Hospitals Have Claimed Nurses Can’t Be Found.
Time Has Come for Safe Staffing, Advocates Say, Will Introduce Budget Amendment.
BOSTON — A new survey of acute care Registered Nurses working part-time shows that more than a third would work additional hours if the Safe Staffing Bill (H. 1282) became law. By the most conservative estimates, this would translate into at least 1,824 full-time RN positions, more than enough to meet the bill’s staffing requirements without new hires.
The Safe Staffing Bill, which was approved by the Legislature’s Health Care Committee and is now before the Ways and Means Committee, sets flexible minimum RN-to-patient ratios in Massachusetts hospitals. The measure will dramatically improve the quality and safety of patient care in Massachusetts hospitals, where current staffing levels have resulted in a 76 percent increase in the rate of injuries, medication errors, and complaints by patients in the last seven years, according to the Massachusetts Department of Public Health (DPH).
The statewide survey of part-time hospital RNs conducted in March by the respected Cambridge-based polling firm, Opinion Dynamics Corp. (ODC), found that 33 percent of all RNs working part-time in acute-care settings (hospitals) would consider working more hours if the Safe Staffing Law is passed. Among those who would consider taking more hours, 47 percent would consider an additional 8 hours a week, 23 percent would consider 9 to 24 additional hours a week, 11 percent would consider an additional 24 hours a week, while 17 percent would consider an additional 7 or fewer hours a week.
“The results of this survey completely and convincingly dismantle one of the key arguments of the hospital industry in opposing this bill, which is, ‘we can’t find the nurses to provide this level of care.’ We have long known that Massachusetts has the highest per capita population of nurses in the nation – there has never been a nursing shortage here. Now we know that the nurses we need are already working in our hospitals and are more than willing to increase their hours, provided they have a guarantee of a safe work environment and the ability to provide proper care for their patients,” said Karen Higgins, president of the Massachusetts Nurses Association (MNA). MNA is a leader of the Coalition to Protect Massachusetts Patients, an alliance of 65 health care and consumer groups working for enactment of H. 1282.
According to Julie Pinkham, RN, executive director of MNA, the survey results mean that patients would benefit from receiving care by experienced nurses who already are familiar with procedures at the hospital. “It is clear that the immediate solution to the hospital staffing crisis is to focus on retaining existing personnel. Every survey of nurses nationally and here in Massachusetts shows that the current staffing crisis is being caused by poor staffing conditions that are driving experienced nurses away from the hospital bedside. It’s not an issue of recruiting new nurses, it’s an issue of keeping the nurses we have.”
Pinkham said the recruitment-focused legislation backed by the Massachusetts Hospital Association and sponsored by Sen. Richard T. Moore (D-Uxbridge) “simply won’t work. Without fixing the staffing conditions, we’ll end up spending the taxpayers’ dollars to recruit nurses into hospitals who will just turn around and walk out a year later.”
She noted that a new study published last month in the scholarly journal, Health Care Management Review on the high cost of RN turnover found the cost for advertising, training and loss in productivity associated with recruiting new nurses to a facility is $37,000 per nurse at minimum and can add as much as 5 percent to a hospital’s annual budget. The study concludes that improving working/staffing conditions is a primary strategy for hospitals that can generate significant cost savings. “Not only is the Safe Staffing Bill more effective than the Moore proposal,” she said, “it is more fiscally responsible.”
Saying that “the time has come to protect Massachusetts patients from avoidable hospital errors caused by inadequate staffing,” Rep. Jennifer Callahan, RN (D-Sutton) said she would introduce an amendment to the Fiscal 2005 Budget implementing the provisions of H. 1282. “The Commonwealth’s hospitals have had a decade to come up with their own solution and all that has happened is that understaffing and the danger to hospital patients has gotten dramatically worse,” Rep. Callahan added.
Judith Sacks of Lynnfield, a nurse at Faulkner Hospital, is one of the nurses who is willing to increase her hours if safe staffing legislation becomes law.
“I am now working part time in a GI (gastrointestinal) unit, leaving a job I loved working nights in the Intensive Care Unit (ICU). I just couldn’t take the conditions and was tired of feeling like I couldn’t take proper care of my patients. But if this bill passes, I would definitely go back to the ICU because that’s the type of nursing I love best. I just need to know I can do it safely.”
