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March 27, 2006 - The Massachusetts Legislature has a long and not very edifying history of micro-managing medical care.
Legislators haven’t the credentials to determine what procedures should be used and in which hospitals, much less how many doctors, nurses or aides should be working on hospital wards. Usually in these matters, the Legislature intervenes at the behest of a particular special interest.
In this case, it’s the Massachusetts Nurses Association, which has been campaigning for years to have the Legislature order specific staffing ratios in hospitals. The hospitals are opposed to this intervention, and with good reason.
The controversy over staffing ratios guaranteeing how many registered nurses would be on a floor relative to the number of patients has raged for years. This week the House passed a bill directing the Department of Public Health to mandate the ratios. The nurses association calls this bill a compromise because it does not specify levels but it tells the DPH to set minimum staffing standards for all acute care hospitals in the state within 12 months. In addition to minimums, there would be an ‘‘enforceable limit’’ on the number of patients assigned to a registered nurse.
By any definition, this is the staffing ratio plan the nurses group has lobbied for all along.
The MNA calls it a matter of safety.
Doubtless any hospital patient would want as many nurses as possible available to meet their needs 24 hours a day. But the availability of a registered nurse at the press of a call button is not the way hospitals now operate.
Opponents of the staffing bill, led by the Massachusetts Hospital Association and the Organization of Nurse Executives, point out that the bill does not take into account the role of licensed practical nurses and other aides working in hospitals. They perform some of the functions nurses once did, leaving RNs available to provide the more sophisticated care that today’s high-tech medicine demands.
Hospital administrators have difficulty as it is managing in a demanding, ever-changing environment. Above and beyond providing high-quality care, they need to be alert to potentially fatal errors by hospital staff. Tying the hands of managers with arbitrary staffing requirements will not improve care overall.
And the Department of Health is overwhelmed by too many responsibilities and too little money and staff. It does not need to add a complicated and very time-consuming task to its crowded agenda.
The Senate should reject the nurses’ staffing bill. On matters of broad policy involving public health or insurance, the Legislature should and does have an important role. However, determining appropriate staffing levels for Massachusetts hospitals is outside its domain, and should remain so.
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