MHA Touts Study Skeptical of Nurse Staffing Ratios

According to a study published recently in the Journal of Nursing Administra-tion, mandatory nurse staffing ratios for Massachusetts hospitals may not be necessary. The Mass. Hospital Association (MHA) has seized on the data to bolster its arguments against nurse-staffing legislation.

The study, “Nurse Staffing, Nurse Intensity, Staff Mix, and Direct Nursing Care Costs across Massachusetts Hospitals,” was prepared by John Welton, PhD, RN, assistant professor in the College of Nursing at the Medical University of South Carolina in Charleston. It examines intensity of care, staff skill mix, and nursing costs per patient in 65 acute community hospitals and nine academic medical centers in Massachusetts.

The study finds considerable variability in the 601 nursing units examined. “The significant differences between community hospitals and academic medical centers, unit type, as well as the high degree of variability in patient-to-RN ratios, nursing intensity, skill mix, and RN costs per day suggests that nursing resource expenditure at Massachusetts hospitals is complex and affected by case mix, unit size, and complexity of care,” the authors suggest.

The research findings challenge the assertions of the Massachusetts Nurses Association, the proponents of mandatory nurse staffing ratios. The study shows that “there is no clear evidence that laws regulating how hospitals address nursing workload improve the quality of care or outcomes of illness.”

According to the study, “implementing mandatory patient-to-RN ratios may exacerbate the underlying staffing and quality of care issues due to the inflexibility it introduces into the system.”

The study’s author also remarked that “staffing ratios are a throwback to a time when all patients received essentially the same nursing care. Our findings clearly show that the modern hospital care environment is very dynamic, and we need to find solutions that address the needs of individual patients.”

One key recommendation of the study is to change the way hospitals are reimbursed. “Nursing care is hidden in room and board charges, just like a hotel,” Welton noted. “Hospitals that want to increase nursing staff are penalized because there is no additional reimbursement from Medicare or other insurance entities. We propose an innovative solution to pay for nursing care directly.”

The study’s recommendations could provide an alternative solution for deadlocked Massachusetts lawmakers, whose efforts to enact nurse staffing legislation died in the Senate in August. “Paying directly for nursing care provides a market-based incentive for hospitals rather than burdensome new regulations. It rewards hospitals for good nursing care,” Welton said.

A national task force has been formed to take up the recommendations from the study and apply them nationally. The task force is made up of leaders from the American Nurses Association, the American Hospital Association, and the American Organization of Nurse Executives.

During a recent town hall meeting in Charleston, S.C., Welton discussed the study’s findings with U.S. Sen. John Kerry, D-Mass., who told a local TV reporter that he is “very, very interested” in the findings. Members of the national task force plan to work with Kerry’s staff to move the plan forward on a national basis and are making recommendations for changes to Medicare reimbursement to hospitals.

The study also compares Mass-achusetts with California, the only state to create a law imposing minimum nurse staffing levels in hospitals.  It finds that Massachusetts already has better staffing, higher RN and staff intensity, and higher percentages of RN to total nursing staff percentages than California hospitals even after California’s minimum nurse staffing law was implemented.

The study analyzed unit-level nurse staffing from the Patients First program managed by the MHA and the Massachusetts Organization for Nurse Executives.

This database provides a unique opportunity to examine the relationships of nurse staffing, intensity staffing mix, and direct nursing costs within and among all hospitals in Massachusetts,” the article states. “This is perhaps the first time statewide unit-level data have been readily available for study.”