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Mandatory Nurse Ratios – Good for Massachusetts?

Posted on October 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On November 6th, Massachusetts will vote on mandatory nursing levels. Proponents cite burnout, injuries and patient safety as reasons to vote YES. Opponents claim ERs wait times will rise, small hospitals will close and patient bills will increase.

There is no better way to get a sense of what is on the minds of healthcare leaders than talking with fellow conference attendees. At the recent SHSMD18 event, I had the opportunity to attend a social gathering hosted by the New England Society for Healthcare Communications (NESHCo). There was one topic that dominated the discussion – the upcoming vote on November 6th on mandatory nursing levels in Massachusetts.

Mandatory nurse ration has been a hotly debated issue in the state. Voters will now decide if the state will forge ahead with plans to “limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities.”

The proposed MA law sets specific limits on the patient-nurse ratio. For example:

  • 3 patients per nurse in units with step-down/intermediate care patients
  • 1 patient under anesthesia per nurse in units with post-anesthesia care or operation room patients
  • 5 patients per nurse in units with psychiatric or rehabilitation patients

The vote has pitted the Massachusetts Nurses Association (the nurses union, MNA), which strongly supports mandatory nurse ratios, against the Massachusetts Health and Hospital Association (MHHA).

The MNA cites numerous studies, like this one from 2016, that shows for every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5% per patient. And  this one from 2017, that concluded “Exposing critically ill patients to high workload/staffing ratios is associated with a substantial reduction in the odds of survival.”

The MNA has mounted a sizeable campaign to convince MA voters to vote YES. Their website, is full of interesting articles, stories from frontline nurses and quotes from physicians that support the measure.

The MHHA, on the other hand, is encouraging a NO vote. They acknowledge that nursing levels need to be monitored but imposing strict limits based solely on the unit or patient type will cost nearly $900 million every year. According to the MHHA, patients would end up footing the bill through higher healthcare costs.

The MHAA also claims that specifying the maximum number of patients for each nurse, effectively puts a cap on the number of patients a hospital can accept in their ERs – resulting in longer wait times.

For an excellent overview of the law and the arguments both for and against Question 1, check out this excellent article by Boston’s local NPR station – WGBH. The article also has information about the impact mandatory nurse ratios has had in California which enacted a similar law back in 1999.

What I found fascinating about the discussions with NESHCo members was how hospitals in neighboring states were also voicing their concerns on Question 1. If MA was to mandate nursing ratios, that state’s hospitals would suddenly need to hire thousands of nurses in order to comply with the new law. Where would these nurses likely come from? You guessed it, neighboring states like New Hampshire, Maine, Vermont and Connecticut. It’s easy to see why hospitals in those states would be worried.

I honestly don’t know which way I would vote.

On one hand the current working condition for nurses is unsustainable. Nurses are often asked to work longer shifts because hospitals can’t fill open nursing positions fast enough and most are expected to work without breaks. Could you imagine working 12hrs or more without being able to eat or go to the restroom? 70% of nurses are already feeling burnt out in their current positions. Clearly the status quo isn’t working.

On the other hand, there is currently no provision in the law to adjust the nursing ratios as technology advances. New York Presbyterian Hospital, for example, has built a remote patient monitoring center that tracks patient vitals in real-time. Using a combination of AI, specialized technicians and remote nurses, this “command center” can alert the local nursing staff when a patient may be experiencing an issue. Armed with this technology, not only are patients safer but on-site nurses can spend more time with each patient in their unit. The MA law would have the unintended consequence of squashing investment in this type of technology since staffing levels could not be significantly adjusted.

For more on this topic, take a look at the transcript for this week’s HCLDR chat. Government regulation is also the topic for this weeks’ #HITsm chat hosted by John Lynn. Join the discussion Friday 10/19 at noon ET.

Nurses need help. Mandatory nursing ratios is one possible solution. However, I’m not sure legislation is the best way to improve the nursing situation.

Increasing Nursing Satisfaction through Technology Helps Improve Patient Care

Posted on October 29, 2015 I Written By

The following is a guest blog post by Karlene Kerfoot, Chief Nursing Officer at API Healthcare.
Karlene Kerfoot - API Healthcare - GE Healthcare
Technology is an undeniable force in the healthcare industry and plays a daily role in a nurse’s life. Nurses are responsible for managing devices and utilizing the electronic health records, among many other things. Whenever patient care requires a nurse, they will interact with advanced technologies. As a result, improving these digital systems to better improve clinicians’ ability to provide care is at the top of mind for most hospitals.

While hospitals and health systems work to implement and improve technologies, it is important to keep in mind how that technology can have larger implications. One consideration is how the innovation impacts your work staff’s satisfaction.

