Seachange Bulletin #116

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Seachange Bulletin #116: AARN/Massachusetts: White-Hot Fight for
RN-to-Patient Ratios

Nurse-patient ratio critical to care
Debra Rigiero, RN & Kate Maker, RN, Worcester Telegram & Gazette, May 28, 2003

According to the latest research in prestigious medical and nursing journals,
the most important question a patient should ask when entering a hospital is,
"How many patients will my nurse be caring for?" The answer can have
life-or-death consequences.

The Journal of the American Medical Association reports that in a study of
232,000 surgical patients, the more patients a nurse has to care for, the more
likely that serious complications or death will ensue. The study found that
each additional patient above four that a nurse is caring for produces a 7%
increase in mortality. If a nurse is caring for eight patients instead of four,
that is a 31% increase in the risk of death.

Another study of 6 million patients published in the New England Journal of
Medicine shows that patient without adequate nursing attention are more likely
to die or suffer serious complications.

The fact is that patients in Massachusetts today must share their nurse with
too many other patients. Here in Worcester, it is not uncommon for nurses on a
typical hospital floor to be caring for six, eight or even 10 patients at a
time.

Every day in Massachusetts and here in Worcester, patients in our hospitals
push a call button and wait ... and wait ... for a registered nurse to come to
their aid. These patients might be in severe pain, they may be frightened or
disoriented; they need help, but they wait, sometimes for hours, to receive the
care they need. In some cases, the wait causes no serious harm, but in
others, the wait and lack of a quick response from a nurse triggers a downturn in a
patient's condition, or leads to a serious and costly complication. A two-day
hospital stay turns into a six-day stay.

Why is the patient waiting? Why isn't the nurse responding? The answer: the
nurse must care for more patients than is medically advisable.

The true cause of the poor staffing conditions in our hospitals is at the
center of an intense debate being waged in hospital boardrooms, on Beacon Hill,
and in the halls of Congress.

To provide flexibility to account for patients' differing severity of illness
and changing needs, the Safe Staffing bill mandates that staffing ratios be
improved when the patient's condition warrants more nursing care.

What will it take to improve the odds that a patient leaves the hospital in
better shape than he or she entered it?

The health care industry claims that there are not enough nurses to fill open
positions. Nurses on the frontline, those who have been working in the
system, those who actually answer those call lights and struggle with increasing
patient loads, tell a different story.

The fact is, there is no shortage of nurses in Massachusetts. We have the
highest per capita population of nurses in the nation. What we have is a shortage
of nurses willing to work under the current conditions.

In one national survey of nurses, one out of five nurses now working is
seriously considering leaving the profession in the next five years. More than 85%
of nurses surveyed said they would stay in nursing if they had better
RN-to-patient ratios.

In addressing the problem of RN staffing, policy makers miss the point if
they focus on simply recruiting more nurses. The real and lasting solution lies
in passing legislation, similar to that which has been made law in California,
to regulate safe registered nurse-to-patient ratios in our hospitals. Such
legislation, H. 1282, An Act Ensuring Quality Patient Care and Safe RN Staffing,
is currently being considered by the Massachusetts legislature.

Using the scientific evidence reported in the JAMA study, and based on the
input of nurses from all areas of nursing practice, the proposed law would
require hospitals in Massachusetts to establish ratios of one nurse to a maximum of
four patients on a typical hospital floor, and one nurse to a maximum of two
patients in an intensive care unit, with specific ratios established for every
unit and area of the hospital.

To provide flexibility to account for patients' differing severity of illness
and changing needs, the Safe Staffing bill mandates that staffing ratios be
improved when the patient's condition warrants more nursing care. This is sound
public policy that has been met with acceptance by the general public, by the
nursing community, and even by the health care industry in California.

Support among the public for this legislation is growing in Massachusetts. A
recent poll of Massachusetts residents found that more than 75% percent of the
public supports legislation regulating RN to patient ratios. To date, 101
legislators, including the entire Worcester delegation, have signed on as
sponsors of the legislation. To day, 57 health care and consumer advocacy
organizations have endorsed the bill.

As to the cost of providing appropriate staffing in our hospitals, studies
conducted in California and reported in the New England Journal of Medicine show
that the average hospital will experience a 1% increase in operating costs if
ratios are introduced. Because patients will receive better care and
experience shorter hospital visits and fewer complications, billions of health care
dollars will be saved.

If we are to preserve the quality of our health care and protect every
patient in Massachusetts, we need to ensure that the supply of frontline registered
nurses is not further reduced by overwhelming nurses so that they cannot care
properly for their patients. When the patient pushes that call button, there
should be a registered nurse ready to respond. Passing an RN-to-patient ratio
bill is the first and most important step to making that a reality.

Debra Rigiero, RN, of Worcester Medical Center and Kate Maker, RN, of U.
Mass/Memorial Medical Center, are elected members of the Massachusetts Nurses
Association Board of Directors, representing the interests of the nurses in
Central Mass.

No shortage of nurses; they're just overworked
Jeanine Hickey & Joanne Laschi, The Salem News, June 16, 2003

According to the latest medical and nursing research, the most important
factor determining your safety as a hospital patient is the number of other
patients you are sharing your nurse with.

If your nurse has too many patients, your risk of dying increases. The fewer
patients your nurse is assigned, the better your care will be.

The Journal of the American Medical Association reports that in a study of
232,000 surgical patients, the more patients a nurse has to care for, the more
likely that serious complications or death will ensue. The study found that
each additional patient above four that a nurse is caring for produces a 7
percent increase in mortality. If a nurse is caring for eight patients instead of
four, that is a 31 percent increase in the risk of death.

