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Limits are voted on nurse workload

House backs bill on staffing rules

Hospitals would be limited in how many patients they could assign to each registered nurse under a bill backed by House legislators yesterday, after almost a decade of wrangling between the state's hospitals and a union representing registered nurses.

The bill, which has been a subject of intense closed-door negotiations and public protests this week, does not set nurse-to-staff ratios. Instead, it orders the state Department of Public Health to regulate the ideal number of patients that hospitals could assign to each registered nurse. The department would also set a limit on the number of patients each nurse could care for in a shift.

The bill would make Massachusetts only the second state after California to regulate nurse-to-patient ratios.

House legislators gave initial approval to the bill in a 129-to-29 vote yesterday, and planned to return for a final vote before sending the bill to the Senate.

The plan is being pushed by the Massachusetts Nurses Association, a union representing registered nurses. The union says the bill would force hospitals to assign enough nurses to guarantee quality patient care.

Hospital administrations oppose the bill. They say it is too restrictive and would create costly new mandates as the state embarks on an overhaul of its healthcare system.

Representative Peter J. Koutoujian, a Democrat of Waltham, said the bill provides hospitals some flexibility to develop staffing plans.

He said they could adapt staffing levels based on the needs of the patients and the experience of the nurses, but in the end there would be limits to the number of patients assigned to a nurse.

``This is a bill about patient safety," Koutoujian said. ``This is going to save lives from Boston to the Berkshires."

A Massachusetts Hospital Association spokesman, Paul Wingle, said the state should not have the authority to tell hospitals what kind of nursing assignments to have across all hospitals, all shifts, and all units.

``It's a ratio" established by the Department of Public Health, he said. ``They're calling it a limit, but it's a ratio by another name."

Janet Madigan, president of the Massachusetts Organization of Nurse Executives, also said she opposes the bill because it focuses only on registered nurses and does not include other staff members, such as nurses' aides and licensed practical nurses.

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