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US union tries to spark law on nurse staffing levels


A nursing union in the United States is pushing for legislation to set limits on the number of patients that can be assigned to a registered nurse at any one time.

On Thursday the Massachusetts Nurses Association is filed a ballot initiative, called the Patient Safety Act, with the aim of introducing a mandatory minimum nurse to patient ratio across the north eastern state.

A ballot initiative, also known as a citizens’ initiative, is a means by which a petition signed by a certain minimum number of voters can force a public vote in the US.

Through the initiative, the MNA said it hoped to reduce mistakes, serious complications and preventable readmission across the state.

Hospitals would also be required to adjust nurse patients assignments based on the severity of the medical needs of those in their care.

There is currently no law regarding the number of patients that a nurse can safely care for at any one time in Massachusetts, plus there is no requirement for hospitals to adjust their staffing levels based on patients’ medical needs.

Nurses are consequently being forced to ration care, claims the union, therefore jeopardising the health of patients.

The ballot question would mandate one-size-fits-all nurse staffing ratios, and is an attempt to pressure lawmakers into approving a similar bill that has repeatedly failed in the state government.

It would require one nurse for every four patients in medical or surgical units, one nurse for up to three patients depending on the severity of the condition in emergency departments, and one nurse for two patients in critical care units.

In support of their action, the MNA cited the recent study by the UK’s National Nursing Research Unit, which showed general medical and surgical wards needed seven patients or fewer per RN to avoid vital care being missed during shifts.

The majority of 10 nurses in the study said they were so busy on their last shift that they were unable to perform at least one vital “care activity”. This ranged from proper patient surveillance, documenting care, administering medication properly, comforting patients, preparing them for discharge or changing a patients’ position in bed to preventing bed sores.

MNA pesident Donna Kelly-Williams said: “The research is clear and unequivocal, the most important factor contributing to the health and safety of patients while they are in the hospital is the number of patients your nurse is assigned to care for during his or her shift.

“The fact is patients in our hospitals are at greater risk because they are being forced to share their nurse with too many other patients at the same time,” she added.

Karen Higgins, a critical care nurse at Boston Medical Center and co-signer of the initiative petition, said: “The bottom line for nurses is our patients.

“When we have too many patients to watch over and monitor at one time, bad things can happen, including delays in nursing assessment, delayed administration of medications and tests, nurses missing significant changes in patients’ health status, poor patient outcomes, patients falling due to lack of assistance in getting up and moving and patients being left in soiled beds for hours at a time.”

California passed a landmark bill in 1999 on nurse to patient ratios, which was fully implemented in 2004.

Massachusetts is one of 10 states to have filed legislation in the last two years to create a maximum limit on the number of patients that can be assigned to nurse at one time.

The move by the MNA echoes calls for similar rules on NHS staffing in the UK from unions and other groups.

These calls have got louder in recent weeks following the publication of high profile reports by the patient safety expert Professor Don Berwick and NHS England medical director Sir Bruce Keogh, both of which discussed staffing levels.

The Safe Staffing Alliance, which inlcudes the Royal College of Nursing, Unison and the Patients Association, has said patient safety evidence supports a maximum of eight patients to each registered nurse.

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Readers' comments (4)

  • As it looks like the government will get its way and turn us into an American style health care system. I wondering, can we have an American union? Their unions seem a little more active on behalf of their members. The RCN isn't really doing it for me.

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  • Anonymous | 9-Aug-2013 12:38 pm

    I don't wqnt to go American I want to go European. many of their systems actually work. better still I would like to see one EU system with consistent care and funding for all.

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  • No surprise since many people say the US govt values its armed forces more than GB!

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  • So why can't the RCN demand this for our nurses and patients....oh no I forgot Peter Carter is in bed with whoever is in power at the time....he has been in bed with Tony and now with Dave and Co during his reign

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