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Unnecessary ‘Human Suffering’ From Insufficient RNs in Emergency Departments, Boston College Professor Testifies at Hearing on Patient Safety Act

Registered nurses from across the state, each representing thousands of their colleagues, stood up for safe patient limits on Tuesday. They shared their message with lawmakers loud and clear. Are patients suffering because nurses are being forced to care for too many patients at one time? Yes. Has the problem gotten worse? Yes. Do we have a solution? Yes.

“Our patients are suffering,” Massachusetts Nurses Association President Donna Kelly-Williams testified. “Every day that goes by without a law in place means more preventable medical errors, more avoidable complications, increased lengths of stay and readmissions. In some cases, it is the difference between life and death.”

Health care advocates, lawmakers, and nurses testified on Tuesday at a hearing held by the Joint Committee on Public Health on the Patient Safety Act (S. 1206/H1958). Last year, legislation was signed into law mandating safe limits for intensive care unit patients. The Patient Safety Act would dramatically improve patient safety by setting a safe limit on the number of patients assigned to a nurse at one time in all hospital units, while providing the flexibility to adjust staffing based on patients’ needs.

New research presented during the hearing by registered nurse and Boston College associate professor Judith Shindul-Rothschild demonstrates the need for the legislation.  Throughout Massachusetts, there are hospitals with emergency departments that far exceed the number of patients a nurse can care for safely. There is a strong, statistically significant relationship, between the numbers of patients cared for by an RN in Massachusetts EDs and how quickly patients are evaluated by a qualified health care professional, according to Shindul-Rothschild.

For example, at UMass Marlborough Hospital, where patient loads are high, patients on average wait more than two hours to be evaluated. At Boston Medical Center, a Level 1 trauma center, patients wait an average of 94 minutes to be treated for a long bone fracture. It also takes an hour and a half for a patient to be given pain medication for that same, painful bone injury at Sturdy Memorial Hospital in Attleboro.

This kind of data provides the public “with a meaningful, evidence-based context within which we can appreciate the human suffering that is extended, unnecessarily, due to insufficient RNs in Massachusetts’ EDs,” Shindul-Rothschild testified.

The hearing followed the release earlier this year of two independent national reports showing Massachusetts hospitals rank near the bottom nationally (46th worst) for preventable patient readmissions and certain types of preventable infections.  Eighty percent of Massachusetts hospitals are currently being penalized by the federal government for excessive rates of Medicare readmissions and nearly half (47 percent) are being assessed for value or quality of care related penalties, according to Peter Arno, Senior Fellow and Director of Health Policy Research, Political Economy Research Institute at the University of Massachusetts-Amherst.

Arno, who is also a distinguished fellow at the Institute for Health Equity at City University of New York, testified Tuesday that “the overwhelming weight of the evidence strongly suggests that improving nurse staffing levels is a key factor in promoting high quality patient care and safety.”

“The health care system is rapidly evolving towards a more value-based system in which providers will increasingly be rewarded for improvements in quality,” Arno said. “Raising inpatient nurse staffing levels, which have been demonstrated to improve quality of care, is a moral, political and economic imperative whose time has come.”

Karen Higgins, an ICU nurse at Boston Medical Center and co-president of National Nurses United, spoke about a law in California enacted nearly a decade ago that successfully established safe patient limits without affecting hospitals’ bottom lines. She urged lawmakers not to be swayed by the hollow, constantly shifting arguments of those who oppose the Patient Safety Act.

“Keep in mind the very people who will come before you today opposing this legislation are the same people who first told us there wasn’t a problem. But there was,” Higgins said. “Then told us there wasn’t research. But there is. Then they told us there weren’t enough nurses – but there are. Then told us they would fix it themselves.  But they didn’t.”