ICU patients as one patient to one nurse. It does so to protect the patient’s safety and it is the strictest, such standard in the world.
While the draft regulations seem to open the door for the industry to violate that standard, by stating the staffing standard can be either one to one OR one to two, Representative Garlick’s remarkable testimony once and for all, lays to rest any arguments about the intent of the legislation, the intent is to establish one patient to one nurse care in all ICUs as the default standard of care.
Below are some key excerpts from her testimony, where she addresses the one-to-one standard, the intended use of the acuity tool as an adjunct to, not a substitute for, the nurses’ assessment of the patient, and her problems with the regulations process for allowing hospitals to have any final say in the acuity tool.
When I tell you that I know what’s in this bill, I know what’s in this bill. And I stake my own name and career on it.
It was a very tough choice for the nurses and for the hospitals who were agreed to this legislation. It was clear in that language what we were agreeing to. We were agreeing to 1:1 nursing care in the intensive care unit. And that legislation was passed unanimously in the house of representatives. Any deviation from that intent of the law would be a travesty. And I ask you not to do that."
The second issue was around the fact that the proposed regulation seems to indicate that the acuity tool could be a substitute for the nurses clinical judgment. That was NEVER the intention and when we were discussing this, In my mind, and in the mind of my colleagues who voted unanimously on this bill, there was a hierarchy of decision making. And in fact, the acuity tool is there just as an adjunct to the nurse’s clinical judgment. This was meant to be a reasoned discussion between the nurse and the person who is making the assignment. And if there was a disconnect, the acuity tool would serve as template. In no way does a tool ever substitute for anyone’s judgment. It’s a way for you to start your conversation in a productive positive way.
The third issue that I was concerned about was that the proposed regulation seems to indicate that the nurse manager is the arbiter of any disagreement — and that was not intended. It was intended that when there was disagreement, in the hierarchy of decision making, it was hoped that two professionals looking at the situation are going to make the same decision. If they do not and they have to have a conversation, they turn to the acuity tool as a template. When that decision can still not be reached, it is on the hospital management to make that final decision. It is not the nurse manager who is the arbiter, because that does not make any sense. It is probably the nurse manager who is making the assignment. So we have to be very careful about how we’re doing that.
And finally, and I understand how you got there and I respect it, but there is this talk in the proposed regulation about the advisory committee. The advisory committee actually is something that is, is, I think, a dangerous proposal because it undermines the intent of the law. And I’ll tell you why.
In my experience, and for years and years, the only committee that would work well is a Labor-Management committee; in which labor gets to choose its own people and management chooses its own people; and its equal numbers; and decisions can be made; and we understand how that decision is going to be finally arrived at.
If you make an advisory committee that is chosen by a certain party — who those members are going to be — who’s going to participate. It actually is a straw man. The people on the advisory committee don’t have power to make those kind of decisions and speak for other people.
I understand how you got there and I appreciate that but I just wanted to put that warning. I have served on hand-picked committees where you can be standing on the table naked screaming, "No. No. NO." And people will say, "Well, she was present at the meeting." So I’m really asking you to think carefully about that even though I know your intention was good.
Bravo Representative Garlick! We are so fortunate to have such a powerful patient and nurse advocate serving in the legislature.