Another study of six million patients published in the New England Journal of
Medicine shows that patients without adequate nursing attention are more
likely to die or suffer serious complications.

Here in Essex County, it is not uncommon for nurses on a typical hospital
floor to be caring for six, eight or even 10 patients at a time. These ratios are
dangerous.

Every day in Massachusetts and here in Essex County, patients in our
hospitals push a call button and wait - and wait - for a registered nurse to come to
their aid. These patients might be in severe pain, they may be frightened or
disoriented; they need help, but they wait to receive the care they need. In
some cases, the wait causes no serious harm, but in others, the wait and lack of
a quick response from a nurse triggers a downturn in a patient's condition, or
leads to a serious and costly complication. A two-day hospital stay turns
into a six-day stay.

The true cause of the poor staffing conditions in our hospitals is at the
center of an intense debate being waged in hospital boardrooms, on Beacon Hill
and in the halls of Congress.

What will it take to improve the odds that a patient leaves the hospital in
better shape than he or she entered it?

The health care industry claims there are not enough nurses to fill open
positions. Nurses on the front line, those who have been working in the system,
those who answer those call lights and struggle with increasing patient loads,
tell a different story.

The fact is there is no shortage of nurses in Massachusetts. We have the
highest per capita population of nurses in the nation. What we have is a shortage
of nurses willing to work under the current conditions.

According to one national survey of nurses, one out of five nurses now
working is seriously considering leaving the profession in the next five years. More
than 85 percent of nurses surveyed said they would stay in nursing if they
had better RN-to-patient ratios.

In addressing the problem of RN staffing, policy makers miss the point if
they focus on simply recruiting more nurses. The real and lasting solution lies
in passing legislation, similar to that which has been made law in California,
to regulate safe registered nurse-to-patient ratios in our hospitals. Such
legislation, H. 1282, An Act Ensuring Quality Patient Care and Safe RN Staffing,
is currently being considered by the Massachusetts Legislature, with hearings
on the bill scheduled for this Wednesday, June 18.

Using the scientific evidence reported in the JAMA study, and based on the
input of nurses from all areas of nursing practice, the proposed law would
require hospitals in Massachusetts to establish ratios of one nurse to a maximum of
four patients on a typical hospital floor, and one nurse to a maximum of two
patients in an intensive care unit, with specific ratios established for every
unit and area of the hospital.

To provide flexibility and to account for patients' differing severity of
illness and changing needs, the Safe Staffing bill mandates that staffing ratios
be improved when the patient's condition warrants more nursing care.

Support among the public for this legislation is growing in Massachusetts. A
recent poll of Massachusetts residents found that more than 82 percent of the
public supports legislation regulating RN-to-patient ratios. To date, 57
health care and consumer advocacy organizations have endorsed the bill.

As to the cost of providing appropriate staffing in our hospitals, studies
conducted in California and reported in the New England Journal of Medicine,
show that the average hospital will experience only a 1 percent increase in
operating costs if ratios are introduced. On the other hand, because patients will
receive better care and experience shorter hospital visits and fewer
complications, billions of health care dollars will be saved.

When the patient pushes that call button, there should be a registered nurse
ready to respond. Passing an RN-to-patient ratio bill is the most important
step to making that a reality.

Jeanine Hickey, RN, of Merrimack Valley Hospital in Methuen and Joanne
Laschi, RN, of Beverly-based Northeast Health Systems, are members of the
Massachusetts Nurses Association, the Nurses Coalition of the North Shore and the Essex
County Coalition of Registered Nurses, which includes nurses from nearly every
hospital in Essex County.

Cutbacks in nursing are harming patients
Suzanne Gordon & Dana Beth Weinberg, Boston Globe, June 17, 2003

Ask most patients about their stay in a hospital and you'll hear the same
story. Nurses rush from patient to patient with barely enough time to provide
basic physical care and no time to deal with patients' anxieties and fears or to
provide needed education. Nurses in Massachusetts insist hospitals are unsafe
and are urging politicians to support ''the Act Ensuring Patient Care and Safe
RN Staffing.'' The bill, filed by the Massachusetts Nurses Assoc mandates
minimum RN-to-patient ratios on every unit and floor, bans mandatory overtime as
a way to staff hospitals, and establishes a system to protect patients who
need intense nursing services.

If enacted, this bill would protect patents and nurses from practices
designed to protect budgets, not people. Hospitals implemented these policies during
the restructuring and cost-cutting mania of the 1990s and are stubbornly
pursuing them today in spite of evidence of their failure.

During the '90s, desperate to cut costs, hospitals hired consultants who sold
them the fantasy that they could deliver high-quality nursing care for less
money. Using the latest cost-cutting techniques from manufacturing, these
consultants viewed the hospital as an assembly line, the nurse as a shift worker,
and the patient as a predictable, homogenous unit of production. They
''increased'' nurses' ''productivity'' by cutting the slack - i.e., extra time with
patients - out of the system and increasing nurses' workloads. When units have
fewer patients than expected, nurses are often sent home and have to use up
their sick days or vacation time as compensation. To avoid paying the cost of
hiring more nurses, nurses are often forced to work overtime.

The result of this untested experiment? More patients are getting urinary
tract infections, pneumonia, deep vein thrombosis, and bedsores. More are
experiencing falls, and more are being victimized by medical errors. In a study that
appeared in the Journal of the American Medical Association last October, for
every additional patient over four that a nurse has, patients face a 7 percent
greater risk of dying.

