Nursing

Medical experts debate bill to mandate number of nurses

Nurse Leader Weekly, January 26, 2004

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A bill that would make Massachusetts the second state in the nation to require minimum nurse-to-patient staffing ratios in hospitals has spurred widespread debate within the health industry. Led by the Massachusetts Nurses Association (MNA), more than 60 groups including the American Cancer Society, American Heart Association, and the Massachusetts Public Interest Research Group (MassPIRG) support the requirement, which they say will cut down on errors and improve care.

The Massachusetts Hospital Association (MHA) argues mandated ratios would harm hospital services by limiting flexibility, and could even force hospitals to close beds if staff is reassigned to meet the ratios. Staffing needs can change from hour to hour, a fact not taken into account by the ratio bill, the association argues.

The Massachusetts bill received a favorable report from the state legislature's joint committee on health care last November, and lawmakers are pressuring leadership in the state house to schedule final debate. Among other things, the bill would require one nurse for every two patients in intensive care units and one nurse for every four patients in medical and surgical areas. But nurses who belong to the MNA report many hospitals would not meet the proposed ratio for medical and surgical areas.

An expert who recently spoke about the nationwide nursing shortage at a MHA conference challenged nurses themselves to improve care, and said staffing ratios are not the answer. "What (California is) doing is showing the rest of the country how stupid--I'm being polite--how stupid that regulatory strategy is in dealing with this important problem," said Peter Buerhaus, PhD, RN, FAAN, senior associate dean for research at Vanderbilt University School of Nursing. "There is no scientific basis, none whatsoever, to show you how many nurses you need on a shift."

In arguing for the ratios, the MNA points to a variety of studies, including one that said the death rate of surgical patients increases markedly when the nurse-to-patient ratio is higher than one to four. When the average nurse's workload is above four patients, the mortality rate increases 7% for each additional patient, according to the study, which appeared in the Journal of the American Medical Association in October 2002.

Julie Pinkham, executive director of MNA, said nurses are leaving hospital jobs because of understaffing.

"They're not putting up with it anymore," Pinkham said. "They're choosing to leave the bedside."

The MHA argues the legislation would not address the nursing shortage, since the state's nurse retention rate of 83% is above the national average.

Source: Milford Daily News



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