Thursday, April 2, 2015
By Susan Spencer TELEGRAM & GAZETTE STAFF
WORCESTER — Scores of nurses packed a state Health Policy Commission hearing Thursday at Worcester State University, telling regulators that proposed rules under the new intensive care unit staffing law would give hospital administrators too much wiggle room to understaff units.
At the same time, representatives of community hospitals and nurse managers asked for more flexibility to determine appropriate staffing.
Last year, the state House and Senate unanimously passed a law that would limit the number of patients assigned to a registered nurse in an ICU to one per nurse, or at most two per nurse depending on the stability of the patient as assessed by an "acuity tool" and by the staff nurses and managers in the unit.
The staffing limits went into effect Sept. 29. Under the proposed regulations, hospitals have until Oct. 1 to submit to the state Department of Public Health for approval an acuity tool to measure in what circumstances an ICU nurse could take a second patient.
Nurses from the Massachusetts Nurses Association argued that the one-patient-to-one nurse standard should always be the presumed appropriate level and that any divergence from that should be made with the judgment of direct-care nurses and an acuity tool that is developed largely by direct-care nurses.
"I am a strong supporter of the new ICU law," said Ellen Smith, a medical ICU nurse at UMass Memorial Medical Center — University Campus. "Unfortunately, my employer has refused to follow the law, and nearly every day fails to provide the nursing and support staff needed to meet the one-to-one standard of care that is called for under the law."
Ms. Smith said the draft regulations would not help this situation.
"In fact, you will give my administration and every other hospital administration the unbridled power to ignore the intent of the law and the standard of care it was intended to provide," she said.
"On a regular basis, our 14-bed unit is staffed with seven or maybe eight nurses, which means, at best, most if not all patients end up being doubled, regardless of their acuity level," added Karen Pettit, a nurse in the coronary care unit at UMass Memorial Medical Center — Memorial Campus.
"I can't tell my patient not to go into heart failure when I leave the floor with another patient, or because I am going to lunch," she said.
Maureen Horan, also an ICU nurse at UMass Memorial's University Campus, said, "I think money's going to be the bottom line and it's not going to be patient safety."
Kathleen Cashin and Laurie Spahl, ICU nurses at St. Vincent Hospital stressed that nurses' judgment, rather than an acuity tool, should be the key factor in determining whether a second patient could be assigned to a nurse.
But representatives of community hospitals maintained that their ICUs care for a range of patients and they don't have the amount or specialization of staff and equipment that academic medical centers do to always maintain a one-to-one staffing ratio.
The proposed regulations "would really create some practical barriers to care," said Paul MacKinnon, vice president of clinical operations and chief nursing officer at Health Alliance Hospital in Leominster.
He said that if a patient couldn't be moved from the emergency room to the ICU while additional ICU staff were being called in, it could harm the patient's health to linger in the ER.
"You have to have flexibility and that's really the bottom line," Mr. MacKinnon said.
Other representatives of smaller hospitals and the Organization of Nurse Leaders, which includes nurse managers, said that different types of ICUs, such as neonatal, burn, cardiac or surgical, face different situations and should be considered separately.
"All, all, all intensive care units... would be covered by this one-to-one ratio relative to this piece of legislation," said state Rep. James J. O'Day, D-West Boylston.
Mr. O'Day, who appeared before the commission with four other state representatives from the Central Massachusetts Legislative Caucus, said it was "mindboggling" that this legislation is being interpreted differently than that.
"This vote wasn't done in a vacuum.... It was decided after much deliberation to not distinguish between sizes of hospitals," said state Rep. Harold D. Naughton, D-Clinton. "That would have been a slippery slope."
Frank T. Kartheiser, speaking on behalf of Worcester Interfaith and Worcester Community Labor Council, told the commission that as patients and advocates for loved ones who might need intensive care, "We need the tools from you to know what we're up against, what our options are."
He asked that the staffing law be posted in publicly visible places in hospitals and that the state support a public education campaign.
Wendy Everett, vice chairman of the Health Policy Commission, said that written testimony on the proposed regulations would be accepted until noon Monday. Final recommendations would be made to the Health Policy Commission board as early as late April.
Contact Susan Spencer at firstname.lastname@example.org. Follow her on Twitter @SusanSpencerTG