News & Events

Latest ‘State of Nursing in Massachusetts’ Survey Shows Need for Safe Patient Limits and Fact-Finding Legislation to Clarify Hospital Industry Misinformation

CANTON, Mass. – Registered nurses throughout the Commonwealth report that quality of care in Massachusetts hospitals is suffering as nurses have less time to spend with patients who are getting sicker each year, according to the 2019 “State of Nursing in Massachusetts,” a survey released annually during National Nurses Week.

The randomized survey of Massachusetts RNs – conducted April 2-18 by Boston-based Beacon Research – shows that almost every nurse supports legislation to independently study nursing and patient care following the Question 1 ballot campaign, in which hospital executives used “inappropriate” political tactics to misinform voters about Safe Patient Limits.

“Nurses are crying out for help to care for the sickest, most vulnerable members of our communities,” said RN and Massachusetts Nurses Association President Donna Kelly-Williams. “When a nurse has too many patients too care for at one time, and hospital executives do nothing about it, the quality of care suffers.”

Click here for a copy of the executive summary of the survey. For the first time since 2014, nearly twice as many nurses say the overall quality of care in Massachusetts hospitals has gotten worse (39%) rather than better (21%). A record-high number of nurses now believe that the quality of care is getting worse.

Nurses are also grappling with sicker patients. Nearly nine-in-ten (88%) think patients today are sicker than patients a decade ago, up seven points from last year. Fully six-in-ten nurses (61%) think patients are much sicker now.

Patient Assignments and Hospital Non-Responsiveness

The staffing situation is not improving: a record-high 44% says staffing has gotten worse in the past four years, and a similar number say it has worsened since October. Two-thirds of nurses (65%) believe nurses at acute care hospitals are assigned too many patients to care for at one time. Just a third report that management typically adjusts patient assignments when they become unsafe.

“Patient care conditions have actually grown worse since last year, when the hospital industry pledged to address this problem after misleading the public about the evidence supporting Safe Patient Limits,” Kelly Williams said. “Executives have not only failed to follow-through on addressing unsafe staffing, they have not even requested a meeting with the nurses and other coalition members behind Question 1.”

Surveyed nurses report similar inaction: A record-high 44% of nurses find that hospital administrators are not responsive to feedback from RNs regarding patient loads and nurse staffing levels. Nearly six-in-ten (57%) report that management does not consistently adjust patient assignments when needed.

Patients at Risk

Faced with this industry-created crisis, nurses have filed thousands of unsafe staffing reports with administrators at hospitals across Massachusetts. These reports document instances where nurses were forced to take excessive patient assignments that “poses a serious threat to the safety and well-being of my patients.” 

“Objection and Documentation of Unsafe Staffing” forms, as they are called, are used by nurses in all MNA-represented hospitals, which is 73 percent of acute care hospitals. They are a tool for nurses to document, in real time, any situation where they come on their shift and are given an assignment that is unsafe for their patients, and that prevents them from delivering the quality care those patients require.

“The State of Nursing in Massachusetts” demonstrates that registered nurses – both union and non-union – believe such unsafe staffing conditions put patients at significant risk. Six-in-ten feel patient over-assignment decreases the quality of care they can provide, including 50% who say unsafe patient assignments greatly decreases the quality of care.

There is widespread awareness of specific negative patient outcomes arising from unsafe patient assignments. Two-thirds of nurses have seen medical complications (65%), re-admission (65%), and medical errors (65%) stemming from unsafe patient loads.


Hospital Industry Misinformation and a Call for Independent Fact-Finding

During the 2018 campaign for Safe Patient Limits, hospital executives distributed materials opposing the initiative to patients, and also mailed opposition materials to patients’ homes. More than two-thirds of nurses (68%) feel these campaign activities were inappropriate.

“It is clear from the severity of this problem and from the misinformation spread by hospital executives why nurses who care for patients in all types of settings back legislation to provide more independent studies about our nursing workforce and the patient care environment,” Kelly-Williams said.

Nearly all nurses (93%) support the creation of an independent legislative commission to conduct studies on the state of nursing in Massachusetts. The Workforce Development and Patient Safety Act (S. 1255/H. 2004) is sponsored by Senator Diana DiZoglio and Representative Dan Ryan. The bill would:

  • Examine the makeup of the current nursing workforce.
  • Determine the nursing needs for the Commonwealth over the next several decades.
  • Provide an independent, evidence-based analysis of issues affecting the RN workforce, including but not limited to workplace staffing, violence, injuries and quality of life.
  • Use the results of these studies to determine the path forward for setting safe patient limits in MA acute care hospitals to ensure optimum patient care.

Survey Background

“The State of Nursing in Massachusetts” was commissioned by the Massachusetts Nurses Association and conducted April 2-18, 2019 by Beacon Research. It utilized gold-standard interviewing practices as outlined by the American Association of Public Opinion Research (AAPOR).

Respondents were randomly selected from a complete file of the 100,000 nurses registered with the Massachusetts Board of Registration in Nursing, and geographic quotas were used to ensure accurate representation across all regions of the state. A total of 501 Interviews were conducted on landlines and cellphones by trained, professional interviewers; the average length of a completed interview was 20 minutes.

A majority (60%) of RNs interviewed were not MNA members.

Many questions were split-sampled (asked of half the sample), with a sample size of approximately 250. Questions asked of the full sample have a margin of error of ±4; split-sampled questions have a margin of error of ±6 (both at the 95% confidence level).


-###- │ │ │


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.