State House Passes Nurse-staffing Bill

The state House of Representatives voted 119-35 on May 22 to approve a bill to guarantee safe registered nurse staffing in all Massachusetts hospitals, dubbed the Patient Safety Act.

The measure calls upon the Mass. Department of Public Health to set safe limits on nurses’ patient assignments, prohibits mandatory overtime, and includes initiatives to increase nursing faculty and nurse recruitment. If enacted into law, Massachusetts would be the only the second state in the nation to set safe staffing limits in hospitals.

While some prominent nursing organizations, such as the Mass. Nursing Assoc. (MNA) support the bill, others, including the Mass. Hospital Assoc. (MHA), oppose it.

“We are committed to working with all of the stakeholders — including the business community — to make reform a success,” said Lynn Nicholas, president and CEO of the MHA. “But we share the serious concerns of Massachusetts business leaders that mandated ratios would wreak havoc on health care costs, raise health insurance premiums, and could seriously threaten to derail our achievements on reform — with no improvement to patient care. As improved technology alters the manner in which we deliver health care, we cannot afford to be wed to an outdated delivery model based on ratios. We need the flexibility to deliver care for the 21st century.”

Conversely, John McCormack, co-chair of the Coalition to Protect Massachusetts Patients, an alliance of more than 130 of the state’s leading health care and patient-advocacy groups, said the law would have a marked effect on improving patient care in the Commonwealth.

“We applaud the House of Represent-atives for its overwhelming vote in support of the Patient Safety Act,” McCormack said. “When enacted, this law will improve the quality of care for all patients in our hospitals and save thousands of lives.”

The proposed legislation will now move to the Senate for consideration. In May 2006, the Mass. House of Representatives passed a similar bill, the Patient Safety Act, but it was not taken up by the Senate. The current bill is co-sponsored by state Rep. Christine Canavan (D-Brockton) and state Sen. Marc Pacheco (D-Taunton).

“The time has come to pass this law and to protect the patients of the Common-wealth,” said Canavan. “I am so pleased that my colleagues have recognized the merits of this bill. Let’s make this the year we finally reach the governor’s desk.”

“The Mass. Nurses Association commends the House for their courageous vote to support the Patient Safety Act,” said Beth Piknick, president of the MNA. “This bill is about patient safety. We want to thank the Legislature for recognizing the need to improve patient safety for all our citizens, and we urge the Senate to vote to support the Patient Safety Act as well. Every day we wait for this bill to pass, patients are suffering and patients are needlessly dying due to lack of appropriate nursing care.”

Among its key components, the bill:

directs the Mass. Department of Public Health to develop and implement staffing standards and enforceable limits on the number of hospital patients assigned to a registered nurse at any one time;

requires that staffing standards be developed within 12 months of the bill’s passage and be based on scientific research on nurse staffing levels, patient outcomes, expert testimony, and standards of practice for each specialty area;

calls for the safe staffing limits to be implemented in all teaching hospitals by 2009, with implementation in all community hospitals by 2011;

allows DPH to grant waivers to hospitals in financial distress;

provides flexibility in staffing and accounts for patients who require more care. Once established, the staffing levels will be adjusted up or down based on patients needs using a standardized, DPH-approved system for measuring patient needs;

aims to reduce errors caused by fatigue and overwork by prohibiting hospitals from forcing nurses into mandatory overtime, and also prevents hospital administrators from moving nurses into unfamiliar assignments without proper orientation;

prevents the reduction of support services, including services provided by licensed practical nurses, aides, and technicians;

establishes strong consumer protections for safe RN staffing, including a prominent posting of the daily RN staffing standards in each unit; and

establishes a number of nurse-recruitment initiatives—sought by the hospital industry and supported by the Coalition—to increase the supply of nurses by providing nursing scholarships and mentorship programs, as well as support for increases in nursing faculty to educate new nurses.

It also creates refresher programs to assist nurses who want to return to practice at the hospital bedside. A survey of Massachusetts nurses found that more than 65% of those not practicing in hospitals would be likely to return if a law providing safe limits was passed.   In California, where similar limits have been in place for three years, 80,000 nurses have returned to the bedside, according to the California Board of Nursing.

To date, 130 of the state’s leading health care and patient advocacy groups have endorsed the Patient Safety Act and have joined forces to push for its passage in both the House and Senate. Recent voter surveys indicate that more than 80% of the public supports establishing safe staffing limits.