By Colleen Quinn


STATE HOUSE -- Nurses working in intensive care units will care for only one patient at a time, except in certain circumstances, under legislation approved unanimously in both the House and the Senate and now headed to the governor's desk for his signature.

The Senate passed the legislation Thursday, less than 24 hours after it cleared the House. The bill dictates nurse staff levels in intensive care units, and emerged after talks between the statewide nurses' association and hospital groups to avert a fight over a broader nurse staffing plan headed for the November ballot.

The Massachusetts Nurses' Association (MNA) agreed to drop two ballot questions, one related to nurse staffing levels and a second question regulating CEO compensation, annual operating margins and financial asset disclosures of hospitals.

David Schildmeier, a spokesman for the MNA, said the nurses agreed to also drop the ballot question on CEO pay and hospital transparency, despite recently launching a radio and advertising campaign, because they are confident lawmakers will consider legislation on the issue in the future.

"We feel confident we can move this in the coming legislative session given there is so much discussion about that lack of transparency in hospital finances, and the fact there is such an unfair distribution of hospital resources," Schildmeier told the News Service.


The compromise followed a years-long logjam on the issue on Beacon Hill.

"Something that looked like it came about quickly was actually 15 years in the making," said Rep. Denise Garlick, a Democrat from Needham and nurse who was instrumental in forging the agreement.

Nurses turned to the ballot after fighting for nearly 15 years to limit the number of patients they care for at any one time. Hospital organizations have argued mandated staffing levels had no merit, and would unnecessarily tie their hands in staffing decisions.

When the nurses launched the ballot campaign last August, Massachusetts Hospital Association President Lynn Nicholas said mandated nurse staffing ratios are "antithetical" to the movement towards integrated care models under which payments are based on quality of care and patient satisfaction.

Before the bill (H 4228) passed, Sen. Mark Montigny said the agreement between the nurses and the hospital never would have happened without the threat of the ballot questions. Montigny called it "a long time coming." Nurses and hospitals had until July 2 to come up with a compromise to avoid a fight at the ballot.

"Anybody who has spent time with someone they love in a hospital realizes nurses are underappreciated, underpaid, and overworked," Montigny said.

"I firmly believe that the other side in this negotiation would not have come to the table without this ballot question," he added.

Under the bill, there will be a one patient, one nurse ratio in intensive care units, unless the nursing staff agrees a patient has become stable, and the nurse can take on another patient, said Sen. Stanley Rosenberg, who helped foster the agreement on the Senate side. If there is disagreement, a nurse manager would become involved in the decision.

"We set in motion, put in place, the ability for hospital administrators and nurses to work together in order to provide the best possible care for their patients," Rosenberg said on the Senate floor.

"We are putting the patient in the center of the conversation. What they need is what will occur," he said. "And in most ICUs, it is known that one-on-one relationship is the norm, and the appropriate thing to do, and you can under certain circumstances add a second patient to a nurse's shift load, but only under certain circumstances."

The Health Policy Commission will regulate implementation.

Donna Kelly-Williams, president of the MNA and a registered nurse at Cambridge Hospital, said nurse staffing limits will save lives, reduce medical complications, and lower the number of patients readmitted to a hospital for follow-up care.

Kelly-Williams called staffing guidelines in ICUs the first step, and said nurses plan to continue to fight for nurse-patient limits in other hospital units. California instituted nurse staffing limits in intensive care, and then expanded to other hospital units, according to Kelly-Williams.

Sen. Richard Moore (D-Uxbridge) who previously chaired the Health Care Finance Committee, praised the agreement, but added he is concerned it might be a step toward a staffing system that does not have science-based research behind it. In California, there have been a number of studies that suggest there have been no improvements in patient care since nurse staffing levels were instituted by law, Moore said.

"It is somewhat concerning that we are placing this in statute because it does interfere with patient care and the opportunity to have some flexibility in patient care. Because a patient's condition can change momentarily, and so having some rigid formula is not the best way to attend to our patients," Moore said before the vote.

House lawmakers moved the bill to the floor for debate quickly Wednesday, using a bill related to a folic acid awareness initiative, pushed by the March of Dimes to prevent birth defects.

According to the bill, the Department of Public Health "shall administer a folic acid awareness initiative to increase public awareness of and education on the importance of folic acid to patients, families and health care providers."

Supporters of the bill said they expect Gov. Deval Patrick to sign it either late Thursday or Friday.