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Pay reform offers new backdrop in long battle over nurse staff

State House News Service, 9/27/11

By Michael Norton

STATE HOUSE NEWS SERVICE
September 20, 2011

BOSTON - Reviving one of Beacon Hill’s oldest and most hard fought battles – whether to force hospitals to abide by nurse-to-patient staffing levels –nurses cautioned lawmakers Tuesday that they’ve left the care of their constituents at risk by failing to pass a staffing law, and the state’s top hospital official calling mandated staffing requirements a “terrible idea” that would represent a step backwards in the fast-changing health care field.

“The public recognizes that nurses are being asked to care for too many patients,” Rep. Denise Garlick (D-Needham) told the Public Health Committee, adding that she testified on staffing bills ten years ago.

Marie Ritacco of Auburn, a registered nurse at St. Vincent’s Medical Center, said nurses there, frustrated by inaction on the staffing bill in the Legislature, won staffing improvements in contract talks but prefer a state law. “Every day we wait for this bill to pass, more patients suffer,” Ritacco said.

The Coalition to Protect Massachusetts Patients, which includes the Massachusetts Nurses Association, is supporting legislation (H 1469) calling on the state Department of Public Health to set limits on the number of hospital patients a nurse may care for at one time and a bill (H 1506) banning the use of mandatory overtime to staff hospitals, a practice the coalition describes as dangerous.

Nurse staffing bills cleared the House in 2006 and again in 2008, but failed to gain traction on Beacon Hill last session. In 2008, the Senate also passed a staffing bill, but the branches never worked out major differences between the House and Senate versions and the legislation died.

Hospital executives in Massachusetts have long resisted strict staffing requirements, arguing personnel deployment issues are best made on a case by case basis, saying hospitals are already committed to the safety of patients, and predicting higher costs should staffing requirements be approved.

Lynn Nicholas, president and CEO of the Massachusetts Hospital Association, called the staffing approach outlined in the bill a “regimented” approach to care that conflicts with a shift away from fee-for-service payment models and towards health care models built on team approaches and more flexibility.

Nicholas said standardized measures showed Massachusetts leading the nation in steadily improving quality of care “for the past decade or more” and argued claims of worsening care were not supported by evidence and were based on “anecdotal stories.”

Nicholas said that in 12 years, no state has followed California’s lead and passed a nurse staffing law, calling it a “terrible idea” that fails to take into account differences between patients, hospitals and nurses.

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Government should not be in the business of mandating how patient care is delivered,” Nicholas said.

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems, which focuses on psychiatric and substance abuse care, also testified against the staffing bill, saying it posed financial burdens in an already fiscally constrained environment and infringed on management flexibility. “It would be really - I guess I’d use the word ludicrous,” Matteodo testified.

Calling the pursuit of a staffing law a “decade-long struggle,” Rep. Garlick, a registered nurse, said she fears health care payment reform legislation receiving attention at the highest levels of state government this year will lead to reduced nurse staffing levels. “Hospitals will cut nursing care,” she testified.

According to the coalition, poor staffing levels and mandatory overtime lead to preventable deaths and complications for patients and higher staffing levels will reduce health care costs, a major goal of legislative leaders pursuing payment reforms and quality of care improvements.

Committee co-chair Sen. Susan Fargo (D-Lincoln), after hearing nurses testify about back injuries they’d suffered moving overweight patients with insufficient help, said payment reform legislation provided an opportunity “to correct some problems.”

Massachusetts Nurses Association President Donna Kelly-Williams disputed claims by hospital officials that strict staffing rules will impose unaffordable costs.

Kelly-Williams acknowledged that some hospitals are “truly struggling” but cited surpluses at some institutions and “huge” expansion projects.

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Bedside nursing today is akin to working in a MASH unit. Move them in, move them out the best you can,” Kelly-Williams told lawmakers, adding, “We need your help as desperately as ever.” 

Kelly-Williams said the staffing bill has undergone 200 language changes over the past six years and said most of the alterations were made at the request of hospitals.

Registered nurse Christine Canavan, a House Democrat from Brockton, said the staffing bill was one piece of legislation she could speak to firsthand. “I’ve lived it,” Canavan said. “It’s not a case where I’m reading a piece of legislation and trying to imagine how it would or would not work.”

While the bill failed to gain momentum last session, Canavan described the House as “very receptive” to addressing the problem of not having enough licensed personnel in hospital units.

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The general public is aware of what the problem is,” Canavan said. “The House is well aware and the House stands behind the patient safety bill.”

Rep. Sarah Peake (D-Provincetown) also testified for the coalition’s bills, saying some nurses are working “egregious hours” with little or no notice. “The answer to patient safety is not to mandate overtime,” she said. “The answer to patient safety is to have adequate staffing levels.”

Rep. Kay Khan (D-Newton) testified against the bill banning mandatory overtime, saying there’s a need to retain flexibility. “I feel that we’re not really ready to legislate mandatory overtime,” said Khan, also a registered nurse. Khan supported a bill establishing a nursing advisory board within the Executive Office of Health and Human Services, saying such a panel could address many important issues affecting nurses.

In written testimony, Nicholas said the nurses association represents only 20 percent of nurses in Massachusetts and claimed that nurse leaders, physicians, behavioral health practitioners, home care and home health professionals, nursing homes and chambers of commerce oppose the staffing bill. Nicholas also said a website established five years ago by hospitals – www.patientcarelink.org – provides the public with a hospital-by-hospital account of staffing levels and patient outcome data.

Nurses also testified for a bill (H 1484) calling for the creation of a safe patient handling program, saying nurses are experiencing high rates of injuries, including back disorders, by regularly lifting large amounts of weight. Lisa Morrissey of Lowell, a registered nurse at Newton-Wellesley Hospital, testified that she ripped her chest muscles while working with three other nurses to move a 600-pound patient. She said six or seven nurses were needed to move that patient, adding that staffing levels also leave patients at risk of injury.

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