Seachange Bulletin #89August 20, 2002Seachange Bulletin ArchivesEmail the editor"... the 1999 (Irish national nurses') strike and its aftermath have wrought Thanks to Bill Bumpus of Union Web Services and the Somerville (Massachusetts) Labor Party, back issues of Seachange remain archived at <http://www.seachangebulletin.org>, although this may change soon as Bill's ISP is changing. This limited edition is produced using an old Performa and dial-up internet connection. It's been an intense spring and summer, partially reflected in these articles. This fall news from Massachusetts and elsewhere will be dominated by elections to public office and a global strike wave against anti-workingclass measures. You may find that surfing through the web directory that concludes these bulletins is a good way to review major issues and campaigns. Through Seachange we will highlight those that otherwise may be slipping through the cracks of public attention. - Sandy Eaton, RN, Quincy, Massachusetts, USA John Healey for State Representative Eighth Worcester District, Massachusetts Democratic Party Primary, September 17, 2002 John has been a leader in the Massachusetts Campaign for Single-Payer Health Care (MASS-CARE) since its inception and a stalwart in progressive independent political action. He chose to run against the incumbent essentially for two reasons. That incumbent has "steadfastly refused to cosponsor or endorse" the Massachusetts Health Care Trust bill (S.599/H.2165) "despite the overwhelming amount of information ... that demonstrates its social justice and fiscal efficiency." The other reason was "his complicity in the cynical and brazen sabotage of the Clean Elections Law," a mild electoral reform passed by a two-to-one margin in a 1998 ballot initiative. Ironicly, John himself did not qualify to receive public funds under Clean Elections and so must seek private financial contributions in this uphill race. Contact John directly to find out more about this campaign (healey@charter.net). Contributions up to $500 may be sent to: Healey for State Rep. Campaign Committee 22 Tanner Road, Webster, MA 01570 Nurses are right to argue there's safety in numbers <http://www.massnurses.org/News/safestaff/saftynumbers.html> Editorial, Springfield Union-News, April 21, 2002 The people who work in one of the state's most critical helping professions are in desperate need of more help. Just ask any registered nurse if his or her patient load is manageable. For that matter, ask any patient who has ever been in a hospital bed waiting for a nurse to respond to a call for assistance. While health professionals and patients agree that there are many things ailing the American health care system, inadequate Medicaid reimbursements and costly prescription drugs to name just two, the critical shortage of nurses is among the most troubling symptoms. Massachusetts nurses say that hospitals increasingly overburden them with responsibilities and overtime that can have negative, and potentially dangerous, repercussions for the patients in their care. Sandy Eaton, a nurse staffing a 12-hour, nighttime shift at Quincy Medical Center, shared his frustration this week during an informational session sponsored by the Massachusetts Senior Action Council in Northampton. Eaton said the safest number of patients for him to care for on his overnight shift in the acute-care facility is three or four, but staffing problems can require him to attend to a fifth patient. That's why Eaton has joined nurses across the state to urge passage of the Safe Staffing bill (House 1186) which would set minimum staffing levels for health care facility floors and units. The bill has been stalled in the Senate Committee on Health Care for months over the issue of mandatory overtime. ... The real story is that nurses care the most <http://www.massnurses.org/News/002005/herald1.html> Beverly Beckham, Boston Herald, April 24, 2002 "Critical Care: When nurses steal drugs on the job." This was the front-page headline of Sunday's Boston Globe. It came with a pie chart. If the headline didn't make you think all nurses were stealing drugs, the chart did. All nurses, of course, are not stealing drugs. Most are working their eight- to 12-hour shifts, going home, then showing up for another day at a job you couldn't pay most of us enough to do. But what kind of a headline would this make? "Nurses tending to the country's neediest." Hardly Pulitzer stuff. Nurses, the kind who never make headlines, took care of my mother when she was in a coma; they took care of my mother-in-law when she had her legs amputated, and my husband when he had open-heart surgery, and my son when he had a bone infection, and my daughter when she had surgery, and me, when I was a child and again when I had my own children. And caring in the nursing profession takes its toll because people don't always get better. Many get worse. Nurses care for them and about them in spite of this. ... Nurses rally for higher staffing <http://www.massnurses.org/News/petdrive/postcoverage.html> Michelle Hillman, MetroWest Daily News, May 10, 2002 Robin DiDonato and nurses like her remember days long gone when they were able to bathe patients and wash their hair, take extra time to listen to their worries and catch problems before they turned into crises. In short, they could do what they were trained to do - provide compassionate care in a safe environment. DiDonato, a Marlborough resident and nurse at UMass Memorial Health Care in Worcester, yesterday said those comforts are luxuries in a system in which nurses say they care for more patients than can be safely handled. "Now you're running from room to room putting out fires," she said. "It's a very scary place. It's not only a scary place for patients, it's a scary place for nurses." Yesterday, nurses from across the state converged at the State House to deliver petitions signed by 75,000 people supporting legislation calling for ratios mandating a minimum number of nurses based on the number of patients. The petitions were brought by ambulance to the State House steps where 30 to 40 nurses gathered with signs and stickers reading "Registered Nurses: The key to Quality Care." Nurses across the state say they face the same dire circumstances. Their day consists of prioritizing and crisis