The cost-cutting experiment has failed because consultants and administrators
do not understand that providing care for sick patients is predictably
unpredictable. Empty beds don't mean empty nurses' heads and hands. If a 20-bed unit
only has 14 patients, nurses do not sit idle. They use the time to help
patients understand how to take their medications to prevent side effects and
potentially fatal drug interactions, to take care of patients who seem stable one
minute and crash the next, and to keep up with changing treatments and
technologies. The hospital industry opposes any measures to regulate staffing and
assure decent working conditions for nurses. Hospital administrators claim that
mandated nurse-to-patient ratios will deprive patients of needed care, will be
too expensive, and will be impossible to meet because of the current nursing
shortage. Given the industry's record, these objections are at best
disingenuous.

Most nurses will tell you that with no barrier to flexibility, hospitals
almost never give RNs the opportunity to give more care to fewer patients. Nurses
are almost always asked to give less care to more and sicker patients.

There is nothing in the proposed legislation that prevents hospitals from
assigning more nurses to patients than legally mandated. Indeed, the bill
includes implementation of a system that requires hospitals to flex up to provide
more nurses if a patient needs more care. Just as having a statutory minimum wage
hasn't driven down wages, having statutory safe staffing won't drive down
care.

Hospitals cry poverty yet have enough money to devote millions to
nurse-cutting consultants, to CEO and executive salaries, to advertising and marketing,
to bonuses to recruit foreign RNs, and to pay the higher costs of temporary and
traveling nurses to replace disaffected staff who have left their jobs or
bedside nursing entirely.

And let's not forget the hidden costs of inadequate nursing care. A
preventable urinary tract infection can add $676 to a hospital stay, a preventable
bedsore can cost between $4,000 and $70,000 to heal, and it can cost up to $12,000
for medication to treat a preventable blood clot.

The idea that there aren't enough nurses to fill mandated ratios ignores the
fundamental connection between retention and recruitment. Nurses are leaving
the bedside or the profession because of poor working conditions, which also
discourage new recruits from entering. New nursing students and grads look at
hospital conditions and begin to develop an exit strategy.

Nurses, backed by recent evidence, contend that nurse-to-patient ratios are
an important first step to solving the nursing crisis.

Hospitals claim they are committed to solving the nursing crisis. Here's an
opportunity to take a first step and give bedside nurses what they need.

Suzanne Gordon is author of ''Life Support: Three Nurses on the Front Lines.''
Dana Beth Weinberg is author of ''Code Green: Money-Driven Hospital
Restructuring and the Dismantling of Nursing.''

© Copyright 2003 Globe Newspaper Company

Minimum staffing levels are goal of state's nurses
Hundreds head to State House today for legislative hearing
Michael Kunzelman, MetroWest Daily News, June 18, 2003

Boston - Nora Watts loves being a nurse, but she isn't surprised that a
dwindling number of people are drawn to the job she has done for nearly three
decades. Watts, a Westborough resident who works in the infusion center at
Newton-Wellesley Hospital, said long hours and deep cuts in staffing levels have fed
the state's growing shortage of nurses. "It's incredibly stressful work," Watts
said. "That's why we're burning out young nurses so fast. It's not healthy."
Frustrated by the state of her profession, Watts plans to join hundreds of
nurses at the State House today for a hearing on legislation that would set
mandatory minimum staffing levels for nurses. In the absence of any state legal or
regulatory requirements, Massachusetts hospitals are free to set their own
staffing levels. But some critics, including the Massachusetts Nurses
Association, claim those staffing decisions are often driven by financial considerations
rather than what is best for patients or the nurses themselves. "You can't
turn down the patient," Watts said, "so they reorganize, they restructure and
they cut jobs for nurses." A bill, co-sponsored by 102 of the Legislature's 200
members, would require hospitals to staff no fewer than one nurse for every
four patients in medical or surgical units. The ratio would be lower in emergency
rooms and intensive-care units. The measure also would bar hospitals from
assigning mandatory overtime to nurses as a way of adhering to the required
ratios. The Health Care Committee is scheduled to hear testimony on the bill today
from a panel of health officials, nurses and advocates. State Rep. Peter
Koutoujian, a Newton Democrat and co-chairman of the committee, co-sponsored the
bill. "Given all the studies that show how staffing ratios correlate with good
care, I think this is something we have to take a very serious look at,"
Koutoujian said. But the bill, which died in the Legislature last year, has
encountered stiff opposition from hospital officials. ...

