2018 ‘State of Patient Care’ Survey Released for Hearing on Safe Patient Limits

Press Release: Over three quarters of Massachusetts nurses (77%) believe RNs are assigned too many patients; Results shared as part of testimony delivered to the Joint Committee on Public Health.

BOSTON – Today, the Committee to Ensure Safe Patient Care released “The State of Patient Care,” which surveys all registered nurses in the Commonwealth. This survey shows the alarming worsening trend of increased patient consequences as a result of poor staffing levels for nurses. The results were shared as part of testimony delivered today before the legislature’s Joint Committee on Public Health in support of H. 4112 and H. 4113, both entitled An Act relative to patient safety and hospital transparency (the Patient Safety Act).

The Patient Safety Act will dramatically improve patient safety in Massachusetts hospitals by setting a safe maximum limit on the number of patients assigned to a nurse at one time, while providing flexibility to hospitals to adjust nurses’ patient assignments based on specific patient needs. The measure will be for voters’ consideration on the November 2018 ballot. According to survey results, nearly 9 in 10 nurses (86%) report that they will vote yes for the Patient Safety Act.

Testimony was delivered by:

  • Donna Kelly-Williams, RN – President, Massachusetts Nurses Association; Co-Chair, Committee to Ensure Safe Patient Care
  • Angela Ortiz – Massachusetts Pediatric Home Nursing Campaign; Co-Chair, Committee to Ensure Safe Patient Care; mother to 5-year-old daughter Ayla, a child with complex medical needs
  • Karen Coughlin, RN – Vice President, Massachusetts Nurses Association
  • Kelly Williams, RN
  • Katie Murphy, RN
  • Mary Crotty, RN, JD
  • Judith Pare, RN, PhD

Copies of testimony are available upon request.

“If Ayla were in daycare, there is a law in Massachusetts that sets a safe maximum limit on the number of children that a childcare provider can care for at one time. But once she enters the hospital, she loses that protection,” shared Ortiz. “Once a child – any child – gets to the hospital, there is no law and no limit on how many other sick children his or her nurse will be responsible for at one time. When these children are at their most vulnerable, they lose that basic protection. That doesn’t make any sense.”

Survey Findings: There should be limits

Numerous independent, peer-reviewed studies indicate that there should be a limit on the number of patients a nurse can care for at one time:

  • For every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5% per patient.
  • For children recovering from basic surgeries, each additional patient assigned to a nurse increased the risk of readmission by a shocking 48%.
  • There is a 20% higher risk that a patient will die within 30 days of having general surgery at hospitals that don’t have patient limits.
  • The risk of death was increased by a factor of 3.5 when the patient to nurse ratio was greater than 2.5.

Despite this research, nurses report caring for an average of 6, 7, or 8 patients at one time.

Over three quarters of Massachusetts nurses (77%) believe that RNs are assigned too many patients to care for at one time.

Quality of care

The survey results clearly show that things are getting worse for patients. Eight-in-ten nurses (81%) report that hospital patients today are sicker than hospital patients 10 years ago. Thirty-six percent of RNs report patient deaths directly attributable to having too many patients to care for at one time – a sharp and alarming increase from previous survey results (2017 – 29%; 2015 – 25%; 2013 – 23%).

The results underscore the sense of urgency in passing the Patient Safety Act as patient safety concerns continued to increase at dangerous rates as compared to just four years ago:

  • 64% of RNs report injury and harm to patients due to understaffing – up from 46% in 2014.
  • 66% of RNs report longer hospital stays for patients – up from 51% in 2014.
  • 72% of RNs report readmission of patients – up from 56% in 2014.
  • 77% of RNs report medication errors due to unsafe patient assignments – up from 57% in 2014.
  • 90% of RNs report that they don’t have the time to properly comfort and care for patients and families due to unsafe patient assignments – up from 82% in 2014.
  • 86% report RNs don’t have the time to educate patients and provide adequate discharge planning – up from 68% in 2014.

The reality of patient care decisions

Hospital 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.

Over six-in-10 nurses (63%) say management only sometimes adjusts nurse staffing levels when RNs face unsafe patient loads, and 40% of nurses report that hospital administrators are not responsive to input from RNs regarding patient loads and nurse staffing levels.

About the survey: “The State of Patient Care” was commissioned by the Massachusetts Nurses Association and conducted between April 2-25, 2018, by Anderson Robbins Research, an independent research firm headquartered in Boston. The 2018 survey respondents were all registered nurses working in Massachusetts health care facilities randomly selected from a complete file of the 100,000 nurses registered with the Massachusetts Board of Registration in Nursing. A majority (54%) of RNs interviewed are not MNA members.


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