News & Events

Safe Patient Limits Ballot Initiative Certified by Attorney General; Measure will Protect Patients and Improve Care in Massachusetts Hospitals

CANTON, Mass.The Patient Safety Act received certification today from the Massachusetts Attorney General’s office. The Patient Safety Act will dramatically improve patient safety in Massachusetts hospitals by setting a safe maximum limit on the number of patients assigned to a nurse at one time, while providing flexibility to hospitals to adjust nurses’ patient assignments based on specific patient needs. Currently there are no requirements for hospitals to provide an adequate level of nursing care in such areas as the emergency department, medical-surgical floors, maternity units or psychiatric units.

Certification is a critical step in the process. Today’s approval by the AG’s Office indicates that the initiative has passed constitutional standards and can be brought to the voters in November of 2018. The Committee to Ensure Safe Patient Care, the group backing the initiative, filed it today with the Secretary of the Commonwealth. The Secretary has 14 days to develop the official petition language, which will be presented to voters for signature collection. 

The Patient Safety Act – certified as the Initiative Petition For A Law Relative To Patient Safety And Hospital Transparency – is supported by a broad coalition from across Massachusetts, including registered nurses, patients and family members, health and safety organizations, community groups, unions and elected officials.

"Every patient has a right to safe and effective nursing care. Unfortunately, outside of intensive care units, there is no law limiting the number of patients that can be assigned to a nurse at one time in Massachusetts hospitals. This must change, for the sake of our patients,” said MNA President and RN Donna Kelly-Williams. “Nurses have advocated for patient safety at the bedside, in our hospitals, outside in our communities and at the State House. During that time hundreds of thousands of community members have stood with us, advocating for themselves and their family members. This tremendous support for safe patient limits will mean a resounding ‘yes’ for the Patient Safety Act in November 2018.”

Patient Safety Act Details

  • The law specifies safe, evidenced-based limits on nurses’ patient assignments, with different maximum patient limits for each care area (ED, psychiatric, medical surgical, etc.). For certain areas, like the ED and maternity ward, the law specifies different limits based on a patient’s condition. Read the full text and safe patient limits here:
  • To provide flexibility in RN patient assignments and to account for patients who require more care, the Patient Safety Act establishes an “acuity” system, which is a tool to measure how sick patients are on a particular unit. Based on the acuity of patients assigned to a nurse, the maximum safe patient assignment would be reduced if those patients require more intensive care.
  • Hospitals will be required to post in each unit, patient room and waiting area the safe patient limits and how violations can be reported. The Health Policy Commission will publicly post violations of the safe patient limits; any facility refusing to comply will be punished by a fine up to $2,500 for each day the facility is in violation of the law (AG’s Office will enforce).
  •  Hospitals would NOT be allowed to meet the safe patient limits for nurses by diminishing other members of the health care team.

A second version of the Patient Safety Act initiative containing a section on hospital financial transparency, including the requirement that all health care facilities receiving funds from the Commonwealth report assets held or invested overseas, was not certified by the AG’s Office. At this time, the Committee to Ensure Safe Patient Care plans to appeal this decision.

Why Safe Patient Limits Matter

Dozens of prominent studies have shown these limits are necessary for safe and effective patient care; read the studies at

  • While the Commonwealth is recognized as a national leader in health care research, as well as one of the most expensive providers of hospital care in the nation, our state’s hospitals rank near the bottom nationally in a number of indicators of patient safety and quality care, including sixth from the bottom nationally for costly and preventable readmissions of patients ( Preventable re-admissions are directly linked to quality of nursing care. (McHugh, Matthew D., Berez, Julie et al., Health Affairs, October 2013.)
  • An August 2017 study in the Journal of Nursing Care Quality, co-written by Boston College professor Judith Shindul-Rothschild, shows that at Massachusetts hospitals where nurses had higher patient assignments, patients were less likely to have catheters removed within 48 hours of insertion for surgery. Removal of a catheter in that time frame “is an evidence-based strategy for preventing catheter-associated urinary tract infection,” according to the study, “Factors Associated with Removal of Urinary Catheters after Surgery.”
  • Shindul-Rothschild’s research at Boston College has also shown that hospitals in Massachusetts, New York and California with better nurse staffing levels had higher levels of patient satisfaction with pain control (“Beyond the Pain Scale: Provider Communication and Staffing Predictive of Patients’ Satisfaction of Pain Control,” Pain Management Nursing 2017).

  •  A 2016 study published by Shindul-Rothschild in the Journal of Emergency Nursing on wait times in Massachusetts hospital emergency departments showed that the number of patients ED nurses care for at one time is directly related to how long patients wait for treatment ( Wait times in trauma EDs for diagnostic evaluation double for every three additional patients an emergency nurse cares for in 24 hours, according to the study’s analysis of 15 Massachusetts hospitals.

o   29% reported patient deaths directly attributable to having too many patients to care for at one time.

o   63% reported injury and harm to patients.

o   62% reported longer hospital stays.

o   71% reported readmission of patients.

o   73% reported medication errors due to unsafe patient assignments.

o   87% reported RNs don’t have the time to properly comfort and care for patients and families.

o   83% reported RNs don’t have the time to educate patients and provide adequate discharge planning.

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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.