Safe RN Staffing Update

By Sandy Eaton, RN

The drive to enact and enforce minimal RN-to-patient staffing ratios in all acute-care settings in the Commonwealth is stalled but unstoppable. Ten years ago the Massachusetts Nurses Association launched a Statewide Campaign for Safe Care, the culmination of which is the promotion of safe nurse staffing legislation. In the 2003-2004 legislative session this was embodied in House Bill 1282, which defines safe staffing as minimal, enforceable RN-to-patient ratios, flexible to account for any rise in acuity, not to be met by mandatory overtime, floating into unknown territory, or layoff of support staff.

The findings from study after study on this issue became high-profile news, demonstrating that patients die, and nurses get injured or leave the bedside, when insufficient professional nursing care is provided. Nurse-researcher Linda Aiken and her associates at the University of Pennsylvania provided much of this evidence. Massachusetts has the highest per-capita number of RNs of any state in the Union. There is no absolute nursing shortage here, only the relative shortage of too few nurses willing to work in the dangerous settings created by the health care industry's job-reengineering consultants over the last fifteen years.

In November 2003, H.1282 was voted out favorably by the Joint Committee on Health Care over the strenuous opposition of Senate chair Richard Moore, who abstained on that vote. It then went to House Ways & Means, chaired by Representative John Rogers, where it languished until the end of the formal session.

The Coalition to Protect Massachusetts Patients, comprised of senior, health advocacy and civic organizations, grew to seventy statewide organizations. On May 11, 2004, one thousand nurses and healthcare advocates rallied in Nurses Hall at the State House demanding action. Ten days later, in a move spearheaded by Senator Marc Pacheco, in a compromise worked out between the Coalition and Senate leadership, the Senate attached language to its version of the FY2005 state budget. This language provided for a ten-hospital pilot project, to be followed in three years by a state wide roll-out of the minimal staffing ratios mandate. This compromise had no input from the industry since hospital industry representatives blatantly refused to sit down with proponents of patient safety legislation when asked to do so by Senate leadership. The House budget conferees failed to concur with the Senate on this, so the compromise language was not brought to a vote.

H.1282's lead sponsor, Representative Christine Canavan, RN, pledged to attach similar language to any supplemental budget the House may have considered in July, but that opportunity never materialized, with legislators generally not wishing to vote on controversial matters so close to elections. An incessant stream of CEOs, lobbyists and nursing administrators into the State House in July convinced enough House leaders and members that this issue was indeed too hot to handle. The formal legislative session ended on July 31st, 2004.

MNA has provided voters with a score-card listing those senators and representatives who support this legislation to protect their constituents when hospitalized and the legislators who have chosen not to support it. You can visit www.massnurses.org/leg/vote2004.htm to find out where your legislator is listed.

Organized nursing and its allies, including the Ad Hoc Committee to Defend Health Care, will continue to press the health care industry for this safe nurse staffing safety net. One can only hope that the recent shake-up in House leadership will open up the existing roadblock so appropriate legislation can go to the Governor's desk early in the next session. One way or another, RNs and their patient-advocate allies will continue to make our case vigorously and with imagination. In this matter of principle-and too often one of life-and-death--there is no quitting.

Sandy Eaton, RN, is a Staff Nurse at Quincy Medical Center