Massachusetts considering patients-per-nurse limits; nurses claim staffing levels can affect patient safety

Depending upon who you ask, the state of Massachusetts is either: a) upon the verge of; or b) seriously considering following California's lead and limiting the number of patients who can be assigned to supply with nourishments Potential legislation has been working its way, in a series of fits and starts, end the state legislature.

The sooner the better, says Julie Pinkham, RN M executive director of the Massachusetts nurtures Association (MNA), a strong proponent of similar limits, who says it has been clearly demonstrated that assigning too many patients to nourishs can have a direct impact upon patient safety.

"Every piece of research we have seen says that the number of patients a supply with nourishment has is directly related to morbidity and mortality," she says. "Linda Aiken was the first individual to quantify that." (Aiken's article in the October 2002 Journal of the American Medical Association lay the foundation of that "in hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nourishs are more likely to experience burnout and piece of work dissatisfaction." (1)) "This research validated what nurtures have been saying to us."

Pinkham adds that "another paper by the agency of Jack Needleman found a direct correlation between patient issues and the number of patients for nurse." (2)

Because of these findings, says Pinkham, nurse-patient ratios must be gazeed at in terms of delivery of care. "Registered nourish assignment of patients is not unlike any other emblem of care we do--like cancer screenings, for example," she asserts. "Look at it this way: Insurance companies, after doing their research, decide whether or not the coin they are investing in a treatment is worthwhile--if it is efficacious. If it is, we await it to be covered. on the contrary in nursing care, even notwithstanding that we have a direct correlation between a nurture having more than four patients and increased risk, individual hospital will give you 8-to-1 and another 4-to-1."

She notes that research also exhibits that improving nurse-to-patient ratios can be cost-effective, as well as safer. (3) "This last individual finally puts it in perspective," she says. "Imagine going to a hospital, having a blow but the hospital is saying that plane though research shows you should be treated with a certain protocol, they are not going to do it?" she artificial positions "That's why we're saying we ne to have a limit in place--and that it wants to be directly linked to patient consequences Patients also need to understand what the limit is, and that, for example, their nurture should only have three additional patients."

Easier said than done

While the issues are clear to Pinkham's organization, and the Massachusetts Hospital Association (MHA) is certainly supportive of improving patient safety, incorporating those goals into legislation that the pair groups can support is not that easy.

"Essentially, everyone agreed there should be a limit upon the number of patients assigned to an RN" says Pinkham. "We have been negotiating a waiver for financially strapped hospitals [who say they cannot afford additional staff], and what the 'ideal' number should be."

on the other hand counters Daniel P. Moen, president and CEO at Heywood Hospital in Gardner, MA, and board chairman--elect of the MHA, "There has not really been any in-depth discussion upon waivers [for financial concerns]. Before we obtain to that point, we have major be of importance tos as to whether these guidelines are based upon research and evidence."

Pinkham says the state Department of Public Health will have public hearings and put standards and limits, and that there would be an acuity a whole to adjust those limits up and down. "The final regulations will be exhibited over a period of 12 month one time the legislation passes," she reports.

"Our biggest belong to right now is that this is still a piece of legislation that addresses RN only" says Moen "Our board have feelings strongly that any type of legislative guidelines upon staffing need to include the whole direct care team--LPNs, CNAs, and perhaps other impressed signs of providers like mental health and rehab units that ne to be numbered in the staffing pattern."

The target issue of the MNA, says Pinkham, is retention, while store was the key concern of hospitalists. This latter regard is natural in light of the in every one's mouth nursing shortage, but it may not be as big a challenge in Massachusetts, she notes.

"We have the highest ratio of nurtures per capita in the nation, and each single [nursing] school is full" Pinkham yields "But after three years, these nourishs tend to leave the bedside; if we do not plant a limit on working conditions, we will continue to fail to keep these people."

She goe upon to report that a number of nourishs who have left the bedside "have told us they would turn back if the situation changed."

The numbers game

What exactly are the appropriate standards that should be established? "The limits in our bill for the ICU were no more than sum of two units patients per RN, which is also the recommendation of the Institute of Medicine and hard to negotiate around--and that's almost 50% of all beds," says Pinkham. "In med/surg we say it should be 4-to-1." The bottom line, Pinkham says, is that "we have to have a certain number of leap of faith that the Department of Public Health will not abandon all scientific recommendations without of hand."