Nurses will rally for staffing ratio
Robin Lord, Cape Cod Times, June 18, 2003

Hyannis - More than two dozen nurses from Cape Cod will join an expected 500
to 600 at the Statehouse today pushing a bill they say will make their jobs
less stressful. The local group will board one of nine buses carrying nurses
from throughout the Bay State to a hearing of the joint Legislative Committee on
Health Care, which is reviewing a bill which would establish a maximum
patient-to-nurse ratio in hospitals of 4-to-1. The Act Ensuring Patient Care and Safe
Registered Nursing Staffing was filed this year by state Rep. Christine
Canavan, D-Brockton, and the Massachusetts Nurses Association. In addition to
mandating the 4-1 staffing ratio, it would also ban mandatory overtime as a way to
staff hospitals. "The point of all this is to set standards and make sure
they're being lived up to," said Marilyn Rouette, a nurse in the emergency
department at Cape Cod Hospital and president of the nurses union there. "If everyone
came in every day and knew they were going to have four patients, it would be
ideal." ... A study published in the Journal of the American Medical
Association last October revealed that for every additional patient over four patients
that a nurse has to take care of, patients face a 7 percent greater risk of
dying. A University of Pennsylvania study showed a direct correlation to injury
and even death when nurses take more than four patients. The study showed a
31 percent chance of injury or death when nurses have eight patients. "Now we
have the data in hand, and it's overwhelming," said Higgins. "It's a public
health issue and it needs to be addressed." The MNA also has done its own survey
of nurses and will release the results at a 9:30 a.m. press conference before
the health care committee's hearing this morning. Higgins said one of the
strongest messages to come out of the survey is that many nurses who have left the
profession because of the stress say they would come back if the patient
ratio was reduced. The survey showed that 65 percent said they would consider
coming back and 42 percent said they would strongly consider coming back, she
said. ...

Lawmakers to hear nurses' debate over staffing
Jennifer Heldt Powell, Boston Herald, June 18, 2003

Two nursing groups plan to square off today during a legislative hearing on a
proposal to limit the number of hospital patients under a single nurse's
care. The debate over safe staffing levels pits the Massachusetts Nurses
Association, for unions, against the Massachusetts Organization of Nurse Executives,
representing managers. Too many patients covered by one nurse can lead to errors
and even deaths, the MNA claims. The group, which has pushed safe-staffing
measures for years, also argues that overloading staff with patients drives many
capable nurses out of hospitals, resulting in shortages. Staffing-limit
supporters point to studies showing increases in errors as the number of patients
per nurse rises. At a rally today they plan to release a poll showing the level
of concern about the issue among nurses. "A shocking number of nurses report
patient deaths directly attributable to having too many patients to care for,"
said MNA spokesman David Schildmeier. Members of the nurse executives group
contend that staffing decisions should be made at the bedside and not on Beacon
Hill. "We are opposed to the safe-staffing bill supported by the MNA because
a strict ratio of nurse to patients doesn't address all the things that go
into appropriate staffing decisions," said Sally Miller, past president of the
nurse executives group. The number of patients a nurse can care for depends on
such things as the experience of the nurse, the illness of the patients and the
support systems within the hospital, she said.

Hospitals, schools join to resolve nurse crisis
Michael McAuliffe, Springfield Republican, June 18, 2003
<http://www.masslive.com/search/index.ssf?/base/news-0/1055921650223410.xml?nn
ae>

Amid a growing shortage of nurses, Pioneer Valley colleges and the University
of Massachusetts are expanding their nursing programs. And hospitals are
taking measures ranging from wining and dining prospective workers to paying the
costs of college in order to draw more men and women into the profession. The
Massachusetts Nurses Association, however, contends that there is no shortage
of nurses in the Bay State. It says there are 82,000 registered nurses in the
commonwealth, more per capita than any other state, and that working conditions
have driven thousands from the field. The association said that the solution
is passage of a bill, scheduled for a public hearing today on Beacon Hill,
that would establish minimum nurse-patient ratios in hospitals, such as one nurse
per two patients in a burn unit and one nurse per four patients in pediatric
units. "That's the model; that works, and it's the safest," said association
spokesman David J. Schildmeier. More than 500 nurses and supporters will attend
a press conference at the Statehouse before the hearing, which will be held
by the Joint Committee on Health Care. At the press conference the association
will release a new statewide, patient care survey of 600 nurses that it said
dramatically demonstrates higher nursing staff levels are needed. "The survey
will show an alarming number of nurses report being aware of patient deaths and
patient injuries directly attributable to having too many patients to care
for," Schildmeier said. ...

One in Three Registered Nurses Report Patient Deaths
that are Directly Attributable to RN Understaffing
93 percent of RNs agree that burnout from high patient
loads is causing nurses to leave the hospital setting
Two-thirds of RNs who have already left the bedside say they
would consider returning if RN-to-patient ratios were established
Massachusetts Nurses Association, June 18, 2003
<http://www.massnurses.org/News/2003/06/june18press_release.htm>

Canton - A study of registered nurses in Massachusetts released today
establishes that poor RN-to-patient ratios are resulting in significant harm and even
death for patients. According to the survey, 87 percent of nurses report
having too many patients to care for, and the results are devastating to patients:

* Alarmingly, nearly one in three nurses (29 percent) report patient deaths
directly attributable to having too many patients to care for;
* 67 percent report an increase in medication errors due to understaffing;
* 64 percent report an increase in complications due to understaffing;
* 54 percent report readmission of patients due to understaffing;
* 52 percent report injury and harm to patients do to understaffing;
* 1 in 2 nurses report that poor staffing leads to longer stays for patients,
which cost more; and
* Only 4 percent of registered nurses report that patient care in their
hospitals is excellent.

"These shocking conditions exist right here in Massachusetts, a state that is
known around the world as a medical mecca," said Karen Higgins, RN, president
of the Massachusetts Nurses Association and one of the spokespeople who
released the survey results at a State House press conference today. The survey,
the first in nine years to examine Massachusetts nurses' views on the quality of
patient care and nurse staffing in area hospitals, follows three national
studies that paint an equally dismal picture of the quality and safety of patient
care, spelling out in detail the conditions in Massachusetts that endanger
patients and that have caused and continue to exacerbate the current nursing
shortage. It was commissioned by the MNA and conducted between May 30 and June 8,
2003 by Opinion Dynamics Corporation, Inc., an independent research firm
headquartered in Cambridge. Survey respondents were randomly selected from the
complete file of the 92,000 nurses registered with the Massachusetts Board of
Registration in Nursing. Fully 68 percent of the respondents have no affiliation
with MNA - the state's largest association of registered nurses, with 22,000
members. ... More than 500 nurses joined leaders from 59 health care and
consumer advocacy groups that have endorsed the legislation to show their support
for the measure. Today's study complements Opinion Dynamics' findings earlier
this year that 82 percent of registered voters support legislation to regulate
RN-to-patient ratios and that 75 percent are willing to pay more for their
health care in order to guarantee their safety as patients. ...

