Hospitals Brace For Battle On Staffing Issues
Nurses say legislation will save lives
A law being proposed by the Massachusetts Nurses Association would take the decision of how many nurses to hire away from hospital administrators and put it with the state Department of Public Health.
The legislature is considering the so-called "patient safety act," and the House committee on public health held a hearing on the bill last Wednesday. The Massachusetts Hospital Association says the bill is an ongoing effort of the Massachusetts Nurses Association to swell its ranks, even as the state's hospitals hire more nurses than they have in years.
According to the MNA, hiring more nurses - as many as one for every four patients in some departments - would save lives that are needlessly lost because of insufficient staffing at Massachusetts hospitals. The association says hospitals are willing to sacrifice adequate patient care for huge executive salaries.
First, Do No Harm
The law would make Massachusetts the only state in which Vanguard Health Systems Inc. operates that mandates specific nurse-to-patient ratios. Vanguard, which owns St. Vincent Hospital in Worcester and MetroWest Medical Center in Framingham and Natick, is a for-profit hospital operator.
"If our labor costs continue to increase, we may not be able to raise our payer reimbursement levels to offset these increased costs, the company said in its SEC filing. Being forced to hire more and more union nurses could threaten Vanguard's profitability, the company said.
While Vanguard's revenue continued a consistent growth trend in the 2006-07 fiscal year, the company reported a net loss of $132.7 million for the same period.
St. Vincent spokesman Dennis L. Irish said, "Whether in connection with the union or state staffing guidelines," mandated ratios "could have a dramatic effect on the hospital."
Top tier nurses can make more than $100,000 per year in Massachusetts, and the average nurse makes between $75,000 and $80,000, according to the MNA. Still, the association contends that hospitals would save money as a result of the cleaner, safer, happier conditions more nurses would bring.
The association has been pushing for state-mandated nurse staffing levels since 1995 because hospitals have failed to hire adequate numbers of nurses, and as a result, patients are dying needlessly, working conditions for nurses are deteriorating and nurses are burned out, dissatisfied and leaving their jobs, said association spokesman David Schildmeier.
Last year, the state House agreed, and passed a bill nearly identical to the current proposal. However, last year's bill required specific ratios, and was never taken up in the Senate.
State Sen. Richard T. Moore, D-Worcester, doesn't buy all the association's claims. Moore said he's studied California's 1999 implementation of mandated nurse-to-patient ratios, and "there's no significant change in incidence of patient falls" or other measurable patient outcomes.
About the only certainty for hospitals is that mandated ratios "will increase the cost of health care," Moore said. "Yet, there's no indication that any particular ratio is the right ratio."
Vanguard sold its three California hospitals in 2006.
According to Rich Copp of the Massachusetts Hospital Association, California's mandated nurse staffing levels have resulted in layoffs of other hospital staff. He said Massachusetts "saw the most dramatic uptick in RN hiring that we've seen in a decade" last year.
Bedside Manner
Moore said he assumes the bill will pass the House again this year. And Irish is certain the bill will be passed in the Senate as well.
"The major problem is, there's no basis on which the ratios are set," Moore said of the legislation. It calls for the state Department of Public Health to set a limit on the number of patients assigned to nurses at any one time, and arbitrary limits lose their usefulness very quickly in real hospital settings where what Copp called "the care-giving team" must be able to think on its feet and adapt to a variety of situations.
"Academic studies suggest that having more nurses is better from a standpoint of quality and safety, but there's no real way to assess what a patient's needs are, and nurses' abilities vary," Moore said.
He said some nurses could probably handle a greater patient load than others, and some hospitals have better technology and more support staff than others.
In its defense of the patient safety act, the Massachusetts Nurses Association says hospitals can afford paltry patient-nurse ratios.
Across the board, nurse-to-patient ratios are "seven, eight, nine patients to a nurse," Schildmeier, who cited studies that suggest that when a nurse has more than four patients, "the risk of death goes up 7 percent per patient. At eight, the risk of death is 31 percent higher."
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