The Same Number Wouldn’t Want Their Family Member Cared for on the Unit in Which They Work

85% of RNs agree that the quality of patient care in Massachusetts hospitals is suffering due to unsafe patient assignments including 61% of RNs who are aware of patient complications and 50% who are aware of patients who have been injured or harmed because hospitals are forcing nurses to care for too many patients at one time.

Results Sound the Alarm for Immediate Action on Pending Legislation to Ensure Safe Patient Limits for Safer Patient Care

CANTON, Mass. In conjunction with the beginning of National Nurses Week (May 6 – 12), a new study of registered nurses in Massachusetts released today by the Massachusetts Nurses Association establishes that hospital administrators are assigning too many patients to registered nurses resulting in significant harm and even death for patients. According to the survey, more than 8-in-10 registered nurses report that the quality of patient care in Massachusetts hospitals is suffering because hospital administrators are requiring nurses to care for too many patients at once and, 6 in 10 RNs report that staffing decisions are driven by administrators’ desire for increased profits, with devastating results for their patients:

• Alarmingly, one in four nurses (25%) report patient deaths directly attributable to having too many patients to care for at one time and the same number report they wouldn’t feel safe admitting their own family member to the unit on which they work;
• 50 percent report injury and harm to patients due to understaffing
• 56 percent report readmission of patients due to unsafe patient assignments;
• 61 percent report medication errors due to unsafe patient assignments;
• 61 percent report complications for patients due to unsafe patient assignments;
• 81 percent report RNs don’t have the time to educate patients and provide adequate discharge planning; and 
• 86 percent report RNs don’t have the time to properly comfort and care for patients and families due to unsafe patient assignments

The release of this statewide data on the impact of unsafe patient assignments for nurses on patient mortality follows a similar report in 2014, with this year’s results showing an increase in the rate of negative patient outcomes and a continued deterioration in the quality and safety of patient care in our state’s hospitals, particularly in the state’s community hospitals. 

“These findings provide an indictment of our system of hospital care in Massachusetts and shine the light on the really dangerous situation for our patients who are being forced to share their nurse with too many other patients at one time, which is resulting in more of them suffering totally preventable complications, medical errors, costly readmissions and, yes, even death for lack of proper care, attention and monitoring from registered nurses,” said Donna Kelly-Williams, RN, President of the Massachusetts Nurses Association and a staff nurse on the maternity unit at Cambridge Health Alliance. “As the nation and many employers look to National Nurses Week to recognize the contributions of its nurses, in releasing these findings we nurses are pushing our own call button for help, in this case from the legislature who has the opportunity to address this crisis by passing legislation to ensure safe patient assignments for nurses and ensure quality patient care.” 

Earlier this year, 85 Massachusetts legislators joined lead sponsors Senator Marc Pacheco (D-Taunton) and State Representative Denise Garlick (D – Needham) as co-sponsors to the Patient Safety Act,

legislation filed by the Massachusetts Nurses Association that will dramatically improve patient safety by establishing a maximum limit on the number of patients assigned to a nurse at one time, while also requiring hospitals to adjust nurses’ patient assignments based on the specific needs of the patients.

Survey Highlight’s the Industry’s Willful Neglect of Patient Safety Concerns

The new study also highlights the underlying causes of these dangerous conditions and the industry’s lack of effort to adjust nurse’s patient assignments to ensure patient safety. For example:

• 59 percent of nurses report staffing level decisions are more often based on financial concerns and profit margins (an 11 point increase over last year’s 48 %) than assessments of patient needs.
• 40 percent of nurses (including 53 percent of those working in community hospitals) report that their administrators are not responsive to their concerns about excessive patient assignments.
• And 37 percent of nurses report that their administrators rarely or never adjusts patient assignments based on the needs of their patients – up from 25 percent last year.  

For nurses, the solution to the patient safety crisis in our hospitals is clear and unequivocal, as nearly 9-in-10 (88%) of nurses support the Patient Safety Act. 

The filing of the Patient Safety Act (H 1958) follows the legislature’s unanimous passage of a landmark law last year to establish safe patient limits for nurses working in hospital intensive care units.  The new law will extend appropriate, scientifically-based limits to all areas of the hospital. 

