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Nurse Staffing Battle Rages On in Massachusetts

 |  By Alexandra Wilson Pecci  
   April 01, 2014

Like it or not, the question of whether maximum nurse-patient staffing ratios should be mandated by law may go before Bay State voters in November.



The call to increase nurse staffing is loud and clear, but is the solution to place limits on the maximum number of patients a nurse can care for? So far, only one state, California, has said yes to that question.

An emergency measure appeared briefly this month before the city council in the District of Columbia before being withdrawn. But now, a proposed safe patient limit for Massachusetts nurses is likely heading to voters in November.

"We are moving it to the ballot in November 2014 unless the legislature acts in the meantime before July," David Schildmeier, spokesperson for the Massachusetts Nurses Association/National Nurses United told me. He says MNA's work to pass the Patient Safety Act, "would set standards for the maximum number of patients that can be safely cared for by hospital nurses at any one time, while providing hospitals with the flexibility to adjust staffing based on patients' needs."

During a hearing last week, Massachusetts lawmakers heard testimony from nurses, researchers, patients, and others who support the passage of such a law. Although Schildmeier says it's unclear whether the legislature will act on passing the law itself, MNA is proceeding with the ballot initiative in the meantime.

"Patients can't wait," he says. "Patients are suffering every day in Massachusetts hospitals. Something needs to be done."

Schildmeier says that during the hearing, nurses in favor of the staffing mandate presented a foot-high stack of all the research that has been done to show that when nurses care for fewer patients, outcomes are better.

How much? "There's a mountain of data," he says.

Among that data is new research that compares standards of nursing care and patient outcomes for hospitals in Massachusetts, where there is no limit on nurses' patient assignments, and California, where nursing patient limits are regulated by law. One of the study authors who presented the data, Judith Shindul-Rothschild, Phd, RNPC, said the study showed an association between nurse staffing in Massachusetts and a higher rate of readmissions for heart failure.

"This suggests that poor nurse staffing ratios combined with high acuity and high patient turnover may have an impact on HF [heart failure] readmission rates," the authors write.

In a blog post, the Massachusetts Hospital Association says that mandated nurse-patient ratios are "still a bad idea." The post also points to an editorial in the Boston Herald that sheds doubt on whether the public is knowledgeable enough to vote on such an issue, and also suggests that the government shouldn't be allowed to mandate patient limits at all.

Hospitals argue that such limits would be expensive and wouldn't allow them the flexibility to adjust staffing according to patient needs. That "is an out and out unmitigated lie," Schildmeier says. "They never adjust staffing for patients' needs." Plus, he says, flexibility is built into the proposed law.

Schildmeier also points out that because of "Romneycare," Massachusetts is a "test case" because its state healthcare system has already experienced the influx of newly insured patients that the nation is facing as a whole because of the Patient Protection and Affordable Care Act.

"We have an incubator; we have a test case," Schildmeier says of Massachusetts. Another study presented at the hearing shows, he says, that "nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions."

Adequate nurse staffing is no doubt critical to patient safety, and countless studies have linked it to everything from better outcomes to lower odds of being slapped with readmission penalties. But as I've pointed out before, mandated nurse staffing limits are not necessarily a silver bullet.

For example, a study published in the journal Health Services Research, found that although the California law succeeded in boosting nurse staffing, the staffing increase had only "mixed effects on quality." And researchers couldn't be certain whether any recorded quality improvements were actually caused by staffing changes.

Schildmeier says the MNA is confident that it will get the required number of signatures in its last round of signature gathering in order to get the staffing ratio issue on the November ballot. He also says that MNA's polling shows that more than 75% of the Massachusetts public supports this measure.

Whether it's a silver bullet or not, and whether it works to help patient safety or not, it looks like when November rolls around, it will be up to the public to decide.

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Alexandra Wilson Pecci is an editor for HealthLeaders.

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