Beth Hulett of Lowell, who works nights on a busy medical surgical floor at St. Elizabeth’s Medical Center, is another nurse who is waiting in the wings. “I have been struggling for years to provide good care to patients, with staffing ratios that are too often unacceptable. Working part-time is the only way I can deal with these conditions. With a guarantee of a safe ratio, I would definitely increase my hours.” (To speak with a nurse in your coverage area, contact the David Schildmeier at 781.249.0430)
These additional work hours (see attached document for details) would result in adding the equivalent of 1,824 full-time RN positions. The numbers used are conservative figures based on independent sources. When MNA did a spot check of actual payroll records at 19 Massachusetts hospitals, the percentage of part-timers—and the potential pool of those willing to work additional shifts—was substantially higher, exceeding 60 percent at several facilities.
Based on projections from the actual experience in California, where a similar law went into effect this year, H. 1282 would require a maximum of 1,800 additional full-time positions. Moreover, another ODC poll of RNs in June 2003 found that 42 percent of RNs who have left bedside nursing said that if the law passes, they will be "much more likely” to return to hospital work if the Safe Staffing Bill is enacted—a pool of 22,433 potential additional hospital nurses.
The 2003 survey found that burnout due to understaffing was driving RNs from bedside nursing and fixing the problem would bring them back.
In addition to this pool of nurses, the Board of Registration in Nursing reports an increase in enrollment to Massachusetts nursing schools and projects a graduating class of nearly 2,000 students this year. Nearly all schools are currently full with long waiting lists of candidates waiting to get into the profession.
Survey Represents All Nurses
MNA commissioned the ODC poll. Survey respondents were randomly selected from the complete file of the nurses registered with the Massachusetts Board of Registration in Nursing. Fully 52 percent of the respondents are not MNA members. According to the research firm, the survey results can be assumed to be representative of the registered nurses to within a + 7 percent at a 95 percent confidence interval.
Bill Draws Significant Support
The safe staffing legislation has won broad public support and the endorsement of 65 of the state’s most influential health care and consumer advocacy groups, including the American Cancer Society, American Heart Association, American Lung Association, Health Care for All, League of Women Voters, Massachusetts Senior Action Council, and the Massachusetts Nurses Association.
The bill, H.1282 An Act Ensuring Quality Patient Care and Safe RN Staffing, would protect Massachusetts patients by ensuring that they receive nursing care appropriate to the severity of their medical conditions. To ensure maximum flexibility, the bill also requires that the Department of Public Health develop an objective system for monitoring patient medical conditions so that staffing levels can be adjusted and improved to meet patient needs. The bill would set minimum staffing standards specific to every unit and department in a hospital to ensure that major disparities in care levels do not exist in the commonwealth’s hospitals, and specifically provides that nothing in the bill “shall be deemed to preclude any facility from increasing the number of direct-care registered nurses.”
Currently there are no standards in existence for nurse staffing in Massachusetts hospitals, and no requirements for hospitals to provide an adequate level of nursing care. RN-to-patient ratios, which have been linked to a variety of patient complications and mortality in hospitals, can vary widely from facility to facility. It is not uncommon for nurses in Massachusetts to have seven, eight or even 10 patients at a time, when a safe ratio would be no more than four patients for a nurse on a typical hospital floor.
Last November the Joint Committee on Health Care gave the bill a favorable report and it is now in the Ways and Means Committee. More than 102 legislators have signed on as sponsors to the bill, and nurses and advocates are pushing to have the bill released from the House Ways and Means Committee by Nurses Week, May 6 – 12.
These studies followed earlier reports in some of the nation’s most prestigious medical and nursing journals, including the New England Journal of Medicine, The Journal of the American Medical Association, the Joint Commission on Accreditation of Health care Organizations, and other prestigious researcher journals revealing that the more patients a registered nurse cares for, the higher the risk of injury, illness and mortality to those patients.
“The scientific evidence is clear and overwhelming: when nurses have too many patients, patients’ lives are in jeopardy. The evidence also makes clear that poor staffing conditions in Massachusetts hospitals have caused and continue to exacerbate a growing shortage of nurses who are willing to work in hospitals,” said Higgins. “Passage of this legislation is the key to improving care to our patients and to creating conditions that will retain and recruit the nurses we need to provide safe patient care.”
Massachusetts Hospital Nursing By the Numbers
- Number of licensed Registered Nurses in Massachusetts (Board of Registration in Nursing, minus advanced practice nurses) – 100,775
- Percentage of RNs who work in acute care (Opinion Dynamics Corp. RN Survey, June 2003) – 47% = 47,364
- RNs working in acute care part-time (US Department of Health and Human Services, Massachusetts) – 42% = 19,893
- Percentage in survey or part-timers who will consider working more hours if required to take care of fewer patients at a time (Opinion Dynamics Corp. Survey March 2004) – 34% = 6,7649
- Additional hours part-timers said they would work (Opinion Dynamics Corp. Survey March 2004) = 72,979 hours
- Divided by a 40-hour/week shift = 1,824 full-time RN Positions
