House Passes Landmark Bill on RN Staffing and Patient Safety in Massachusetts Hospitals

Measure Calls for Safe Limits on Nurses’ Patient Assignments, Prohibits Mandatory Overtime, and Includes Initiatives to Increase Nursing Faculty & Nursing Scholarship.

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BOSTON, Mass. – The state House of Representatives voted 119-35 today 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 law, when enacted, will make Massachusetts only the second state in the nation to set safe staffing limits in hospitals. 

“We applaud the House of Representatives for its overwhelming vote in support of the Patient Safety Act,” said John McCormack, the co-chair of The Coalition to Protect Massachusetts Patients, an alliance of more than 130 of the state’s leading health care and patient advocacy groups. “When enacted, this law will improve the quality of care for all patients in our hospitals and save thousands of lives.”

The “Patient Safety Act” will now move to the Senate for consideration. The bill responds to increased concern over quality care in Massachusetts hospitals, as well as to evidence linking disease and deaths to poor patient oversight caused by nurses being forced to care for too many patients at one time. In recent years, medical errors and hospital-acquired infections have soared. Numerous studies link the rise in hospital-acquired infections and other medical complications to understaffing of nurses. Most recently, a report published in the July issue of the journal Medical Care found that safe RN staffing levels could reduce hospital acquired infections by 68 percent.

Meanwhile, the Massachusetts hospital industry continues to fight the bill at a time when hospital-acquired infections and medical errors are sharply on the rise.   The Massachusetts Coalition for the Prevention of Medical Errors, to which Massachusetts hospitals belong, reports that 2,000 people—or six people per day—are dying in Massachusetts because of preventable medical errors every year.

In May 2006, the Massachusetts House of Representatives passed the same version of The Patient Safety Act, but the bill was not taken up by the Senate. The bill is co-sponsored by State Representative Christine Canavan (D-Brockton) and State Senator Marc Pacheco (D-Taunton).  “The time has come to pass this law and to protect the patients of the Commonwealth,” said Rep. Canavan.  “I am so pleased that my colleagues have recognized the merits of this bill. Let’s make this the year we finally reach the Governor’s desk!”

“The Massachusetts Nurses Association commends the House for their courageous vote to support the Patient Safety Act,” said Beth Piknick, president of the Massachusetts Nurses Association. “This bill is about patient safety. We want to thank the legislature for recognizing the need to improve patient safety for all our citizens, and we urge the Senate to vote to support the Patient Safety Act as well. Every day we wait for this bill to pass, patients are suffering, and patients are needlessly dying due to lack of appropriate nursing care.”

Key components of the bill include the following:

• The bill directs the Massachusetts Department of Public Health to develop and implement staffing standards and enforceable limits on the number of hospital patients assigned to a registered nurse at any one time

• 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 2009, with implementation in all community hospitals by 2011.

• The bill allows DPH to grant waivers to hospitals in financial distress.

• The bill provides flexibility in staffing and accounts for patients who require more care. Once established, the staffing levels will be adjusted up or down based on patients needs using a standardized, DPH-approved system for measuring patient needs.

• The Act will reduce errors caused by fatigue and overwork by prohibiting hospitals from forcing nurses into mandatory overtime.  It will also prevent hospital administrators from moving nurses into unfamiliar assignments without proper orientation.

• The Act prevents the reduction of support services, including services provided by licensed practical nurses, aides, and technicians.

• The bill establishes a number of nurse recruitment initiatives—sought by the hospital industry and supported by the Coalition—to increase the supply of nurses by providing nursing scholarships and mentorship programs, as well as support for increases in nursing faculty to educate new nurses.  It also  creates refresher programs to assist nurses who want to return 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.   In California, where similar limits have been in place for three years, 80,000 nurses have returned to the bedside, according to the California Board of Nursing.

• The bill establishes strong consumer protections for safe RN staffing, including a prominent posting of the daily RN staffing standards in each unit.

To date, 130 of the state’s leading health care and patient advocacy groups have endorsed the Patient Safety Act and have joined forces to push for its passage in both the House and Senate. Recent voter surveys indicate that more than 80 percent of the public supports establishing safe staffing limits.

How the House Voted on Safe Staffing

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