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ANOTHER VIEW:
Nursing Ratios Called A Bad Idea On The Cape (Or Anywhere Else)

(EDITOR’S NOTE: The following letter was written in response to an article by State Representative Cleon H. Turner calling for support of the Patient Safety Act, which mandates—with some exceptions—limits for the number of patients hospital nurses may be required to cover.)

As Cape Cod Healthcare continues to build on its excellence, garnering recognition as one of the nation’s Top Ten healthcare systems for the quality of care it provides, the last thing it, or any Massachusetts hospital or patient needs is a mandated nurse staffing law that will only result in artificially inflated wages and increased healthcare costs.

Nurses are important leaders in the provision of high-quality healthcare and they are an essential and valued component of the larger patient care team. We're proud that Massachusetts employs perhaps the most skilled and well-compensated nursing workforce in the country.

However, for at least the past 14 years, one union, the Massachu­setts Nurses Association (MNA), has repeatedly filed legislation aimed at the establishment of one-size-fits-all mandatory staffing levels for registered nurses that ignores the professional status and individual capabilities of nurses. In 1999, California adopted such a law and since then the shortcomings of this approach have been clear; no other state in the nation has followed California's lead. And yet one union—representing less than one-quarter of nurses in Massachusetts—continues its pursuit.

Patient care is not an assembly-line process. Nurse staffing decisions should always be based on the individual needs of each patient, site-specific hospital, and the education and abilities of the entire caregiving team—not on an arbitrary, government-mandated number. No study has ever produced a workable, one-size-fits-all number because no two patients, nurses, or hospitals are alike.

That's why every hospital in the state, every nurse leader in Massachusetts, numerous non-MNA nursing groups, the Massachusetts Medical Society, and a whole slate of employer groups concerned about the quality of healthcare and healthcare costs vehemently oppose the MNA's bill.

And there is an alternative: in 2008, the Massachusetts Senate voted in favor of compromise legislation that is based on data-driven evidence that wisely accounts for patient condition and the valuable contributions of every member of the care team. The Senate bill would have given Massachusetts the strongest regulation of nurse staffing in the country—yet the union rejected it. Massachusetts hospitals remain committed to transparent quality improvements and staffing. Check out www.patientcarelink.org to review staffing in every unit of each of the Commonwealth's hospitals and get caught up on status of numerous quality and safety initiatives focused on the patients of Massachusetts.

Massachusetts is now in the process of reforming its healthcare payment and delivery system to refocus how patient care is paid for, to improve quality, and to reduce healthcare costs for everyone. Rigid staffing mandates such as the one promoted by the MNA would stand in the way of these efforts and destroy the hope for meaningful change.

Lynn Nicholas, FACHE
President & CEO
Massachusetts Hospital Association

Sharon Gale
Chief Executive Officer
Organization of Nurse Leaders, MA-RI