Gratitude for Caregivers, RNs Decry Ratios, and more...

Gratitude for Those Who Care for Us

National Nurses and Hospital Week – May 6 to 12
MHA Unveils “Caring for the Caregiver” Initiative

While it is certainly appropriate to designate a single week to honor registered nurses and all those who work in hospitals, it is important for us to acknowledge that each day across Massachusetts individuals and families entrust their very lives to the men and women who have dedicated their working lives to the caring professions.

We owe each one of them gratitude for the difficult work they do on our behalf.

Nearly all of us have spent anxiety-filled moments when our health or the health of our loved ones has been imperiled. Many of us can recall the comfort and care we received in those difficult times.  What we often fail to measure, however, is the profound stress borne by those caring for us. RNs and other healthcare professionals, no matter how steeled against the daily stresses of their job, nonetheless bear the burdens of care, of comforting the afflicted, and of coping with sorrow when a patient under their care succumbs to illness.

The caregiving professions are profoundly difficult jobs, taking an emotional and spiritual toll on the healthcare workforce. And hospital jobs are dangerous as well, as nurses and others face environmental risks, violent attacks from the public, and even harm from workplace cultures where supportive encouragement is replaced by demeaning behavior.

Massachusetts hospitals have for years engaged in “culture of safety” initiatives to ensure that everyone in a hospital – from the Board of Trustees through maintenance personnel – are aligned in placing patient safety as the overriding mission-driven objective. Lagging behind that patient-centered focus has been a community-wide recognition that the wellbeing of the healthcare workforce is equally important. But good healthcare leaders recognize that caring for the caregiver will, in turn, strengthen patient care. Empowering workers and supporting their emotional, physical, social, intellectual, spiritual and even financial health are necessary steps to allow the healthcare workforce perform their mission to the best of their abilities.

Over the past year, MHA has worked with its membership across the commonwealth to address issues of workplace safety and wellbeing. 
MHA’s Workplace Safety and Violence Prevention Workgroup is focused on developing and disseminating workplace safety program best practices, and the MHA Statewide Quality Forum is devising and implementing a statewide educational strategy for alleviating violence in the healthcare workplace. The Massachusetts Medical Society-MHA Joint Task Force on Physician Burnout will advocate for statewide adoption of identified strategies and practices to alleviate this common problem.

And now the MHA Promoting Employee Wellbeing Committee will soon unveil a webpage that will allow hospitals to share best practices about how they are working with frontline clinical caregivers and all hospital staff to improve and enhance their current work environment and wellbeing, including reducing violence in the workplace.

The goal of this new “Caring for the Caregiver” initiative is to acknowledge the valued contributions of hospital staff and support them with resources to enhance the safety of their work environment and well-being.

The quantifiable elements involved in helping hospitals support their workforce’s wellbeing involve coordinated surveys of best practices, focus groups, shared data, educational programs, and more.  But the less concrete, yet even more valuable element, involves creating a work environment of mutual respect to allow workers to find joy and fulfillment in the honorable work they do.

This week allows us to express what is, or should be, expressed each day – gratitude for our nurses and the whole hospital care team.

Local Pilot of Data-Driven Justice Project Announced

Last Tuesday, Middlesex Sheriff Peter Koutoujian announced a new pilot project to link data from local police, jail, hospital and other service providers to help identify “frequent utilizers” – people whose contact with law enforcement, healthcare and social services is recurring and often overlaps.

Middlesex County is one of three national pilot locations selected for the Data-Driven Justice project, sponsored by the Laura and John Arnold Foundation. LJAF has committed $1.6 million for all three sites – some $600,000 locally – to securely identify frequent utilizers. The pilot program will evaluate innovative forms of crisis response to guide the frequent utilizers to the support they need, in hopes of avoiding either hospitalization or incarceration.

“MHA supports and applauds this much-needed effort to assist patients struggling with mental illness and addiction,” said MHA’s Vice President of Government Affairs Michael Sroczynski. “Our member providers are actively engaged across the state with local resources that offer support to individuals suffering from behavioral health issues. With the right medical and social services, many of these individuals can stay in the community and break the cycle of repeated stays in hospital emergency departments or jail.”

Nurses Decry Ratio Bill at State House Hearing

Last Monday, April 30, approximately 180 opponents of government-mandated nurse staffing ratios attended a hearing on ratio legislation before the Joint Committee on Public Health.

Among the 20 who testified against two ratio bills from a nursing union were frontline RNs, nurse managers, healthcare researchers, behavioral health experts, and a hospital’s chief medical officer.

“I can’t even begin to imagine how a code blue or multiple code blues would work under this mandate without breaking the law,” said Amy Underwood, an R.N. at Cooley Dickinson Hospital. “The rigid mandates will not work in an ever-changing hospital environment where patients’ needs and conditions can change within seconds.”

The nursing union, which represents less than one-quarter of the RNs in Massachusetts, has proposed a ratio question for the November statewide ballot. Since the ballot question process in Massachusetts offers the legislature the opportunity to weigh in, all proposals slated for November are filed as legislation and a public hearing is required.

