Nurses push for patient limits as a matter of safety
Renewing what has been a perennial battle between labor and management, nurses and hospital administrators clashed Tuesday over proposed legislation that calls for a maximum limit on the number of patients assigned to any one nurse, while requiring hospitals to adjust nurses' patient assignments based on the needs of the patients.
Having no limit on the number of patients a nurse can care for at one time is "dangerous" and is "putting patients at great risk," Donna Kelly-Williams, president of the Massachusetts Nurses Association, said.
During her testimony before the Joint Committee on Public Health, about three dozen nurses stood behind Kelly-Williams.
She asked the nurses if they though patient care was suffering due to a nurse being asked to care for too many patients at once, and whether they know of any medical errors that resulted from a nurse having too many patients in her care at once. Nearly every nurse raised their hand to answer affirmatively.
Then Kelly-Williams asked the nurses if their concerns about nurse staffing levels and patient safety would stop them from admitting a loved one to their own hospital. About half of the nurses raised their hand to agree.
"We have just told you what we are experiencing. Our patients our suffering. Every day that goes by without a law in place means more preventable medical errors, more avoidable complications, increased lengths of stay and readmissions," Kelly-Williams said. "In some cases, it is the difference between life and death."
But the Massachusetts Hospital Association said those concerns are not borne out in patient safety data, noting that Massachusetts has a lower patient mortality rate and a higher rated patient experience than California, the only state to have implemented fixed nurse-to-patient ratios.
"Mandated fixed staffing ratios ignore the fact that every patient is different, the education and experience level of every nurse is different, the technology utilized at a hospital is different, and patient care units in every hospital are different," Pat Noga, vice president of clinical affairs for the MHA, said.
"Studies do not support the establishment of fixed nurse-to-patient ratios because the staffing needs vary from patient to patient, shift to shift, care team to care team."
The bills (H 1958 and S 1206) set a range for the maximum number of patients any one nurse can care for at once. The limit could be as low as one patient per nurse -- as is called for in the case of operating room patients under anesthesia -- and as high as six patients per nurse, as is the case for postpartum patients. In hospital units for which the bills do not specifically set a limit, the maximum patient assignment would be four patients per nurse.
Also opposing the bill was the Organization of Nurse Leaders of MA/RI/NH/CT (ONL), which said legislatively mandated staffing ratios diminish the role of the nurses. The organization also noted that hospitals cannot turn patients away and fixed staffing ratios would create problems in times of great need.
"What we oppose is a bill that limits the flexibility. Unlike other industries such as the daycare industry, hospitals can't turn patients away. Patients are different, patients's needs are different. And the flexibility that is limited in this type of a bill would significantly impact the care that can be delivered to patients," Maria Ducharme, president of ONL, said. "We want the appropriate ratios, that is what our desire is and we strive for them every day. There is just not one size (that) fits all."
Among the supporters of the bills at Tuesday's hearing were about a dozen of the approximately 80 legislators who have signed on to the legislation.
Rep. Denise Garlick, the House sponsor of the bill, noted that the Legislature last year handily passed a law setting a maximum patient limit for nurses who work in intensive care units, but said hospitals have been resistant to extending those limits to other units.
"This was a tacit agreement that there is indeed a limit on the number of patients a nurse can safely care for using the ICU as the setting," Garlick, who said she has been a registered nurse for 40 years, told the committee. "However since the passage of this law, hospital management, at times and in some places, is still assigning more patients to a nurse than the law calls for. This behavior is alarming and makes it all the more relevant that we must pass an act relative to patient safety."
Massachusetts AFL-CIO President Steven Tolman, a former state senator, said he supports the bill and wishes he had worked harder on the issue during his time in the Senate.
"In our health care system today, nurses are the credibility of the health care system. If they're coming out and saying there is a need for this, there's no question there's a need for this," he said. "Without any doubt I think it's time to take this serious and pass it and move it forward in the spirit, most importantly, of patient care."
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