- Implementing the Massachusetts nurse-to-patient staffing ratio ballot question could cost the state $676 million to $949 million a year if the law is passed, according to a new study from the Massachusetts Health Policy Commission.
- If enacted, the law would force hospitals in the state to hire as many as 2,286 to 3,101 additional full-time nurses to be in compliance. Hospitals that don't comply would be fined $25,000 per violation.
- Proponents of mandated nurse staffing ratios argue that such laws are investments in patient and worker safety that pay out with better health outcomes. The commission found that Massachusetts' mandate could reduce adverse events and length of stay for patients, resulting in potential savings of up to $47 million.
The hospital industry has been successfully railing against mandated nurse staffing ratio legislation for years. Hospital groups have poured money into anti-mandate studies and lobbying efforts, often threatening the closure of hospitals as a last resort, as Massachusetts Health & Hospital Association did last year.
Many hospitals oppose nurse-to-patient ratio mandates, along with the American Hospital Association and the American Organization of Nursing Executives. Both of those groups say mandatory ratios won't guarantee better patient outcomes. Opponents of mandatory ratios largely believe they will create unmanageable hiring costs, resulting in higher costs of care for patients.
Opponents of the mandate also cite the looming nurse shortage, but proponents of the mandate, coalitions largely composed of nursing unions, point to California as a model. When the state passed its mandate in 2004, applications for nursing licenses there reportedly increased by more than 60%, with vacancies for RNs reducing 69% by 2008.
There are other ways to address nurse staffing, such as holding hospitals responsible for setting ratios within their own facilities and forcing them to publicly disclose staffing data, but proponents of the ratio mandate say those methods are proven to be ineffective. Currently, 14 states have laws that address nurse staffing in some way, with California being the only state to have a ratio mandate.
The Massachusetts study does not bode well for advocates in other states, such as Pennsylvania, where nurses have been visiting with legislators and their mid-term opponents in hopes of corralling support for staffing ratio bills in the state House and Senate. Pennsylvania nurses have even gotten a nod of approval for staffing ratios from Governor Tom Wolf.
"Hospitals are focused on how many dollars they'll spend at the end of the year. How can you put a price on patient safety and patient mortality?" Sharon Mitchell, a nurse and safe staffing advocate in Pennsylvania, told Healthcare Dive. "To me, in the long-term, having adequate nursing staff on the floor, having a safe patient limit, there's no price to put on that. That's what nurses are standing for."
Those who favor a staffing mandate do so out of fear of the real risks that short-staffed and overworked nurses pose to patient safety, health outcomes and workforce retention in hospitals. Kronos Incorporated polling shows that 90% of nurses are considering leaving their hospital for another job, and recent research has shown that patient-heavy staffing ratios are costing patients their lives, especially in intensive care units.
Massachusetts passed a ratio mandate solely for ICUs in 2014 in a compromise between the Massachusetts Health & Hospital Association and the Massachusetts Nurses Association. This time, the decision will be completely up to Massachusetts voters.