News & Events

Registered Nurses Unite for Question 1: Safe Patient Limits

Nursing organizations representing hundreds of thousands of nurses from across North America have endorsed the effort by Massachusetts nurses to pass for An Act relative to patient safety and hospital transparency (the Patient Safety Act). The Patient Safety Act will be Question 1 on the ballot.

A yes vote on Question 1 will dramatically improve patient safety in Massachusetts hospitals by setting a safe maximum limit on the number of patients assigned to a nurse at the same time, while providing flexibility to adjust nurses’ patient assignments based on the specific patient needs of patients and the professional judgment of the nurse providing direct patient care. The measure will be for voters’ consideration on the November 2018 ballot. Today, outside of acute care hospital intensive care units, there is no law that specifies how many patients a nurse can safely care for at one time.

Numerous surveys – some noted below – outline the concerns voiced by nurses at the bedside, illustrating the reality of patient care and staffing. And numerous studies – some also noted below – show a direct link between excessive patient assignments for nurses, nurse burnout / understaffing, and a variety on negative patient outcomes, including medication errors, increased risk for infections, bed sores, and longer hospital stays.

“The need for safe patient limits is one that is shared by nurses in every state and in many countries,” said Donna Kelly-Williams, RN at the Cambridge Hospital Birth Center and President of the Massachusetts Nurses Association. “We are proud and empowered that so many organizations and so many nurses have endorsed our initiative, particularly because these organizations represent frontline nurses, those who actually provide direct care to patients and understand what it means to have human lives in your hands, and what it means for those vulnerable patients when you are forced to care for too many at one time.”

Organizations Across the U.S. and Canada

To address this growing patient safety crisis, a number of other states are currently pursuing similar measures, including: Florida, Illinois, Michigan, Minnesota, Nevada, New York, New Jersey, Ohio, and Pennsylvania. There is also federal legislation to set safe patient limits for all hospitals.

  • Health Watch USA
  • Show Me Your Stethoscope Foundation
  • National Nurses United
  • National Union of Healthcare Workers
  • California Nurses Association
  • Massachusetts Student Nurses Association
  • Michigan Nurses Association
  • Minnesota Nurses Association
  • New York Professional Nurses Union
  • New York State Nurses Association
  • Northeast Nurses Association
  • Pennsylvania Association of Staff Nurses & Allied Professionals
  • United Nurses & Allied Professionals
  • National Union of Public and General Employees
  • New Brunswick Union
  • Newfoundland and Labrador Association of Public and Private Employees  
  • Nova Scotia Government and General Employees

The State of Patient Care

In April 2018, the Committee to Ensure Safe Patient Care released “The State of Patient Care,” which surveys Registered Nurses across the Commonwealth. This survey shows the alarming worsening trend of increased patient consequences as a result of poor staffing levels for nurses. [See footnote 1.]

Over three quarters of Massachusetts nurses (77%) believe that RNs are assigned too many patients to care for at one time. Thirty-six percent of RNs report patient deaths directly attributable to having too many patients to care for at one time – a sharp and alarming increase from previous survey results (2017 – 29%; 2015 – 25%; 2013 – 23%).

The results underscore the sense of urgency in passing the Patient Safety Act as patient safety concerns continued to increase at dangerous rates as compared to just four years ago:

  • 64% of RNs report injury and harm to patients due to understaffing – up from 46% in 2014.
  • 66% of RNs report longer hospital stays for patients – up from 51% in 2014.
  • 72% of RNs report readmission of patients – up from 56% in 2014.
  • 77% of RNs report medication errors due to unsafe patient assignments – up from 57% in 2014.
  • 90% of RNs report that they don't have the time to properly comfort and care for patients and families due to unsafe patient assignments – up from 82% in 2014.
  • 86% report RNs don't have the time to educate patients and provide adequate discharge planning – up from 68% in 2014.

According to survey results, nearly 9 in 10 nurses (86%) report that they will vote yes for the Patient Safety Act.

