Hospitals, nurses differ on ICU staffing law

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BOSTON, OCT. 29, 2014…..Members of a nurses union on Wednesday pressed for hospitals to be penalized for not complying with a new nurse staffing law covering intensive care units.

Hospital officials and members of the nurses union, two groups that have frequently clashed over the years and are accusing each other of misinterpreting the new law, packed an oversight agency’s hearing on staffing regulations and offered their differing interpretations. The law was passed in order to avoid two ballot question proposals that had also divided nurses and hospital executives.

Julie Pinkham, executive director of the Massachusetts Nurses Association, said there should be monthly, easy-to-understand reports on nurse staffing, and non-compliance should endanger a hospital’s grant funding as a penalty.

Pat Noga, a vice president of clinical affairs at the Massachusetts Hospital Association (MHA), said the law did not mention penalties.

The two organizations also differed over whether the law covers pediatric and neonatal intensive care units and what the nurse staffing default is. According to the MHA, the law covers adult intensive care units.

Draft regulations are expected by the end of the year.

The law charges the Health Policy Commission (HPC), an independent body that analyzes the health care market, with creating regulations on public reporting on hospital compliance, patient safety quality measures and an “acuity tool” certified by the Department of Public Health.

The law, which went into effect on Sept. 28, calls for all intensive care units to have a nurse to patient ratio of 1 to 1 or 1 to 2, “depending on the stability of the patient as assessed by the acuity tool and by the staff nurses in the unit, including the nurse manager or the nurse manager’s designee when needed to resolve a disagreement.”

Dozens attended the hearing, which was chaired by commission member Marylou Sudders, an associate professor at Boston College’s Graduate School of Social Work. The hearing was also attended by Wendy Everett, the commission’s vice chair; commissioner Carole Allen and a representative from Health and Human Services Secretary John Polanowicz, who serves on the commission.

“There’s no question the law is in effect, we’ve been very clear about that, and we need to establish regulations so that there’s clarity and a standard for everyone to operate by,” Sudders said.

“I think we are sensitive to age, the complexity of patient needs and coming up with a regulation that is fair to patients, nurses and nurse leadership,” she said.

The hospital association’s executive vice president, Tim Gens, said before the law can be implemented or enforced, the commission must first issue the regulations, and the hospitals need to see them.

“For example, the new law will require the use of an acuity system in determining nurse staffing assignments, but there are not yet regulations explaining the requirements of an acuity system, or how varying acuity systems will be certified, or when hospitals without an acuity system in use in the ICU must choose or develop one,” Gens said in a statement after the hearing.

When Sudders was asked by the News Service if the commission believes all intensive care units are covered under the law, including pediatric and neonatal ICUs, commission general counsel Lois Johnson cut in. “I think that we’re still looking at that just ’cause the way the law was drafted, we need to sort of nail that down, but we’re looking at that issue,” she said.

Sudders added, “I think one, we’re going to define what is covered by the law . . . I think we are, given today’s hearing or listening session, I think we’re inclined to really understand the differences of how the units are operated.”

Asked about including penalties in the regulations, Sudders said, “It’s the first we’ve heard it, and in fairness, I want to read everyone’s testimony before we draft regulations, before I say what’s going to be in or out of the regulations.”

During her testimony, the president of the Massachusetts Nurses Association claimed some hospital administrators and managers are misinterpreting the new law and failing to follow it, and called the one-to-one nurse-patient ratio “the baseline standard.” Donna Kelly-Williams, the president, said the law does not allow exceptions for a hospital’s financial concerns.

Pinkham, the union’s executive president, added that the Center for Health Information and Analysis should handle staffing compliance data, filed on a monthly basis, and the commission should handle oversight of implementation and operation of the law since “funding and staffing reductions have left [the Department of Public Health] unable to effectively take on additional responsibilities.”

Noga, the Massachusetts Hospital Association official, argued the baseline is not one-to-one, since the law allows for one-to-two ratio. Her colleague, Gens, added in his post-hearing statement that the union’s “misinterpretation of the law’s provision is clear proof” of why regulations and guidance are needed before the law can be implemented.

The nurses’ union represents “only 1 in 5 nurses” in the Bay State, Gens added.

“Since patients in need of intensive care in ICUs already receive staffing that is consistent with the law, there is no patient safety issue at Massachusetts hospitals,” Gens said. “In fact the quality of care provided in Massachusetts ICUs is amongst the highest in the nation.”

Noga asked the commission to choose nationally endorsed measures of quality and reporting frameworks.

“Collaboration on a common quality measurement and reporting framework led by national alliances is important to advancing a shared agenda for quality improvement, reducing onerous and duplicative reporting requirements, and minimizing confusion,” she said in her testimony.

“This law requires measures, and reporting of those measures, and that is something that all hospitals do every day,” Noga said. “But the core of this law, and the core of what hospitals do each day, involves carrying out sound patient care that leads us to beating the benchmarks and improving care.”

Before the two-hour hearing ended, Sudders said the commission will schedule another listening session before drafting regulations. A public hearing will follow the release of the draft regulations.

“This is the beginning of a process,” she told the crowd, which spilled out into the hallway.

Copyright 2014 State House News Service

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