The Massachusetts Nurses Association (MNA) is trying a
second time to establish patient limits in state legislation. This comes six
months after losing a ballot question in the November 2018 state election.
As reported by the Boston Business Journal, the current legislation being reviewed now would hire an independent researcher to study issues affecting nurses, such as staffing, violence, injuries, and quality of life. The data collected by the researcher will then be used by state legislators to determine healthcare staffing needs and acute care patient limits.
“If these studies determine there is a best practice limit on the number of patients a nurse should care for at one time, that should inform future policy discussions,” MNA spokesman Joe Markman told the Boston Business Journal.
The original measure from this past election was defeated
largely because of lobbying from the Massachusetts Health & Hospital
Association (MHA), who spent $25 million to defeat the ballot. This current
bill would be revisiting the same legislation, which raises points for state
consideration regarding nurse staffing measures.
“The recent ballot measure raised important issues and challenges that our nurses still face today regarding their ability to give patients the quality care they need and deserve,” Massachusetts state Senator Diana DiZoglio, a sponsor of the current legislation, shared with the Boston Business Journal in an email. “While the policy prescription on the ballot was rejected by the majority of voters, we still need to remain vigilant in identifying best practices to ensure the very best patient care is afforded to all.”
MNA has been working to get nurse-to-patient ratios at all Massachusetts
hospitals for several years, including a ballot measure in 2014 that was removed,
after Governor Deval Patrick passed a law patient limit law. Markman said this
study is necessary to convince voters, after the 2018 election.
“The hospital industry spent … million(s) misleading people about those facts and sometimes outright lying,” Markman told the Boston Business Journal. “For example, they continuously said ED wait times would increase with safe patient limits. That is just wrong and not supported by the evidence. Based on how the industry ran its campaign, it’s clear the public will benefit from additional independent studies.”
From 2014 to 2017, physician burnout increased by 5% at the Massachusetts General Hospital Physicians Organization in Boston, according to a recent analysis.
Other research indicates that nearly half of physicians nationwide are experiencing burnout symptoms, and a study published in October found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction. Burnout has also been linked to negative financial effects at physician practices and other healthcare organizations.
The research published in JAMA found exhaustion and cynicism were the primary drivers of increased burnout at Mass General. The research was based on survey data collected from more than 1,700 physicians.
The survey data showed exhaustion increased from 52.9% in 2014 to 57.7% in 2017, and cynicism increased from 44.8% in 2014 to 51.1% in 2017.
The exhaustion finding was particularly troubling, the JAMA researchers wrote. “We found physicians were more vulnerable to emotional exhaustion than any of the other subscales of burnout. Physicians reporting high levels of exhaustion were more likely to reduce their clinical schedules, reduce the number of patients in their practice, leave the practice, or retire.”
The researchers noted that physician turnover has several costs including patient and clinician distress as well as the expense of replacing physicians, which can be as high as three times a doctor’s annual salary.
Primary care physicians reported higher levels of exhaustion compared to medical specialists. “These findings may be associated with the amount of time primary care physicians spend documenting on the EHR and serving as the clinicians responsible for the management of patients’ multiple complex medical and social problems,” the researchers wrote.
Burnout data points
The JAMA article has several other key data points:
- Early-career physicians who had less than a decade of practice experience since their training were more susceptible to burnout than veteran physicians.
- The higher burnout rate in 2017 may be linked to implementation of a new electronic health record system because average time devoted to administrative tasks increased from 23.7% in 2014 to 27.9% in 2017, and increased time spent on administrative tasks was linked to higher burnout.
- Several favorable working conditions were associated with lower odds of burnout: workflow satisfaction, positive relationships with colleagues, time and resources for continuing medical education, opportunities to impact decision making, and having a trusted adviser.
Addressing physician burnout
The lead author of the research, Marcela del Carmen, MD, MPH, explained that the physician group has implemented several efforts to reduce burnout.
“We have allocated funding to each of our 16 clinical departments to develop and institute initiatives to mitigate burnout in their departments. We have central efforts including sponsoring social events to enhance connectivity amongst the faculty, efforts to improve our use of the electronic health record through personal- and practice-level training, and funding to support peer-to-peer coaching programs, yoga, and meditation sessions.”
Del Carmen’s research team also suggested that burnout prevention efforts could be tailored for early-career physicians, who reported relatively high dissatisfaction with department leadership, relationships with colleagues, quality of care delivery, control over work environment, and career fit.
“These findings point to potential opportunities in this vulnerable group to mitigate burnout, such as initiatives that promote community building and networking and harnessing effective leadership,” the researchers wrote.
