RNs Urge DPH to Consider Current and Proposed RN-to-Patient Ratios as Part of Effort to Determine Legitimacy of this and other Health Care Projects
CANTON, Mass. — Warning that hospital expansion can be dangerous to patients if there isn’t adequate registered nurse staffing for the new beds, members of the Massachusetts Nurses Association (MNA) will ask the Massachusetts Department of Public Health (DPH) to consider the current and proposed ratio of registered nurses-to-patients as part of their review of the Lahey Clinic’s $55 million expansion plan at a public hearing tonight.
DPH is reviewing a pending application from Lahey to build a seven-story addition to its Burlington health care facility, which would include a number of medical surgical and intensive care unit beds as well as new operating rooms. The public hearing will be held at the Marriott Burlington on Thursday, Oct. 9, 2003 at 7 pm.
"Lahey is seeking to build a new patient tower to include 36 medical/surgical beds, 24 intensive care beds, and four operating suites; but our question is, what guarantee is there that they will be able to attract nurses to staff these beds, and if they do staff these beds, what guarantee is there that these beds will be staffed with an RN-to-patient ratio that will provide the level of care promised by this institution?" said Karen Higgins, president of the MNA (for a fax or email of Higgins’ testimony, call 781.830.5717).
"These comments are offered at a time when Massachusetts finds itself in the midst of a severe nursing crisis, where poor staffing conditions, and a lack of recognition of the value of nurses has created conditions that have placed the health and safety of thousands of Massachusetts patients in jeopardy," said Higgins.
"We want DPH to understand that registered nurse staffing not only matters, it is a matter of life and death. You can have the nicest building, the most expensive supplies and the world’s greatest surgeons and physicians, but if you don’t have registered nurses with a ratio of patients that allows them to apply their skills and experience to the care of the patient, none of these other factors matter," said Higgins.
The MNA concerns are supported by recent national and statewide medical and nursing research, which they intend to share at the hearing, including a study in the Journal of the American Medical Association, which found the higher the patient-to-nurse ratio, the more likely there will be a death or serious complication. Each additional patient above four that a nurse is caring for produces a 7 percent increase in mortality. If a nurse is caring for eight patients instead of four, there is a 31 percent increase in the risk of death.
"Many of the nurses in Massachusetts and nurses we have talked to at the Lahey Clinic today report that they are regularly being assigned ratios that fall into this dangerous range, and the majority of nurses in our state are working with ratios above what would be considered appropriate, according to this study," Higgins said.
The MNA will also present data from a recent survey of Massachusetts nurses conducted by Opinion Dynamics, a respected independent research firm, which provides evidence of the dangers of understaffing in our state’s hospitals.
- 87 percent of nurses report having too many patients to care for safely;
- 2 in 3 nurses report an increase in medication errors due to understaffing;
- 2 in 3 nurses report an increase in complications due to understaffing;
- 1 in 2 nurses percent report readmission of patients due to understaffing;
- 1 in 2 nurses report injury and harm to patients do to understaffing;
- 1 in 2 nurses report that poor staffing leads to longer stays for patients; and
- Most alarming of all, nearly one in three nurses (29 percent) report patient deaths directly attributable to having too many patients to care for.
As part of its testimony, the MNA recommendation is for DPH to require facilities that apply for expanded services to provide:
- Data on current staffing levels, with a focus on daily RN-to-patient ratios;
- Patient care data, including mortality and morbidity, records of medication errors and patient falls and other outcomes of care; and
- Projections on staffing ratios for the new units as proposed, as well as the proposed skill mix (skill mix refers to the types of caregivers on a typical floor, i.e. the mix of RNs, LPNs and aides) for these floor.
In addition to testifying at the public hearing, the Massachusetts Nurses Association has filed and is actively promoting passage of legislation – H. 1282, An Act to Ensure Quality Patient Care and Safe Registered Nurse Staffing — which would mandate by law specific RN-to-patient ratios for all acute care hospital units and departments, as well as call for a standardized patient classification system that will mandate improvements in staffing based on the needs of patients.
Last month, Leaders from more than 60 of the state’s most influential health care and consumer advocacy organizations announced the formation of the Coalition to Protect Massachusetts Patients, which will mobilize support for House Bill 1282, which is now before the Joint Committee on Health Care.
Impact on Surrounding Hospitals
The MNA also questions the expansion of Lahey and its impact on the overall health care system in the region, citing the recent closure of Waltham Hospital, as competing hospitals siphoned off physicians and deprived the 100-year-old facility of admissions needed to keep it viable.
"We are now considering a significant expansion of Lahey Clinic’s services, while we just allowed an existing 100-year old institution to die, leaving the citizens of Waltham with no access to appropriate emergency services," Higgins said.
"If DPH approves this service at Lahey, what will happen to surrounding community hospitals, such as Winchester Hospital, where they might find themselves losing patients and services? As you approve this service, will you find yourself at some other nearby facility at a public hearing concerning its potential closing or arguing for an increase in state funding to keep it afloat?
"We believe that it makes no sense to consider each of these applications in an ad hoc fashion," Higgins added. "We urge you to consider this and future determinations of need in the broader context of what represents rationale health care delivery for all citizens and all communities."
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