Unsafe staffing reports point to growing health care crisis in Massachusetts hospital

Press Release: RNs for Question 1 share thousands of official reports detailing situations when excessive patient loads posed a “Serious Threat to the Safety of My Patients” and executives failed to provide any help

FRAMINGHAM – As the debate continues over the merits of Question 1 and the need for safe patient limits for nurses that will ensure safer patient care in our state’s hospitals, a group of nurses with the Committee to Ensure Safe Patient Care presented to the public thousands of official reports documenting instances where nurses were forced to take excessive patient assignments that “poses a serious threat to the safety and well-being of my patients.”  Each of these reports was shared with and signed by management representatives in real time, and in nearly every case management refused to alter the nurse’s patient assignment or provide any relief to ensure appropriate care.

Watch video of the press conference:

Responses included, “Do the best you can,” or “We have no one to send you.” One manager responded by writing “whatever.” And one nurse who was struggling with an 8-patient assignment – an assignment that medical research shows placed all her patients at a 31 percent increased risk of death*  – was told in writing “If something happens call rapid response.” **

These reports are used by nurses in all MNA-represented hospitals, which is 73 percent of the hospitals impacted by this law. They are called “Objection and Documentation of Unsafe Staffing” forms. As the name implies, they are used by nurses to document, in real time, any situation where they come on their shift and are given an assignment that is unsafe for their patients, and that prevents them from delivering the quality care those patients require. They are filled out in triplicate:

One copy is kept by the nurse,

One is given to the supervisor/manager on duty (who often times signs the form),

And one copy goes to the MNA.

The forms are used for two reasons:

First, to have a means of documenting and reporting to management situations and patterns of conditions that are a problem for the safety of patients and the quality of patient care.  These forms are also shared with senior Management of the hospital at regular monthly meetings in the hopes of convincing them to fix dangerous conditions.

Second, the form provides nurses with legal protection in case something untoward happens on that shift so they have some proof that the conditions they are working under are or were unsafe.

Under Massachusetts state law, nurses uniquely are personally and legally accountable for the safety of their patients regardless of the assignment they are given. (Code of Massachusetts Regulations Title 244)

In a press briefing today, Donna Kelly-Williams, R.N., President of the Massachusetts Nurses Association, said: “While there is a massive pile here today, this only represents those reports filed in the last year, and this does not include all of the hospitals where these forms are utilized. And for every one of these instances where a nurse takes the time to fill out these forms, there are many instances where nurse don’t fill them out, simply because they are too exhausted or harried to do so, or because management’s refusal to provide the support they need leaves them feeling like there is no point raising these concerns. This is a conservative estimate of the scope of this problem.”

These reports, and responses by executives, clearly refute the claims made by opponents of Question 1: That our state’s hospitals are safe for patients, and that hospital executives can be trusted to provide a safe level of care based on the needs of patients. These forms provide hard evidence that:

There is no flexibility in staffing levels in our hospitals today;

There is no autonomy for nurses to make decisions about how much care their patients need;

And there is no accountability for hospitals to staff to meet the actual needs of patients.


*Patient Mortality Is Associated with Staff Resources and Workload in the ICU: A Multicenter Observational Study. Neuraz, Antoine, MD, MSc et al. Critical Care Medicine. 2015. Vol. 43[8]: 1587-1594 August. DOI: 10.1097/CCM.0000000000001015.
** Rapid response refers to a team of staff designated to respond when a patient goes into cardiac arrest and needs to be resuscitated.


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