Massachusetts Nurses Association Prepared by Opinion Dynamics Corporation July 2005

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

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

3. 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". % very serious problem The acute care units are understaffed and nurses working in acute care are forced to care for too many patients Fewer young people are choosing nursing as a career RNs are forced to work mandatory overtime Registered nurses are too often floated from one unit to another without appropriate training and orientation Liability and malpractice lawsuits Low pay Managers rarely implement recommendations made by staff nurses regarding patient care Q12 - 18

4. 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? The acute care units are understaffed and nurses working in acute care are forced to care for too many patients. Fewer young people are choosing nursing as a career. Registered nurses are too often floated from one unit to another without appropriate training and orientation. RNs are forced to work mandatory overtime. Low pay. Liability and malpractice lawsuits. Q19

5. 9-in-10 Nurses Agree Patient Care is Suffering Due to Nurse Staffing Issues 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? Q20

6. RN’s Report Wide Range of Adverse Patient Outcomes As A Result of High Patient Loads 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 educate patients and their families 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 Q38 - 46

7. Establishing RN-to-Patient Ratios Seen As Most Effective Solution to Nurse Staffing Issues 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". % very effective Regulating RN-to-patient ratios Providing flexible scheduling programs Increasing nursing salaries Scholarships and loan forgiveness programs to recruit new nurses Weekend and Off-shift bonus programs Prohibiting mandatory overtime Requiring hospitals to post a nurse-staffing plan Sign-on bonuses Utilization of agency and travel nurses Utilization of foreign-schooled nurses Q21 - 30

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

9. 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? Q32, 33 Oppose Favor Favor Oppose

10. By Wide Margin, RNs Favor Ratio Plan Over Posting and Reporting Plan 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 Q34

11. Nearly Two-Thirds of RNs Not Currently at the Bedside Would Consider Returning To Acute Care Settings if Ratios Are Established (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? Q37