Opinion Dynamics Corporation
M E M O R A N D U M
<http://www.massnurses.org/News/2003/06/executive_summary.htm>

TO: Massachusetts Nurses Association
FROM: John Gorman, Chris Anderson
DATE: June 18, 2003
RE: Survey of Massachusetts Registered Nurses

Executive Summary

Our survey of 600 Registered Nurses in Massachusetts finds a stressed
workforce that largely views the state’s hospitals as declining in quality and
understaffed to a degree that is harming and even killing patients. Most Registered
Nurses in Massachusetts believe that the quality of health care in the state’s
hospitals is worse today than five years ago, and they expect it to be even
worse five years down the road. Over two-thirds of Registered Nurses feel the
problems with the state’s health care system are so deep that it needs a major
overhaul. When RNs are asked what problem facing the nursing profession has
the biggest impact on patient care, understaffing of RNs is by far the most
frequently cited problem. ...

Survey of Registered Nurses in Massachusetts
Presentation of Key Findings
Julie Pinkham, RN, Executive Director
Massachusetts Nurses Association, June 18, 2003
<http://www.massnurses.org/News/2003/06/findings.htm>

There’s an old adage in medicine that says: if you don’t listen to nurses
you will not hear the patients. The results of the survey I will share this
morning tell us what nurses, those on the front lines, are thinking and
experiencing. If we listen to what they are saying, we will hear the sound of patients
who are suffering. Worse, we will hear the deafening silence of patients who
can no longer speak because they are no longer alive to tell their stories.
These findings are at the core of a telephone survey of 600 registered nurses in
Massachusetts completed by Opinion Dynamics, an independent research firm
located in Cambridge. The 600 nurses interviewed were randomly selected from a file
of all Massachusetts RNs. Survey respondents were interviewed at home,
between May 30 and June 8, 2003. ...

Nurses care for staffing proposal:
Too many patients hurt, survey says
Jennifer Heldt Powell, Boston Herald, June 19, 2003

Nearly one in three Bay State nurses say they have had a patient die because
they had too many to care for, according to a survey released yesterday.
Understaffing has also contributes to medication errors, complications and longer
stays, according to the report from the Massachusetts Nurses Association.
"People have actually died in Massachusetts because of this situation," said Julie
Pinkham, the association's executive director. "That has a shock factor."
Armed with the new survey, hundreds of nurses rallied on Beacon Hill yesterday
and in support of a proposal that would mandate nurse-to-patient ratios. Many
also spoke at a public hearing in favor of the plan. Under the safe-staffing
proposal, hospitals could assign no more than four patients to a nurse. Opponents
say the proposal would create an undue burden on hospitals, driving up costs
and reducing patient access. But those in favor urge that it would protect
patients and bring nurses back into practices, they said. High patient ratios are
contributing to the nursing shortage as burned-out nurses leave, say nurses.
According to the survey, 65 percent who aren't working at the bedside would
consider returning if the safe-staffing legislation passes. "My biggest fear is
how many more nurses we are going to lose if we don't do this," said Karen
Higgins, the MNA's president. "We need to get this done or more nurses are going
to walk." Kerrie Studley, a psychiatric nurse at Pembroke Hospital, said she
nearly quit in the middle of a shift because there weren't enough nurses on
staff. "It's basically a big concern with patient safety," she said. "We have
suicidal patients and you may have two or three going off at the same time." The
psychiatric patients know when the hospital is short-staffed, she said. "They
tend to act up more, which makes it dangerous," Studley said. Psychiatric
patients are more likely to hurt themselves when there aren't enough nurses to
tend to them, said Mary Marengo, a psychiatric nurse at St. Vincent's Hospital
in Worcester. "It's very frustrating," she said. "They have patients who are
very volatile and very fragile." ...

Nurses mobilize for staffing bill
Dan Ring, Springfield Republican, June 19, 2003
<http://www.masslive.com/search/index.ssf?/base/news-2/1056007925203340.xml?nn
ae>

Boston - Armed with a new study that shows patient care is suffering, nurses
yesterday converged on Beacon Hill to push for a law that would force
hospitals to boost staffing levels of nurses. ... "The results come to a glaringly
simple conclusion: Patients are being harmed and patients are dying because their
nurse has too many patients to care for," registered nurse Patricia E.
Healey, 48, of Northampton told members of the Committee on Health Care. The
committee yesterday aired a bill that would require all acute-care hospitals to
provide minimum registered nurse-to-patient ratios in different units. ... Irene D.
Patch, 49, of Belchertown, a registered nurse at the Holyoke Soldiers Home,
said she is the only nurse on her shift for a 33-patient unit. Many of the
veterans in the unit need help being fed and many need to be lifted into their
beds, she said. Some newly-hired nurses decided the job at the Soldiers Home is
too overwhelming, she said. "They walked right out," she said. "They said, 'My
God, I can't do this.'" Sandra A. Hottin, 50, of Agawam, a registered nurse at
Mercy Medical Center in Springfield, said a registered nurse at Mercy can be
caring for as many as nine to 10 patients in a medical and surgical unit.
"Some of the younger nurses ... are burning out and leaving the profession,"
Hottin said. ...

