Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA
Massachusetts will be the second state in the United States to put a vote to a mandated nurse staffing ratio, behind California in 2004. This ballot support and opposition has been highly contentious and this vote may set a precedence for other states to support a similar law. The ballot measures are very strict, and the general public seem to be very confused as to the impact of the law on healthcare in the state of Massachusetts as a whole.
The ballot question 1 in Massachusetts (Nurse Patient Assignments Limit Initiative) which will be voted upon November 2018 was designed to establish patient assignment limits for registered nurses working in hospitals, with limits determined by the type of unit or patient with whom a nurse is working, and the maximum numbers of patients assigned would apply at all times. Massachusetts is a hub for medical advancement. In Boston specifically, there are 6 major medical centers within a few feet of one another. Most are teaching hospitals of Harvard University, so staffing, technology, and innovation to support patients and safety are at the forefront of care. Despite that, there has been a push by the Massachusetts Nurses Association (a union) to enact a similar law for over 20 years. It was brought as a ballot question in 2014 but tabled after allowing for a change in ICU staffing ratios (which showed no change in patient mortality or complications, in a study from Beth Israel Deaconess Medical Center). Now it's more stringent and on the ballot for November 2018.
Why does this ballot question face so much opposition? It seems like more nurses is a good thing, right? No one disagrees that nurses are good, and its beneficial for us to take care of our patients. That being said, attached to this proposed bill is not only tighter staffing ratios than California, a 37-day window to comply (to which California had five years), but there is also a $25,000 fine for each time there is not that exact nursing ratio on the unit. The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay. What about leaving the unit for a lunch break, or getting coffee? Not if it means the nursing ratio will be off for any period of time. Shared governance or interdisciplinary meetings? Sorry, you will have to schedule those on your days off. Because of the quick turnaround time to become compliant, and the few numbers of nurses in MA, any resource staff, unit based educators, and/or clinical nurse specialists will be pulled into staffing. There will not be anyone extra to help and "cover" a patient for a quick break. In California, the law allowed for Licensed Practicing Nurses (LPNs) to be hired to assist with upstaffing, but not in MA; RNs only. Differences also include that MA law has higher RN numbers to start and the bill in MA has a prohibition against reducing levels of other healthcare workers (CA did not). MA does not allow any exemptions, whereas in CA 25 hospitals sought and obtained an exemption from the law.
These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city. Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services. Currently, according to the 2017's Best & Worst States for Healthcare Massachusetts is ranked #9 overall for Best hospitals (#1 being the best), with California ranked at #25, despite these ratio laws being fully compliant since 2009. Furthermore, Massachusetts has a current ranking of #3 for access to care, meaning access to healthcare is readily available throughout the state. California is ranked #48, meaning the public has less access to healthcare. It's pretty telling that despite making nursing ratios legally required, the state of California has not improved the patients access to care and their overall satisfaction with care.
On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day. If I have 4 patients, 3 of which are ready for discharge, I cannot take a new PACU admission to help out the unit. A nurse who may have three heavy patients, one requiring a Rapid Response and eventual transfer to the unit, may have to take that patient, or it negatively impacts throughput and the patient has to sit and back up the PACU waiting until someone can admit them. That scenario may seem extreme, but it is something staff face every day, and if I am willing to take that extra patient to support my colleagues and support patient care, my hospital can be fined $25,000? That makes no sense. However, it is the reality of this bill. 4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up.
The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole. This is not to say lay people don't understand good care, they are our customers and they deserve the safest and best care possible and their input is invaluable. However, they do not know how to run a hospital, how it is budgeted, how we currently run staffing matrix, and what this bill means not only to their care but the state of Massachusetts. It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible). It is an estimated $900million annually to maintain these new staffing ratios, without any revenue to the state, and more headaches and difficulty for the public to access care. No other field asks laypeople to make a decision on how they guide their business/care (think Medicine). It is bad policy-making for nurses to do the same; we all believe that highly trained nurses at the bedside, with an appropriate number of patients, benefits not only patients but the work/life balance of our staff. This bill is not the way to do it. We don't want hospitals to close, and patients to have to search for care. We want the best care possible for all of the residents of Massachusetts, and eventually, all patients in all states, as this will set a precedence for mandated ratios in all states in the future!
