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Mass. House approves cap on nurse workload

Nurses union may drop ballot questions

The Massachusetts House passed a bill Wednesday night establishing statewide limits on the number of patients assigned to nurses in hospital intensive care units, as part of a deal between the state’s largest nurses union and hospitals.

The measure, passed unanimously, now goes to the Senate, and if it is passed there and signed into law before next Wednesday, the Massachusetts Nurses Association has agreed to withdraw two questions from the November ballot. One question calls for a more sweeping cap on nurses’ workloads in all hospital units. The other would require hospitals to publicly disclose financial information and total CEO compensation and establish penalties for excessive profits and pay.


“We’re very hopeful that it will get through the Senate and to the governor,” nurses union spokesman David Schildmeier said Wednesday night, noting that Senate majority leader Stanley Rosenberg was instrumental in brokering the compromise.

Lynn Nicholas, president of the Massachusetts Hospital Association, wrote in a memo to hospital executives Wednesday that the compromise had been approved by leaders at the hospital group, the nurses union, and an organization representing nurse executives.

Under the bill, registered nurses in hospital ICUs would be assigned one or two patients, “depending on the stability of the patient” as determined by a new “acuity tool’’ and by the nurses in the unit. The tools for determining how sick patients are would be developed by each hospital in consultation with nurses and have to be certified by the state Department of Public Health.

The state Health Policy Commission would develop regulations on public reporting of staffing compliance in ICUs, and identify several related patient safety measures to be publicly reported by hospitals.

“This measure will protect the most critically ill patients,” Donna Kelly-Williams, president of the nurses association, said in a statement. “We intend to continue working to protect all Massachusetts hospital patients by extending the limits in this bill to other units in hospitals.”


In her letter to hospital executives, Nicholas said of the bill, “We believe that the alternative is not perfect,’’ but she said it achieved the hospital organization’s goals of focusing “on the care needs of patients’’ and “did not involve mandating ratios in all units and at all times.’’ She noted the legislation provides for no fines for hospitals.

Nurses have been pushing for staffing legislation since 1995. The House and Senate passed a version of the bill in 2008 but were not able to agree in the end.

The union believes workload limits are a pivotal patient safety issue now that hospitals are under growing pressure to control the cost of care. Some have laid off nurses or not replaced those who have left their jobs.

The hospital association contends that patient limits etched in law will needlessly drive up costs and undercut hospitals as they try to develop new staffing models to increase efficiency and improve care.

For example, some hospitals have added respiratory therapists to patients’ care teams, which may mean they don’t need as many nurses.

Gideon Gil and Jim O’Sullivan of the Globe staff contributed to this report. Liz Kowalczyk can be reached at kowalczyk@globe.com.