Leadership Unveils Compromise Bill on RN Staffing – House
Vote Set for May 23
Calls for Safe Limits on Nurses' Patient Assignments, Prohibits
Mandatory Overtime, and Initiatives to Increase Nursing Faculty
& Nursing Scholarships
Strongly Supports the Measure as a Balanced and Fair Solution that
Promises to Address a Growing Crisis in Patient Safety in the State’s
Mass.—After three days and more than 15 hours of
negotiations between legislative leaders, the Massachusetts Nurses
Association and the Massachusetts Hospital Association, the leadership
of the House of Representatives has completed a compromise bill
to guarantee safe RN staffing in all Massachusetts hospitals, with
a debate and potential vote on the measure scheduled for May 23.
The measure calls upon DPH to set safe limits on nurses' patient
assignments, prohibits mandatory overtime and includes initiatives
to increase nursing faculty and nurse recruitment.
law, when enacted, would make Massachusetts the second state in
the nation to set safe staffing limits in hospitals.
effort to reach a compromise began in earnest this week as advocates
for both sides of the issue were flooding the State House to influence
debate over competing amendments introduced as part of the House
budget for 2007. The Massachusetts Nurses Association and the Massachusetts
Hospital Association had both filed competing amendments to deal
with a growing crisis in patient safety in the state’s acute
care hospitals. The nurses' measure called for setting safe limits
on the number of patients assigned to a nurse, while the MHA proposal
called for funding to support recruitment of new nurses, with no
changes in current staffing patterns in hospitals.
negotiations, with a group of state legislators, the MHA and the
MNA, began in the office of Rep. John Rogers on Tuesday and continued
off and on through Thursday, until the final wording of the bill
was finished and presented to both sides. The negotiations culminated
with a meeting in the offices of House Speaker Sal DiMasi, where
a date was set for a floor debate on the bill for May 23.
Rep. Peter Koutoujian, House Chairman of the Joint Committee on
Public Health, said he is proud of the compromise language and commended
the leadership of House Majority Leader John Rogers and representatives
Steven Walsh, Stephen Tobin, Christine Canavan, Martin Walsh Jennifer
Callahan and Kay Khan, who were all active in the negotiations.
Koutoujian also commended the MHA and MNA for their willingness
to remain at the bargaining table and address the issue of safe
staffing levels in good faith.
MNA strongly supports the compromise as a balanced approach to a
complex problem that addresses the key concerns of all parties involved
in this debate," said Beth Piknick, RN, president of MNA. "We
are grateful for the intense effort by the House leadership to bring
the parties together to find a real solution to what is a growing
crisis in patient safety in our hospitals. We look forward to working
with the Legislature over the next month to see that this bill is
components of the bill include:
Directs the Massachusetts Department of Public Health to develop
and implement specific minimum RN staffing standards for all units
in the state’s acute care hospitals, which would include
an enforceable limit on the number of patients assigned to each
The staffing standards would be developed within 18 months of
the bill’s passage and be based on scientific research on
nurse staffing levels/patient outcomes, expert testimony and standards
of practice for each specialty area. The staffing standards will
include an optimum target RN-to-patient assignment, as well as
a safe limit on the number of patients assigned to each nurse.
The bill calls for the safe staffing limits to be implemented
in all teaching hospitals by 2008, with implementation in all
community hospitals by 2010.
Provides flexibility in staffing and accounts for patients who
require more care. The measure calls on DPH to create a standardized
acuity-based patient classification system, which is a standardized
formula for rating the illness level of patients. Based on the
acuity of the patients assigned to a nurse, if those patients
require more intensive care the nurse would be assigned fewer
Prohibits the practice of assigning nurses mandatory overtime
as a means of staffing the hospital.
Allows hospitals that can prove a financial inability to comply
with the law to delay implementation of the staffing standards
for up to six months, with oversight provided by DPH.
Assures that institutions cannot delegate to unlicensed personnel
duties which demand nursing expertise. Throughout the 1990s, the
hospital industry attempted to cut costs by replacing nurses with
unlicensed personnel, which led to deterioration in patient care
and led to the exodus of nurses from bedside care.
Establishes a number of nurse recruitment initiatives sought by
the hospital industry, and supported by MNA, to increase the supply
of nurses, including nursing scholarships and mentorship programs,
and support for increases in nursing faculty to educate new nurses.
It also would create refresher programs to assist nurses in returning
to practice at the hospital bedside. A survey of Massachusetts
nurses found that more than 65 percent of those not practicing
in hospitals would be likely to return if a law providing safe
limits was passed.
Establishes strong consumer protections for safe RN staffing,
including a prominent posting of the daily RN staffing standards
on each unit.
Calls upon DPH to monitor compliance and to investigate violations,
with the ability to impose fines.
three days of negotiations among legislative leadership and the
two organizations there was clear agreement on one fact by all parties
– there should be a limit on the number of patients assigned
to an RN at one time in Massachusetts hospitals. From that starting
point, all aspects of the issue were negotiated to reach this compromise,"
said Julie Pinkham, RN, executive director of the MNA. "While
we would prefer that the staffing standards would be in place much
sooner, we understand the nature of the legislative process and
the need for compromise to reach a solution that was acceptable
to the Legislature, while also meeting our goal of protecting patients
in all hospitals."
added that the compromise addresses all of the objections expressed
by the hospital industry.
hospital industry had objected to having legislators set staffing
levels. The compromise bill directs the DPH to set the staffing
limits. The hospital industry opposes a rigid ratio. The compromise
provides for staffing based on patients needs. The hospital industry
said setting limits will cause financially strapped hospitals to
close. This bill provides hospitals in legitimate financial distress
an extension and oversight to reach compliance. The hospital industry
said we need to focus on recruitment of nurses. This measure includes
the recruitment initiatives put forth by their own bill, while giving
hospitals time to prepare for the implementation of the staffing
changes. Everybody wins here; hospitals, nurses, and most important
of all, the patients."