"The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay."
This is a good argument if you are a hospital, it's a bad argument if you are a nurse or a patient. Why should staff nurses have to put their license on the line in order to cover the hospital's inability to fill a whole in the schedule? Why should patients have to be put at risk for that reason? I'd rather the hospital correctly staff or risk a fine vs putting my license on the line and patients at risk.
I also disagree that many hospitals don't have the money to pay; their execs make big salaries by keeping costs as low as possible, and nurses are one of the largest costs.
"What about leaving the unit for a lunch break, or getting coffee?"
Clocking out and leaving or going on a quick break. If the nurse is clocking out and leaving this would be effected, if not, it wouldn't (at least to my read).
"These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city."
Can we see the citations for this? This is a bit of fear-mongering from the hospitals and is more evidence that their primary concern is the bottom-line not patient care. Major hospital systems have been eagerly buying up/merging suburban community hospitals because they are revenue generating.
"Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services."
Only if they don't increase their staffing to safe levels! If they increase their staffing to those levels they can open whatever they want.
"On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day."
I just don't understand this argument that I keep hearing (and I don't work as a floor nurse and so maybe I am just naïve) but maybe someone can explain this to me: how does this take away nursing judgement? These are not maximum staffing levels they are the minimum. If patient A and nurse A need a closer ratio then there is nothing here that says patient A can't have it; it does say that patient B, C, and D (and nurse B) don't get shortchanged because of patient A.
"4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up."
This statement is the embodiment of the problem at hand: these are minimum staffing levels. If the acuity of the patients requires closer staffing ratios, then there is no law preventing having additional nurses. Why is the hospital thought process that high-acuity centers should hold the bare minimum? Why should they pass that risk on to the nurses and call it nursing judgement?
"The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole."
This is how our country works.
"It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible)."
Cost the state? Or cost the hospitals? There is a big difference there.
"On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day."
I just don't understand this argument that I keep hearing (and I don't work as a floor nurse and so maybe I am just naïve) but maybe someone can explain this to me: how does this take away nursing judgement? These are not maximum staffing levels they are the minimum. If patient A and nurse A need a closer ratio then there is nothing here that says patient A can't have it; it does say that patient B, C, and D (and nurse B) don't get shortchanged because of patient A.
This is probably the argument that makes me the craziest. It's also why many non-nurses that I know are thinking of voting no. They think they are HELPING us by making sure we still have our "judgment" on how to allocate patients and nurses. It is in every one of the opposition's commercials and it makes me batty.
I've never heard of a new patient coming on the floor when all of the current nurses were "full", and then the RN to be assigned the "hair that broke the camel's back" patient says to the manager, "actually, there are too many patients on the unit and we could use an extra nurse, can you call one in so that we don't have so many patients each? It won't really be safe for anybody" And then the manager says, "sure. If your judgment says that we need an extra nurse, I'll go call one in."
Instead, nurses are overburdened with a large number of high acuity patients.
I hope that came out right. Like I said, it's the most blatant propaganda by the opposition and it causes a reaction in me each and every time I hear/see it. And. It. Works! Quite genius of them, actually. Grrrr... My husband has heard me yell at the TV a time or two
"The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay."
This is a good argument if you are a hospital, it's a bad argument if you are a nurse or a patient. Why should staff nurses have to put their license on the line in order to cover the hospital's inability to fill a whole in the schedule? Why should patients have to be put at risk for that reason? I'd rather the hospital correctly staff or risk a fine vs putting my license on the line and patients at risk.
I also disagree that many hospitals don't have the money to pay; their execs make big salaries by keeping costs as low as possible, and nurses are one of the largest costs.
"What about leaving the unit for a lunch break, or getting coffee?"
Clocking out and leaving or going on a quick break. If the nurse is clocking out and leaving this would be effected, if not, it wouldn't (at least to my read).
"These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city."
Can we see the citations for this? This is a bit of fear-mongering from the hospitals and is more evidence that their primary concern is the bottom-line not patient care. Major hospital systems have been eagerly buying up/merging suburban community hospitals because they are revenue generating.
"Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services."
