Massachusetts Nurses Association Prepared by Opinion Dynamics Corporation July 2005 The State of Nursing and Patient Care

Q20 Two-Thirds of RNs Interviewed Do NOT Belong to the MNA Do you belong to the Massachusetts Nurses Association? Yes 34% No 67%

Q Fewer young people are choosing nursing as a career The acute care units are understaffed and nurses working in acute care are forced to care for too many patients Registered nurses are too often floated from one unit to another without appropriate training and orientation RNs are forced to work mandatory overtime Liability and malpractice lawsuits Low pay % very serious problem Managers rarely implement recommendations made by staff nurses regarding patient care Understaffing Most Likely to Be Rated Very Serious Problem Rate the seriousness of the following problems facing the nursing profession as they relate to providing health care to patients. Use a scale of "1" meaning "not a problem at all“, to "7" meaning "a very serious problem".

Q19 Fewer young people are choosing nursing as a career. The acute care units are understaffed and nurses working in acute care are forced to care for too many patients. Registered nurses are too often floated from one unit to another without appropriate training and orientation. RNs are forced to work mandatory overtime. Liability and malpractice lawsuits. Low pay. One-Half of RNs Cite Understaffing As The Single Most Serious Problem Facing Profession Which one of the above problems do you think is the most serious problem facing the nursing profession today?

Q20 Some people say that the quality of patient care in Massachusetts hospitals is suffering because there are not enough registered nurses working in the hospitals and nurses are being forced to care for too many patients at once. Do you agree or disagree? 9-in-10 Nurses Agree Patient Care is Suffering Due to Nurse Staffing Issues

Q Nurses not having enough time to educate patients and their families Are you aware of any incidents in Massachusetts hospitals that a registered nurse having to care for too many patients has led to... Nurses not having enough time to comfort and assist patients and their families Patients having to wait for long periods of time for their medication and medical procedures Medical errors, such as improper medication or dosages Complications or other problems for a patient Re-admission for a patient Injury or harm to patients Longer hospital stays Mortality for patients RN’s Report Wide Range of Adverse Patient Outcomes As A Result of High Patient Loads

Q Rate how effective you feel each one would be as a solution for addressing the nurse staffing issue using a scale of "1" meaning "not effective at all" to "7" meaning "very effective". Providing flexible scheduling programs Regulating RN-to-patient ratios Increasing nursing salaries Weekend and Off-shift bonus programs Scholarships and loan forgiveness programs to recruit new nurses % very effective Utilization of foreign-schooled nurses Utilization of agency and travel nurses Sign-on bonuses Requiring hospitals to post a nurse-staffing plan Prohibiting mandatory overtime Establishing RN-to-Patient Ratios Seen As Most Effective Solution to Nurse Staffing Issues

Q31 Of the possible solutions we just discussed, which one do you feel would be the single most effective for addressing the nurse staffing issue? Providing flexible scheduling programs Regulating RN-to-patient ratios Increasing nursing salaries Weekend and Off-shift bonus programs Scholarships and loan forgiveness programs to recruit new nurses Utilization of foreign-schooled nurses Utilization of agency and travel nurses Sign-on bonuses Requiring hospitals to post a nurse-staffing plan Prohibiting mandatory overtime RN-to-Patient Ratios Seen As Single Most Effective Solution to Nurse Staffing Issue

Q32, 33 8-in-10 RNs Favor Ratios; Less Than Half Favor Hospital Proposal One proposal is a bill that would require hospitals to appropriately staff acute care facilities and limit the number of patients RNs could care for at one time by setting minimum registered nurse-to-patient ratios. These ratios would vary by unit—in an ICU the ratio would be 1 nurse to not more than 2 patients; in Medical/Surgery units the ratio would be 1 nurse to not more than 4 patients. Would you favor or oppose the legislature passing such a bill? The second proposal is a bill that would not regulate a nurse to patient ratio but require each hospital to post a nurse-staffing plan that has been approved by the hospital’s board of directors, and require hospitals to report their nurse staffing plan to the Department of Public Health. This plan is designed to ensure transparency in hospital nurse staffing, and to provide a process for evaluating measures to improve the quality of patient care. Would you favor or oppose the legislature passing such a bill? Favor Oppose

Q34 Which do you think is a better approach to addressing the nurse staffing issue: The plan which would regulate staffing levels and set a minimum nurse staffing level The plan which would require hospitals to post a nurse staffing plan and report it to the Department of Health, but would not set minimum staffing levels Neither/not sure By Wide Margin, RNs Favor Ratio Plan Over Posting and Reporting Plan

Q37 (Non-acute care nurses): Let's say this safe staffing law was passed by the Legislature and registered nurses were required to care for fewer patients at once - for example, a 1:2 ratio was the standard in an ICU and 1:4 in Med/Surg. Would you consider taking a job as a staff nurse providing direct patient care in a hospital if such a law were passed to regulate RN-to-patient ratios? Nearly Two-Thirds of RNs Not Currently at the Bedside Would Consider Returning To Acute Care Settings if Ratios Are Established