Before the Joint Committee on Health Care
Finance
The Massachusetts Medical Society wishes to be recorded in
support of Senate Bill 539, "An Act to Promote the Nursing
Profession and Promote Safe Patient Care," which would take an
appropriate approach to dealing with the issue of nurse
staffing. We believe that this legislation appropriately
addresses the problem. We are opposed to the approach
taken in Senate Bill 543, "An Act Relative to Patient Safety," also
before the Committee.
The Massachusetts Medical Society supports the concept of
adequate nurse staffing levels without across-the-board statutory
or regulatory ratios. This legislation would require
each hospital to develop and implement an annual written nurse
staffing plan that addresses the needs of that facility. The
plan would be made public and filed with the Department of Public
Health, so that the hospital would be accountable to its patients
and staff, as well as the community at-large, for its proper
implementation. The DPH would be charged with monitoring
compliance and demanding corrective action, if needed.
The Society has grave concerns about enacting laws and
regulations to establish standards of medical care. While we
have done so in the past, for example in the areas of mammography
and obstetrical length of stay, we did so reluctantly and only when
it is evident that legitimate patient issues were being
unmet. Best medical practices and standards of care are
generally not appropriate for codification in statute or
regulation. In this case, we are not convinced that an
across-the-board "one size fits all" staffing ratio is a useful
approach. On an individual basis, each patient deserves the
best care as determined by that patient's caregiver. Just as
each caregiver brings different experiences to patients, each
hospital provides varied clinical, physical plant and technological
resources to its patients. There are unpredictable variations
in the presentation of patients to a hospital, as well as
variations in the need for specialized care within different
clinical areas in a hospital. Thus, we believe that no single
formula or solution should be applied to all facilities by statute
or regulation.
We are deeply concerned that such a mandate will result in
clinical delays or inefficiencies in rendering care to
patients. These inefficiencies can result in overcrowding or
boarding of patients in emergency departments and in delays in
getting patients to appropriate medical/surgical units within a
hospital. Likewise, the possibility of diverting patients
from one institution to another may jeopardize the provision of
timely, local care to patients in need of emergency care. Each patient's care must revolve around the needs of the individual
patient, not around the staffing of one component of their total
care.
We urge the Committee to report out Senate Bill 539 favorably
and reject Senate Bill 543.
