EagleTribune.com, North Andover, MA

November 12, 2013

Nurses seeking limit on patients

By Douglas Moser

---- — METHUEN — Several nurses set up shop near the School Street entrance of the senior center here last month, catching visitors for their signatures for a ballot initiative that would limit the number of patients a nurse can have at one time.

The proposal, which could reach the ballot for next year’s gubernatorial and midterm Congressional election, would limit many nurses in hospitals to four patients at a time. Critical care and intensive care nurses and emergency room nurses would be limited to fewer patients, depending on those patients’ conditions.

Hospitals and hospital groups oppose the proposal, saying it reduces flexibility by binding their hands in providing care and could jack up already high medical costs in the state.

“There is no limit to the number of patients a nurse cares for,” said Karen Higgins, a staff nurse at Boston Medical Center and a member of the Massachusetts Nursing Association, which was collecting signatures here Oct. 22. “You could have four (per nurse) or you could have eight.”

The petition would cap at four the number of patients most nurses, including emergency, pediatric, medical and surgical, according to a copy of the initiative. Intensive care or critical care nurses could only have one patient, or two if the patients’ conditions are stable. Emergency room nurses would have between one and four, depending on the patients’ conditions.

Donna Kelly-Williams, president of the Mass. Nurses Association, said in many situations four patients per nurse is ideal, but hospital and provider consolidation has led to a higher ratio.

“More patients are being assigned to nurses,” she said, adding the trend has been getting worse over the last five years.

Lynn Nichols, president of the Massachusetts Hospital Association, said in a statement that the group opposes assigning ratio limits because “patient care is best determined by the care-giving team at the bedside, not by a government-set fixed formula. Patient care staffing decisions should always be based on the best interest of the patient – not a number. Nurses don’t treat numbers, they treat people. Hospitals shouldn’t be required to staff by numbers, either.”

Kelly-Williams said that the requirements would mean more nurses would have to be hired, increasing payroll costs to hospitals. But she argued it would not increase the overall cost of care because high staffing levels would reduce expensive complications.

“Caring for the patient right the first time decreases the cost of care,” she said.

Lawrence General Hospital did not provide a response to the proposal, but through a spokeswoman said that patient-to-nurse ratios are available on a state website at www.patientcarelink.org. Information is organized by hospital, and further by the floor or unit of a hospital.

Holy Family Hospital did not respond to a request for comment.

A 2004 study conducted by the Agency for Healthcare Research and Quality, in the federal Department of Health and Human Services, found that lower staffing levels are linked to higher “adverse outcomes,” including infection, pneumonia and internal bleeding.

However, two studies of a law similar to the Mass. Nurses’ proposal enacted in California in 2004 showed conflicting results on the reduction of death or adverse outcomes.

Locally, Lawrence General Hospital’s patients-per-nurse ratio in medical/surgical wings is a little more than three patients per nurse during the day and evening, according to state data. It is nearly six patients per nurse at night. The critical care and intensive care unit ratios are between 1.2 and 1.7 patients per nurse in the day and evening.

At Holy Family, the ratio in the medical units vary between 4.9 to 5.6 patients per nurse around the clock, according to state data. The intensive care and critical care ratio is 1.8 patients per nurse.

Several people at the senior center last month said they had not been in a situation where they noticed nurses were short staffed, but signed the petition to make sure it does not happen.

“I’m due to go into the hospital soon, and I want to make sure the care I get is good,” said Tony Abati, who signed the petition at the senior center.

Signature gathering has been ongoing to months with the goal of keeping pressure on the Legislature, which is considering a similar bill. Nurse advocates in Methuen said the ballot initiative will move forward until either the governor signs a bill or the initiative is voted on in an election.

A proposal in the Legislature now would direct the state Department of Public Health to “develop nurse’s patient assignment standards which shall be an ideal number of patients assigned to a direct-care registered nurse that will promote equal, high-quality, and safe patient care at all facilities,” according to the state Senate version of the bill.

Jennifer Johnson, associate director of media relations for Mass. Nurses Association, said Higgins and Kelly-Williams gathered about 100 signatures in 2.5 hours at the Methuen senior center. In all, Mass. Nurses Association collected about 114,000 signatures statewide, and has sent them to cities and towns for certification.

Petitions must be filed by Nov. 20 and must have 68,911 – or 3 percent of the total ballots cast for governor in the last election – valid signatures to make it unto the 2014 ballot, according to the Secretary of the Commonwealth’s office.

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