Only if they don't increase their staffing to safe levels! If they increase their staffing to those levels they can open whatever they want.
"On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day."
I just don't understand this argument that I keep hearing (and I don't work as a floor nurse and so maybe I am just naïve) but maybe someone can explain this to me: how does this take away nursing judgement? These are not maximum staffing levels they are the minimum. If patient A and nurse A need a closer ratio then there is nothing here that says patient A can't have it; it does say that patient B, C, and D (and nurse B) don't get shortchanged because of patient A.
"4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up."
This statement is the embodiment of the problem at hand: these are minimum staffing levels. If the acuity of the patients requires closer staffing ratios, then there is no law preventing having additional nurses. Why is the hospital thought process that high-acuity centers should hold the bare minimum? Why should they pass that risk on to the nurses and call it nursing judgement?
"The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole."
This is how our country works.
"It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible)."
Cost the state? Or cost the hospitals? There is a big difference there.
Yes, all of this!
The overriding the judgment of nurses argument drives me crazy, too. This law in no way does that. It simply says "this is the maximum number of patients a nurse can have." In pediatrics, it's 4. That was a typical overnight ratio when I worked in the hospital. If there's a patient who's too acute and demands a 2:1 ratio, there is NO reason whatsoever why the charge nurse can't still assign one nurse only 2 patients. She just cannot assign another nurse more than 4. And there's no reason why day nurses can't continue to take 3 patients.
OP's argument is the same template and rhetoric for anti-unionists. This same word salad and fear mongering was used prior to unions in MA, CA, RI, NY, and PA.
The hospitals will go under. No. They didn't.
Patient care will suffer. No. It didn't.
Employees will be laid off. No. Just the opposite. Unions created jobs.
I was in Philly when Allegeny came in, bought up a bunch of the unionized hospitals, promising to keep everything the same. Management at each of these hospitals had attempted to break the unions for years, then this Saudi guy comes in and they all sold out. The hospital I worked at literally had the doors padlocked one day when I went in. Over 3000 employees lost their jobs in two days. Flooded the market with everything from clerks to pharmacists. Drove salaries into the ground, hospitals snapped up cheap labor. Unions were broken and employees made to reapply for their own jobs at the lowest salary in the scale and accepted this or lost their job entirely (no more union protection) .
Then Allegeny filed for bankruptcy. Think i am tzlking about two different things? I am not.
The main focus for any business is to make money, but not just neutral...they want growth. They have a fiduciary responsibility to shareholders to increase returns YOY. The same goes for these highly paid MBAs that are employed by each system to maximize profit, they want to be paid exhorbitant salaries as well or else they will go down to Wall Street. The argument is the same as when our financial system was melting down. Gotta pay the extortionists or our business will not be competitive.
OP's arguments have been discredited here over and over. She won't respond to anything but the few posters who attack her based on emotion. Please, OP, answer the posters who have READ the legislation and state there is no "37 day compliance" rule, or the absolute assertion that each incidence of non compliance WILL exact a $25,000 fine.
I watched people like OP come in to different facilities I have worked at, usually it was a union busting or union pevention tactic. Buying "one of us" to make the arguments against our own self interests seem logical.
There is no logic to having 8 highly acute patients and never sitting down for an entie 12 hour shift and being expected to provide quality care. Period.
One other thing. Hospitals are tax exempt. They own property, investments, assets galore...and never pay taxes. Those tax savings should be legislated to be diverted back into salaries, nursing and ancillary staff, additional facilities/beds. That is how they received the tax exempt status in the first place...supposedly doing public service.
Since they are tax exempt, and the taxpayers are picking up the tab for the hospital's properties, then the taxpayers SHOULD have a say in how these businesses are run. Hospitals are not unlike any other business....privatize the profits, socialize the costs.
Here is a great example of what I mean. The EPA would not exist if businesses did the right thing. It would be common sense not to pollute the air, water and land we rely on to survive on this planet....yet a regulatory body had to step in and FORCE businesses to comply with not poisoning the populace.
You think hospitals are any different? Follow the money. This fear mongering that hospitals will go under if a small percentage of a tax free profit margin is reinvested into their own businesses...is nonsense.
