She says that when she came into the position, she felt that the nurse-to-patient ratio was not up to snuff. So she examined the quality and patient satisfaction data and built a business case, saying: "Here's my concern, and this is why we need more nurses."
Moreover, Vitello says, now that Massachusetts hospitals participate in PatientCareLink, a healthcare quality and transparency collaborative, hospitals with bad outcomes and poor staffing "can't get away with it."
"We can't hide behind having poor quality in our hospitals," Vitello says. "We won't be reimbursed for it. It's all about the reimbursement."
It's no secret, though, that adequate nurse staffing is a problem, and nurses often care for too many patients at once. So if mandatory ratios aren't the answer, what is?
"Value-based purchasing is the answer," Vitello says without hesitation. "Value-based purchasing has to do with quality indicators. When you hit the hospitals in their pocketbook, and it has to do with quality, they'll figure it out."