Editorial State Takes Some Important Steps To Help Hospitals

The state’s fiscal ’05 budget hasn’t been finalized yet — a House-Senate conference committee has passed a $24.8 billion compromise plan on to the governor for his review — but it appears that the Commonwealth’s elected leaders are giving some relief to hospitals and other providers — finally.

The budget plan includes an additional $140 million to pay for hospital care for the uninsured, whose numbers have risen steadily in recent years, and it also restores health coverage for tens of thousands of low-income children, people with HIV, and immigrants.

These moves certainly won’t cure all the ills of the state’s beleaguered hospitals, but they are certainly steps in the right direction. In short, it appears that the Legislature is trying to repair some of the damage it has caused in recent years rather than inflict any more.

This is evident in the conference committee’s decision to reject a Senate plan to implement minimum nurse staffing ratios. The Senate had passed a proposal that called for set ratios in several areas of care — from the emergency room to the ICU — that would be tested in what was dubbed a “pilot program” that would involve 10 of the state’s hospitals in the first year.

Opponents of nurse-staffing ratios said the term ‘pilot program’ was a misnomer, and that this was merely phased-in implementation that would eventually involve all hospitals. They also said the pilot was a somewhat rigged experiment, one that would involve only fiscally sound hospitals (if there are such things) and thus provide a skewed view of the overall economic impact of the staffing ratios.

We agree with all of those assertions, and maintain that minimum nurse staffing ratios, while they sound good in theory, are not the panacea that they are made out to be. In fact, the only real beneficiaries of the plan, as proposed, would be the registered nurses who so ardently back it.

Proponents of the ratios, who say patient safety is at the heart of their argument that they are needed in the Commonwealth, cite studies showing that as the number of patients each nurse is responsible for increases, so too do the number of deaths and serious complications. Minimum ratios will improve patient safety, they say, by ultimating reducing the number of errors made in the administration of care.

Proponents also say that by implementing minimum staffing ratios, more nurses will stay in the profession due to reduced levels of stress and more friendly work environment, and that some who have left the profession will return if ratios are implemented.

We believe that both arguments are dramatic oversimplifications of some very complex issues.

Regarding the quality of patient care, we think this matter is one that involves far more than the number of registered nurses on a given floor at a given time. While it might make some sense to argue that patient care improves as a hospital adds more nurses, the setting of minimum ratios would seem a largely arbitrary exercise. One of the authors of a study on patient care — one that is, ironically, often cited by ratio backers as they press their case — says as much.

“It is stupid to use regulatory policy to deal with the nursing problem,” said Peter Buerhaus in a piece called “Nurse Staffing and Quality of Care in Hospitals in the U.S.,’ published in the New England Journal of Medicine. “There is no scientific basis, none whatsoever, to show you how many nurses you need on a shift.”

As for the nursing shortage, ratios may help solve one problem, supply (with emphasis on may) but it will also cause others, especially a sharp escalation in wages and benefits as hospitals vie for a currently insufficient volume of nurses. This phenomenon will severely impact smaller, community hospitals, including many in Western Mass., that are already struggling to stay afloat amid inadequate reimbursements from public and private payers.

In the final analysis, we believe minimum nurse staffing ratios will rob hospital administrators of much needed flexibility when it comes to finances and how their resources are utilized. The ratios would likely make life easier for current and future nurses, but they would make it much more complicated for all others who are involved in the delivery of health care.

The House-Senate conference committee was wise to put the nurse-staffing issue on ice for at least the time being. To burden hospitals with such a costly, logistically complicated measure — when there is no hard evidence that it will improve patient care — would have been a step in the wrong direction