Vote YES people of MA. I worked in both MA and in CA. I do prefer the CA model, because I received my lunch and my breaks. I could spend time with my pts and not be dead on my feet or fearful my license was going bye bye.
But do not ever, for one moment, believe that CA businesses...er...hospitals didn't attempt every single day, every single shift...to circumvent the law. If you were a boat rocker and filed complaints with compliance, you were usually forced out. Nurse Mgrs routinely would change acuity levels, MDs would push pts thru like a sausage grinder whether the pt was stable for d/c or not. They will find a way around not making that 20% growth of revenue YOY.
Medicine is a trillion dollar business. One of the largest portions of our national GDP. This has absolutely zero to do with patients. It has everything to do with protecting the bottom line and fiduciary duty hospitals have to their shareholders. And by that i dont mean stock in Mass General. I MEAN the research dollars, the surgical instrument sales and development, the drug trials....it is all wrapped up in the hospital's ability to hoard dollars for the pet projects they want pushed thru.
Businesses do not "do the right thing". Ever. Medicine is big business.
It's not clear to me from this post how "access to care" is being quantified. Are we talking about there not being a hospital within an x minute drive from everyone's house? Or are we talking about uninsured people? Because the latter category is who I mostly see this term being used to refer to. The nursing staffing ratio law will have no effect on how or whether people have insurance or other financial resources to seek care for themselves. Since it's not physically possible to be more than a one-hour drive from a major medical center in the entire state of MA, is the closure of a handful of community hospitals in the suburbs of Boston (already one of the densest concentrations of medical care facilities in the country) really going to affect "access to care"? Having lived in that area for 20 years, I really doubt it.
In terms of logistics of covering a floor during break times and sick time call-ins, the only thing a hospital needs to do is staff a larger RN float pool. Combine that with staggered shift start times across units, and that group of nurses could also circulate from floor to floor to provide staffing during breaks, meals, and meetings. It's not a complicated process at all; large school districts have been doing it for decades with substitute-teacher pools. Hospitals don't need to reinvent the wheel here, they just need to learn from the professions who already work according to these kinds of limits (i.e. most other highly-unionized professions).
So you want nurses to work an hour here and an hour there to cover for breaks, meals and meetings? That seems pretty unsafe to me. How can they ever know what's going on, and who would be willing to do this?
Someone suggested that management will have to get out and get to work on the floors. Great idea except if they have a large staff they'll be on the floor most of the day. When do they do their management work, after hours? Ha. Not to mention that most managers cause more work for floor nurses because they don't know all the ins and outs of the floor. How does CA deal with these issues, anyone know?
Someone suggested that management will have to get out and get to work on the floors. Great idea except if they have a large staff they'll be on the floor most of the day. When do they do their management work, after hours? Ha. Not to mention that most managers cause more work for floor nurses because they don't know all the ins and outs of the floor. How does CA deal with these issues, anyone know?
I have never seen any managers out on the floor working either before or after the ratios were implemented. Maybe because they staff appropriately knowing they will have to be on the floor (because of the mandated ratios) and they don't want to. They staff appropriately to begin with, and use floats, PRN, and registry when needed for sick calls etc.
Specializes in Critical care, tele, Medical-Surgical.
So you want nurses to work an hour here and an hour there to cover for breaks, meals and meetings? That seems pretty unsafe to me. How can they ever know what's going on, and who would be willing to do this?
I worked three years as a break relief nurse. I went to work at 11:00 and received my assignment from the charge nurse.
I first took report from one RN and took over his or her assignment during break time. Then reported any change to the nurse returning from break.
Next I repeated the same.
I was scheduled for 11 to 3, 4, or 5:00.
How is having a nurse responsible for twice as many patients safer than having a competent RN take over the assignment during a nurse's break?
At my former job several units have a weekday break nurse who works when her kids are in school.
Someone suggested that management will have to get out and get to work on the floors. Great idea except if they have a large staff they'll be on the floor most of the day. When do they do their management work, after hours? Ha. Not to mention that most managers cause more work for floor nurses because they don't know all the ins and outs of the floor. How does CA deal with these issues, anyone know?
Elaine, i am not sure you have a good grasp on how breaks occur or what staffing actually is on the floor during any given shift, if you can ask these two questions.
