To Be Continued? Some Movement, but Still No Compromise on Nurse-staffing Levels

There’s a development in a debate that’s been ongoing in Massachusetts for more than five years, but players on both sides are still wary that a decision is coming any time soon.

On July 17, the Mass. Senate voted 23-13 to approve a patient safety bill that differs greatly from the bill approved in the House in May, which called for nurse-staffing ratios in all of the Commonwealth’s hospitals. The Senate bill, in contrast, would allow hospitals to set their own staffing standards that would then be monitored by the state, if passed.

The bill passed in the Senate has been largely lauded by hospital administrators across Massachusetts, and denounced by other organizations, including its most vocal opponent, the Mass. Nursing Assoc. (MNA). The Senate version was redrafted by Senate Ways and Means Chairman Steven Panagiotakos (D-Lowell) and others, in an effort to reach a compromise between supporters of nurse-to-patient ratios and those who see mandated staffing as a precarious financial burden, especially within smaller community hospitals. The bill also prohibits mandated overtime for nurses.

Following the vote, the Mass. Hospital Assoc. released a formal letter of support, citing that, while the MHA’s position had differed from the one that prevailed in the Senate, the group was ready and willing to back the bill and its move forward.

“If enacted into law, the Senate bill would clearly be the most stringent one in the country for addressing regulation of hospital staffing,” the statement reads. “While we are confident that Massachusetts hospitals are already safely and appropriately staffed, and while we have advocated for a different approach than the Senate adopted, we recognize that the Senate has based its bill on principles hospitals support: primary focus on patient care, support for the entire care-giving team, and a balance between public accountability and respect for sound clinical judgment.”

Locally, all senators from all four counties of Western Mass. voted in favor of the redrafted bill, and several members of the region’s health care community have also been vocal about avoiding staffing mandates in area hospitals. In 2005, nine medical centers banded together as the Western Mass. Hospitals Coalition, sending more than 100,000 letters to residents across the region and pooling their marketing resources to run various advertisements speaking out against mandatory nurse-to-patient staffing levels and in support of the Patient Safety Act, legislation originally drafted by Sen. Richard Moore (D-Uxbridge). Moore’s bill focused on individual hospital accountability and transparency regarding staffing patterns in hospitals system-wide.

The coalition includes Baystate Medical Center, Cooley Dickinson Hospital, Baystate Franklin Medical Center, Holyoke Medical Center, Baystate Mary Lane Hospital, Mercy Medical Center, Providence Behavioral Hospital, Noble Hospital, and Wing Memorial Hospital, and was the first coalition of its kind in the Commonwealth to form in response staffing ratio legislation.

Conversely, however, the MNA has long been a strong supporter of nurse-to-patient ratios, citing as a primary reason increased patient safety that would result from nurses being assigned fewer patients at one time. In a statement released on July 18, MNA leaders blasted the Senate, stating they were “angered by the Senate vote … which will allow the state’s hospitals to continue the dangerous and deadly status quo.”

The vote is “nothing short of a travesty for patients who are suffering every day from hospital administrators who place their concern for the bottom line over a concern for patient safety,” said MNA President Beth Piknick. “As long as nurses can be forced to care for 8 or 10 patients at one time, those patients will continue to receive substandard care.”

The new bill, S. 2805, will now move to the House/Senate conference committee, which will attempt to work out differences between the House and Senate versions. However, both supporters and opponents of nurse-to-patient staffing ratios fear that a compromise won’t happen before the legislative session concludes. This is the second time the House has approved a bill recommending ratios; in 2006, that legislation died on the Senate floor.