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March 10, 2006 - A bill offered by state Sen. Richard T. Moore would allow hospitals to retain the flexibility to adjust staffing levels for maximum effectiveness and cost-efficiency. The Uxbridge Democrat, Senate chairman of the Health Care Financing Committee, has offered the legislation as an affordable alternative to the one-size-fits-all nurse staffing mandates under consideration in the House.
In recent years, enacting legislation mandating staffing levels in hospitals has been a major goal of the Massachusetts Nurses Association. Legislation before the House would impose rigid staffing ratios, albeit indirectly. The state Department of Public Health would set staffing levels, including an enforceable limit on the number of patients assigned to each registered nurse.
The nurses union casts mandates as a quality-of-care issue and, to be sure, set staffing levels may be desirable in certain areas. However, to deny hospitals flexibility to move nurses between floors and units when the need arises generally would be counterproductive. Quality of care is not enhanced if nurses in, say, a near-empty pediatric ward could not be redeployed to a maternity ward that was bursting at the seams.
In addition, giving hospitals the flexibility to use other caregivers when appropriate, such as licensed practical nurses, nurse’s aides and technicians, would save health care dollars and ease pressure on registered nurses. Certainly, many routine chores and procedures could be handled by caregivers under supervision without compromising safety.
Mr. Moore’s alternative to the legislation proposed in the House effectively would allow hospitals to continue current practices regarding staffing levels. Hospital administrators are no more likely to abuse that authority now than in the past, if for no other reason than the fact that unsafe staffing levels would unnecessarily expose their institutions to legal liability.
The Moore bill also addresses long-term considerations. It would provide financial incentives to recruit more nursing students and faculty; would limit mandatory overtime; would monitor quality; and would step up reporting of care data to the state.
In an era of soaring health care costs, expensive mandates that tie administrators’ hands are counterproductive. The House Committee on Public Health, currently redrafting the House proposal, should use the Moore bill as its template.
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