management, leaving little time for human interaction. Caring for seven to 10 patients at a time, nurses fear they are unintentionally putting patients and their licenses at risk, said Karen Higgins, president of the Massachusetts Nurses Association. "It's not easy to practice in this environment," said Higgins. "You see the medical errors going up. It's not that they're sloppy; it's that they're running too fast." Connie Hunter, a nurse at Newton-Wellesley Hospital for 25 years, said she believes staffing ratios would ensure better care. A nurse on a psychiatric unit, Hunter said she has just 10 to 15 minutes to assess and treat patients. "If you had more nurses, people would be taken care of and assessed and seen on a more timely basis," said Hunter, co-chairman of her union's bargaining team. Some nurses leave their jobs because they believe the working environment is too dangerous. Others, like DiDonato and Hunter stay in the profession because they care about their patients and they want to see things change. ... Nurses wield petitions in 'Safe Staffing' fight <http://www.masslive.com/news/unionnews/index.ssf?/news/pstories/ae510sta.html > John F. Lauerman, Springfield Union-News, May 10, 2002 It was a cool, cloudy morning with a bit of a light rain in the air. A group of about 35 nurses and observers stood in the Providence Hospital parking lot as an ambulance pulled into view. But the cargo inside wasn't a patient; it was a sign of frustration. Ambulances criss-crossed Massachusetts to pick up signatures on a petition in support of the "Safe Staffing" bill and carry them to Beacon Hill. House bill 1186 would set minimum staffing levels that would be required to take care of different number of patients on various types of nursing wards. According to Massachusetts Nursing (sic) Association spokesman David Schildmeier, nurses collected 75,000 signatures in one week. "It was the most amazing experience," said Patricia E. Healey of Northampton, a nurse at Brigham and Women's Hospital in Boston. "People took the petition right out of my hand and signed it. I signed up 450 people myself." The petition also gained the support of the Massachusetts Senior Action Council, which has joined with the nurses' association to advocate for better health care statewide. "Seniors will not be silent while nurses fight to make hospitals and nursing homes safer for patients," said the council's Isaac BenEzra of Amherst. ... Nurses rally for staffing law <http://www.massnurses.org/News/petdrive/postcoverage.html> Erik Arvidson, Berkshire Eagle, May 10, 2002 Boston. Wheeling a stretcher carrying 75,000 signatures from residents across the state, registered nurses staged a rally at the Statehouse yesterday advocating for minimum nurse staffing rules. Saying that many registered nurses are overburdened with too many patients to care for and mandatory overtime, the nurses lobbied for passage of a law that would require health care facilities to keep minimum nurse-to-patient ratios. Judybeth Crowell, a registered nurse at Berkshire Medical Center in Pittsfield, delivered more than 1,000 signatures from people in Pittsfield supporting the bill, which is now stalled in committee. Crowell said that while nurse staffing at BMC is not bad, some hospitals assign nurses to care for eight to 10 patients, and force nurses to work 16 hours at a time. This has resulted in nurses fleeing the profession, and in some cases in patients not receiving appropriate health care, leading to complications and increased costs to hospitals, she said. Many nurses feel its just not worth it to put their life on the line, Crowell said. "They want a job that they'll be able to take pride in. We're not working in a widget factory." She added, "If this bill is passed, registered nurses will come back. People who were afraid will come back to the bedside. This will make it a more attractive career for young people." ... Fewer RNs can deter good health, study says <http://www.businesstoday.com//business/business/nurs05312002.htm> Jon Chesto, Boston Herald, May 31, 2002 Patients in hospitals with fewer nurses often take longer to recover and develop more complications than those who get a higher level of nursing care. That's what a Harvard School of Public Health professor and other researchers describe in a study published in yesterday's New England Journal of Medicine. "The problem of low staffing is very serious at many hospitals," said Harvard professor Jack Needleman, lead author of the federally funded report. "The consequences for patients can be really severe." The study - which is based on data from 799 hospitals in 11 states - shows connections between registered nurse staffing and negative health complications. For example, Needleman said the number of patients who develop pneumonia at hospitals with low staffing levels would likely drop by 6.4 percent if those hospitals increased their staffing to match those with higher staffing levels. The report found that reductions would also occur in urinary tract infections, hospital stays, gastrointestinal bleeding and instances of shock or cardiac arrest. ... Improving the RN-to-patient ratio <http://www.massnurses.org/News/002006/higgins.html> Karen Higgins, RN, Boston Globe, June 22, 2002 EVERY DAY in Massachusetts, patients in our hospitals push a call button and wait ... and wait ... for a registered nurse to come to their aid. You could be one of those patients. You might be in severe pain, or frightened or disoriented. You need help, but you wait, sometimes for hours, to receive the care you need. Fortunately, in some cases the wait causes no serious harm. But with some frequency, the lack of a quick response from a nurse can trigger a downturn in a patient's condition, or lead to a serious and costly complication. And a two-day hospital stay could turn into a six-day stay. This is why it is critical that legislation pending on Beacon Hill to set registered nurse-to-patient ratios and insure safe patient care be passed. The measure is vital to ending dangerous delays in attending to urgent patient needs. Why is the patient waiting? Why isn't the nurse responding? The answer: insufficient RN staffing. A groundbreaking study published in the New England Journal of Medicine in May made the consequences of RN understaffing