PRESS RELEASE

For Immediate Release

June 10, 2015

Contact: David Schildmeier 781-249-0430

MNA Reaction to the Health Policy Commissions Vote to Approve Final

Regulations Underpinning ICU Law Setting Safe Patient Limits for Nurses in
Hospital ICUs
MNA Applauds Decision to Follow Laws Intent by Ensuring Neonatal Intensive
Care Units are Covered Under the Law
HPC Rejects Cynical Attempt by MHA to Exclude Safer Care Standards for the
Most Vulnerable Newborns
The Health Policy Commission voted today to approve final regulations underpinning the ICU Safe Patient Limits
Law, which was enacted last year to ensure patients in Mass hospital ICUs receive one-on-one care from their
registered nurse, while allowing a nurse to take a second patient if and when it is deemed safe to do so. The
regulations approved today put in place a process for hospitals to follow in developing a tool nurses can use, known
as an acuity tool, to assist them in determining when patients are stable enough to allow a two-patient assignment.
The most important development coming out of todays meeting was a decision by the HPC to follow the intent of
the law, which calls for the law to apply to all ICUs, including neonatal intensive care units. The MNA applauds the
HPCs decision to follow the intent of the law, and to reject a cynical attempt the by Massachusetts Hospital
Association to convince the HPC to exclude neonatal and pediatric intensive care units from coverage under the
law.
We couldnt imagine how any responsible public official could support a policy that provides a lower standard of
care for critically ill babies, and we are very pleased that the HPC came to the same conclusion and agreed to follow
the law, said MNA President Donna Kelly-Williams, RN, who is a maternity nurse at Cambridge Health Alliance.
While applauding the decision to include all ICUs, the MNA has serious concerns about these regulations,
including:
The regulations fail to clearly state the laws key intent, which was that there is a default one nurse to one patient
standard of care for all patients in ALL ICUs. Our fear is that the industry will use the vague language in the
regulation to avoid meeting the one-to-one standard for patients that clearly need that level of care which is
happening every day in most of our states hospitals.

The regulations call for the committees formed at each hospital to create an acuity tool to support nurses in
determining if and when they can take a second patient to be only advisory in nature, leaving management
with the final say on what tool is submitted to DPH for certification. The committees formed under these
regulations at each hospital are to include at least 50 percent ICU staff nurses. Senior management should
not have the power to overrule or undermine the acuity tool ICU nurses at their hospital have developed to
ensure the safety of their patients.

The regulations appear to allow management to step in and guide staffing decisions when a nurses
assessment is in conflict with the acuity tool (the intent of the law was for nurses on the unit to have sole
discretion on determining patient stability, and the tool was there to augment that process, with management
having a say only when the staff nurses on the unit couldnt agree). As written, the nurses judgement and the
tool appear to be given equal weight and again, management is given the authority to step into the decision
making process when a nurse and the tool disagree. The failure of hospital administrators to provide nurses
with safe patient assignments and the resources nurses need to deliver safe patient care was the driving force
behind the laws creation and passage. The clear intent of the law was to place decisions regarding the level of
care for patients in the hands of those accountable for the patients care the frontline staff nurse on the unit
specifically removing managers and administrators from that process.

The regulations fail to ensure that notice of the law is posted in all ICUs so that patients and their families are
informed of the standard of care called for under the law. The regulations also call for very limited and lax
reporting. We believe that patients and their families have a right to know about this law and of their right to
receive a safe standard of care. Providing patients with this information upon admission and the ability to
report violations is key to ensuring the law is upheld and enforced.

Despite these concerns, the MNA intends to pursue any and all means to ensure that the true intent of the law and
the safe standard of care it dictates for critically ill patients is followed to ensure patients in our hospitals are as
safe as possible.
The MNA was shocked to learn at the meeting two weeks ago by the HPCs Quality Improvement Patient Protection
Committee that the committee had not made a final determination as to whether NICUs should be covered by the
new law, despite the fact that this is what the law clearly stated and intended. They have left the question of
inclusion of NICUs in the law up for a discussion and decision by the full Health Policy Commission.
The HPC Quality Improvement and Patient Protection (QIPP) Committee has held two listening sessions to collect
general comment and testimony on issues related to implementation of the law, including the formulation of acuity
tools, methods of public reporting, and relevant patient safety quality indicators.
Representatives from the Massachusetts Nurses Association, along with other health care and consumer advocacy
groups and legislators who drafted this law, provided testimony at the public hearings on March 25 and April 2 to
express our serious concerns about the initial draft regulations and where we advocated for needed changes to
ensure the intent of the law is followed.
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Founded in 1903, the Massachusetts Nurses Association/National Nurses United is the largest professional health care
organization and the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the
nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the
workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health
care issues affecting nurses and the public. The MNA is a founding member of National Nurses United, the largest national
nurses union in the United States with more than 170,000 members from coast to coast.