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House Leadership Unveils Compromise Bill on RN Staffing – House Vote Set for May 23

Measure Calls for Safe Limits on Nurses' Patient Assignments, Prohibits Mandatory Overtime, and Initiatives to Increase Nursing Faculty & Nursing Scholarships

MNA Strongly Supports the Measure as a Balanced and Fair Solution that Promises to Address a Growing Crisis in Patient Safety in the State’s Hospitals

BOSTON, 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.

The law, when enacted, would make Massachusetts the second state in the nation to set safe staffing limits in hospitals.

The 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.

Active 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.

State 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.

"The 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 passed."

Key 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 registered nurse.
  • 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 patients.
  • 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.

"With 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."

Pinkham added that the compromise addresses all of the objections expressed by the hospital industry.

"The 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."


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