all too clear. The study, which reviewed the records of more than 6 million patients in 11 states, including Massachusetts, showed that poor RN staffing leads to increased patient complications, while higher RN staffing results in better outcomes. ... Editorial Comment: The Boston Sunday Globe's lead editorial on health costs and health insurance (reprinted in part below) raises a number of pressing questions for all of us. Chapter 141 and its Task Force on Consolidated Health Care Financing and Streamlined Delivery isn't mentioned. Yet it appears that Corporate Massachusetts and its organ the Boston Globe are weighing in heavily for small bandaides and further cost-shifting onto workers and the poor, despite our best efforts. On May 16th, a delegation of representatives of a number of organizations committed to fundamental health care reform, including MNA, met with editorial writers from the Globe, hoping to impress upon the Globe the newsworthiness of the report from lead consultant LECG about to be issued. Readers of Seachange are well aware of the genesis of Chapter 141. It was introduced by the Senate and House leaderships in July 2000 at the behest of the industry to block action on Question 5. As a sop to the single-payer coalition, it included the provision for this study on how Massachusetts can 'consolidate health care financing and streamline delivery.' The health reform movement was split, yet Question 5 was certified for the ballot and nearly passed despite supporters being outspent 50-1. Of significance is that the delegation to the Globe on May 16th included those who had been most bitterly divided by the introduction of Chapter 141 less than two years earlier. Health care incentives Boston Globe Editorial, July 7, 2002 AFTER SEVERAL years of calm, the Massachusetts business community is beginning to stir again in protest over the rising cost of employee health benefits. The new pressures on businesses could lead to useful reforms in an often chaotic medical delivery system. But some of the more radical proposals employers are floating need more research before they are sprung on workers. Business owners and managers, after all, are consumers of health care, too. The Massachusetts Business Roundtable and the Associated Industries of Massachusetts are just two of the business groups that recently convened urgent task forces to discuss how to rein in health care costs. And with good reason: A 2001 survey of employer health plans conducted by Mercer Associates shows their costs rising 13 percent in 2002, with another 15 percent increase expected next year. Of course, the more health care costs rise, the harder it becomes for businesses and government to provide the universal health insurance coverage that should be society's goal. ... The Business Roundtable white paper recommends that companies move away from ''paternalistic'' relationships with employees to encourage sharing responsibility - and costs - for health care. Nothing is wrong with education or rewarding healthy lifestyles. Companies should inform workers of the true cost of their health insurance, including the company contribution with the regular deduction that appears on an employee's pay stub. But it is a bit of a stretch to say that forcing decisions on sick or worried patients creates ''empowered consumers.'' The very concept behind insurance is not just shared responsibility but shared risk - the idea that healthy workers will indeed subsidize sicker workers so that their own costs will be covered if and when it becomes necessary. As the debate continues, employers and employees alike need to work on tweaking medical incentives while keeping this central. Comments of Judith Shindul-Rothschild, PhD, RN Representative of the Massachusetts Nurses Association LECG Study of a System of Consolidated Health Care Financing and Streamlined Health Care Delivery Thank you for the opportunity to address the report distributed to members of the Advisory Committee on Consolidated Financing on June 19. At the July 19 meeting, myself and other attendees posed specific questions regarding the methodology of calculating costs and other financing assumptions that I will not reiterate. The LECG has proposed four models for achieving the aims of the legislation for consolidating health care financing. I will address the position of the Massachusetts Nurses Association for each of the four models. Model #1- Baseline (Status Quo). The MNA position is that Model #1, Status Quo, is not an option and should be removed for consideration. The intent of the legislation and the ballot initiative is to mandate consolidation of health care financing and improve access to care. Retaining the status quo assures these goals will not be achieved. Model #2- Medicaid Expansion. The MNA position is that Medicaid Expansion programs may improve access, but it would not meet the goal of consolidating financing. Administrative savings could not be realized in any degree; indeed, it could be persuasively argued that administrative costs would be exacerbated. Model #3- Mandating a Basic Benefit Plan. In the mid-1980s, the Commonwealth of Massachusetts enacted a mandate that small businesses provide health insurance to their employees. The Commonwealth also mandated that schools of higher education require health insurance as a condition of enrollment for full-time students. The provision for small businesses was allowed to sunset under the Weld Administration in the early 1990s. While a mandated benefit model was effective in expanding coverage to 18% of young adults who were uninsured, it is not a viable option for the majority of Massachusetts's citizens without health insurance, and it would not consolidate health care financing. Mandating health insurance similar to a car insurance model would group high-risk, high-cost individuals in a separate health insurance pool. Providing health insurance to families or individuals in the pool would by definition, become extraordinarily expensive, even with state or federal sliding scale subsidies. Model #4- Single Payer System. The Massachusetts Nurses Association supports the single payer system. Single payer is the only model that meets the dual objectives of consolidating health care financing and improving access to health care services. The