BOSTON, DEC. 10, 2014…..The head of an effort to implement the new nurse staffing law said Wednesday that the measure applies to neonatal intensive care units.
Marylou Sudders, who is also slated to ascend next year to the top of incoming Gov. Charlie Baker’s health and human services secretariat, said a “plain reading” shows neonatal units, known as NICUs, fall under the law.
Lawmakers passed legislation this year subjecting intensive care units to nurse staffing ratios. The move was a bid to avoid two ballot questions pushed by the Massachusetts Nurses Association, including one proposal that called for more sweeping nurse staffing rules in hospitals.
“The option is, obviously, people can go back and talk to the Legislature about changing that, but I would that say a plain reading of it is that NICUs will be a part of our regulatory process,” Sudders said.
The 309-word law includes a reference to the broad definition of general and specialty ICUs under the Department of Public Health licensure regulations, which include pediatric and neonatal intensive care units.
The law calls for a patient-nurse assignment ratio of 1:1 or 1:2 “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 a nurse manager’s designee when needed to resolve a disagreement.”
Under the law, the state Health Policy Commission, an independent body analyzing the Massachusetts health care market, must create the regulations on public reporting of hospital compliance, patient safety quality measures and the “acuity tool” that would be certified by the Department of Public Health.
Since the law’s passage, the nurses union and the Massachusetts Hospital Association have battled over how to interpret it, with the hospital association arguing that the law was meant to apply to adult intensive care units.
“There are many issues involved in developing regulations to implement the new ICU staffing law, and some are quite complex,” Tim Gens, executive vice president of the hospital association, said in an emailed statement. “While we read the statute as not applying to Neonatal Intensive Care Units for both legal and clinical reasons, we look forward to working with the HPC on this and any other regulatory issues that arise. We are hopeful that the final regulations will prioritize the needs of each and every patient and reflect the best interests of the commonwealth’s healthcare system.”
The nurses’ union and the hospital group have also vehemently disagreed over whether the law includes a default nurse staffing ratio.
David Seltz, the commission’s executive director, said in their reading of it, the law does not require a default ratio. But he added that the commission has the regulatory ability in the creation of the acuity tool to potentially suggest that the tool should be based on a 1:1 default.
David Schildmeier, a spokesman for the nurses’ union, pointed to a video they posted on their website of Sen. Stanley Rosenberg on the Senate floor explaining the law before it passed earlier this year. Schildmeier said the video shows the intent of the law is to have a 1:1 ratio.
“We were the ones in the room negotiating it with Senator Rosenberg,” Schildmeier said. “And every word was in there for a reason.”
Draft regulations from the Health Policy Commission, originally slated to be released by the end of the year, are tentatively set for release in early January.
Sudders is head of the Health Policy Commission’s Quality Improvement and Patient Protection Committee, which has been tasked with overseeing the drafting of regulations. That committee met on Wednesday in Boston.
“It’s very complicated work,” she told commission staffers after they offered a presentation on a pair of public hearings, staff visits to ICUs in Boston Children’s Hospital and Brigham and Women’s Hospital, and staff meetings with stakeholders, including the hospital association and nurses union, the Department of Public Health, and Steward Health Care System. The issue’s complexity is due to the involvement of patient safety and care issues, and labor-management relations, Sudders said.
The staff presentation also included a look at the use of “acuity tools” that are used to measure a patient’s condition.
Less than 20 percent of Massachusetts hospitals currently use an acuity tool, and the tools are more commonly used in academic medical centers than in community hospitals, according to Lois Johnson, the commission’s general counsel. The type of tools vary from a “paper checklist” to software.
The models in use measure patient mortality risk and a nurse’s workload, but they tend to be used for budgeting and long-term staff planning, Johnson said. “We don’t see hospitals using them to make real-time staff assignments, as is contemplated by the statute, and we’ve seen that typically, if they are used, they’re used as one of several variables to consider in staffing plans.”
Hospital officials told commission staff that they need “significant” time and resources to implement acuity tools across their ICUs, Johnson said.
At the beginning of Wednesday’s committee meeting, Sudders went out of her way to stress that while she has been designated as Baker’s health and human services secretary, she was attending the meeting in her capacity as the chair, as a Boston College associate professor, and as an appointee to the commission of Attorney General Martha Coakley.
Copyright 2014 State House News Service