Bay State Addresses Nurse Safety, But Is It Enough?

Massachusetts Gov. Deval Patrick this summer signed into law a bill that stiffens criminal penalties for those who assault on-duty nurses and other healthcare providers.

The new law treats assaults on healthcare professionals doing their jobs as a separate crime with its own set of penalties—extending to healthcare providers the protections and enhancements that were already in the law for assaulted emergency medical technicians.

"This law gives us the tools to further protect the many healthcare professionals who work tirelessly to ensure the care of all Commonwealth residents," Patrick-flanked by nurses-said at a signing ceremony in his office.

Donna Kelly-Williams, president of the Massachusetts Nurses Associationwhich lobbied heavily for the law said it validates nurses' concerns and will raise public awareness of about violence in the healthcare workplace. "Nurses are assaulted on the job to the same degree as police officers and prison guards," she said.

While Bay State nurses are cheering the new protection, they also say it's not enough. Kelly-Williams said two other MNA-sponsored bills that would address healthcare violence are opposed by the Massachusetts Hospital Association. One of the bills requires healthcare providers to have in place proactive policies and procedures to prevent workplace violence from occurring in the first place. The second bill calls for what MNA describes as "safe patient limits for nurses, as the lack of staff to adequately respond to patients and families concerns [that] is a major factor leading to these types of incidents." Translation: staffing ratios.

"We have been trying for over 10 years to get safe patient limits assigned to an RN at one time and that has been met with much opposition," Kelly-Williams said, adding that MHA has "fought us every step of the way."

Kelly-Williams said it's almost impossible to talk about other safety strategies—such as de-escalation—if nurses are already overworked and unable to recognize and address the behavior of patients in pain, or with substance abuse or mental health issues, and their anxious relatives and friends.

MHA issued a statement saying it is aware of the concerns of hospital safety and has long supported increased criminal penalties for those who assault healthcare workers. MHA said its member hospitals have "gone to great lengths to provide a variety of security and social services to maintain a level of safety in both the clinical setting and administrative offices. Such safeguards are designed to address the unique needs of every community. A 'one size fits all' approach simply doesn't work in dynamic hospital settings."

Even with the best planning, MHA said it is impossible to account for every potentially violent situation in the hospital setting, owing to the hospital's unique healing mission, and the fact that it is open 24 hours a day to the general public. "While important safeguards are continually updated and improved, healthcare facilities are stressful environments and violence can be perpetrated by patients, families, friends, visitors, and even co-workers," MHA said.

The MHA raises valid points. For hospitals, staffing ratios could prove to be extremely expensive, and the benefits could be questionable if the management and scheduling aren't done properly. This is a legitimate bottom line issue. 

However, MNA can make the emotional connection with the public on this issue. Overworked nurses and long waits in the ER provide visceral images for the public many of whom have endured that experience. The argument that violence occurs in part because understaffed nurses can't adequately control upset patients is simple, commonsensical, and easily understood for most of the public. This message will resonate even more in the coming months and years as millions of newly insured Americans?unable to find care elsewhere—head to the ER for medical treatment.