transition to single payer could lead to a transition of workers from the insurance industry to the health delivery system. Retraining and relocating workers transitioning from one sector to another sector of the economy has been provided to workers in the Commonwealth, especially in the 1980s. We would advise revisiting programs through the Department of Labor and Workforce Development that would form state-business-union partnerships to mitigate any untoward economic effect on communities or displaced workers in the insurance industry. The Department of Public Health last month conducted a series of workshops on the critical shortage of nursing personnel. It is conceivable that workers in the health insurance industry could be retrained to meet the growing need for health care professionals. The relocation of displaced insurance workers to the health care industry has the potential to improve access to care while simultaneously accomplishing the goal of consolidating health care financing. The LECG Report does not describe potential savings achieved in a single payer model through improved continuity of care, nor the cost benefits of achieving economies of scale, in for example, bulk purchases of pharmaceuticals. The LECG Report does not account for the administrative costs in the teaching and training of physicians, nurses and other allied health professionals, or medical research for hospitals or other health care facilities. Health care research and training costs add significantly to the overhead of health care facilities in the Commonwealth. How the administrative costs of health care training will be shared, or separated between the Commonwealth and Massachusetts educational institutions, needs to be described. Finally, we would also advise a review of the tax dollars and costs associated with a transition to a single payer system based upon a recent analysis of tax revenue and health care spending by Woolhandler and Himmelstein that was published in the July/August edition of Health Affairs. If I may be of any further assistance in the review or revision of the LECG Report, please feel free to contact me ... On behalf of the over 20,000 registered nurses who are members of the Massachusetts Nurses Association we want to express our ongoing commitment to devising an innovative health care delivery system in the Commonwealth that will consolidate health care financing and guarantee assess to care for all citizens under a single payer model. Sentence is lenient in assault by patient Prosecutors, nurse's aide (sic) had hoped for a stay-away order; judge rejects request <http://ledger.southofboston.com/archives/index.inn?loc=detail&doc=/2002/July/ 19-2833-news06.txt> Sue Reinert, The Patriot Ledger, July 19, 2002 A Quincy District Court judge yesterday gave a more lenient punishment than prosecutors sought to a former mental patient convicted of assaulting a Quincy Mental Health Center nurse. Prosecutors wanted Dawn Jacqueson, 32, to serve three years of probation, obtain anger management treatment and stay away from the psychiatric hospital and the victim. But Judge Paul Buckley imposed one year of probation and angrily rejected the request for a stay-away order. His voice rising, Buckley said: ''If a patient is in distress and brought to that institution, they will not reject her or any other patient.'' Referring to assault victim Charles Belanger, the judge said: ''If he works with disadvantaged people he should expect that. Not that anyone should expect to be assaulted, but I heard the case, I heard the evidence.'' A jury convicted Jacqueson in May of assault with a dangerous weapon for jabbing Belanger with a pen when she was treated at the state facility in May 2001. Belanger and a Quincy police officer testified that the attack punctured the skin on the nurse's side. ... A call for nurses <http://nl9.newsbank.com/nl-search/we/Archives?p_product=BG&p_theme=bg&p_actio n=search&p_maxdocs=200&s_dispstring="A%20call%20for%20nurses"%20AND%20date(las t%2012%20months)&p_field_date-0=YMD_date&p_params_date-0=date:B,E&p_text_date- 0=-12qzM&p_field_advanced-0=&p_text_advanced-0=("A%20call%20for%20nurses")&p_p erpage=10> Boston Globe Editorial, July 10, 2002 ANY DOUBT that adequate staffing of nurses improves the care of patients was eliminated by a Harvard School of Public Health study published this spring. Without enough nurses, the report in The New England Journal of Medicine indicated, patients at the 799 hospitals reviewed were more likely to contract a urinary tract infection or hospital-acquired pneumonia or suffer other setbacks. There was also a link, though weaker, between inadequate staffing and ''failure to rescue'' - death caused by complications that alert staff can sometimes head off. The Harvard study puts in context the finding by the Massachusetts Hospital Association and the Massachusetts Organization of Nurse Executives last week that 9.9 percent of nursing jobs at acute-care hospitals are unfilled. Not only does short staffing hurt patient care; it is also a factor in the common phenomenon of emergency room diversions, in which staff-short hospitals close their ER doors to ambulances with all but the most critically ill or injured patients. Because it was focused on hospitals, the survey did not look at the even more severe nurse staffing problems of long-term care facilities and home health agencies. The most direct way to recruit and keep nurses is through recruitment bonuses, student loan assistance, and higher pay, which will inevitably increase the already steeply rising cost of health care. Specialists in the field also say hospitals can hold onto their nurses better by offering them more mentoring with experienced colleagues and by improving their working conditions. The Massachusetts Nurses Association wants to improve conditions by having the Legislature set mandatory minimum staff-to-patient ratios, as California has done. This has several drawbacks, however. Appropriate staffing levels can vary depending on the case mix and the level of support nurses are getting from other personnel with paperwork, moving patients around the hospital, and other tasks. Moreover, there is often a tendency for staffing minimums to become ceilings, not floors, leaving nurses effectively short-handed in situations