Cape Hospitals Worried About Patient Limits for Nurses

Cape Cod Hospital in Hyannis.

HYANNIS – Local healthcare organizations are expressing concerns about how mandated nurse staffing ratios would negatively impact the region if approved by voters in November.

A “yes” vote on Question 1 would set a maximum limit on the number of patients assigned to a nurse at one time, along with allowing nurses to adjust patient assignments based on specific patient needs.

Cape Cod Healthcare, which operates Cape Cod and Falmouth Hospitals, and Spaulding Rehabilitation Hospital say the limit would drastically increase costs for staffing or limit patient services.

Spaulding’s Vice President of Hospital Operations Stephanie Nadolny said the hospital would need 14 new nurses at a cost of $1.9 million if the measure passes.

“I don’t even think that is doable,” Nadolny said. “Between the cost and the ability to recruit and high nurses on Cape Cod, I’d be worried that we wouldn’t be able to staff under this new model.”

Cape Cod Healthcare would need to hire 250 nurses at an annual cost of more than $34 million.

“Not only would it be expensive, it would immediately impact where care is delivered and what units are open to deliver that care,” said Michael Lauf, the president and CEO of Cape Cod Healthcare.

“Lastly, the unintended consequences involve wait times to not only get into the ER but also to get into physician practices, and more and more care would be sent to Boston.”

Lauf said key programs, including behavioral health and addiction recovery would be jeopardized.

“We would be forced to make some extremely tough decisions, if this ballot question passed,” Lauf said.

Nadolny said the nurses at Spaulding would only be able to provide care for five patients all the time. She says that it has been proven that it will not improve quality of care.

“It’s been in existence in California for several years and it has not changed the quality measures,” Nadolny said. “In fact, Massachusetts hospitals have a significantly higher levels of quality based on all different metrics that we look at regularly.”

According to Leapfrog’s 2018 report, the national database that tracks patient safety ranks Massachusetts #4 in patient safety. The same report has California, the only state that has implemented universal nurse staffing ratios, at #25.

The Massachusetts Nurses Association supports a “yes” vote on Question 1 and says the Patient Safety Act will dramatically improve patient safety and care in the state.

The association says the initiative is supported by a broad coalition from across Massachusetts, including registered nurses, patients and family members, community groups, unions, elected officials and health and safety officials.

A survey is conducted every year by the association of all nurses in the state and the 2018 report indicated that eight-in-ten nurses described that hospital patients today are sicker than they were ten years ago.

Other statistics indicate significant increases in the number of nurses who report injury and harm to patients due to understaffing, longer hospital stays for patients, readmission of patients and medication errors.

Nadolny said nurses supporting the limit are not looking at the bigger picture and the broad implications of regulating something that is not meant to be regulated.

“It’s way too prescribed and it doesn’t account for the difference between human beings – the patients in the bed and the capabilities of the nursing team,” she said.

Lauf said he admires and respects the nurses on Cape Cod and across the state or the great care they provide, but a ratio that is ill advised. He said the MNA does not represent all of the nurses in the state and three out of four don’t belong to the organization.

“We need to have a collective discussion with all medical professionals to decide what is the best number of people to care for a patient, what has the best impacts?” Lauf said.

Lauf said Massachusetts currently has the best quality outcomes in the county.

“Why are we adding over $1 billion worth of expense on a ballot initiative when we already have the best outcomes in the country,” he said.

The MNA says that executives opposed to the Patient Safety Act argue that decisions to address understaffing should be made at the bedside, but the reality is that those adjustments are not made.

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