The Health Policy Commission’s Quality Improvement Protection Committee today approved its “Proposed ICU Staffing Regulations” governing the implementation of the new law that sets safe patient limits on nurses’ patient assignments in all hospital ICUs, including: the formulation of an acuity tool, the method of public reporting of staffing compliance, and identifying three to five patient safety quality indicators to be measured and reported by hospitals.
The committee made it clear that these are “draft” regulations subject to further revision and improvement in the coming months. With the approval by this committee today, the proposed regulations will be reviewed and approved by the full Health Policy Commission at the next meeting of the HPC on January 20, which will open the regulations for public comment at a public hearing to be held sometime in March. The HPC has made it clear they intend to engage in ongoing discussions with the MNA and other stakeholders for input on this initial draft. The final regulations are expected to be finalized and approved by the end of April 2015
Below is a link to the regulations themselves. The MNA has serious concerns about this proposal and will be working over the coming weeks to advocate for needed changes to ensure the intent of the law is followed.
Specifically, the regulations fail to make clear that the baseline staffing assignment for any ICU nurse is one nurse to one patient, which is the clear intent of the law. The MNA will demand stronger language to this effect in the final regulations.
The regulations also fail to follow the MNA/NNU’s strong recommendations regarding the need for the HPC to be prescriptive in delineating specific clinical conditions for ICU patients that would prevent a nurse taking on a second patient. Instead, the regulations stipulate a process whereby individual hospitals will form “Advisory Committees” with staff nurses making up at least 50 percent of each committee, to develop a hospital specific acuity tool, which would then be submitted to DPH to be certified for use at the hospital. The problem is the committee is purely advisory, and upper management retains the right to submit the final tool to DPH. The MNA opposes any process that grants hospital administrators final say over what constitutes acuity, and thereby the staffing level at a hospital. We have had too much experience with hospital administrations that form staffing advisory committees and then fail to follow those recommendations.
Again, this law was written specifically to ensure that each patient is guaranteed care by a single nurse, except in those circumstances when frontline staff nurses on that unit determine if and when a nurse can take a second assignment.
If approved and made final, these regulations could result in situations where a patient with the same condition could receive a different level of nursing care depending on which hospital they are admitted to, based on the different acuity tools developed by each hospital administration. This is precisely the problem the law was created to prevent.
A positive aspect of the regulations is the clear statement that the limit of one or two patients per nurse “is at all times during a shift (i.e., no more than two patients).” This is very important, as many hospitals have been expecting nurses to take on a third or even fourth patient when ICU nurses go off the unit to transport the patient or go on a break. The regulations echo and enforce what the law has always intended which is, it is never acceptable to for nurse to be assigned a third patient under any circumstance.
The regulations also follow the MNA’s recommendation that environmental factors (such as the skill mix on the unit, level of ancillary support, and physical layout of the unit) must be included and accounted for in any acuity tool developed and certified for use by the hospitals in determining if and when a nurse can take a second patient assignment.
As stated above, these are draft regulations and far from final. We will continue to advocate for improvements in the regulations in the weeks to come. We encourage nurses, particularly ICU nurses, to review these regulations and provide the MNA with your own feedback. We will also be organizing nurses to attend and provide testimony at the public hearing on these regulations.
Here is the link on the HPC website to the Proposed ICU Staffing Regulations
http://www.mass.gov/anf/docs/hpc/regs-and-notices/20150106-proposed-nurse-staffing-regulation-approved-by-qipp.pdf
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