that meet the legal minimum but really call for more than minimum staffing. If accrediting agencies acted more aggressively, they could go a long way toward ensuring that patients get the nursing care they deserve. For its part, the state could require that when staffing levels fall short of minimum standards, notice of that would have to be prominently posted at the hospital. Large employers who insure their workers' health could also play a role by monitoring health providers to make sure they maintain adequate staffing. But as useful as such pressure from outside is, hospitals should see it in their own interest to provide nurses the pay and conditions they deserve. © Copyright 2002 Globe Newspaper Company ©Copyright 2002 New York Times Company Reasons why it's hard to recruit nurses <http://ledger.southofboston.com/archives/index.inn?loc=detail&doc=/2002/July/ 30-3174-opin04.txt> Sandy Eaton, RN, Quincy, The Patriot Ledger, July 30, 2002 Your article of July 24 (''Bill to help relieve nurse shortage nears passage") highlights positive initiatives aimed at attracting and educating more nurses. However, merely recruiting new nurses into the current system of unsafe staffing levels and cookie-cutter care plans will only result in rapid burnout as ideals are shattered. After 14 years of privatization, deregulation, job reengineering, deskilling, layoffs, speedup, mergers and managed care, we face an assembly-line health care system in which patients' lengths of stay are now measured in hours instead of days. RNs, educated and trained to provide quality care, have been driven from the bedside or fled in droves because of the very practices that the captains of the health care industry have imposed or passively accepted during the era of marketplace mentality. Ironically, Massachusetts has more RNs per capita than any other state in the nation. Nurses have not left the bedside to get rich. In order to maintain sanity and safety, many are now working in the bureaucracies engendered by managed care. Some, like myself, have cut back to part-time. Some have switched from regular assignments to per diem. Many have opted for early retirement. Material incentives alone will not work. Nurses will return to the bedside when there's a guarantee that inhumane patient-care assignments are banned, that minimum staffing ratios, with provision for increased staffing as patient acuity rises, will be enforced by the Department of Public Health. Legislation to set such standards (H1186) is now before the Health Care Committee on Beacon Hill and deserves broad support. Copyright 2002 The Patriot Ledger Drug makers out of the loop in price talks State has done little to lower what manufacturers charge pharmacies <http://ledger.southofboston.com/archives/index.inn?loc=detail&doc=/2002/Augus t/07-3305-news02.txt> Julie Jette, The Patriot Ledger, August 7, 2002 While the state puts the muscle on pharmacies, there are no plans for drug manufacturers to even participate next month in a hearing to determine how much the state pays for Medicaid prescriptions. The state spends $1 billion a year on prescriptions for the one out of six Massachusetts residents who get Medicaid benefits. Drug stores have balked at getting less for those prescriptions, but the state so far has done little to get lower prices from the pharmaceutical companies that make the drugs. One critic said not having the drug companies at the hearing in September leaves the most important player out of the discussion - the one that sets the costs of drugs. ''I think that's where the problem lies,'' said Josh Greenberg, deputy director of the consumer group Health Care for All. ''If we're going to reach an equitable solution that insures access for low income and vulnerable people and maintains our current pharmacy system ... they need to be at the table.'' ... Casualties tied to gaps in nursing Hospital data cited in report on injury, death Anne Barnard, Boston Globe, August 7, 2002 Inadequate nurse staffing contributes to nearly a quarter of hospital incidents that kill or injure patients, the national group that accredits hospitals says in a report being released today. The group called on the federal government and the health-care industry to act more aggressively on the growing shortage of registered nurses. The report suggests that the shortage of nurses is a factor in tens of thousands of deaths annually from causes ranging from medication errors to patient falls and hospital-acquired infections. Nationally, 98,000 deaths a year have been blamed on medical errors, and one in 10 nursing jobs is currently empty. "There's a problem out there," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations. "We knew other people were going to gulp and say, 'That's really high.'" The commission is a private group that inspects and accredits hospitals. Nurses unions and patient groups have sometimes called it too friendly to hospital administrations. The commission based its findings on the hospitals' assessments of unexpected adverse outcomes that either killed patients or caused them serious physical or psychological harm. Of the 1,609 adverse events that hospital officials voluntarily reported to the commission between January 1996 and March 2002, 24 percent took place in part because hospitals had an insufficient number of registered nurses on the job, according to hospital officials. THE NURSING SHORTAGE Nurse staffing levels were deemed a contributing factor in... ------------------------------------------------------------------------ 50% of ventilator-related incidents. ------------------------------------------------------------------------ 42% of surgery-related incidents. ------------------------------------------------------------------------ 25% of transfusion incidents. ------------------------------------------------------------------------ 25% of delays in treatment. ------------------------------------------------------------------------ 25% of infant abductions. ------------------------------------------------------------------------ 19% of medication errors. ------------------------------------------------------------------------ 14% of inpatient suicides. ------------------------------------------------------------------------ 14% of patient