In concept, it would seem local control over nurse staffing is best. However, the history of the problem highlights why and when regulation is important to protect the public. A successful hospitalization, after all, is the difference between life or death, health or dysfunction.
In the 1980s, our health care system took a hard business turn. Managed care was useful at first, as it helped to streamline the delivery of medical care. But it also masked the rapid increase in the cost of pharmaceuticals and technology.
In the 1990s, the sharp rise in those costs began to show as the efficiencies in delivery had been attained. However, the same cost-cutting tool was again applied. Deeper cuts in the delivery system, including nursing care, began to cause problems.
Nurses spoke up about their concerns regarding the lack of staff and risks they were taking. They were regularly asked to work double shifts at a moment's notice to cover for short staff. At the same time, a higher percentage of hospital patients was acutely ill, as the practice was to send people home earlier and delay admission until there was a serious problem.
There was little responsiveness to the problem despite much concern. In some instances, managers and directors of nursing, who supported their clinical staff, were let go. It was during these years that many left the field and the unionizing began.
I had mixed feelings about mandatory nurse-patient ratios at first, as I have never believed the Legislature should decide staffing levels. But under the present bill, the Department of Public Health, which licenses hospitals, would set staff regulations as they set many other standards. (In fact, we have had nurse staffing regulated in intensive care units for years.)
The bottom line is the general public must be protected. Currently, there is little incentive for a business-based health care facility to staff at the appropriate clinical level. Hospitals have charitable immunity so they have no risk if something goes wrong, but the nurses and physicians who practice under licenses can lose their livelihoods.
Hospitals have all of the power and none of the risk. Clinicians have all of the risk and none of the power.
I have asked hospitals if they are willing to give up their charitable immunity status to assume some of the risk in their decisions, but there were no takers.
Every professional research paper has shown much better clinical outcomes for patients when the staffing is at higher levels — which is the goal of this bill.
In recent years under the business-based health care model, our hospital infection rates have increased along with medical errors. These problems are very costly and entirely preventable. When clinicians have to more quickly care for more seriously ill patients, corners get cut. Over time, these corners become standard practice, and you begin to see the effects.
For many years, this business-based model of health care management has referred to our system of care as a "consumer-driven" system. This cannot be further from the truth.
A consumer-driven system suggests there is a market for consumers to shop and buy in. But there is no choice when it comes to purchasing health care. We are dead or dysfunctional without it.
What makes people better quicker is a patient-oriented system that highly values trust between a patient and their provider. And in order to ensure trust, you must have compliance with a treatment plan.
Regulation is not an appealing word in a strictly business model, but it is what is needed to balance power in a system on which the general public must rely so heavily. We have survived with staffing levels being present in our intensive care units for years with no problem. Risk and power must be balanced. The results of imbalance are too costly.
Mary Grant, MS, RN, is the state representative from Beverly.