In addition to this new study, dozens of studies and reports have shown the need to set a maximum limit on the number of patients that can be assigned to each registered nurse if we are to avoid – medical errors, serious complications, hospital acquired infections and preventable readmissions.

Earlier this year, two reports have been published which show Massachusetts hospitals rank near the bottom nationally in preventing these types of complications. For example, a Kaiser Health News report detailing the 2015 penalties for hospitals under the Medicare program for preventable readmissions found that Massachusetts has the forth worst rate of preventable readmissions. Patient readmissions refer to instances where a patient has to be readmitted to the hospital within 30 days of discharge due to complications caused by poor care during the patient’s initial hospital stay. A second report, issued by CDC last month also found that Massachusetts ranks fourth worst nationally for incidents of Catheter Associated Urinary Tract Infections. Massachusetts hospitals’ incidence of these preventable infections is a shocking 58 percent above the national average. Again, there are several studies that clearly show that both readmissions and hospital acquired infections can be significantly reduced with safer patient limits for nurses. 

As legislators undertake consideration of this bill, conditions in Massachusetts hospitals continue to deteriorate as hospitals and hospital networks look to cut nurse staffing levels, increase patient assignments for nurses and implement a number of dangerous staffing practices, utilizing manufacturing-based management practices to cut costs and boost hospital profit margins, which surpassed a billion dollars in the last year. 

In fact, in recent months, nurses working in hospitals from the Berkshires to Cape Cod have taken to the streets, conducting demonstrations, informational picketing, signing petitions and holding community forums to warn their employers and the public about dangerous staffing cuts and increases to their patient assignment load. Last month, nurses at Newton Wellesley Hospital conducted informational picketing outside their hospital to protest dangerous patient assignments and staffing conditions. In March nurses at Norwood Hospital held a community rally to call for improvements in staffing levels.  In December, nurses at Berkshire Medical Center, Cape Cod and Falmouth Hospitals, and Leominster Hospital held demonstrations outside their hospitals to protest unsafe conditions.  In August, nurses at Brigham & Women’s Hospital held a press conference to alert the public of dangerous conditions for critical care patients due the hospitals refusal to follow the ICU law, and in July nurses from throughout the UMass Memorial Health Care system conducted a press conference to protest dangerous conditions at both campuses of UMass Memorial Medical Center in Worcester and at Marlborough and Leominster Hospitals. 

In fact, at a recent hearing on the Patient Safety Act, Boston College Researcher, Judith Shindul-Rothschild, presented groundbreaking findings of two recently published studies that for the first time provide concrete, peer-reviewed data comparing standards of nursing care and patient outcomes for hospitals in Massachusetts, where there is no limit on nurses’ patient assignments, and California, where such a law has been in place for nearly a decade.  Rothschild’s study provides conclusive evidence that Massachusetts hospital nurses are caring for significantly more patients than their counterparts in California and that patients in Massachusetts are receiving over three hours less care per day from registered nurses than patients on the West Coast (just over six hours of care for patients in our hospitals vs. over nine hours of care per day in California).

“From the public’s perspective, it is absolutely in their interests to support this ballot initiative so that when they’re in the hospital or a loved one is in the hospital, there is no doubt there will an adequate number of registered nurses to care for them to assure they get safe, quality nursing care,” says Shindul-Rothschild, whose article in the Journal of Nursing Care Quality showed an association between nurse staffing in Massachusetts and a higher rate of readmissions for heart failure.  She points out that heart failure is the most common and the most expensive condition for which patients are admitted to hospitals, and the number one cause of death in America.  

The new survey of Massachusetts nurses was commissioned by the Massachusetts Nurses Association and conducted between April 10 -16 by Anderson Robbins Research, an independent research firm headquartered in Boston. The 2015 survey respondents were all nurses currently working in Massachusetts randomly selected from a complete file of the 92,000 nurses registered with the Massachusetts Board of Registration in Nursing. Fully 61 percent of the respondents have no affiliation with the MNA.  According to the researchers, the survey results can be assumed to be representative of the 92,000 nurses to within ±7% at a 95% confidence interval.