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ICU nurse staffing bill on way to Gov.’s desk

BOSTON — Nurses working in intensive care units will care for only one patient at a time, except in certain circumstances, under legislation approved unanimously in both the House and the Senate and now headed to the governor’s desk for his signature.

The Senate passed the legislation Thursday, less than 24 hours after it cleared the House. The bill dictates nurse staff levels in intensive care units, and emerged after talks between the statewide nurses’ association and hospital groups to avert a fight over a broader nurse staffing plan headed for the November ballot.

The Massachusetts Nurses’ Association (MNA) agreed to drop two ballot questions, one related to nurse staffing levels and a second question regulating CEO compensation, annual operating margins and financial asset disclosures of hospitals.

The compromise followed a years-long logjam on the issue on Beacon Hill.

“Something that looked like it came about quickly was actually 15 years in the making,” said Rep. Denise Garlick, a Democrat from Needham and nurse who was instrumental in forging the agreement.

Nurses turned to the ballot after fighting for nearly 15 years to limit the number of patients they care for at any one time. Hospital organizations have argued mandated staffing levels had no merit, and would unnecessarily tie their hands in staffing decisions.

When the nurses launched the ballot campaign last August, Massachusetts Hospital Association President Lynn Nicholas said mandated nurse staffing ratios are “antithetical” to the movement towards integrated care models under which payments are based on quality of care and patient satisfaction.

Under the bill (H 4228), there will be a one patient, one nurse ratio in intensive care units, unless the nursing staff agrees a patient has become stable, and the nurse can take on another patient, said Sen. Stanley Rosenberg, who helped foster the agreement on the Senate side. If there is disagreement, a nurse manager would become involved in the decision.

At Baystate Franklin Medical Center in Greenfield, the hospital already limits its ICU nurses to one to two patients.

“We don’t expect an impact. We’ve been practicing this all along,” said Chuck Gijanto, the outgoing hospital president said Thursday.

“We’re really happy about this compromise,” Gijanto added. “Patients are in intensive care for a reason. They need more hands- on care and monitoring. You want to have time and attention placed on them. These are patients whose conditions can change rapidly.”

Donna Stern, a Baystate Franklin nurse and co-chair of the Massachusetts Nurses Association, said it’s a landmark decision.

“It will only make patient care stronger in all hospitals,” Stern said. “We believe this is a good beginning. We hope it will lead to limits on other units.”

“We set in motion, put in place, the ability for hospital administrators and nurses to work together in order to provide the best possible care for their patients,” Rosenberg said on the Senate floor.

“We are putting the patient in the center of the conversation. What they need is what will occur,” he said. “And in most ICUs, it is known that one-on-one relationship is the norm, and the appropriate thing to do, and you can under certain circumstances add a second patient to a nurse’s shift load, but only under certain circumstances.”

The Health Policy Commission will regulate implementation.

Donna Kelly-Williams, president of the MNA and a registered nurse at Cambridge Hospital, said nurse staffing limits will save lives, reduce medical complications, and lower the number of patients readmitted to a hospital for follow-up care.

Kelly-Williams called staffing guidelines in ICUs the first step, and said nurses plan to continue to fight for nurse-patient limits in other hospital units. California instituted nurse staffing limits in intensive care, and then expanded to other hospital units, according to Kelly-Williams.

Supporters of the bill said they expect Gov. Deval Patrick to sign it today.

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