falls. ------------------------------------------------------------------------ Sources: Joint Commission on Accrediting Healthcare Organizations analysis of 1,609 incidents from 1996 through March 2002. Despite increasing public attention to both medical errors and the nursing shortage, neither hospitals nor the government have reacted strongly enough, said O'Leary. He called for more federal spending to train and support nurses and to encourage hospitals to increase staffing with incentives such as tying extra Medicare and Medicaid payments to improved nurse staffing and better patient outcomes. "There seems to be a tacit belief that where we are now is OK," he said. "We're saying somebody ought to be really bothered about this right now, and it's probably going to get worse if we don't wake up." There are now 126,000 unfilled nursing positions in the United States. Nursing specialist Peter Buerhaus, who helped write the commission's report, has predicted a shortage of 500,000 registered nurses by 2020; a federal report issued last month put the number at 800,000. A study published in Health Affairs magazine said that only 34 percent of registered nurses believe their hospitals have adequate nursing staff and that 83 percent said the number of patients in their care had increased. The shortage of nurses is particularly worrisome because research increasingly shows a link between the staffing shortage and patient recovery. For instance, recent studies showed that increased nurse staffing is associated with fewer urinary tract infections and cases of pneumonia, as well as lower mortality. In another study, patients who had abdominal aortic surgery in hospitals with fewer intensive-care nurses had longer hospital stays and more complications. The report by the Joint Commission on Accreditation was produced by a panel of academics, nurse executives, and a union representative. It recommends a range of initiatives, from more federal scholarships for nurses to establishing training regimens akin to doctors' residencies. And it argues that the cost of such changes will be offset by reducing the amount hospitals must spend to replace nurses who quit over adverse working conditions. O'Leary, an internist, said he believes that the reports hospitals voluntarily submit to the commission are representative of all medical errors and that a quarter of the 98,000 deaths attributed to medical errors each year could be caused by staffing issues. Hospital executives did not dispute the data. "Now we have data to really demonstrate that this ... affects patient care," said Jeanette Clough, a registered nurse and president of Mount Auburn Hospital, which temporarily closed two of its 10 intensive-care beds last year because of inadequate staffing. The commission's figures may understate the effect of the nursing shortage on adverse medical events, O'Leary said, because medication errors are often underreported and because hospitals may blame some of them on miscommunication or insufficient training that could also be related to staffing levels. In proposing solutions, the commission is wading into a longstanding debate over levels of staffing. Hospitals say they have fallen victim to workplace trends that have pulled people away from nursing, and they want more subsidies for nursing education and recruitment, like those in a $30 million bill that President Bush signed last week. But some nurses' groups say that hospitals created the shortage by laying off so many nurses in the mid-1990s that workloads became intolerable and nurses shied away from hospital employment, fearing they would make a fatal mistake. Those groups are calling for laws specifying nurse-to-patient ratios, such as a law and regulations that took effect this year in California. A similar bill was filed in Massachusetts last fall but has languished in committee. The Massachusetts Nurses Association, the state's largest nurses union, welcomed some of the suggestions in the commission's report, but said it did not go far enough, because it stopped short of endorsing ratios. "JCAHO was accrediting all these organizations for the last 15 years that purposely implemented staffing cutbacks and replaced nurses with less skilled people to save money," said Julie Pinkham, the union's executive director. The commission accredits 80 percent of the nation's hospitals through site visits that hospitals usually know about in advance, with details kept private. But the commission has recently vowed to get more aggressive. Last month, it introduced regulations that require hospitals to track staffing issues such as overtime and clinical outcomes that are affected by staffing, such as infections and patient falls. The commission also plans to take public-policy stances on problems such as hospitals' emergency preparedness and overcrowding of emergency rooms. It addressed the nursing shortage first, O'Leary said, because that was the issue "that really curled our hair." Anne Barnard can be reached at abarnard@globe.com. This story ran on page A1 of the Boston Globe on 8/7/2002. © Copyright 2002 Globe Newspaper Company ©Copyright 2002 New York Times Company Panel: Nurse crisis takes toll on patients <http://www.masslive.com/news/unionnews/index.ssf?/news/pstories/ae88nurs.html > Patricia Norris, Springfield Union-News, August 8, 2002 Reporting that the nursing shortage is increasing patient injuries and deaths, a national commission recommends improving federal funding, education and retention plans for nurses. A report by the Joint Commission on Accreditation of Healthcare Organizations said yesterday the nursing shortage contributed to 24 percent of the hospital injuries and death reported to the commission as of March 2002. The organization accredits hospitals. "This is a call to action," said Dr. Dennis S. O'Leary, commission president. Roughly 12 percent, or 126,000, nursing positions are unfilled. The report said poor staffing contributes to emergency department overcrowding, cancellation of elective surgeries, discontinuation of clinical services, and the limited ability of the health system to respond to mass casualty incidents. In addition, 90 percent of nursing homes report an insufficient number of nurses to provide basic care, and some home health agencies are forced to deny admissions. ... Stephen P. Mikelis, a