Numerous Surveys Echo These Findings

Several surveys conducted over the last decade indicate that nurses have been battling understaffing for years.  A handful of examples:

A July 2016 ‘State of Nursing’ survey noted: “Among our respondents, adequate staffing represents their largest obstacle, and staffing problems are far and away the most common complaint from these nurses. Many secondary concerns, like patient safety or patient satisfaction, could be ameliorated by changes to staffing policy.”

According to a June 2017 survey by Kronos: 98% of nurses found their work physically and mentally demanding; 60% of RNs cited excessive workloads as the top source of fatigue; and 83% of Registered Nurses believe hospitals are losing skilled nurses because of these conditions.

A February 2014 survey of RNs by Jackson Healthcare noted: “Factors such as inadequate staff to cover the number of patients … are cited by large numbers of the 1,333 hospital-based registered nurses surveyed as inhibiting patient time.”

A May 2015 nationwide survey conducted by Harris Poll on behalf of CareerBuilder found that 7 in 10 nurses (70 percent) report feeling burnt out in their current job.

According to a February 2017 survey by RNnetwork, 46% of nurses reported an increase in their workloads. The survey went on to note: “That increase in workload may be the reason why 43 percent of respondents say their workplaces don’t support a healthy work/life balance. [See footnote 2.]

Science Supports Nurses Voices

Numerous independent, peer-reviewed studies indicate that there should be a limit on the number of patients a nurse can care for at one time:

  • For every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5% per patient. [See footnote 3.]
  • For children recovering from basic surgeries, each additional patient assigned to a nurse increased the risk of readmission by a shocking 48%. [See footnote 4.]
  • There is a 20% higher risk that a patient will die within 30 days of having general surgery at hospitals that don’t have patient limits. [See footnote 5.]
  • Every additional patient assigned to an RN is associated with a 7% increase in the risk of hospital-acquired pneumonia, a 53% increase in respiratory failure, and a 17% increase in medical complications. [See footnote 6.]

About the Patient Safety Act

Today, outside of acute care hospital intensive care units, there is no law that specifies how many patients a nurse can safely care for at one time. It is not uncommon for nurses in Massachusetts to have six or seven patients at one time, when a safe limit would be no more than four patients for a nurse on a typical medical/surgical floor.

The Patient Safety Act will dramatically improve patient safety in Massachusetts hospitals by setting a safe maximum limit in the number of patients assigned to a nurse at one time, while providing flexibility to adjust nurses’ patient assignments based on the specific patient needs of patients and the professional judgment of the nurse providing direct patient care. It also protects other valuable members of the health care team by preventing the reduction of other caregivers to meet the limits set by the law. It also allows hospitals to exceed the patient limits during times of state and national emergency.  

1.    “The State of Patient Care” was commissioned by the Massachusetts Nurses Association and conducted between April 2-25, 2018, by Anderson Robbins Research, an independent research firm headquartered in Boston. The 2018 survey respondents were all registered nurses working in Massachusetts health care facilities randomly selected from a complete file of the 100,000 nurses registered with the Massachusetts Board of Registration in Nursing. A majority (54%) of RNs interviewed are not MNA members.

2.    Note: This survey also indicates a nursing shortage at the national level. Massachusetts ranks near the top nationally for nurses per capita and a recent report found MA to be one of two states with no nursing shortage. In the last four years, Massachusetts nursing schools graduated more than 18,000 nurses, with an average of 3,500 graduates per year. Over the last 4 years, this has resulted in a population nearly three times greater than the number the industry says they need. In California following implementation of their limits law, more than 100,000 nurses flocked to the state within two years to work under safer conditions. There is no shortage of nurses in Massachusetts, there is a shortage of nurses willing to work under current conditions.

3.    “Better Nurse Staffing and Nurse Work Environments Associated with Increased Survival of In-Hospital Cardiac Arrest Patients.” Medical Care, January 2016.

4.    “An Observational Study of Nurse Staffing Ratios and Hospital Readmission Among Children Admitted for Common Conditions.” BMJ Quality & Safety, May 2013.

5.    “Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk.” JAMA Surgery, January 2016.

6.    Robert L. Kane, MD., et al, Evidence Report/Technology Assessment for Agency for Healthcare Research and Quality, AHRQ Publication No. 07-E005, May. 2007.