FROM THE OTHER SIDE OF THE STREET
Hi All,
When I forwarded the message on for question #1, I hadn???t talked to my sisters, both nurses, as they were on vacation.?? Now they told me more information from the other side so I did some research.?? Those who say that 86% of nurses want the regulations polled only 302 nurses of 145.000.????
There are problems with the regulations.?? CA passed the regulations in 1999 and started enforcement in 2004.?? Here they will have 37 days to implement.?? Since the regulations, 47 CA hospitals have closed, over 12%, mostly regional hospitals.?? Another 14 have had to close their ERs, another 4%.?? So over 16% of acute care facilities have closed.?? Nurse staffing requirements has been cited as one of the factors.?? Now yes there are ???Express??? clinics but they are very limited in what they can do as I have found out, having been to several and been sent to ERs.?? Also when a hospital closes, all its supporting clinics close too.?? CA is expecting another 8% of hospitals to close and are trying to regulate if a hospital can close.?? Tough to do unless taxpayer money is pumped in to remedy the losses.?? Most hospitals in MA, like Sturdy and Brighams, are Not-For-Profit hospitals and some are already running in the red. This will make some close.
What will staffing requirements do??? There is already MA regulations for ICUs.?? The bill would cover other parts of the hospital including the ER.?? That means if in the ER, a nurse has their limit of patients, even if a massive trauma (car accident, fire, etc.) or cardiac case comes in, they can???t touch them.?? Because of the hospital and ER closings in CA, there has been 27.6% more patients that had to go to other hospitals, often further away, where there were long waiting times or wait there until someone was discharged from the ER.?? This caused a 5% increase in mortality of these patients who were sent elsewhere.?? If Sturdy, Norwood, Taunton, or others closed, that would be the situation here.
There is a 5% shortage in RNs in MA.?? Bringing in the graduates from the nursing schools won???t help with the critical care areas with which the regulations applies but the hospitals will try it with a loss to patient care by inexperienced staff.?? Nor will moving nurses between specialties to provide coverage as they also won???t have the experience and knowledge necessary.?? Remember this is 24/7 coverage including breaks.?? In CA the state funded more nursing schools, costing more taxpayer money.?? For the nurses, they brought in truncated schedule nurses for coverage, denied nurses taking breaks, or made nurses work less hours per shift and more days or split shifts.?? Scheduling is a nightmare.?? For the hospitals that are union, it will be a big contention, with nurses ending up suffering in the end for the hospitals must meet the regulations and they will cite that as reasoning.
What about cost??? The MA Health Policy Commission, an independent state agency and the ones who would implement and enforce the regulations, estimates it would cost the hospitals conservatively, $646 to $949 million dollars annually after the first year.?? This would have to be passed on to consumers in higher insurance and medical costs since the insurance companies won???t cover it.
The regulations prohibits the removal of a position of ancillary staff (nursing assistants and clerical) like CA did, but that doesn???t stop hospitals from decreasing hours and not hiring replacements when staff left.?? In CA nurses complained that this increased their workload.
In an ideal world there would be plenty of nurses and ancillary staff to care for the patients at low cost and those coming to the hospitals would be at a predictable rate.?? All beds would be full and as one is vacated, another patient would fill it. Nurses wouldn???t get sick or have personal problems to take care of, and doctors, staff, and patients would be right on time.?? Weather wouldn???t be a factor and all cases would be routine and meet timelines.?? Unfortunately, we don???t live in an ideal world.
Patient care is important but is regulation the way to go??? Do we let hospitals and nurses decide on care or regulations??? There are already a lot of inspections going on and if a hospital does poorly, it will soon change management or close.
I???ll let you decide.
Bill
Editor’s Note:??Referenced to LTE: THE BOTTOM LINE ON MA QUESTION #1 posted recently in My Backyard.??