Editorial Patient Safety Act A Good Compromise For State’s Hospitals

Legislation that would have created a pilot program for the establishment of minimum nurse-staffing levels in the state’s hospitals never made it to a full vote during finalization of the state’s budget last summer.

Speculation as to why the measure died after going to conference committee centers on several issues. First, there was the cost that would have to be borne by hospitals participating in the pilot — and who would eventually pay that cost, meaning consumers, insurers, and already financially strapped hospitals. And then, there were early reports out of California, the first state in the nation to implement strict ratios of nurses to patients, that the concept was bringing unanticipated costs and a number of problems concerning access to care and quality of care.

Whatever the reason for the bill’s demise, we’re glad it never became reality. We don’t see the logic in minimum nurse-staffing levels, and believe it would be a costly mistake to even experiment with them.

Which is why we’re glad to see that a compromise bill of sorts has been filed. Called ‘The Patient Safety Act,’ the measure, filed by state Sen. Richard Moore, chairman of the Legislature’s Joint Committee on Health Care, would address the issues of safety in our hospitals and the ongoing shortage of nurses — but without imposing ratios that would tie the hands of hospital administrators.

We understand why groups like the Mass. Nurses Assoc. (MNA) like minimum ratios. For starters, such a measure would create more jobs and job security. The MNA also states that ratios would, in theory, address some alarming statistics concerning the numbers of medical errors reported in the nation’s hospitals and complaints about the quality of nursing care.

Further, minimum staffing levels would (again, in theory) create a better working environment for those in the nursing profession, thus encouraging more people to enter the field while also prompting some who have left it to return.

Reducing errors and putting more nurses in the pipeline are worthwhile goals to be sure, but we believe there must be a better way than ratios, which would rob hospitals of needed flexibility and greatly increase the cost of providing health care at a time when most hospitals are using red ink, not black, for year-end financial reports.

The Moore bill looks like it could be that ‘better way.’

It addresses patient-safety issues by requiring hospitals to institute a process to collect, monitor, and evaluate patient care through the use of evidence-based nurse-sensitive performance measures. Annual reports on performance and comparisons to industry benchmarks would be made public, creating a stern measure of accountability that is currently lacking.

By doing so, the Patient Safety Act would, in essence, make the public the entity that ultimately decides what is safe when it comes to nurse staffing and what isn’t.

The bill would also address the concerns about the current and future supplies of nurses by providing financial aid for people who attend nursing school and agree to work in a Massachusetts hospital. The bill includes programs to increase the number of critically needed nurse educators, and studies show that thousands of people who are qualified to attend nursing school cannot because there are not enough seats in the classroom, instructors to teach these individuals, or both.

Most importantly, though, the Moore bill puts the responsibility for setting safe staffing levels where it belongs — with doctors and nurses — and not with the state Legislature. Area hospital administrators and officials with the Mass. Hospital Assoc. (MHA) are right when they say that set minimum ratios are arbitrary and that they rob health care providers of needed flexibility in creating staffing plans and administering care.

Early results from California show an increase in the number of hospital diversions since ratios were put in place. This is a direct result of that loss of flexibility.
The Mass. Nurses Assoc., in conjunction with the Coalition to Protect Massachusetts Patients, has re-filed legislation that would create minimum RN-to-patient ratios. Those groups firmly believe that this is the way to reduce errors in the Commonwealth’s hospitals and improve the supply of nurses for today and tomorrow.

We don’t agree. We believe that another answer can be found — one that doesn’t put doctors, nurses, and hospitals in a straitjacket, as one MHA official put it.

The Patient Safety Act could be that answer.