Are you a nurse? Because most would know how breaks work "usually" without a breaker. It's either done by the "nurse buddy" system, which is profoundly UNSAFE, because you take on the assignment of another nurse while they go to dinner or it is done by a breaker.
Either way, A NURSE, somehow, somewhere, is taking on an assignment of YOUR patients, not knowing those cases "in depth". The patients can be an addition to the breaking nurse's assignment, or the breaking nurse has only your patients.
Breaking someone on the buddy system is a recipe for death. I can barely keep tabs on my own 6, about which i know everything, because they are mine. You hand me 6 of yours and i have what....2 minutes to hear your report while i stop everything on mynown assingment to listen to you? If your patients are acute, have dopamine or insulin or heparin drips going? What about assessments? I worked at a place that forced breaking nurses to do a COMPLETE COMPREHENSIVE ASSESSMENT on each of the patients in the offgoing nurses assignment.
Try doing 6 brand new comprehensive assessments on 6 new patients in 30 minutes. And....take cqre of your own patient load.
So breaking nurses are vital. Floats are what i usually saw. They have a list. Jane, joe, sally and jim are on breaker's list. She goes to each, gets a quick and dirty report and off the nurse goes to dinner. Upon return, hand off and move to the next nurse.
Why is this unsafe? That makes absolutely zero sense. I would take a float any day over someone who already is overburdened with their own patient load.
Or are you implying....we should never be allowed to go on break, therefore not handing off to ANYONE? That is sure how it sounds to me.
The managers are supposed to be the cream of the crop on any unit. Unit specialists who are to know every facet of that department. Or so we are lead to believe....when we apply for nurse management positions. So that nurse manager sure as hell better know my job.
Any nurse manager i have ever worked with were floor nurses at one time. Some get so far removed from actual skill, they know they can't perform, and they don't try. In CA, the staffing ratios are usually, at least where i worked, strictly adhered to.
We had 24 rns on the floor. 36 beds. 4 pts each, max. 1 charge, 1 resource, 4 floats, 2 breakers. There were other rns there that i wont go into what they do, but they are counted on the staffing. They are usually not resources, lets put it that way. Two managers always on duty. 3 secretaries, 4 or 5 techs.
My lunch was at a certain time, with 3 others. Clearly we could not all go at the same time, but at times, they could send 2 at a time. I have had a nurse manager answer phones on a short night. I have had charges sit psych pts. I have had charges and resource rns running for meds or transporting pts.
Its do able and completely within the realm of reality. There are no special secrets to it. The hospital follows the staffing rules, or they close down beds. Period. I have seen a whole unit of 12 beds not being utilitzed because there was no one scheduled to staff it.
The hospitals in Ca, at least the ones i know, would rather not utilitze bed space than incur the fine that will come if they dare to go outside of ratio or deny people their breaks.
Do they like it? Nope. They tried constantly to do crappy things like consistently running with razor thin margin, theefore, my dinner break would jot come as per mandated by CA law...after 5 hours of work on a 12 hour shift, employers must provide a dinner break. I would go maybe.....8 hours into my shift. That happened a lot. I choose my battles on that though. I take beraks to pee and just dont come back to the floor in a rush....i go sneak a snack from my locker or what have you. I know mynpeers do the same, so nobody is left watching patients outside of ratio.
The hospitals dont like it, but its the law. And that it what OP is fearmongering about. The hospitals will have to increase staff or close beds. Pick one. Staffing up is not difficult. There are many that would take part time just to be a relief nurse and go home. I would do it in a heartbeat.
At the end of the day, thebhospitals simply do not want to spend the money on anything other than new cancer centers when one just went up in the big hospital across town, CEO bonuses, exhorbitant MD salaries to pander to the public that so and so from such and such is here on staff. I saw it at Beth Israel when i worked in Boston. They wanted a famous Neuro guy who wrote books to be on staff....and they paid him a RIDICULOUS amount of money to relocate from NYU.
Did he live up to the hype? No. Did he bring in patients or research dollars to compensate for that salary? No.
In fact, he left several years later because he was known as a problem MD, difficult and diva like...causing discord with the entire staff. He used his few published works and a name like "NYU" to bully a big paycheck and a bunch of promises.
