Opinion Nurse Ratios Would Harm Hospitals

The Mass. Nurses Assoc. is attempting to force through the Legislature a potentially harmful and scientifically suspect piece of legislation. 

The union, which represents fewer than one-quarter of Massachusetts RNs employed in nursing, has been pressuring the Legislature to support its mandatory nurse staffing ratios as if it were their patriotic health care duty.

Ratios would force every hospital in the state, no matter its size or specialty, to assign a certain number of nurses to a particular number of patients on every shift. Never mind the condition of the patient — conditions that can change hour by hour, shift by shift.

Ignore the choreographed interplay of hospital staffing — how RNs, nurse managers, doctors, administrators, and support staff all weave through the wards to keep patients well and alive. Scrap the long-accepted patient safety idea of aligning a nurse’s training and experience with the conditions and needs of the patient. The nurses association says forget it all in favor of etched-in-stone ratios.

Under the proposed law, if the community hospital you rely on breaks the ratio, it would face a daily $25,000 fine and could lose its license to operate. If a nurse manager wants to shift a nurse at 3 a.m. from a relatively quiet maternity ward to a busy ICU, he or she couldn’t if the move violates the nurses association’s maternity ratio.

There are no scientific studies that conclude that specific mandated staffing ratios are a requirement for assuring high-quality patient care, but the idea has strong emotional support. In January, California enacted a mandatory ratio law less stringent that the nurses association’s proposal. It allows hospitals to count LPNs in the ratio, which the proposed Massachusetts law does not. Hospitals in California are predicting they will not be able to meet the standard; one California hospital has already closed its doors as a result. The same could occur in Massachusetts.

In pushing its ratio idea, the nurses association seems to have forgotten that Massachusetts, like every other state in the country, is facing a nursing shortage of epic proportions. Nearly 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all nursing positions are vacant.

The nurses association says nurses would return to the workforce if the ratios passed. But reports prove otherwise. Our nursing shortage exists because we never replenished the nursing workforce. Colleges have closed nursing programs, and nursing instructors have retired. Lifestyles have changed also, and many potential nurses are choosing careers with more traditional hours.

In recent years, hospitals, nurses, colleges, and businesses along with state and federal government have been trying to fill the gap. There have been media campaigns, senior nurses mentoring new nursing students, scholarships, grant money, and more. In the middle of these collaborative efforts to train more nurses, state government should not be mandating how many people to hire and where to place them, and it should not be imposing daily $25,000 fines for every violation of its fiat. And perhaps the nurses association’s leadership should step back and see the big picture, rather than focusing on mandated ratios, mandated hiring, and, hence, increased union membership.

Nurse salaries currently average about $60,000 across the state and often can exceed $100,000. They’ll jump if providers, including nursing homes and home health agencies, are forced to bid on a supply of nurses that just does not meet demand. That’s good for the nurses association but not good for LPNs and numerous support staff who will be forced out of their jobs. It’s bad for the collective-bargaining process when state government makes hiring decisions for health care providers. It’s bad for you when hospitals are forced to reduce services, divert ambulances, and lose flexibility in how they assign people to care for you.

Massachusetts nurses are the cornerstone of our inpatient health care system — a system that is the envy of the world. Mandated staffing ratios jeopardize this standing. We need to leave staffing decisions to on-site caregivers. And we need to encourage young people to join the health care profession.

We don’t need a self-serving bill from a nurses union with a short-sighted solution to a complex problem. And we don’t need the Legislature determining how many nurses, physicians, pharmacists, or technicians care for individual patients without regard to patients’ particular medical needs.

There are better, more comprehensive, and more inclusive solutions than that.

Dr. Charles Cavagnaro is CEO and president of Wing Memorial Hospital and Medical Center in Palmer.

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