Survey: Shortage of nurses linked to patient deaths
Associated Press, June 19, 2003
<http://www.gazettenet.com/06192003/health/6809.htm>

Boston - Nearly 30 percent of the state's nurses report that understaffing
has led directly to patient deaths at Massachusetts hospitals, according to a
survey released Wednesday by the Massachusetts Nursing (sic) Association. The
survey, which polled 600 of the state's 92,000 nurses, was presented to the
Legislature to bolster the association's request for a law that would require all
acute care hospitals to meet minimum nurse-to-patient ratios as a condition of
licensure. "If nothing is done, this situation will only get worse," said
Julie Pinkham, executive director of the Massachusetts Nursing (sic) Association,
which represents 22,000 nurses. "We are pushing the call button and we are
waiting for the Legislature to respond." ...

Nurses decry lack of staffing
Say shortages lead to errors, deaths
Associated Press & Jennette Barnes, New Bedford Standard-Times, June 19, 2003
<http://www.southcoasttoday.com/daily/06-03/06-19-03/a01sr005.htm>

... More than four patients to a medical or surgical nurse increases the risk
of death, MNA spokesman David Schildmeier said yesterday, citing a University
of Pennsylvania study published in the October 2002 issue of the Journal of
American Medical Association. For each additional patient beyond four assigned
to a nurse, the study of 232,000 patients found a 7 percent greater chance of
death within 30 days from a complication not present when the patient entered
the hospital. "If you get hit by a car and you go to a hospital that has a
one-to-eight ratio, you may have a 31 percent risk of dying. If the ratio is one
to four, your chances are very good," he said. Operating under the slogan
"Safe Staffing Saves Lives," more than 500 nurses descended on the Statehouse
yesterday to lobby for the bill, which was the subject of a public hearing before
the Health Care Committee. In addition to establishing ratios for various
hospital services, the bill would end the practice of assigning nurses to
mandatory overtime or requiring them to serve in departments they might not be
familiar with. ...

Health care proposals deserve support
Sandy Eaton, RN, Quincy, The Patriot Ledger, June 21, 2003

The provocative article of June 12th ("Area hospitals have big worries")
raises a number of related issues. While the focus of the moment in saving needed
community hospitals is on juggling available state funds among the free care
pool, MassHealth Basic and Medicaid reimbursement, with some hope of added
funds from the feds, it was South Shore Hospital’s Paul Taylor, ironically, who
called for "long-term reform, not just another Band-Aid." Aside from the
commonwealth raising taxes to fund our piecemeal healthcare system, education and
other basic human needs, there are some very specific cost-effective
legislative goals being actively pursued by organized nursing. The first is Quality
Patient Care/Safe RN Staffing legislation, H.1282, a bill whose enactment will
stabilize the rapid turnover of RNs and reduce costly errors and missed cues
through setting enforceable RN-to-patient ratios and a standard system to evaluate
patient acuity. The second is the Massachusetts Health Care Trust Fund,
S.686, the enactment of which will create a universal health insurance system - no
more uninsured. Both bills have hearing dates set before the legislature’s
Joint Committee on Health Care at the State House in Boston. (Testimony on the
safe staffing bill will be heard this Wednesday, June 18th.) The hearing on the
proposed Massachusetts Health Care Trust will take place on October 8th. This
is the time for Mr. Taylor, (whose institution seems to have had no difficulty
in unfolding a million-dollar anti-union campaign recently,) and other area
hospital administrators and the Massachusetts Hospital Association to join with
the nurses, senior citizens and so many other healthcare stakeholders in
speaking out on behalf of these far-reaching progressive proposals.

Editorial Comment: This letter was faxed to The Patriot Ledger on June 13th.
It appeared in print on June 21st, three days after the historic State House
hearing on H.1282, minus the two passages in parentheses. While this letter was
sitting on an editor’s desk, on June 18th, Quincy Medical Center’s CEO had
the audacity to testify against safe staffing as a sizable contingent of QMC
nurses sat there aghast.

Nurses see dangers in short staffs
Many support legislation to set patient ratios
Rhonda Stewart, Boston Globe, June 22, 2003

In her time as a Newton-Wellesley Hospital emergency room nurse, Betty Sparks
has seen her share of drama.

She has helped deliver a baby in the waiting room and has faced potentially
violent patients with psychiatric issues. In the middle of treating one
patient, she has had to run outside and administer CPR to a man in the back seat of a
car whose heart had stopped beating. On an average night, she might be
tending to someone with chest pains while three other patients are waiting to be
seen and still more are lined up in the hallway.

''The ER is never empty. You have to be prepared for absolutely anything,''
Sparks said. ''If I have four to six patients, the chances of anything
happening can be even more. The chances of me missing it and not being there are even
greater.''

Sparks, who lives in Norwood, was among the advocates who traveled to the
State House Wednesday to support a bill to regulate nurse-to-patient ratios. The
hearing was held the same day that the Massachusetts Nurses Association rele
ased a study that said understaffing poses a significant threat to patient
safety.

''The only thing that will take us anywhere is to get these ratios in place.
I think it would be a nice sigh of relief that if I got hurt in Boston, if I
got hurt in the Berkshires or on the Cape, no matter which hospital I went to
I'd have the same level of care,'' said Karen Higgins, president of the
association. ''It's now time for legislators to put something in place that makes
sure every patient in the state is safe.''

