Patient Safety Act is needed

By LEO MALEY

Published on June 13, 2008

On May 22, the Massachusetts House voted by the overwhelming margin of 115 to 35 to pass the Patient Safety Act. The act would require the Department of Public Health to issue regulations that would limit the number of hospital patients that could be assigned to an individual nurse. These limits would be based on public testimony and scientific research.

The last three decades have seen a remarkable transformation in the delivery of patient care in American hospitals. During the 1980s and 1990s hospital administrators decided to reduce labor costs by drastically reducing nurse staffing. The result was massive layoffs and a drastic increase in the workload of those nurses who remained. In no state did hospitals cut as deeply as in Massachusetts. Relative to the number of patients seeking hospital care, nurse staffing fell by an incredible 45 percent in our state. Combined with routine mandatory overtime, this was a recipe for degraded work conditions and poorer patient outcomes.

Registered nurses are highly-trained professionals. Most professionals are generally satisfied with their jobs. Ten years worth of data from the National Opinion Research Center show that only10 percent of professionals (and 15 percent of U.S. workers overall) are dissatisfied with their jobs. Among RNs, however, more than 40 percent were dissatisfied. The reason is clear. In a 2003 Opinion Dynamics random survey of 600 Massachusetts RNs, 93 percent reported being "burned out" by excessive patient loads, and 75 percent reported that hospital management scheduled too few nurses per shift.

Inadequate staffing takes a physical as well as a mental toll on hospital nurses. The Bureau of Labor Statistics reports that nurses have one of the highest rates of occupational injuries. A study of 12 Minneapolis-area hospitals that reduced nurse staffing by 9.2 percent showed an increase in on-the-job injuries of 65.2 percent.

Hospital management practices also are harmful to patients. A study of 232,000 surgical patients published in the Journal of the American Medical Association shows that the higher the patient-to-nurse ratio, the greater the likelihood that the patient would experience a serious medical complication or even death. For every patient over four that a nurse carried there was a resulting seven percent increase in patient mortality. If a nurse had to care for eight rather than four patients, the mortality rate jumped fully 31 percent. A 2007 study published in the journal Medical Care found that safe staffing levels could cut hospital-acquired infections by 68 percent. Dozens of additional academic studies confirm these findings.

Fully 2,000 hospital patients - six per day - die each year in Massachusetts due to hospital-acquired infections and medical errors. This horrible statistic would improve with adequate nurse-to-patient staffing ratios.

Hospital administrators created this crisis in hospital care, and their efforts to appear to address it would be laughable if the consequences were not so serious. The Massachusetts Hospital Association's current initiative is to have hospitals post nurse staffing plans - yes, plans, not actual patient-nurse staffing outcomes - on a website. Thus patients are reduced to consumers, and marketing substitutes for badly needed regulation.

Despite the overwhelming House vote in favor of the Patient Safety Act, final passage is not guaranteed. The current legislative session ends on July 31. If the state Senate fails to vote on the bill it will die, just as it did two years ago when similar legislation passed the House by an overwhelming vote only to have the clock run out in the Senate. Nurses and their allies have been fighting for some version of this legislation since 1994. Please urge your State Senator to call on Senate leadership to allow a vote of the full Senate on this critical piece of legislation before the clock runs out yet again.

Leo Maley first became aware of the issue of nurse-patient staffing ratios while working several years ago as a political organizer for the Massachusetts Nurses Association. He lives in Amherst.