Nurses: too many patients hurts quality of care
Massachusetts nurses believe patient safety and quality of care are declining amid increased patient counts for nurses and health care corporatization, and the nurses union is weighing a 2018 ballot campaign to limit the number of patients assigned to a nurse at once.
A survey, conducted by the Massachusetts Nurses Association and released Thursday to coincide with National Nurses Week, found that having too many patients to care for at one time is the most commonly cited challenge to providing quality care, with 77 percent of the nurses surveyed identifying unsafe patient assignments as a problem.
The nurses association survey reported that 87 percent of nurses said they do not have the time to properly care for their patients "due to unsafe patient assignments," 73 percent reported medication errors due to unsafe patient assignments and 29 percent of nurses reported patient deaths "directly attributable to having too many patients to care for at one time."
"Our nurses are telling us that things are not working," Rep. Denise Garlick, a nurse and former president of the MNA, said in a statement. "We need to listen to them. Three years ago, I worked with my colleagues in the House and Senate to pass safe patient limits in our Intensive Care Units, knowing that it was the first step towards limits in all hospital units. Today's survey confirms that we must take that next step. Our nurses are telling us we need safe limits in all units to protect patients."
The MNA has not filed or backed legislation to set patient limits this session, but an MNA spokesman said the union is exploring a 2018 ballot initiative on the topic. If the union does pursue a ballot question on staffing levels or patient limits, the Legislature would first have a chance to review the proposed language and take its own action, or risk having the issue settled with a ballot law. Legislative leaders have shown little interest in tackling the issue.
Staffing has long been a point of contention between the nurses union and hospital management. Nurses and hospital officials have battled for years over legislation imposing staffing ratios, with nurses arguing they are overtaxed and patients at risk, and hospitals countering that they are in the best position to make the call on staffing requirements, based on the changing needs at different facilities.
Meanwhile, hospitals are under pressure to hold costs down while operating on thin margins. Statewide median total margin -- excess of total revenues over total expenses -- fell to 3.7 percent in the 2015 fiscal year from 4.2 percent in 2014, according to a Center for Health Information and Analysis report on the financial performance of acute hospitals in Massachusetts.
Median total margin for the state's nine teaching hospitals experienced a "significant decrease," according to the report, falling to 4.2 percent in 2015 from 8.2 percent in 2014.
The union survey also found that nurses are "more likely to say hospital mergers and acquisitions ... and emerging business relationships between hospitals and pharmaceutical companies and/or medical device manufacturers ... worsen the quality of patient care" by 21-point and 19-point margins, respectively.
The MNA survey results -- a poll of a random sample of registered nurses working in Massachusetts health care facilities, the union said -- are slated to be released late Thursday morning to coincide with a State House press conference in Nurses Hall. The union will also debut a video series, "What Nurses Really Do," in which nurses explain "the specialized patient care they provide every day," according to the MNA.
The union said "many people don't really know what nurses do on a daily basis" though national public perception of nurses ranks high. The MNA survey found that 43 percent of nurses "do not believe patients understand their role."
"The reality is that nursing today is a complex and demanding profession," the unions said.
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