At Monday’s hearing nurses explained to committee members that ratios do not help nurses but actually take autonomy on patient care decision from them. Nurse managers described how patient care decisions are made, how they change from minute to minute, hour to hour, and are based not on a specific number of patients per nurse, but on the education and skill set of the nurse, patient acuity, availability of other care team members, and more.

“The strict, uniform standards required under this measure would supersede the hard-earned professional judgment of nurses, and instead potentially presents them with a moral dilemma: Do I care for a patient who needs me and break the law, or do I comply with the mandated ratio and turn the other cheek?” said Allison Conlon, R.N., from South Shore Hospital.

Cost of Ratios: $1.3 Billion in First Year

While caregivers at last Monday’s State House hearing on ratios clearly laid out the negative patient-care consequences of government-mandated nurse staffing ratios, another anti-ratio argument – their outrageous annual cost – was discussed.

Previous to the hearing, an independent study of mandated nurse staffing ratios found that the proposed ballot question will conservatively cost the state’s healthcare system $1.31 billion in the first year, and $900 million annually thereafter.  Those costs are in addition to approximately $100 million in direct state spending.

The study, conducted by Mass Insight Global Partnerships and BW Research Partnership, found that a “one-size-fits-all statewide implementation will be a costly and poor allocation of resources, leading to greater inequity in the delivery of care, less local access to healthcare, and reduced patient choice.” Ultimately, the proposal is likely unfeasible, the study concludes.

MHA had earlier concluded that, according to financial data filed with the state, 14 Massachusetts hospitals in Fiscal Year 2016 had negative operating margins. If the ratio ballot question had been in effect at the time, an additional 25 hospitals would have had negative operating margins and some of those may have been forced to close or severely cut back services.

The study from Mass Insight Global Partnerships and BW Research Partnership found that the ratio question will affect some regions of the state more than others. Communities outside of Boston and Worcester, such as the Cape and Islands, MetroWest, and Western Massachusetts are all at risk of losing entire facilities, according to the report, which added that local physician groups also will lose funding, further exacerbating the shortage of primary care options.

The complete study is on the Mass Insight Global Partnerships website here.

MHA Supports Campaign to Protect Transgender Rights

MHA President and CEO Steve Walsh attended the kickoff event of the Freedom for All Massachusetts Coalition, a bipartisan group seeking to defend the state’s transgender nondiscrimination law at the ballot. MHA joined more than 1,000 organizations representing healthcare, law enforcement, the business, faith, and transgender rights communities, among others to voice support for voting “yes” to uphold the law Governor Baker signed in 2016.

Shortly after the law went into effect in October 2016, opponents gathered the signatures required to place a repeal of the on the ballot in November 2018. Massachusetts will be the first state in the nation where transgender protections will be up for a vote on a statewide ballot measure. Currently, Massachusetts is among 18 states and more than 250 municipalities with nondiscrimination protections for transgender people in public places, such as restaurants, shops, and medical offices. The law also protects transgender people from discrimination in public restrooms and locker rooms.

“The passage of the transgender nondiscrimination law in 2016 was one of my proudest moments as Speaker of the House, due in large part to the incredible advocates and families who bravely shared their stories,” said Speaker DeLeo at the campaign kickoff. “Now we must do all we can to be sure Massachusetts doesn’t take a giant step backward. This is not about political party, as evidenced by the support of many Republicans – including Governor Baker – for this law. It’s about people. I’m ready to do all I can to be sure we uphold this critical law at the ballot because it is about the values Massachusetts stands for.”

Freedom for All Massachusetts launched this website and released a campaign video to showcase what is at stake for transgender individuals and their families.

May 23 Conference: Management of Dementia in Acute Care Settings

Attend A Map Through the Maze to learn the latest on newly released care standards from the Alzheimer’s and Related Dementias Acute Care Advisory Committee, and how they will affect your work and patient care.  Celebrating its 25th year, A Map Through the Maze – a practical-based Alzheimer’s and dementia care conference – offers professionals the opportunity to learn current and cutting edge information on a wide range of Alzheimer’s-related care topics. There are 30 breakout sessions, offering diverse topics for any interests.  CEU offerings are included.  For more information, visit here.  Direct questions to Lorraine Kermond at lkermond@alz.org.

Annual Design, Operations, and Construction Conference

Friday, May 11; 8:30 a.m. to 3 p.m.
MHA Conference Center, Burlington, Mass.

MHA's Annual Design, Operations & Construction program provides the latest information on critical topics such as:  security and emergency management, energy and sustainability, and preparing for the Joint Commission. This program always provides great education, information and networking.

The conference is FREE for MHFPS, NEHES or other facility professionals working for a member hospital or health system. The event is supported by the vital consultant and vendor community in the Healthcare A/E/C/RE industry. Through generous sponsorship and registrations, this event is available to all facility professionals at all levels.  We encourage you to attend!

Click here for complete program details.

John LoDico, Editor