Pledge Only Validates the Dangerous Status Quo for RN Staffing in Mass. Hospitals
Canton, Mass.—The Massachusetts Nurses Association finds the Massachusetts Hospital Association’s "Pledge for Patient Safety" campaign to be a cynical example of "feel good" public relations replacing a true commitment to patient safety and true accountability.
That MHA would ask its member hospitals to sign a "pledge" to keep patients safe speaks for itself. Patients in Massachusetts’ hospitals deserve more than a promise of safe nursing care, they should expect and deserve a guarantee.
In this case, hospitals will be signing a pledge to maintain the status quo—a situation that has led to a 76 percent increase in DPH-reported errors, injuries and complaints for patients in the state’s hospitals over the last seven years.
We have a disturbing crisis in Massachusetts—nurses are being forced to care for too many patients at once, and patients are suffering the consequences in the form of preventable errors, avoidable complications, increased lengths of stay and readmissions. Studies by the most respected scientific and medical researchers affirm the significance of safe minimum RN-to-patient ratios for patient safety
The MHA pledge is written by hospital administrators for hospital administrators and fails to provide any minimum standard that will protect hospital patients from the current dangerous practice of understaffing of registered nurses. It gives only the illusion of accountability. Nearly every nursing-related requirement called for in this campaign is already called for under the industry’s JCAHO accreditation process, a process that has proved totally ineffective in guaranteeing patients safe care.
A fundamental defect with this pledge (and similar legislation filed by MHA) is it fails to heed the key findings of the scientific research and the legislature’s own 2001 Nursing Commission Report, which called for the implementation of a minimum standard for nurse staffing ratios. Instead of addressing this crisis and protecting patients with a minimum standard, this measure protects an industry that has endorsed the practice of understaffing of registered nurses to the detriment of patient care.
Specific problems with the measure include:
- Merely allows the hospital industry to file a report about its staffing "plan", with no requirement that they meet any minimum standard of safety.
- Requires posting of the staffing plan, providing the health care consumer with no standard to judge the plan against. One hospital could post a ratio on a medical/surgical floor of one nurse to seven patients, while another could post a ratio of one nurse to four patients. Both comply with the pledge, but the 1:7 ratio carries a 21percent increase in the risk of death for those patients.
- Approval of the staffing "plan" by the board of directors of the hospital allows those responsible for the current practice of understaffing of registered nurses to continue to approve similar staffing plans—leaving the fox in charge of the chicken coop.
- Only calls for evaluation of the safety of the ratios retrospectively, at least a year after the fact. This offers little comfort to the patients jeopardized by the ratios they are subjected to at the time of their hospital stay.
- Fails to address the root cause of the nursing crisis: nurses burned out with high patient loads leaving the bedside. This is the number one reason why RNs continue to leave the bedside. Years of experience with recruitment incentives has proven that they just don’t work; the crisis is with retention.
The nurses of Massachusetts and the 70 health care and consumer organizations that are part of the Coalition to Protect Massachusetts Patients say the evidence is clear that legislation to set minimum RN-to-patient ratios in hospitals is the only way to truly protect patients.
State Rep. Christine Canavan (D-Brockton), who is a registered nurse and vice chair of the Joint Committee on Health Care, is the lead sponsor for the bill, which is entitled "An Act Ensuring Patient Safety." Canavan was also the chair of a special legislative commission which was formed in 2001 to study the crisis in nursing in Massachusetts.
The bill 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."
As of today, 104 legislators, a majority in both houses, have signed on as sponsors to the true Patient Safety bill. The House Ways and Means Committee is in the process of creating a subcommittee to address this bill. We made a commitment to work with all parties in this debate to craft a bill to address this crisis. The Coalition to Protect Massachusetts Patients and the MNA "pledge" to work with the Committee and all stakeholders to make pass a law creating a "real" solution to the staffing crisis in our hospitals that guarantees safe patient care and true accountability.
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