The Committee to Ensure Safe Patient Care (The Committee) has passed the final hurdle and successfully secured a place on the November 2018 ballot for An Act relative to patient safety and hospital transparency (the Patient Safety Act). The Patient Safety Act will be Question 1 on the ballot.
The Secretary of the Commonwealth notified The Committee that the office had certified 18,145 signatures, well over the number of required signatures for this step of the process. In December 2017, the Committee submitted more than 100,000 signatures to the Office of the Secretary of the Commonwealth, per the Attorney General’s Initiative Petition Process.
Nurses who drafted, and are promoting, this measure to improve care for their patients are responding to what they see as a public health crisis. More than three quarters of Massachusetts nurses (77%) believe that RNs are assigned too many patients to care for at one time. And 90% of RNs report that they don't have the time to properly comfort and care for patients and families due to unsafe patient assignments, with 86% of RNs reporting that they don't have the time to educate patients and provide adequate discharge planning. According to recent survey results, nearly 9 in 10 nurses (86%) report that they will vote yes for the Patient Safety Act.
“This has been a long time coming, and nurses have been advocating for a YES for patient safety for decades,” said Donna Kelly-Williams, RN at the Cambridge Hospital Birth Center and President of the Massachusetts Nurses Association. “As an active bedside nurse, I see it every day on the hospital floor and I hear it every day from my colleagues across the state. It’s time for hospital executives to put patient care over profits.”
“The overwhelming number of signatures gathered across this process has been a clear signal that voters want to weigh in, and when voters hear our message – that nurses are saying YES for patient limits – they are immediately on board, recognizing the impact for them and for their families,” said Kate Norton, spokeswoman for The Committee. “It’s crazy to think that there are no limits the number of patients that managers can assign to a nurse at one time, and the negative consequences are so clear.”
Get the Facts: Beyond the Lies and Scare Tactics of Hospital Executives
Independent Studies on Patient Outcomes
Dozens of independent scientific studies have consistently found that the quality of care decreases dramatically when nurses are forced to care for too many patients at once, putting patients at increased risk for complications like pneumonia, infections, bedsores, medication errors and more. These peer-reviewed studies specifically address the impact of safe patient limits on the care of patients in Massachusetts hospitals, including:
- A 2017 study in the journal Nursing Care Quality showing the number of patients assigned to our state’s nurses is associated with the more timely removal of urinary catheters to prevent costly and debilitating infections.
- A 2017 study in the journal Pain Management Nursing found that safer patient limits result in higher patient satisfaction with the control of pain, which is key to addressing the opioid epidemic.
- A 2017 study in the journal Emergency Nursing found the number of patients assigned to Emergency Department (ED) nurses has a direct impact on ED wait times, at a time when our state ranks 48th out of 50 for patients waiting for needed care.
The Success of California
More than ten years ago, California established maximum limits on the number of patients that could be assigned to a nurse at one time and the results have been universally positive. This includes a number of independent scientific studies including:
- A 2010 study in the journal Health Services Research to evaluate the impact of the California law limiting nurses’ patient assignments found that mortality rates and other outcomes for patients were better in California compared to states without limits. Linda Aiken, RN, PhD, the study’s author and the nation’s leading researcher on nurses work environment and patient safety concluded, “Most California nurses, bedside nurses, as well as managers, believe ratio legislation achieved its goals of reducing nurse’s workloads, improving recruitment and retention of nurses and having a favorable impact on the quality of care."
- Two studies that make a direct between patient assignment limits in California and Massachusetts hospitals, which found that patients in Massachusetts receive 3.5 hours less nursing care than patients in California hospitals, resulting in higher rates of complications for our patients, including preventable cases of pneumonia (Journal of Nursing Administration, 2016) and heart failure (Journal of Nursing Care Quality, 2014).
- A 2010 study in the journal for the Society for Academic Emergency Medicine to evaluate the impact of the limits law in California, which found that following the implementation of the law, “ED wait time and ED care time were shorter” with limits in place, and concluded that efforts to staff EDs with mandated limits “do have a beneficial effect on patient flow.” It is important to note that ED wait times in Massachusetts are now 47% longer than those for California patients.
Costs and Financial Performance
In addition, a number of peer reviewed studies indicate that costs incurred through implementation of safe limits will be offset by a number of positive outcomes related to safe patient limits: preventing costly complications, reducing hospital lengths of stay, and reducing hospital readmissions. For example:
- A 2013 study in the journal Health Care Management Review found that safe patient limits have a positive association with financial performance in competitive hospital markets. Reducing nurse staffing is inefficient and can negatively affect financial performance.
- A 2006 study in the journal Health Affairs concluded there is “a strong business case” that increasing the nurse staffing levels “could reduce costs and improve patient care by reducing unnecessary deaths and shortening hospitals stays.”
- A 2005 study in the journal Medical Care found that implementing safe patient limits would produce significant cost savings and is less costly than other basic safety interventions common in hospitals including clot busting medications for heart failure and PAP tests for cervical cancer.
About the Patient Safety Act
Today, outside of acute care hospital intensive care units, there is no law that specifies how many patients a nurse can safely care for at one time. It is not uncommon for nurses in Massachusetts to have six or seven patients at one time, when a safe limit would be no more than four patients for a nurse on a typical medical/surgical floor.
The Patient Safety Act will dramatically improve patient safety in Massachusetts hospitals by setting a safe maximum limit in the number of patients assigned to a nurse at one time, while providing flexibility to adjust nurses’ patient assignments based on the specific patient needs of patients and the professional judgment of the nurse providing direct patient care. It also protects other valuable members of the health care team by preventing the reduction of other caregivers to meet the limits set by the law. It also allows hospitals to exceed the patient limits during times of state and national emergency.
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