HB1186
An Act to Promote Patient Care Transparency and Nurse Advancement

The Massachusetts Health & Hospital Association (MHA), on behalf of its member hospitals, health systems, physician organizations and allied health care providers, appreciates this opportunity to offer testimony in strong support of HB1186, “An Act to Promote Patient Care Transparency and Nurse Advancement.” This legislation advances a responsible approach to transparency and accountability for patient care staffing in hospitals and advances the practice of nursing through the design of academic pathways in support of the goals of the Massachusetts Action Coalition (MAAC) to ensure that 95% of all registered nurses in the workforce have obtained a baccalaureate degree in nursing by 2030.

Section 1 of HB1186 creates state-vetted transparency for patient care staffing plans and requires the public reporting of nurse-sensitive patient outcome measures. When it comes to measures of patient care staffing and quality, Massachusetts hospitals have already gone beyond any public reporting required by state and federal authorities. In 2006, Massachusetts hospitals implemented a first-in-the –nation effort to provide public transparency about patient care staffing – www.patientcarelink.org.

This public website provides a hospital-by-hospital account of staffing levels and measures of the quality of care. HB1186 would create state oversight of such reporting. This bill requires hospitals to report to DPH, on an annual basis, their staffing plans, which shall indicate the team of patient care professionals involved in the direct care for patients for certain units in hospitals. Such reports would be publically posted on DPH’s website. DPH is further directed to develop a process to collect, monitor and evaluate evidence-based, nurse-sensitive, clinical performance measures endorsed by the National Quality Forum that measure how well hospitals prevent pressure ulcers, patient falls, and falls with injury. Such information would be annually issued to the general public through hospital-specific and aggregated industry trend reporting.

Section 2 of HB1186 advances the practice of nursing by establishing a commission to design academic pathways and necessary supports to advance 95% of all registered nurses in Massachusetts to the baccalaureate degree–level by nursing by 2030. The legislation is aligned with the efforts of the Massachusetts Action Coalition (MAAC) to achieve the Institute of Medicine’s (IOM) landmark recommendations included in the report entitled “The Future of Nursing: Leading Change, Advancing Health.” Among its key charges, the IOM report calls for transforming nursing practice through nurses practicing to the full extent of their education and training, and for transforming nursing education so that nurses achieve higher levels of education and training through an improved education system.

HB1186 directs the creation of a Special Commission on Nursing Education and Experience, to be jointly led by the Commissioner of Public Health and the Commissioner of Higher Education. This Commission is directed to make recommendations to advance the practice of nursing through the design of academic pathways and supports needed to ensure that 95% of licensed registered nurses (RNs) have attained a baccalaureate of science in nursing (BSN) degree by 2030.

To achieve these lofty goals, fundamental changes are needed, including: new competency-based curricula; seamless educational progression; more funding for accelerated programs, educational capacity building, and student diversity. HB1186 will establish important academic benchmarks for the commonwealth and help define the path necessary to successful attainment.

A key partner in this work will be the MAAC, a partnership of the MA Department of Higher Education (DHE) and the Organization of Nurse Leaders of MA, RI, NH, CT & VT (ONL), initiated in 2011 to put into action the IOM goals in Massachusetts. MAAC’s workgroups have been working on goals to advance academic progression and workforce diversity in nursing and increase employer engagement in these goals.

Research shows that strongest correlation between nurses and patient care outcomes is the education and experience level of the nurse. As the way healthcare is delivered continues to evolve in order to be most responsive to patient needs, one of the visions of the IOM report is that the nursing workforce will become better educated and more ready to take on new roles as care providers and leaders in health reform. To make this vision a reality, the report calls on all nurses, as well as other health care stakeholders, to set aside divisive debates and begin concerted action to increase the formal education of nurses. The Massachusetts Action Coalition is an important element of that effort.

While one union continues promote outdated and misguided proposals calling for forced mandatory nurse staffing ratios, at all times, in all hospitals via ballot question, this legislation would instead align with the goals of the reform effort in the commonwealth by promoting full transparency and accountability for patient care staffing. Under the bill, every member of the public would know how each respective unit of each hospital is staffed and they would be able to compare the quality of nurse staffing offered by each hospital. Policymakers could then rely on the facts of patient care outcomes – the most important measure of health care- not anecdotes advanced in support of a self-serving ballot proposal. This legislation will instead help enhance the visibility of patient care staffing data and bolster the academic preparedness of the Commonwealth’s nurses to contribute to the health of our patients, health systems and communities of care. MHA urges the committee to issue this bill a favorable report.