Safety In Numbers Western Mass. Hospitals Band In Support Of Patient Safety Act

Seeing an advertisement run by a local hospital in the Sunday paper isn’t unusual. Seeing one ad sponsored by nearly every hospital in Western Mass., however, certainly is.

 

As Western Mass. residents flip through the pages of their local newspapers, many are pausing to take in just that: an ad (see page 9) that depicts a large image of a pair of empty nurse’s shoes, which serve as the header for the words “If The State Nursing Association Has Its Way – The Future Of Nursing Will Be An Empty Promise.”

The sentiment has been set forth by the newly formed Western Mass. Hospitals Coalition, and the ad is just one part of a larger marketing effort that calls attention to the coalition’s support of the Patient Safety Act and opposition to mandatory nurse staffing ratios – legislation that is sponsored by the Mass. Nurses Assoc. (MNA).

Steve Bradley, vice president for Government and Community Relations at Baystate Medical Center and a member of the coalition’s planning committee, said the partnership is a first for the area’s hospitals, and he expects the group will continue with its efforts to influence public policy in the future.

“This is unheard of,” he said. “All of the hospitals coming together like this on one issue … it has never happened before. It shows how strongly opposed to nurse staffing ratios we are. We’re united, and we’re going to stay united – one voice, saying enough is enough. Stop shackling us.”

The Debate on Beacon Hill

The coalition includes Baystate Medical Center, Cooley Dickinson Hospital, Franklin Medical Center, Holyoke Medical Center, Mary Lane Hospital, Mercy Medical Center, Providence Behavioral Hospital, Noble Hospital, and Wing Memorial Hospital. It was formed in March expressly to serve as one unified voice in support of the Patient Safety Act, filed by state Sen. Richard Moore (D-Uxbridge), which proposes several initiatives to bolster the nursing supply and increase hospital accountability and transparency regarding staffing patterns (see box).

It’s the first coalition of its kind in the Commonwealth to form in response to Moore’s bill and the MNA’s proposed legislation, currently the subjects of heated debate in the Legislature, although the group is a strong partner with the ‘Patients First’ initiative, endorsed by the Mass. Hospitals Assoc. (MHA) and the Mass. Organization for Nurse Executives (MONE), and inclusive of many Massachusetts hospitals.

The government mandated ratios bill filed by the MNA proposes a uniform nurse-staffing standard, which would require minimum registered nurse-to-patient ratios of one RN for every four patients in medical and surgical units, and one nurse for two patients in critical care areas. The legislation would also include additional reporting requirements for hospitals; violations of either could result in fines or revocation of a facility’s license. The only state with such ratios currently in place is California, where the ratios are set at five patients for every one nurse, including RNs and LPNs.

Both measures are geared toward increased patient safety, according to their proponents; the MNA’s position is that imposing ratios will set a patient-safety standard and alleviate problems associated with chronic understaffing and the lack of limits on how many patients one nurse can be assigned to at a given time.

“It’s just common sense,” said Karen Higgins, president of the MNA. “When nurses have the appropriate number of patients to monitor, assess, and provide the care patients need, (the patients) get better, faster.”

The coalition, along with the MHA, MONE, the Mass. Assoc. of Registered Nurses (MARN), the local affiliate of the American Nurses Association (ANA), with which the MNA is not affiliated, the Mass. Medical Society (MMS), and the Affiliated Chambers of Commerce of Greater Springfield (ACCGS), however, disagree with several aspects of the mandated ratios legislation. They call it a punitive, unfunded mandate that threatens the viability of Massachusetts hospitals and does not include specific interventions to increase the quality of patient care or produce new nurses in the midst of a shortage.

“The mandated ratios would essentially create a finite number of nurses,” said Susan Richman, vice president of Nursing at Noble Hospital. “How could the smaller hospitals compete? Noble is a big employer in Westfield … if we suffer, the community suffers. And if Noble were to close, none of the other hospitals could absorb that impact.”

The Patient Safety Act, members of the coalition contend, would increase the supply of nurses in the state, promote safe patient care, and make solid investments in support and services within the Commonwealth’s hospitals.

“The Moore Bill would begin growing a new generation of nurses, not leave it to happenstance whether or not there will be enough,” said Bradley. “That’s exciting for a number of reasons besides the obvious. It would allow for mentoring opportunities, for greater cultural diversity, and for a greater number of nurses to enter the field than that which will soon be retiring.