Critics agree there is a need to maintain quality patient care and keep
nurses from being overburdened, but say the issue is too complex to be solved
mainly through legislation. They say it is important to look at the bigger picture
behind how staffing decisions are made, and that those decisions should rest
with the hospitals themselves.

''It's not the magic bullet. It's an idea and it's well-intentioned but it
doesn't consider some aspects that need to be considered,'' said Sharon Gale,
president of the Massachusetts Organization of Nurse Executives. ''The
nursing-ratio bill only looks at one part of a phenomenally growing problem, the
nursing work force shortage.''

Of the 600 nurses surveyed in the Massachusetts Nurses Association study, 93
percent said burnout from high patient loads causes nurses to seek work
outside of hospitals, and 50 percent said understaffing in acute care units is the
most serious problem facing the nursing profession.

But Gail Douglas, an associate professor of health services and associate
dean of Boston University's School of Public Health, cautioned that the survey
provides only a snapshot of a problem that dates back 20 years and threatens to
become worse within the next decade, not just for hospitals but for all health
care facilities.

''Historically there were cutbacks way back in the late '80s relating to
incentives given to hospitals. Nurses being the majority of personnel were the
first target,'' said Douglas, who is also a registered nurse. ''As a defense [the
proposed legislation] isn't a good strategy. We need to ensure the quality
standard is being met and probably link it to payment in order for this to
succeed,'' she said, suggesting financial penalties for facilities that fall short.

Representative Peter J. Koutoujian, chairman of the Joint Committee on Health
Care, said the problem posed by understaffing is twofold. First, the level of
medical errors is greater. The Massachusetts Nurses Association study also
found reports of more complications, longer hospital stays, and higher death
rates.

Second, Koutoujian said, is a problem with recruiting and retaining nurses.

''We're in an absolute crisis here in Massachusetts in our shortage of
nurses,'' said Koutoujian, whose 10th Middlesex District covers parts of Newton,
Waltham, and Watertown. ''We have a lot of nurses out there who refuse to
practice under these pressures.''

It will be several weeks at least, Koutoujian said, before the proposed bill
comes to a vote in committee.

He said that the only state he knows of with similar legislation is
California, where advocates spent at least six years working on their bill.

Rhonda Stewart can be reached at rstewart@globe.com

© Copyright 2003 Globe Newspaper Company

Nurse numbers up to pros
Boston Herald Editorial, June 23, 2003

The last person who should be dictating how a patient should be cared for in
the hospital is a state legislator. But that's just who the Massachusetts
Nurses Association wants to put in charge. The Legislature's health care committee
is considering a safe staffing bill, spelling out the ratio of nurses to
patients among other micromanaging details. Nurses lobbying for the bill cast the
debate in simple good guy vs. bad guy terms. Wearing the white caps are the
nurses, armed with a survey in which 30 percent of 600 nurses polled claim
understaffing has led to patient deaths. The black hats are worn, of course, by
hospital administrators looking to save a buck by cutting corners on patient
care. The fact that the safe staffing measure also contains proposals to prohibit
mandatory overtime and curb discretion on nursing duty assignments speaks more
to resolving some union beefs about cost controls than quality of patient
care. But no matter the motivation, Beacon Hill is ill-equipped to micromanage
hospitals' staffing decisions. And certainly more goes into those decisions than
raw patient numbers. The nursing needs of a cancer patient are far different
than a patient recovering from a Caesarean section. And an experienced nurse
can juggle more duties than someone fresh out of nursing school. Only a health
care professional should make those medical judgment calls.

Editorial Comment: The Herald’s editorial got it half right, and all wrong.
The professionals of the Massachusetts Nurses Association have set the numbers,
based on unimpeachable research and the experience of thousands of bedside
nurses. The industry has created this horrid mess and cannot be trusted to
propose solutions. The very day this editorial appeared, the following letter was
printed. Then MNA president and bedside nurse Karen Higgins wrote a letter of
rebuttal, of which only a snippet appeared.

Nursing the problem
Elizabeth A. Kenrick, RN, Belmont, Boston Herald, June 23, 2003

I have been a nurse for 34 years, and have many times left my shift feeling
as though one or more of my patients had been short-changed because of staffing
("Nurses care for staffing proposal; Too many patients hurts, survey says,"
June 19). Sharon Gale, president of the Massachusetts Organization of Nurse
Executives, and the hospital managers who oppose safe-staffing legislation need
to know that their flexibilities and the cost of health care has to take a
back seat to a patient’s welfare. Gale says that if "too many nurses are
assigned to a given shift," hospital costs will "go up and beds might have to be
closed, and patients turned away." In reality, management’s real concern is that
more nurses mean revenue will be used for their salaries, therefore lowering
the salaries of the CEOs and CFOs etc.

Nurse staffing at issue
Karen Higgins, RN, Weymouth, Boston Herald, July 2, 2003

The editorial’s conclusion that hospital administrators are the right people
to set staffing patterns is a significant threat to the safety of patients
("Nurse numbers up to the pros," June 23). A recent survey found that nearly one
in three Massachusetts nurses reports patient deaths directly attributable to
their having too many patients to care for. And more than 90 percent of nurses
point to hospital staffing practices as the primary cause of the nursing
shortage we now face.

