Hospitals dodge a bullet over nurse staffing
Massachusetts hospital executives have staved off a fight against a ballot initiative intended to mandate nurse staffing ratios in all hospital departments — a measure that, by most accounts, would have inflicted a huge cost burden to health care systems already feeling the pinch under health care reform.
The Massachusetts Nurses Association (MNA), the union representing nurses at many Bay State hospitals, was the driving force behind the initiative. After it received enough signatures required to bring the issue before voters at the polls in November, the MNA agreed to withdraw it when the Legislature sent a bill to Gov. Deval Patrick at the end of June that implemented staffing ratios in intensive care units. The MNA also gave up a separate ballot initiative that would have regulated CEO compensation and hospital operating margins, and required asset disclosures for hospitals and other facilities as a compromise for the nurse-staffing bill.
The bill doesn’t give the MNA everything it was looking for — hospital-wide staffing ratios that would have limited a nurse’s patient load to ensure safety, according to the MNA — but mandating staffing levels in intensive care units is a good start, according to David Schildmeier, spokesman for the union. He said union nurses have been pursuing staffing regulations for the past 15 years.
“We see this as a foundational agreement to build on,” Schildmeier said after the bill’s passage.
Meanwhile, the Massachusetts Hospital Association (MHA) has accepted the ICU staffing mandate as a favorable outcome, compared with the prospect of voters having to weigh in on the two ballot initiatives in November. In a statement, the MHA called the ICU staffing mandate a “reasonable approach."
“The new law moves away from the ballot questions and previous legislative proposals that would have locked in fixed nursing quotas in all units, at all times,” the statement read.
The MNA has held California up as an example of a state that has mandated staffing levels across all hospital departments throughout the state. Massachusetts is the second to follow with some form of legislation that dictates staffing, after California passed its minimum nurse staffing law in the late 1990s.
Data support union claims
According a report published by the Journal of the American Medical Association (JAMA) in 2002, the California law was passed due to a nursing shortage that many attributed to burnout brought on by burdensome workloads.
The JAMA report analyzed the relationship between staffing levels and job satisfaction among nurses working with surgical patients at 168 hospitals. Larger patient loads were associated with lower job satisfaction and more frequent emotional exhaustion.
Another report, released in 2004 by the federal Agency for Research and Health Care, a division of the U.S. Department of Health and Human Services, linked higher nurse staffing to improved patient outcomes, and lower staffing to adverse outcomes. For example, each additional surgical patient assigned to a nurse was associated with a 7-percent higher likelihood of dying within 30 days of admission.
Hospital executives take
tolerant view of ICU mandate
Despite the research, hospital administrators in Massachusetts have largely opposed blanket regulation of nurse staffing, saying it should be left up to administrators who can make decisions based on patient load and needs.
But Edward Moore, president and CEO of Harrington HealthCare in Southbridge and an MHA board member, said the ICU mandate is manageable.
“The staffing ratio is not as prescriptive … in the sense that this one allows for nurse manager and staff to (exercise judgment),” said Moore, who was referring to the flexibility the bill gives nurse managers to determine whether to pair a nurse with one patient or two, depending on how serious the patients’ conditions are.
Under the new law, all hospitals are also charged with developing a system, called an “acuity tool” to determine whether nurses should have one patient or two, based on patients’ stability. The acuity tool for each hospital will require certification by the state Department of Public Health.
The MNA has said that it will continue to pursue staffing mandates in other hospital departments, and Moore recognized this intention, saying he and other hospital executives will rally in the face of future proposals that would open the door to wider nurse staffing regulations. It’s a difficult battle to fight, Moore admitted, because the public is generally more receptive to nurses’ arguments than those of hospital administrators.
“Who would argue that more nurses doesn’t sound better, on the surface?” said Moore, adding that a closer look at how hospitals would be impacted by higher staffing costs, resulting in possible service cuts, might make consumers think twice.
In addition, Moore said Harrington already employs staffing ratios of one nurse to one or two patients, depending on how acute the cases are. And Robert Brogna, spokesman for Worcester-based UMass Memorial Health Care, echoed Moore in an e-mail statement, saying the new law respects the importance of allowing hospitals to make staffing decisions based on real-time factors.
Judy Kelly, director of inpatient services at Milford Regional Medical Center, offered a similar view. Following news that Patrick had signed the ICU staffing mandate on June 30, Milford Regional nurses, who are not union members, met to discuss the potential impact. Kelly said the nurses reported that a one-to-one or one-to-two ratio is already standard practice in the Milford Regional ICU.
Still, state regulation of staffing brings hospitals into uncharted territory, according to Kelly.
“The mandate has a different feel to it. It’s so black and white,” Kelly said.
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