Mass. law would set ICU nurse staffing ratios

Massachusetts lawmakers have passed a bill to mandate how many nurses must be on duty in intensive-care units—and hospital officials are encouraging the governor to make it law.

This week both chambers of the Massachusetts Legislature unanimously approved a bill that would require every patient in a licensed intensive-care bed to have at least one nurse caring for them, except in cases where the ICU nurse determines she can care for two patients, because one of her charges is less acutely ill. Staffing in Massachusetts ICUs could never drop below one nurse for every two patients.

“There is a strong role for the staff nurse and nurse leaders to decide what the patients' needs are for nursing care, and there is a patient acuity requirement built into this legislation,” said Jeanette Ives Erickson, chief nurse and senior vice president for patient care at 947-bed Massachusetts General Hospital in Boston. “That really allows nurses to define the care that each and every patient needs.”

The union-backed bill (PDF) is expected to be signed by Gov. Deval Patrick, though it's not clear when he will do so. Union officials have said they will drop two ballot initiatives opposed by hospitals if the governor signs the bill by July 2.

The law would only apply to ICUs, although the labor group backing the bill, the Massachusetts Nurses Association/National Nurses United, said its ultimate goal is to expand the staffing rules to all hospital units.

“It's really sad that patients are going to have to wait to get ratios throughout the hospital,” said NNU co-president and Minnesota nurse Jean Ross. “It's become 'we decide what we can afford,' which is absolutely asinine. You shouldn't be running a hospital if you don't have money to run a hospital, and they do have the money.”

A number of nurse-staffing bills are pending around the country, including state bills in Minnesota and Washington, D.C., as well as twin federal bills in the U.S. House and Senate. NNU is a five-year-old national nurse union that has made the passage of nurse-staffing laws one of its top national priorities.

California is the only state in the nation with a nurse-staffing law that applies throughout the hospital, not just in intensive-care units. The 1999 California law requires one nurse for every five patients on general medical-surgical floors, and one nurse for every two patients in ICUs.

In 2005, Arizona lawmakers passed an ICU-staffing bill that mandated one nurse must be on duty for every two patients.

Hospital executives have staunchly opposed nurse-staffing bills wherever they have been proposed. They argue that the laws disregard the unique needs of staff and patients, and make it difficult to hire enough nurses to meet statutory demands, increasing reliance on expensive temporary nurses and caregivers immigrating from overseas.

Ross argued that the California law has improved nurse morale in the state, cut staff turnover and encouraged some nurses to leave temp agencies and join hospital staffs.

In Massachusetts, many hospital officials will continue to oppose the expansion of a staffing requirements system applicable to all departments of the hospital. Hospital officials say nurse-staffing laws can end up favoring nurses over other members of hospital care-giving teams, including physicians, nurse assistants, pharmacists and therapists. That can drive up costs of care and limit patient access.

“What we owe every patient is that they receive the care they need for every moment they are in the hospital,” said Tim Gens, executive vice president of the Massachusetts Hospital Association. “A fixed formula that treats all the patients the same is not fair to the patient and not fair to the care-giving team.”

Spokespeople for Patrick would not comment on whether the governor will meet a July 2 ultimatum to sign the bill.

The nurses union has said that if Patrick signs the bill by that date, it will not go ahead with plans to place two ballot questions before voters in November to limit CEO pay and hospital profits, and mandate hospital-wide staffing ratios for nurses.

“The MNA/NNU has gathered more than enough signatures to place both measures on the ballot this November,” said a press release from the union, which represents 23,000 nurses in the state.

Follow Joe Carlson on Twitter: @MHJCarlson