“The MNA approach doesn’t take any of that into account,” he continued, making reference to the reported cost of implementing the legislation if it passes. “The demand would go up and the supply would go down, all at $450 million a year.”

“The staffing mandates would take away our nurses’ ability to use their professional judgment regarding which patient needs what type of care at a given time. We feel that each nurse should be utilized to the best of their talents.”

Karen Moore, vice president of Hospital Operations at Franklin Medical Center in Greenfield, added that although the MNA states that its bill “would also be adjusted based on patient acuity and the educational level of the nurse,” the mandated ratios bill does not adequately take into account the various career strengths of nurses, nor does it consider the varying needs of different patients.

“There are so many options to improve quality that ratios would block,” she said. “The ratios don’t account for levels of expertise. There are nurses who are new graduates and there are seasoned, master’s-prepared nurses who would find themselves doing the same job with these mandates because of the minimums. They would also take away our nurses’ ability to use their professional judgment regarding which patient needs what type of care at a given time. We feel that each nurse should be utilized to the best of their talents, and their skills matched with the most appropriate job.”

Early Signs

With its positions on the issue firmly in place and publicly announced, the coalition has mobilized a three-pronged collaborative force in the last four months – an administrative faction made up of CEOs and vice presidents of each involved hospital, a planning committee including marketing, community relations, government, patient care, and other professionals, and an implementation team, consisting primarily of public affairs and marketing managers and directors.

The primary objectives of the coalition are to bolster its position by implementing a number of awareness initiatives internally within each facility and externally across the region and the state. In addition to placing newspaper ads, the coalition is also teaming with the MHA to run radio spots on various stations speaking out against nurse staffing ratios; holding internal meetings and information sessions within each facility to foster dialogue within hospital staff, on both sides of the argument; spearheading a letter-writing campaign on behalf of each hospital’s CEO, directed at friends of the hospitals; and pooling their resources to reserve four separate billboard spaces across Western Mass., in Springfield, Westfield, and Greenfield, which will display the same announcement into the month of August.

The coalition has also already initiated a postcard campaign, which sent information to households across the region and urged them, if in support of the Patient Safety Act, to send a card to their state representative or senator. Suzanne Hendery, director of Corporate Marketing for Baystate Medical Center, said the postcard campaign was a new venture for most on the coalition, but that its early success has suggested that many Western Mass. residents back the legislation along with their community hospitals.

“About 20,000 of our postcards were received at the statehouse, from the constituents of Western Mass. legislators,” she said. “That gives a broad view of the issue as it relates to Western Mass.; that many people cared enough to take the time to correspond with their legislator. I think what it says to the statehouse is that people want nurses by the bedside making decisions.”

All of the marketing initiatives, said Hendery, have been planned to augment the coalition’s unified message, and calling attention to the unique circumstances of the coalition itself has been a part of the plan.

“California has already spent $1 billion on what amounts to an experiment, but these ratios are already a real possibility here. All eyes are on Massachusetts.”

“The question we asked ourselves was ‘How do we get the word out that we’re in grave danger if this (mandated ratios) legislation passes?’ Putting together a unified front first has given our position the weight we would not have had if we had come at this issue as separate entities. It’s unusual to see all of these hospitals’ names together in one place, so people take notice. To have this issue seen so broadly in the Western Mass. community is invaluable, and we’re setting a legacy for ourselves here.”

East Meets West

The legacy Hendery referred to is one that also extends beyond the borders of Western Mass., and even the state. Due in part to its close affiliation with the Patients First movement, the coalition is now corresponding with several Massachusetts hospitals in the eastern parts of the state to assist them as they join forces and employ public policy initiatives similar to those of the Western Mass. Hospitals Coalition, in varying degrees.

And although it is an issue central to Massachusetts, the Patient Safety Act and mandated ratios legislation have garnered national attention for a number of reasons; Gov. Romney’s strong focus on health care reform, as he mulls a bid for the White House, for one, is already calling attention to any major health care legislation on the Commonwealth’s drawing board.

The debate over mandated ratios in Massachusetts also brings to mind California’s ratio system – the only such system in the country – still in its early stages. As data slowly begins to roll in, Moore said, some troubling statistics are emerging, including layoffs of ancillary staff in order to finance the required nurse staffing levels and declining job satisfaction rates.

“California has already spent $1 billion on what amounts to an experiment,” she said. “There are other key indicators associated with better nursing staffing that we have yet to see out of California, but these ratios are already a real possibility here. All eyes are on Massachusetts.”

Jaclyn Stevenson can be reached at stevenson@healthcarenews.com