nurse at Mercy Medical Center in Springfield, said nurses there are overburdened. Some have found themselves responsible for up to 10 patients on a floor, he said. "If someone calls in sick, they (floor nurses) are being assigned more patients, which provides an unsafe situation for the nurses and the patients," he said. Mikelis, a member of Massachusetts Nurses Association and a nurse at Mercy for 17 years, meets monthly with the hospital's Staffing Advisory Committee to discuss the shortage. "Some nurses are getting fed up," he said. "We are under terrible stress, and if something isn't done, more nurses will leave the profession." ... Massachusetts Nurses Association Executive Director Julie Pinkham called the commission's findings "old news." "Nurses were saying these things for the last decade and were being ignored," she said. Pinkham said the report did not go far enough to address the issue because it did not advocate for mandatory patient-nurse ratios in hospitals. The report urged institutions to evaluate their staffing needs. "If we want to know that patients are safe, we are going to have to make it a form of regulation," she said. ... Nurses: Shortage of help hurts patients <http://www.eagletribune.com/news/stories/20020810/FP_002.htm> Marjory Sherman, Eagle Tribune, August 10, 2002 Jeanine M. Hickey is hardly surprised by a new study that blames a nationwide nursing shortage for one in four deaths or serious injuries that befall hospitalized patients. The Haverhill resident spent 25 years as an intensive care nurse at Hale Hospital -- now Merrimack Valley Hospital -- and has seen first-hand how staffing shortages can put a patient's life in jeopardy. "I think it's something that we've been trying to tell the hospital industry for a long time. Nurses are taking care of too many patients and the result of that would tend to be more negative outcomes,'' Hickey said. She shares the Joint Commission on Accreditation of Healthcare Organizations' assessment that the growing shortage requires immediate attention. ... "The shortage we now face is the creation of a decade's worth of bad decisions by the health care industry to cut costs and deal with managed care by laying off nurses, replacing nurses and having the nurses left behind to care for too many patients and work far too many hours,'' said David Schildmeier, spokesman for the Massachusetts Nurses Association. Massachusetts nurses are aggressively petitioning the state to regulate the nurse-to-patient ratio. ... Foreign nurses recruited to ease local shortage Unions decry move, but nursing homes see no alternative <http://www.boston.com/dailyglobe2/223/west/Foreign_nurses_recruited_to_ease_l ocal_shortage+.shtml> Christopher Rowland, Boston Globe, August 11, 2002 Maria Cecille Ruby Ticzon is small, like many women from the Philippines, but her arms are strong and she has little trouble supporting the frail nursing-home residents in her care. She helps them out of bed and gently settles them into wheelchairs, expertly whisking them along carpeted hallways to meals or bingo games. She helps them bathe and change their clothes and treats them with dignity in their helplessness. In her last job, Ticzon, 30, worked as a nurse on a pediatric ward in Saudi Arabia. Now, she is making a new start in the United States - part of a new wave of foreign nurses responding to a national shortage of nurses in this country. ... In the 1980s, during the last major nursing shortage in the United States, most foreign nurses came from Ireland, Australia, and South Africa. In 2001, the top five countries of origin for foreign nurses working in Massachusetts were the Philippines, Canada, Nigeria, Great Britain, and Kenya. The practice of recruiting from overseas is controversial, because it drains badly needed nurses from some Third World countries. The state's nursing union, the Massachusetts Nurses Association, disapproves of recruiting nurses from overseas. The problem in Massachusetts, said David Schildmeier, is not a lack of nurses, but staff cuts and high patient loads that have driven many nurses into other areas of health care or out of the business altogether. 'It's an unnecessary and short-sighted approach to dealing with the real problem,'' he said of hiring from abroad. 'The reason [domestic nurses] aren't working in direct care is because of staffing conditions that were created and implemented by the industry over the last decade in response to managed care.'' ... Solomon Islands nurses, courts join protest over no pay <http://www.pacificislands.cc/pm72002/pinadefault.cfm?pinaid=5248> PINA Nius Online, August 8, 2002 Magistrates courts were closed and nurses working only limited hours as the growing protest by Solomon Islands public sector workers over pay delays spread. The government - facing a deepening financial crisis - was confronted today by: - Solomon Islands Nurses Association members saying they will now work limited hours during day time only, and are giving a 28-day strike notice. - No magistrates available in Honiara for police cases because court staff have joined other public servants in the sit in protest. Teachers were amongst the first to stop work because of the continuing delays in getting their pay. The financial crisis follows more than two years of ethnic conflict and continuing law and order problems despite a peace agreement. Key export industries remain closed or only in limited operation. According to a position paper given to the government, Solomon Islands Nurses Association members will work eight hours during the day. There will be no afternoon and night shifts. Nurses working in the operating theatre and the Eye Department will only work from 8am to noon, and will be on stand by from then on for emergency cases only. ... October strike to go ahead <http://www.cosatu.org.za/news/weekly/20020809.htm> Cosatu Weekly, August 9, 2002 COSATU general secretary Zwelinzima Vavi this week expressed disappointment at a lack of commitment within the tripartite alliance in taking agreements seriously and implementing them. Urging workers countrywide to remain prepared for this October's nationwide strike against government's economic policies, the federation's leader said the recent Alliance Summit demonstrated a problem of lack of capacity of all parties