Nurses in Massachusetts, alarmed by sharp decreases in their ranks as hospitals tighten the purse strings, are pressing a bill in the state Legislature that would require hospitals to meet minimum nurse staffing levels.
Another bill would mandate public hearings and notice to employees of any hospital merger, acquisition, consolidation, closure or conversion.
Both bills resemble federal legislation written in Washington by the American Nurses Association, which applauds the Massachusetts initiatives (March 24, p. 4).
Proposed by the Massachusetts Nurses Association, the first bill would set up a commission to define guidelines to establish minimal acceptable levels of nursing staff. Those guidelines, the association underlines, would be flexible and wouldn't assign ratios. The bill defines "sufficient nursing care" based on the patient's acuity, functional level and standards of nursing practice in force.
A quality-assurance nurse would be designated for each facility, and there would be a reporting mechanism for insufficient care. Whistleblowers would be protected. The bill was heard in the Legislature's Joint Committee on Healthcare on May 15. It must vote on the measure before June 15.
The MNA represents 18,000 nurses in the state. Gloria Craven, MNA director of legislation, said the Massachusetts Medical Society even supports the nurse staffing bill.
But the Massachusetts Organization of Nurses Executives does not. Its president, Maureen Sroczynski, said the methodology to figure out suitable staffing levels can't possibly work because staffing "is normally driven by needs of patients and local communities. Staffing done by one organization in one location might not meet the needs of another."
Quality patient care, she said, "is defined by a nurse's role, experience and education, rather than by the number of nurses." The nurse executives have been working together with the Massachusetts Hospital Association to defeat the bill.
The MHA said the bill "would inhibit hospitals from exploring innovative ways to combine nursing care (numbers and skill mix) with the services of other providers and technological advancements."
Judith Shindul-Rothschild, a nursing educator at Boston College, said nurse staffing bills have been debated extensively without consensus on the national level. "State by state, people are trying to decide what to do. The concern is, can any formula be sensitive enough to increase the number of RNs if acuity increases?"
The second bill would require hospitals to give employees 90 days' notice of changes in job status resulting from mergers or conversions. Its sponsors are the top leaders in the Legislature, including the Senate majority leader. Craven said it has a good chance of passing before Christmas.