Published: 8/1/2017 10:17:11 PM
Minimum nurse staffing levels would be initiated in operating rooms, maternity wards and outpatient units under a proposed ballot question that the Massachusetts Nurses Association says would affect every hospital in the state.
“It would set safe limits to the number of patients that are assigned to a registered nurse at one time in the hospital setting,” said Donna Kelly Williams, president of the Massachusetts Nurses Association (MNA). She said, “It’s specific to each specialty area.”
The hospital lobby described the proposal as a “misguided attempt to impose assembly-line-like staffing quotas” on health care facilities.
The maximum number of urgent non-stable patients one nurse could care for would be two, under the initiative petition, which would limit nurses to caring for no more than five psychiatric patients. During childbirth, one nurse would be assigned to the mother and one nurse would be assigned to the baby until the condition of the mother and baby are deemed stable, at which point one nurse could care for both mother and child.
The MNA filed two similar initiative petitions ( Version A, Version B) with the attorney general one day before the Wednesday deadline for submitting proposed ballot questions.
If questions are certified by the attorney general, those using initiative petitions to accomplish policy goals need to gather 64,750 certified signatures to place the matter before the Legislature and then if lawmakers decline to pass it, another 10,792 signatures to put it on the 2018 ballot.
The proposal was submitted as the Legislature and Gov. Charlie Baker wrangle over how to address rising MassHealth costs of MassHealth, with the federal government debating its commitment to health care system funding, and amid a gradual reshaping of the state’s health care landscape as providers aim to position themselves in networks and experiment with new models of care delivery.
In 2013, the MNA filed a similar petition to institute minimum nurse staffing levels, but then reached a compromise with lawmakers who in 2014 enacted nurse staffing mandates within intensive care units (ICUs). The law limits nurses to caring for one or two patients in ICUs depending on the patients’ stability.
Kelly Williams said the new petition would create “more reliable enforcement” than the prior proposal as well as new requirements for publicly posting the mandatory staffing levels.
The initiative petition drew opposition from the state’s hospital lobby, which argued managers at the facilities are best suited to make staffing decisions.
“Massachusetts hospitals place patient safety and quality of care as their top priorities. They do this in collaboration with their teams of doctors, nurses, and a wide range of other clinicians and support staff. Today’s rapidly evolving healthcare delivery system is focused on flexible, integrated care,” said Massachusetts Health & Hospital Association Vice President for Clinical Affairs Pat Noga in a statement. “MNA’s misguided attempt to impose assembly-line-like staffing quotas takes decision-making away from nurse leaders in each hospital, where it belongs. This approach ultimately harms not only hospitals, but all hospital employees, patients and the communities they serve.”
Kelly Williams said the proposal would affect every hospital, and the cost to each hospital would depend on how close their current staffing levels already are to the proposed requirements.
“We have some that are a lot closer than others,” Kelly Williams said.
Kelly Williams said she expects patients and their families to be part of a coalition working to put new nurse staffing mandates into law, and she hopes health care managers will also join the cause. She contended that hospitals might be able to save money because with more nurses patients would be “better prepared for discharge,” and therefore less likely to be readmitted.