IN THE several years since the Massachusetts Nurses Association began pressing for a law setting minimum staffing levels for nurses at acute-care hospitals, patients have gained access to an enormous amount of information about internal hospital operations. In addition to public data required by state and federal agencies, hospitals in this state report voluntarily through a program of the Massachusetts Hospital Association on such indicators as frequency of falls, bed sores, and the administration of vaccines during flu season.
Making such information available to patients puts pressure on hospital administrators to achieve the goal of the mandated-staffing bill: to ensure that patients get the attention they need. This public-information approach to improving the quality of care is less direct than the nurses' bill, but it also avoids the bureaucratic pitfalls of having state officials overly involved in the administration of hospitals.
Patients and their families would have even more information available under a bill approved this week by Senate Ways and Means. This bill would require hospitals to publicly post nurse staffing plans that have been developed with input from nurses. The state Department of Public Health would audit the plans to ensure compliance.
The Ways and Means bill, like the nurses', recognizes that working conditions in hospitals, including understaffing, are a factor in the high turnover rates of nurses. The bill bans mandatory overtime for nurses, except in emergency cases in which patient safety is at risk. In line with recommendations from the Institute of Medicine, under the Ways and Means bill no nurse could be required to work more than 12 hours in a shift and no more than 16 hours in a 24-hour period.
Both bills would attempt to recruit more nurses with scholarships, a loan repayment fund, and a faculty bonus payment initiative, among other measures. The faculty bonus is crucial because colleges find it difficult to hire nursing educators, who can earn significantly more money working in the profession.
The nurses' bill is more flexible than a previous version, but it still shifts too much authority from hospital administrators to officials in Boston, whose mandates can never reflect all the individual circumstances of a ward in a city that is miles away. The purpose of both the nurses' bill and Ways and Means' is the same - to strengthen the nursing profession and to foster the high-quality nursing care that is crucial to a patient's recovery. But the Ways and Means bill, combined with existing reporting requirements on hospitals, offers the better approach.
