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05.25.2006
House Passes Landmark Bill
on RN Staffing in Massachusetts Hospitals
Measure Calls for Safe Limits on Nurses’
Patient Assignments, Prohibits Mandatory Overtime and Includes Initiatives
to Increase Nursing Faculty & Nursing Scholarships
[Test of House Leadership's
Redraft of the Safe RN Staffing Bill Passed by the House]
[Fact Sheet on
the Redrafted Safe RN Staffing Bill]
[How They Voted]
BOSTON, Mass.—The state House
of Representatives voted 133 – 20 yesterday to approve a landmark
bill to guarantee safe RN staffing in all Massachusetts hospitals.
The measure calls upon the Massachusetts 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.
The “Patient Safety Act” will now move
to the Senate for consideration. The measure was crafted by House
leadership after days of negotiations between legislative leaders,
the Massachusetts Nurses Association (MNA) and the Massachusetts
Hospital Association.
“This is a bill about patient safety; it’s
about saving lives, from Boston to the Berkshires. It’s fundamentally
about guaranteeing a baseline of quality care that all citizens
can depend on,” said Rep. Peter Koutoujian, co-chair of the
Joint Committee on Public Health, who co-authored the redraft of
the bill with House leadership. “While drafting this legislation
we made every effort to address the concerns of the hospitals, while
also addressing the real concern that some units in some hospitals
are dangerously understaffed.”
“We are very pleased with this vote for patient
safety,” said Beth Piknick, RN and president of the Massachusetts
Nurses Association—one of 104 of the state’s leading
health care and consumer groups supporting the bill. The MNA had
filed the original version of the patient safety bill.
The law, when enacted, will make Massachusetts only
the second state in the nation to set safe staffing limits in hospitals.
A similar law was passed in California in 1999, and 14 other states
currently have similar legislation pending.
The approval of the bill by the House follows years
of scientific research and reports by health policy experts that
show the safety of patients in hospitals, including those in Massachusetts,
is suffering due to understaffing of registered nurses. Last year,
a survey of recent patients in Massachusetts hospitals conducted
by Opinion Dynamics Corp. found one in four (an estimated 235,000
patients each year) reported their safety was compromised during
their hospital stay due to the understaffing of registered nurses.
A survey of Massachusetts physicians found that one in five reported
patient deaths attributable to nurses having too many patients.
The scientific research clearly shows that when nurses have fewer
patients, patients get better care, medical errors are reduced and
millions of dollars are saved.
Key components of the bill include:
- Directs the Massachusetts Department of Public
Health (DPH) to develop and implement specific minimum RN staffing
standards for all units in the state’s acute care hospitals,
which would include an optimum RN-to-patient assignment, as well
as an enforceable limit on the number of patients assigned to
each registered nurse.
- The staffing standards would 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.
- The bill calls for the safe staffing limits
to be implemented in all teaching hospitals by 2008, with implementation
in all community hospitals by 2010.
- Provides flexibility in staffing and accounts
for patients who require more care. The measure calls on DPH to
create a standardized acuity-based patient classification system,
which is a standardized formula for rating the illness level of
patients. Based on the acuity of the patients
assigned to a nurse, if those patients require more intensive
care the nurse would be assigned fewer patients.
- Protects valuable members of the patient care
team who support nurses in caring for patients, which was the
major sticking point identified by the hospital industry. The
new provision prevents “understaffing of other critical
health care workers, including licensed practical nurses and unlicensed
assistive personnel.” It also includes consideration of
ancillary staff in the criteria created by DPH for the standardized
acuity-based patient classification system.
- Prohibits the practice of assigning nurses mandatory
overtime as a means of staffing the hospital.
- Allows hospitals that can prove a financial
inability to comply with the law to delay implementation of the
staffing standards, with oversight provided by DPH.
- Assures that institutions cannot delegate to
unlicensed personnel duties which demand nursing expertise. Throughout
the 1990s, the hospital industry attempted to cut costs by replacing
nurses with unlicensed personnel, which led to a deterioration
in patient care and to the exodus of nurses from the bedside.
- Establishes a number of nurse recruitment initiatives
sought by the hospital industry, and supported by MNA, to increase
the supply of nurses, including nursing scholarships and mentorship
programs, and support for increases in nursing faculty to educate
new nurses. It also would create refresher programs to assist
nurses in returning to practice at the hospital bedside. A survey
of Massachusetts nurses found that more than 65 percent of those
not practicing in hospitals would be likely to return if a law
providing safe limits was passed.
- Establishes strong consumer protections for
safe RN staffing, including a prominent posting of the daily RN
staffing standards on each unit.
- Calls upon DPH to monitor compliance and to
investigate violations, with the ability to impose fines.
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