What's in a Number?
The debate over mandatory nurse ratios heats up in Massachusetts
Timothy A. Mercer, ADVANCE for Nurses, July 7, 2003
<http://www.advancefornurses.com/common/editorialsearch/viewer.aspx?FN=03jul7_
n6p13.html&AD=7/7/2003&FP=nw>

While the nation watches as California attempts to become the first state to
initiate mandatory nurse-patient ratios, Massachusetts nurses are pushing for
similar legislation. That push picked up intensity last month at a public
hearing of the Joint Committee on Health Care, where the state's largest nurse
union released new data linking patient safety to nurse staffing levels. The
Massachusetts Nurses Association (MNA) announced the study as lawmakers met to
consider, among other things, HB 1282, a bill that would establish
nurse-to-patient ratios in Massachusetts hospitals. At the same time, the Massachusetts
Hospital Association (MHA) testified to lawmakers that mandatory ratios are too
costly and rigid, and that they ignore the dynamics of patient acuity and
census. State Rep. Christine Canavan (D-Brockton) and the MNA filed HB 1282 earlier
this year. It has been co-sponsored by 101 out of 200 members of the
legislature, including 13 of the 17 members of the Joint Committee on Health Care. The
bill calls for a 1-to-4 nurse-patient ratio in med/surg units, with ratios
ranging from 1-to-1 and 1-to-3 in EDs. To accomplish these standards, the state
health department would create a patient classification system based on acuity.
In theory, this would allow for some flexibility in staffing while assuring
that adequate staffing numbers are maintained. ...

Massachusetts nurses look for legislative life support
Edana Kleinhans, Hampshire Gazette, August 5, 2003
<http://www.gazettenet.com/08052003/health/7996.htm>

There are times when Gunner Lambert, a critical care nurse at Northampton's
Cooley Dickinson Hospital, feels like he's being pulled in all directions. A
patient needs him. One of his fellow nurses could use a hand. A doctor wants to
confer about a patient's care. And they all want him now. In his unit, every
situation is a potential emergency - and Lambert says there are times he simply
can't always give patients the best care. "Even I don't always realize how
sick people are," he says. "They're so sick they can't feed themselves. They
can't turn themselves in bed." Lambert says that his usual patient load of two to
three people per shift, some or all of whom might be on ventilators, does not
always allow him enough time to perform crucial tasks, such as turning
patients every two hours to make sure they don't get pneumonia. And, he says, he
worries about matters such as who would monitor his remaining patients if he had
to take one away from the unit for a CAT scan or some other test. For these
reasons Lambert has joined many of his colleagues across the state in supporting
a bill that would mandate the maximum number of patients a nurse would be
allowed to care for. On June 18, more than 500 members of the Massachusetts
Nurses Association assembled before the Massachusetts Statehouse in Boston to rally
in support of the legislation when it was presented to the Joint Committee on
Health Care for a preliminary hearing. Titled "An Act Ensuring Quality
Patient Care and Safe Registered Nurse Staffing," the bill would set
nurse-to-patient ratios for hospital units: one nurse to four patients in medical and
surgical units, one nurse to one to two patients in intensive care units and so on.
Among other things, it would also establish a patient-classification system
based on points to determine the number of nurses needed for a patient's care,
require adequate preparation for nurses moving from one unit to another to fill
in, and ban mandatory overtime. ...

What the bill says
Hampshire Gazette, August 5, 2003
<http://www.gazettenet.com/08052003/health/7997.htm>

As it stands now, these are the key components of the bill, "An Act Ensuring
Quality Patient Care and Safe Registered Nurse Staffing."

* Ratios for each hospital unit. For example, general ratios are one nurse to
four patients in medical and surgical units, and one nurse to one or two
patients in intensive care units.
* A patient classification system based on points to determine the number of
nurses needed for a patient's care.
* A ban on the use of mandatory overtime in hospitals.
* A requirement that nurses who are moved from one unit to another undergo
proper education and training before being allowed to begin work in their
assigned units.
* A requirement that hospitals post the legal nurse-to-patient ratio in each
unit.

The bill states that violations of any of its stipulations could result in
fines, an investigation by the state Department of Public Health, and, if a
hospital failed to correct the violation, a loss of license. A hotline number for
nurses, patients and family members to call to report violations would also be
prominently posted. ...

Web Directory:

AARN <http://www.aarn.org>
Australian Nursing Federation <http://www.anf.org.au>
California Nurses Association <http://www.calnurse.org>
Canadian Federation of Nurses Unions <http://www.nursesunions.ca>
CCDS <http://www.cofc.org>
Irish Nurses Organisation <http://www.ino.ie>
Labor Party <http://www.thelaborparty.org>
LabourStart <http://www.labourstart.org>
Maine State Nurses Association <http://www.mainenurse.org>
Massachusetts Ad Hoc Committee <http://www.massadhoc.org>
Massachusetts Green-Rainbow Party <http://www.massgreens.org>
Massachusetts Nurses Association <http://www.massnurses.org>
MASS-CARE <http://www.masscare.org>
New York Professional Nurses Union <http://www.nypnu.org>
New Zealand Nurses Organisation <http://www.nzno.org.nz>
PASNAP <http://www.pennanurses.org>
PNHP <http://www.pnhp.org>
Québec Nurses’ Federation <http://www.fiiq.qc.ca>
Revolution Magazine <http://www.revolutionmag.com>
Seachange Bulletin
<http://www.seachangebulletin.org>
Southern Arizona Nurses Coalition <http://SAZNC.homestead.com>
Union Web Services <http://www.unionwebservices.com>
United Health Care Workers <http://www.uhcw.org>

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