Karen O. Moore RN, MS, FACHE President, MONE Massachusetts Health Policy Forum March 30, 2005
MA Acute Care Hospitals Have Added RN FTEs More Rapidly Than Growth in Patient Volume Percent Change, 1998-2003 12 10.6 10 8 6 5.3 3.5 4 2 0.9 0 RN FTEs Inpatient Outpatient Case-mix Days Visits Source: MHA analysis of MA DHCFP 403 cost reports
Massachusetts RN shortage #’s 25,382 25,382 16,779 16,779 9,096 9,096 3,299 4,820 2005 2005 2010 2010 2015 2015 2020 2020 Source: U.S. DHHS, HRSA, Bureau of Health Professions, July 2002
Improving safety and quality takes more than an arbitrary number “You cannot legislate a culture.” MNA representative Quincy Patriot Ledger, 1/27/05
Decisions must be based on patient acuity “I can have six patients and have a great day; and I can have two patients and have a miserable day.” -- RN from a Boston-area hospital
No evidence supporting ratios “Literature offers no support for specific, minimum nurse to patient ratio” -- Thomas Lang et al, JONA July 2004
Public prefers Patient Safety Act over Ratios 60 50 40 Patient Safety Act 30 56 20 Government Mandated Ratios 10 21 0 Do you prefer ratios or an alternative that lets hospitals, together with nurses, draw up their own nurse staffing plans and publicly report those plans to an independent entity?
Massachusetts cutting nurse staffing Medicare In-hospital Mortality, U.S.,% Change ‘95-‘02 Pneumonia 15.4 % Heart Attack 21.6 % Stroke 14.6 % Heart Failure 31.2 % GI Hemorrhage 29.5 % Cardiac Bypass 26.3 % Craniotomy 9.9 % AAA Repair 10.2 % “Failure to Rescue” 14.7 % Source: MedPAC March 2004; change in risk-adjusted rate per 10,000 discharges
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