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, https://safepatientlimits.org/ 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.