Below is a story that appeared in the Boston Globe this Sunday 3/17/02, which focuses on MNA legislation to regulate nurse to patient ratios in Massachusetts. For more information about the MNA's legislation and what you can do to support it, visit our safe staffing web page or call our Department of Legislation and Government affiars at 800.882.2056 x725.

Nurses lobby for minimum staffing levels
New bill would put ceiling on staff-to-patient ratios
By Kathy McCabe, Globe Correspondent, 3/17/2002

Area nurses converged on Beacon Hill last week to lobby for a controversial bill that would set minimum staffing levels at Massachusetts health-care facilities.

The so-called Sufficient Nurse Staffing bill would require hospitals, nursing homes, and other health-care facilities to establish nurse-to-patient staff ratios.

An amendment proposed by state Senator Richard T. Moore (D-Uxbridge), chairman of the Legislature's Joint Committee on Health Care, also would ban mandatory overtime, and prevent the use of unlicensed personnel from performing nursing tasks.

The bill, still pending in committee, is backed by the Massachusetts Nurses Association, the state's largest nurses union, which represents nurses at hospitals in Beverly, Gloucester, Haverhill, and Newburyport. The association last week organized a "Nurse Lobby Day" on Beacon Hill to win support for the bill.

Local nurses said the legislation is critical to ensure patient safety, and help alleviate a chronic national nursing shortage. Whereas 10 years ago a nurse may have been charged with three or four patients, nurses today can be assigned as many as 10 patients at a time, they said.

What's more, nurses are often required to work mandatory overtime shifts as long as eight to 10 hours to cover shifts when there are not enough nurses on duty, they said.

"We're mandated by law what we can do as a nurse," said Joanne Laschi, cochairwoman of the Northeast Hospital Professional Nurses Union, which represents 450 nurses at Beverly Hospital, Addison Gilbert Hospital in Gloucester, the Hunt Center in Danvers, and Cable Emergency Center in Ipswich. "But there is no mandate as to how many patients we can safely care for at any one time."

Said Jeanine Hickey, president of the Merrimack Valley Hospital Professional Nurses Unit in Haverhill, "This bill will save patient care in Massachusetts and the nursing profession. If we can improve nursing conditions, we can draw more people into the profession."

Health-care administrators take a different view, however. Minimum staffing requirements would merely address the symptoms of the nursing crisis in Massachusetts, and not the overall problem of recruiting and retaining nurses, they said.

"This approach would introduce rigidity into the health-care system at a time when more flexibility is needed," said Richard Averbuch, senior director of communications at the Massachusetts Hospital Association.

Averbuch said that the nursing shortage is among the most critical issues facing the state's financially struggling hospitals. There is now a 9 percent nursing vacancy rate at Massachusetts hospitals at a time when most hospitals are operating at a loss, he said.

On the whole, Bay State hospitals last year spent 1.3 percent more on health care than they received in payment, the Massachusetts Hospital Association reported last week.

Although the loss is an improvement over last year's 3.2 percent loss, the state's hospitals are still struggling, Averbuch said.

"Finances are still tight and the environment isn't likely to improve anytime soon. We don't believe that establishing nurse staffing ratios is a solution. Every hospital is different. There is no one single approach to nurse staffing that fits all hospitals," he said.

One local hospital executive agreed a one-size-fits-all approach to nurse staffing is not a viable option. "When you mandate something like this, you run into difficulty," said Steve Salvo, vice president of human resources at Anna Jaques Hospital in Newburyport. "Each hospital has different floors, units that serve different types of patients. It's not practical."

Jan Bishop, a vice president of nursing services at Northeast Health Systems in Beverly, was unavailable for comment, a hospital spokesman said. An official at Merrimack Valley Hospital in Haverhill could not be reached for comment.

Both Averbuch and Salvo said they support other legislation, such as the so-called Clara Barton bill, which would create mentoring positions, expand access to health-care education, and financial assistance to train nurses. "We have to look at ways together to make nursing a more attractive field," Salvo said.

One local legislator, who supports the mandatory staffing bill, agreed more needs to be done to boost nursing employment across all health-care facilities. "Solving a problem like nurse staffing ratios is never as easy as it seems," said state Representative Harriet Stanley, a Democrat from West Newbury who chairs the House Committee on Health Care. "The nurse staffing problem is just one symptom of the underlying problems in health care, which can't be solved in one bill."

Nurses, however, said the minimum staffing bill is a good place to start. Although in its current form the bill does not specify the number of patients that should be assigned to a nurse, the state nurses association favors a 5-to-1 ratio adopted in January in California. The number was determined after negotiations between the state nurses union and health care executives.

"That's the model we support," said David Schildmier, spokesman for the Massachusetts Nurses Association. "All the problems that we hear about in hospitals today, such as emergency room diversions, all comes down to staffing."

"The problem with nursing today is very simple," said Jeanine Cunningham, chairwoman of Anna Jaques Hospital Nurses, the union at the Newburyport hospital.

"We have too many patients and not enough staff to take care of them. Somethin has to give. This bill is a place to start."

This story ran on page W1 of the Boston Globe on 3/17/2002.