But these admins go for this. Its all about image management.....MAGNET STATUS!!!! All of our RNs are BSN or above!! (as if they make no mistakes there? I would like to see the rates of medical errors at 'all bsn' hospitals...) we have this 12m cancer center that is 1.2 inches closer to your house than our competitor!!
Yeah. I know Boston hospitals all too well. Worked at BIDMC as well as Brigham. SO worked for Dana Farber as well as Mass Gen. I know how we were treated, and i am glad that there is a real threat to Partner's and the rest of them to tone down this image and PR machine and get back to caring for patients.
If that means the nurses strike or they twist some arms for safe staffing...and those nurses get help...and it costs multi billion dollar corporation monopolies like Partner's to return a little of that tax free cash....i am cheering the nurses on!!
We have 7-10 patients on average . At night in a MASs hospital, on a medsurg tele floor with very sick patients who need 24 hour care. No time for lunch or bathroom breaks. Most nights we have 1 or no CNAs. Its a very unsafe environment for patients, RNs and other staff. The hospital has done nothing to fix this and they want us to vote no. The RNs and CNAs are burnt out. We all love our job. We just want to be safe, for us and patients.
Your hospital practice in giving you such number of patient's are the practices in the 1900's. We are already in the 20th century with so many regulations left and right from different government agencies to make sure that we provide safe nursing care, it's not possible to take care of 5 or more patients in a highly acute and specialty areas like Tele or even Med Surg.
If you want to be safe and with your patients, vote yes on the nurse patient ratio in November if you are eligible to vote in MA.
They actually can't. Even large teaching hospitals cant afford it.
They actually can, not only did every hospital not shutter their doors as they predicted doom and gloom when this was implemented in California 2004, same hospitals spent millions to fight it even after Governor Gray Davis signed it in. As for less support staff they had been whittling away at that for years already. Much like the doom and gloom which is predicted every time minimum wage goes up by a dime it never came to pass and no CEO/CFO had to forego their zillion dollar bonus. They can pay RNs less but, based upon difficulty new grads have getting jobs, there really is not a shortage and huge monopolies such as Kaiser just avoid benefits by staffing with travelers. They can afford it, I assure you they are spending a fortune fighting it.
BostonFNP, APRN
2 Articles; 5,584 Posts
"The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay."
This is a good argument if you are a hospital, it's a bad argument if you are a nurse or a patient. Why should staff nurses have to put their license on the line in order to cover the hospital's inability to fill a whole in the schedule? Why should patients have to be put at risk for that reason? I'd rather the hospital correctly staff or risk a fine vs putting my license on the line and patients at risk.
I also disagree that many hospitals don't have the money to pay; their execs make big salaries by keeping costs as low as possible, and nurses are one of the largest costs.
"What about leaving the unit for a lunch break, or getting coffee?"
Clocking out and leaving or going on a quick break. If the nurse is clocking out and leaving this would be effected, if not, it wouldn't (at least to my read).
"These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city."
Can we see the citations for this? This is a bit of fear-mongering from the hospitals and is more evidence that their primary concern is the bottom-line not patient care. Major hospital systems have been eagerly buying up/merging suburban community hospitals because they are revenue generating.
"Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services."
Only if they don't increase their staffing to safe levels! If they increase their staffing to those levels they can open whatever they want.
"On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day."
I just don't understand this argument that I keep hearing (and I don't work as a floor nurse and so maybe I am just naïve) but maybe someone can explain this to me: how does this take away nursing judgement? These are not maximum staffing levels they are the minimum. If patient A and nurse A need a closer ratio then there is nothing here that says patient A can't have it; it does say that patient B, C, and D (and nurse B) don't get shortchanged because of patient A.
"4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up."
This statement is the embodiment of the problem at hand: these are minimum staffing levels. If the acuity of the patients requires closer staffing ratios, then there is no law preventing having additional nurses. Why is the hospital thought process that high-acuity centers should hold the bare minimum? Why should they pass that risk on to the nurses and call it nursing judgement?
"The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole."
This is how our country works.
"It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible)."
Cost the state? Or cost the hospitals? There is a big difference there.