The state is poised for the first time to mandate a minimum level of nurse staffing in hospitals, reigniting a debate over patient safety and health care costs.
The Health Policy Commission, the agency that monitors medical costs and related issues, will vote Wednesday on regulations requiring hospitals to staff intensive care units so that each registered nurse is responsible for no more than two patients. If approved, the rules would implement a law passed last year.
But a labor union, the 23,000-member Massachusetts Nurses Association, says the proposed rules give hospitals more discretion to assign two patients per ICU nurse than the law intended. In nearly all circumstances, union officials said, a nurse should be assigned just one patient needing intensive care. The only time a nurse should care for two ICU patients, the union says, is if other nurses in the unit — not hospital administrators — agree it is safe.
“The intent of the law is to have a one-to-one standard,” said David Schildmeier, spokesman for the nurses union. “Our fear is [commissioners] are writing regulations that will allow the hospitals to violate the intent of the law.”
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Nurse staffing has long been a point of contention between unions, seeking to protect their members, and hospital executives, both in Massachusetts and nationally, who are trying to maintain flexibility and control labor costs.
At Newton-Wellesley Hospital in Newton, part of the Partners HealthCare system, contract negotiations have bogged down in recent months over disagreements on staffing levels, and nurses there will vote Wednesday on whether to authorize a one-day strike. The union is accusing Newton-Wellesley of cutting staffing, but hospital officials say they have maintained nursing care and are looking to fill several open positions.
Last fall, the nurses union also accused Brigham and Women’s, another Partners hospital, of understaffing intensive care units, which hospital officials again denied. In 2013, nurses at UMass Memorial Medical Center in Worcester were just hours away from a strike when the union and management reached agreement on staffing levels.
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Hospitals say their priority is always patient safety, but that mandated nurse staffing levels prevent them from hiring other workers who take care of patients, from technicians to physician assistants to doctors. Under pressure to control medical costs, which in Massachusetts are among the highest in the world, hospitals increasingly ask health care professionals to practice at the top of their licenses, so nurses for example, don’t perform duties such as checking vital signs or bathing patients that can be handled by lower-level — and lower-paid — aides and assistants.
“Registered nurses are critical members of the care-giving team, but they are not the only members,” said Timothy F. Gens, executive vice president of the Massachusetts Hospital Association, a trade group.
The association supports the Health Policy Commission’s proposed rules because they are not overly rigid, Gens said. Neither the nurses union nor the hospital association provided estimates of how much it would cost hospitals to comply with the regulations.
“Are there things we would change [about the regulations] if we could? Yes,” Gens said. “But given the complexity, and the time and effort that went into this, we commend the Health Policy Commission on what they achieved.”
Hospitals typically set their own staffing levels. In units with the sickest patients, nurses are already limited to one or two patients each, according to the hospital association. Still, the Massachusetts Nurses Association has long pushed for a state law to mandate minimum nurse staffing in hospitals. Last year, the union prepared an initiative campaign asking voters to pass a law setting staffing levels across all hospital departments.
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But it dropped that ballot question when lawmakers passed compromise legislation negotiated with hospitals and nurses to mandate staffing levels in ICUs only.
Only two other states, California and Arizona, have some kind of nurse staffing mandate, according to the nurses union.
The Massachusetts law went into effect in the fall, but it will not be fully implemented until the Health Policy Commission adopts regulations.
The regulations the commission is set to approve would allow ICU nurses to care for one or two patients, depending on the severity of the patients’ illnesses. A subcommittee of the Health Policy Commission drafted the rules after several months of research and public meetings.
“It has been, we think, an extensive public process,” said Lois Johnson, general counsel of the commission. “It’s a challenge any time you’re trying to interpret a law and there are different perspectives from the nurses to the hospitals on what the goal of the law is, the intent of the law, and how it should be implemented.”
The regulations detail how hospitals should establish a set of criteria to determine whether an ICU nurse should be responsible for one patient or two. Commissioners also must decide whether the rules should apply to all ICUs, including specialty units for children and newborns, or only to adult ICUs. The nurses union has pushed for the rules to apply to all ICUs, while the hospital association wants the rules to be limited to adult units.
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Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.