Nurses are the heart of the healthcare team and are the most patient-facing representatives. Research has shown that changes in technology, among other things, may allow for substantial improvements in the use of nurses’ time and the delivery of safe patient care. However, technology that isn’t nurse-friendly can impede the work of the nurse. When hospitals find ways to streamline processes and make things more convenient for nurses to do their jobs, it can lead to increased job satisfaction. Furthermore, nurses who feel empowered in their roles are more effective and report better patient care, which is one of the ultimate goals hospitals set for success.

In addition to how technology helps nurses during their day-to-day jobs, hospitals can also use technology to manage broader job satisfaction when it comes to things like staffing and scheduling. Nurses often face a unique set of challenges when it comes to their schedules, workflow and even things like career development – all of which requires hospitals to rethink how they enable work satisfaction through technology.

For example, because patient needs can be unpredictable, it is often times challenging for hospitals to predict their staffing needs on an hourly or daily basis, especially during spikes around the holidays that pull nurses away from families and personal needs.

If a nurse is consistently working overtime hours, situations like handling too many patients or being assigned to patients outside of their training/expertise can inhibit their ability to advance their careers. In addition, fatigue and stress as a result of nurses working extensive periods of overtime can result in serious and potentially life-threatening medical errors. In fact, the odds of making an error are more than three times higher when nurses work shifts of 13 hours or more.

Newer workforce technology systems for nurses can help to ensure a fair and equitable workload so managers can set up their staff for success, and make changes to schedules by pairing up staffing needs to things like patient acuity or census numbers by the day or hour. These technologies also give nurses the opportunity to take more control over their schedules and avoid the burnout.

The ability to use tools that help with staffing needs supports additional research that shows that nurses who work excessive amounts of overtime, produce lower quality work and their happiness levels decrease, which ultimately impacts the patient satisfaction and hospital’s bottom line.

The value technology has brought to healthcare is growing by leaps and bounds, but at the core of healthcare are the patients and the people who can help them. Technology has infinite ability to help both, and it is important that health systems have access to resources that allow them to make better staffing decisions.

About Dr. Karlene Kerfoot
Dr. Karlene Kerfoot is the Chief Nursing Officer for API Healthcare, a GE Healthcare Company. API Healthcare is a leader in healthcare workforce optimization technology and service. Dr. Kerfoot is widely acknowledged for her work in patient safety, data-driven staffing and scheduling, creating healing environments and healing sanctuaries for staff, pioneering models of shared governance, and achieving excellence in quality outcomes.

Applying Technology to Healthcare Workforce Management

Posted on June 10, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I mentioned before that at HIMSS this year I made a shift in focus from EHR technology to a look at what’s next after EHR. In most cases, the technology has some connection or tie to the EHR, but I was really interested to see where else a healthcare organization can apply technology beyond the EHR software.

I found one such case when I met with Ron Rheinheimer from Avantas. For those not familiar with Avantas, they’re a healthcare scheduling and labor management solution. In most cases, their workforce solution is something the nurses choose and often the CNO. I imagine that’s why it’s not talked about nearly as much as things like the EHR. It takes a pretty progressive CIO at a hospital to be able to see through all the noise of other regulations and work with the CNO on a workforce management solution. Or it takes a pretty vocal CNO who can make the case for the solution.

Ron Rheinheimer from Avantas made a pretty good case for why workforce management should have a much higher priority for hospital CIOs. He noted that about 60% of a hospital’s budget is labor expenses and 50% of the labor budget is for nursing. It’s no wonder that nurses take it hard when a hospital goes through layoffs thanks to an EHR implementation. However, given those numbers, optimizing your workforce could save your organization a lot of money.

I think this is particularly true as hospital systems get larger and larger. We’ve all seen the trend around hospital system consolidation and as these organizations get larger their staffing requirements get much more complex. Most of them start moving towards a centralized nurse staffing model. They start working on a floating pool of nurses in the hospital. While humans are amazing, once things get complex, it’s a great place for technology to assist humans.

Ron Rheinheimer also told me about the new incentive models that many hospitals are employing to be able to incentivize nurses to take the hard to fill shifts. Night shift differential has long been apart of every workforce, but with technology you can use analytics to really understand which shifts are the hardest to fill and reward your nurses appropriately for taking those hard to fill shifts. My guess is that we’re still on the leading edge of what will be possible with technology and managing the schedule in a hospital. Real time dynamic pricing for shifts is something that only technology could really do well.

As you can tell, I’m new to this area of healthcare technology. However, I find it fascinating and I believe it’s an area where technology can really improve the current workflow. I look forward to learning more.