This story was originally posted on MedPage Today.
Jeffrey Ballard, R.N. and Army Veteran, began his medical career as an emergency medical technician (EMT). After gaining experience as a paramedic and a licensed practical nurse (LPN), he became a registered nurse in the Emergency Department at a Level 1 Trauma Center. He was deployed to Afghanistan two years later as an infantry medic, where he sustained injuries in combat. Following a year and a half of surgeries and physical therapy back home, Ballard returned to emergency nursing, but his struggle with PTSD prompted his departure within a year.
Ballard received care at the Manchester VA Medical Center, and he decided to continue his nursing career there. “I wanted other Veterans to have the same comfort I experienced,” he said.
Today, Ballard has been working with the VA for nearly five years and serves in a program that helps elderly Veterans maintain their independence. Working alongside compassionate nurses and caring for combat Veterans like himself has helped Ballard rediscover his passion and flourish in his career. With his experience, he’s been able to better understand and build trust with Veterans in a way that generates comfort and healing for both parties. Recently, Ballard won the title “Red Sox Nurse Hero of 2018” and was invited to throw a game-opening pitch at the historic Fenway Park.
VA offers Veterans not only life-changing care but also life-changing careers. Join our team and discover the unique rewards that come from serving our nation’s heroes. To get started, search for opportunities near you and apply today.
This story was originally posted on VAntage Point.
Earlier this year, the Massachusetts Nurses Association proposed a ballot initiative to mandate nurse staffing ratios in Massachusetts hospitals. The proposed mandate would lead to the reduction of 1,000 behavioral health beds, increase emergency room boarding for mental health patients, and decrease access to recovery services statewide according to a study by the Massachusetts Association of Behavioral Health Systems.
The mandate calls for one nurse to be responsible for no more than four typical medical or surgical patients at a given time. Different guidelines would apply for sicker patients and staffing ratios would differ by unit. Supporters of the initiative argue that legislating nurse-to-patient ratios will improve patient care. Nurses are currently overworked, which keeps them from doing their best and can lead to medical errors.
David Matteodo, executive director of the hospital association, tells BeckersHospitalReview.com, “If the initiative passes, it will result in a 38 percent decrease in patient volume. That’s the equivalent of removing roughly 1,000 behavioral health beds from service. This result would be devastating to both patients and the behavioral health system as a whole, as there would be no place for displaced patients to go when they are in acute distress and need immediate behavioral health services.”
The Coalition to Protect Patient Safety opposes the initiative and was assembled by the Massachusetts Health and Hospital Association, which argues that the proposal would negatively affect nurse care delivery.
Under the initiative, emergency departments at maximum nurse-to-patient ratios would have to turn away patients. Patients seeking inpatient psychiatric or substance abuse care in an emergency department would have to wait longer for a bed and mental health providers would face nurse recruitment challenges to meet staffing mandates.
To learn more about the Massachusetts Nurses Association proposed ballet initiative to mandate nurse staffing ratios in Massachusetts hospitals, visit here.
Spacelabs Healthcare, a medical equipment manufacturer based in Washington, has invested $720,000 into the University of Massachusetts Amherst Center at Springfield’s nursing laboratory. The generous investment will benefit UMass Amherst’s College of Nursing Accelerated Bachelor of Science in Nursing program, which serves as a pipeline for highly trained nurses to enter the region’s healthcare sector.
UMass Amherst Chancellor Kumble R. Subbaswamy tells UMass.edu, “It’s exciting that Spacelabs understands the benefits of investing in the College of Nursing. Nurses are at the frontline of healthcare, using these tools extensively. By providing our students with access to this equipment and fostering faculty research partnerships, Spacelabs has created an opportunity to develop the best possible healthcare management tools while contributing to our students’ educational experience and job training.”
The state-of-the-art equipment provided to the Springfield center includes two Sonicaid fetal/maternal monitors, ambulatory blood pressure monitors, multiple nursing monitors, and invasive cardiac outputs. Spacelabs’ gifts will help provide the opportunity to improve students’ experience in the nursing lab.
The 17-month Accelerated Bachelor of Science in Nursing Program moved to the UMass Center in Springfield in 2017. Students training at the Springfield center are also in close proximity to leading healthcare facilities where they complete the clinical portion of their education. Since moving the program to Springfield, 10 new seats have been added to each incoming class.
Thanks to the new equipment, students can now practice at the level of real-world situations, developing critical thinking and psychomotor skills in a safe environment created specifically to enhance safety and health outcomes. To learn more about Spacelabs’ investment into UMass Amherst’s accelerated nursing program, visit here.