to take forward agreements. Vavi said the parties at the summit were able to reaffirm basic agreements on basic social, economic and political strategies but have been unable to take programme of action agreed upon. He said the circumstances have made it impossible for the federation to twist government's arm on economic policies - hence the October shall go on. The General Secretary further voiced frustration at speeches being made by government ministers which ignore the agreements made between COSATU, the African National Congress and the South African Communist Party. The federation is demanding, among others: * An end to privatisation, which raises the cost of basic services to the poor and weakens the democratic state * Measures to address the hardships caused by poverty and soaring food prices, including a qualitative improvement in welfare measures, a 96 percent windfall profits tax on maize and job creation through public works on a massive scale; and The redirection of government's economic policies to create jobs and meet the needs of the people. Upwards of one million public sector workers stage three-hour strike <http://www.jpost.com/servlet/Satellite?pagename=JPost/A/JPArticle/ShowFull&ci d=1028814663235> Mati Wagner, Jerusalem Post, August 12, 2002 Public sector workers walked off their jobs Monday morning for three hours in a strike called by the Histadrut Labor Federation to press for wage increases. The lasted between 10 a.m. and 1 p.m. The strike went ahead despite a last-minute call by Histadrut Chairman Amir Peretz on Prime Minister Ariel Sharon to avert the sanctions by negotiating a policy package that would compensate employees for inflation. Peretz told Histadrut activists last night in Rishon Lezion that today's strike would be a one-time action, and that the government would have another two weeks to open wage talks. "We are staging a symbolic strike and afterward we'll give another chance for talks over the next two weeks. If after those two weeks there's been no progress, we'll undertake a series of more serious actions starting Sept. 1," Peretz said. Avinoam Magen, a Histadrut spokesman, estimated close to 1.5 million workers are participating in the strike, the first in a series of actions planned to take in a bid to win a cost-of-living wage adjustment and to protest government plans to cut the 2003 budget. ... Laila Harre takes job with nurses' union Former Alliance minister Laila Harre has a new job with the nurses' union. <http://www.nzherald.co.nz/latestnewsstory.cfm?storyID=2349231&thesection=news &thesubsection=general> NZPA, August 13, 2002 Ms Harre held women's affairs, youth affairs and associate labour portfolios in the Labour/Alliance coalition Government. An MP for six years, she lost her seat at last month's election. Nurses Organisation chief executive Geoff Annals said Ms Harre brought a wealth of experience in the industrial, legal and political arena to her new job, which she starts next week. ... Sharon foe seeks Labor party's nod to run in election Israeli mayor seen as viable contender <http://www.boston.com/dailyglobe2/226/nation/Sharon_foe_seeks_Labor_party_s_n od_to_run_in_election+.shtml> Dan Ephron, Boston Globe, August 14, 2002 TEL AVIV - A popular retired general who favors immediate negotiations with the Palestinians declared yesterday he would run for leader of Israel's Labor party and for prime minister against Ariel Sharon, posing a credible challenge to the ruling right-wing coalition. Amram Mitzna, mayor of Haifa, Israel's third-largest city, and a dovish member of the centrist Labor party, said that if elected he would enter negotiations unconditionally and dismantle most Jewish settlements even without a peace accord. In challenging Sharon, Mitzna would extend a 20-year-long personal feud. As an army general in 1982, Mitzna publicly criticized Sharon, then defense minister, for engineering the ill-fated invasion of Lebanon. ... Brazil's currency slips <http://www.boston.com/dailyglobe2/226/business/Brazil_s_currency_slips+.shtml > Reuters, August 14, 2002 BRASILIA - Brazil's government scrambled yesterday to stem investor panic over upcoming presidential elections after Moody's Investors Services dealt a fresh blow to the punch-drunk economy by cutting its debt outlook, despite last week's $30 billion bailout by the IMF. The credit rating agency's downgrade added momentum to a vicious cycle plaguing Latin America's largest economy. Brazil's currency, the real, slipped yesterday - nudging up the cost of huge federal and corporate debt loads, while cash- and credit-starved companies put additional pressure on the currency as they scraped for dollars to pay off foreign debts. ... Investors fear a victory for one of two left-leaning candidates atop the polls could lead to a default on $250 billion in net public debt. Wall Street worries that front-running leftist Luiz Inacio Lula da Silva or center-leftist Ciro Gomes, if elected, could undo Cardoso's free-market policies. ... Gomes and Lula have said they will respect the accord but they have slammed Cardoso for pushing Brazil to the brink of collapse. Web Directory: Australian Nursing Federation <http://www.anf.org.au> California Nurses Association <http://www.califnurses.org> Canadian Federation of Nurses Unions <http://www.nursesunions.ca> CCDS <http://www.cofc.org> Irish Nurses Organisation <http://www.ino.ie> LabourStart <http://www.labourstart.org> Maine State Nurses Association <http://www.mainenurse.org> Massachusetts Ad Hoc Committee <http://www.massadhoc.org> Massachusetts Green Party <http://www.massgreens.org> Massachusetts Labor Party <http://www.masslaborparty.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> 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> FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. I am making such material available in an effort to advance understanding of environmental, political, human rights, economic, democracy, scientific, and social justice issues, etc. I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 US Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. For more information go to: <http://www.law.cornell.edu/asked/17/107.shtml>. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use,' you must obtain permission from the copyright owner. |