On November 6th, citizens of Massachusetts will vote on a nurse staffing proposal limiting the number of patients assigned to a nurse depending on the type of patient and the patient's condition. Supporters of the proposal claim it will increase safety and improve patient outcomes. Opponents disagree.
In 2017, the Massachusetts Nurses Association created a ballot campaign committee - the Committee to Ensure Safe Patient Care - with the objective of setting a limit to the number of patients assigned to one nurse at a time. The Association claims unsafe patient assignments in healthcare facilities are responsible for higher rates of readmission, medication errors, and patient deaths, and is campaigning in favor of a Patient Safety Act (PDF) that would enforce patient limits throughout the state.
The Association is supporting its campaign for safe patient assignments with the results of a survey conducted earlier this year among nurses registered with the Massachusetts Board of Registration in Nursing. The survey - “The State of Patient Care” - reveals that patient safety concerns among nurses (fewer than half of which were members of the Association) have increased significantly compared to a similar survey conducted in 2014. Among some of the key statistics reported include:
- 64% of respondents reported an incident of patient injury due to unsafe patient assignments - up from 46% in 2014.
- 77% of respondents reported a patient medication error attributable to understaffing - up from 57% in 2014.
- 66% of respondents reported patients were staying longer in hospitals (from 51%), while 72% reported an increased number of re-admissions (from 56%).
- The increased number of re-admissions (according to 86% of respondents) is due to nurses not having the time to educate patients and provide adequate discharge planning.
- 77% of Massachusetts nurses said they were assigned too many patients to care for at one time, while 36% reported patient deaths directly attributable to understaffing.
This is not the first time the Massachusetts Nurses Association has campaigned for limits to be applied to patient assignments. In 2014, the Association campaigned for a similar proposal, but agreed to withdraw its campaign after a compromise was reached setting a two-patient limit for nurses in intensive care units. This time around, there has been no compromise agreement, and opponents of the nurse staffing proposal are campaigning fiercely to have the proposal defeated at the polls.
What Don't Opponents Like about the Patient Safety Act
Opponents to the nurse staffing proposal include the Massachusetts Health and Hospital Association, the Organization of Nurse Leaders (representing nurses now working in healthcare management), and ANA Massachusetts - the state chapter of the American Nurses Association. Under the banner of the Coalition to Protect Patient Safety, these organizations argue that the blanket proposal is too rigid and expensive, and could even force some smaller hospitals to close.
The coalition of opponents claim there is already a nursing shortage in Massachusetts and that the requirement to hire more nurses to cope with the new assignment limits will result in less experienced nurses caring for patients - which will make patients less safe. The coalition also claims the nurse staffing proposal will result in longer waiting times, and budget cuts in other areas of healthcare operations in order to comply with the Patient Safety Act.
To support its opposition to the nurse staffing proposal, the Massachusetts Health and Hospital Association commissioned a study which found that mandated patient assignment limits will cost the healthcare system $1.3 billion in the first year and $900 million each year after that. The Massachusetts Nursing Association disputes there is a nursing shortage in Massachusetts and argues that the cost to the healthcare system will decrease as the quality of care improves.
However, Nancy Gaden - the Chief Nursing Officer at Boston Medical Center - estimates that, if passed, the nurse staffing proposal will result in sixty-two bed closures, a decrease in capacity of the emergency department of more than one hundred patients, and eight hundred fewer childbirths at the medical center each year. She also claims the costs associated with complying with the Patient Safety Act would lead to major cuts in the medical center's community health program.
So, Who's Right and Who's Wrong?
There is no doubt there is a national shortage of nurses, and the US Bureau of Labor Statistics predicts 1.1 million additional nurses are needed by 2022 to avoid a further shortage due to retirements, burnout, and nurses leaving the profession because of the increasing rates of violence in the healthcare industry. However, those in favor of the nurse staffing proposal claim there is an oversupply of nurses in the Bay State due to Massachusetts' nursing schools graduating 3,500 nurses each year.
With regard to the cost of hiring additional nurses to comply with the patient assignment limits, an independent analysis was conducted by the Massachusetts Health Policy Commission (PDF). The Commission determined healthcare facilities would need to hire between 2,286 and 3,101 additional nurses to meet the ratio requirements at a cost of between $676 million and $949 million, and noted that Massachusetts already had a higher-than-national-average nurse-to-patient ratio.
The Commission also conducted a comparison between the proposed initiative and the situation in California - the only other jurisdiction to have state-mandated patient assignment limits. Although not an apples-for-apples comparison due to differences in the scope of Californian law and the proposed Patient Safety Act in Massachusetts, the Commission's four key takeaways from the comparison were:
1. There was a significant increase in nurse staffing in California hospitals post-implementation of ratios.
2. There was a moderate effect on Registered Nurses´ wages post-implementation of ratios.
3. There was no systematic improvement in patient outcomes post-implementation of ratios.
4. There has been no comprehensive, retrospective analysis of implementation costs.
The Good, the Bad, and the Solution
Regardless of who's right and who's wrong, the outcome of November's vote will have implications for both sides of the argument. If Massachusetts' citizens vote in favor of the nurse staffing proposal, nurses will be less likely to suffer from workplace burnout and violence, while the healthcare industry will have to find the funds to pay for increased staffing costs. If the vote goes against the initiative, the fact the proposal was brought to a vote will raise the profile of the problem, while failing to resolve it.
A potential solution to either outcome is a Geo-Poll tool for shift management. This tool has many valuable uses and, in the context of Massachusetts' nurse staffing proposal; it can be used to ensure safe nursing levels are maintained without healthcare facilities having to divert funds from other critical healthcare operations. The concept behind the Geo-Poll tool is simple, and it is easy for nursing administrators to use. Whenever a shift is understaffed - or forecast to be understaffed - nursing administrators send a single message simultaneously to all the nurses suitable for covering the shift. The message is in the form of a poll, asking a simple question with a choice of answers. An example would look like this:
Q. Looking to cover two early shifts in the Oncology Unit. Are you available?
Messages are delivered to nurses' mobile devices by email, SMS text, and voice broadcast. Emails contain a link the recipient clicks to answer the question, while responses to SMS texts and voice broadcasts are controlled by the keypad on the mobile device. The poll has an auto-close feature, so as soon as the nursing administrator has received (in this case) two positive responses, the poll closes - thus avoiding confusion and the scenario in which nurses re-arrange other commitments unnecessarily.
The Secondary Benefits of a Geo-Poll Tool
As we discovered in our recent survey of “Emergency Preparedness and Security Trends in Healthcare”, a communications gap in healthcare facilities exists that can result in emergency messages not getting through to the right people at the right time - potentially placing staff in danger. Our survey also found that perceived safety concerns in the healthcare industry do not necessarily reflect day-to-day reality, and consequently there is a lack of coordination when events occur that staff are ill-prepared for. Sign up for our webinar on October 25th to not only access the survey results, but also hear from healthcare industry experts discussing hot topics in emergency preparedness.
As well as being able to resolve understaffing issues quickly and inexpensively, a Geo-Poll tool is a go-to solution for other vital communications. The Geo-Poll tool can be used to notify staff of events affecting healthcare facility operations and provide information of ways to overcome these events. Although it is not necessary to send the messages in a Q&A format, by requesting a response, nursing administrators can ensure the messages are reaching their intended recipients.
This solution makes healthcare facilities safer and more secure, and can be managed from any Internet-connected device - meaning it is not necessary for a nursing administrator to be physically present at a hospital in order to resolve understaffing issues or ensure business continuity when an adverse event occurs. You can find out more about the nature of the adverse events we found by downloading our survey here.
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