4 Critical Priorities for the Healey Administration from the 25,000 Nurses and Healthcare Professionals of the Massachusetts Nurses Association

CANTON, Mass., Dec. 20, 2022 /PRNewswire/ -- The nurses and healthcare professionals of the Massachusetts Nurses Association have released four critical priorities as part of an effort to encourage the incoming administration of Governor-elect Maura Healey to join them in ensuring patients have access to safe, high-quality care regardless of patients' unique medical needs, demographics, or geography.

"The Massachusetts Nurses Association endorsed Maura Healey for Governor because she is a true champion for workers and workers' families," said Katie Murphy, ICU RN, and president of the MNA. "She has always had an open door for frontline healthcare workers. She actively listens to our concerns, empathizes with the challenges we face, and works hard to help nurses and healthcare professionals provide quality care for our patients."

"In that spirit of ongoing cooperation, we invite Governor-elect Healey to join us in adopting these four critical priorities when she takes office," Murphy said. "The COVID-19 pandemic has exposed the existing fault lines in our broken healthcare system. Now is the time to make lasting, structural improvements that will benefit patients, caregivers, and all our communities. As we look forward, it is essential nurses and other healthcare professionals who provide direct patient care and support are empowered to be the problem solvers, rather than relying on strategies proposed by the very industry executives who seeded the ground for today's crisis."

1.      Protecting Healthcare Access

Since 2009, more than 30 hospitals or units have closed in Massachusetts, according to a review of public records. In most cases, they closed even though the Department of Public Health examined the closure's impact and deemed the services "necessary for preserving access and health status in a particular service area." Hospitals make millions of dollars from DPH licenses. The state should ensure they provide necessary services, especially where closures have a disproportionately negative effect on vulnerable minoritized and under-resourced communities. These closures have hit mental health, pediatric and maternity services especially hard.

In a White Paper published in March 2021, the MNA's Congress on Nursing Practice called for a moratorium on any further closure or reduction in maternity services including midwifery services in the Commonwealth. Since then, Beth Israel Lahey closed the North Shore Birth Center despite overwhelming community and caregiver opposition.

"The Massachusetts Nurses Association identifies access to reproductive care, including maternity and birth-related services, as essential to racial and social justice," members of the Congress on Nursing Practice wrote in the MNA white paper. "Unfortunately, due to the state's lack of any viable regulatory authority to protect these and other public health services, and a privatized health care system that values a market-based health care model over its mandate of ensuring the communities it serves the full spectrum of health services, including maternity care, too many families are seeing their access to these services curtailed, placing both mother and newborns at unnecessary risk, particularly those living in poorer communities and communities of color."

Recent maternity service closures in Massachusetts:

• Beth Israel Lahey closed the North Shore Birth Center in Beverly in December 2022 despite overwhelming patient and community opposition.
• Southcoast Health closed the maternity unit at Tobey Hospital in Wareham in December 2019, forcing families to travel to an already overcrowded maternity unit at St. Luke's Hospital in New Bedford or further away.
• Cape Cod Healthcare closed maternity and pediatric services at Falmouth Hospital in 2020 and then announced it was cutting back midwife services.
• Holyoke Medical Center closed its entire maternity ward and an affiliated midwifery practice in the fall of 2020.
• Steward Healthcare closed the Morton Hospital maternity unit in 2018, following its closure of pediatric services. The closure especially impacted marginalized groups that were forced to travel long distances for the same type of care, including to Good Samaritan Hospital in Brockton. There were reports of patients giving birth on the way to another hospital with the help of emergency services personnel.
• Harrington Hospital closed its obstetrics department in 2017.

Closures or proposed closures of mental health services in Massachusetts:

• All (22) mental health beds at Baystate Franklin Medical Center in Greenfield.
• All (28) mental health beds at Baystate Wing Hospital in Palmer.
• All (20) mental health beds at Baystate Noble Hospital in Westfield.
• The three above proposed closures are part of an ongoing plan by Baystate Health to open a for-profit mental health facility in Holyoke.
• In 2020, Trinity Health closed 74 child and adult mental health beds at Providence Behavioral Health Hospital. These included at the time the only child mental health beds from New York to Worcester.
• Norwood Hospital: Flooding caused a closure of the hospital in June 2020. Reopening plans do not include a replacement for the hospital's mental health unit.
• In 2021, Good Samaritan Medical Center announced plans to permanently close its inpatient detox unit, located in Foxborough. DPH found it to be an essential service, and the company then issued notice that it was closing anyway.
• In 2017, UMass Memorial Medical Center closed 13 psychiatric beds and then opened with US HealthVest a standalone for-profit mental health hospital.
• Vibra Hospital in Springfield, a psychiatric facility, nursing home behavioral health unit and a long-term, acute care services, closed in 2017.
• The state closed 125 of 170 beds at Taunton State Hospital in 2012.
• Westborough State Hospital, a mental health facility, closed completely in 2010.
• In 2010, UMass Health Alliance Burbank Campus closed a 15-bed inpatient psychiatric unit.
• In 2009, Cambridge Health Alliance closed 60 of 127 mental health beds at Whidden Memorial Hospital.

The MNA has called on the legislature to take significant action in this area, and encourages Governor-elect Healey to support its legislation:

An Act Relative to the Closing of Hospital Essential Services will:

• Extend the official notice period to the DPH in advance of a closure or discontinuation of health services.
• Require any hospital proposing closure or discontinuation of health services to provide evidence of having notified and provided the opportunity for comment from affected municipalities before the notification period begins.
• Instruct the Attorney General to seek an injunction to maintain the essential services for the duration of the notice period.
• Prohibit the hospital from eligibility for an application for licensure or expansion for a period of three years from the date the service is discontinued, or until the essential health service is restored, or until such time as the DPH is satisfied with a modified plan.
• Prohibit the closure of beds, units, or facilities during any declared state of emergency pertaining to health care.

The Hospital Essential Service Accessibility Act will:

• Require the Department of Public Health in consultation with the Health Policy Commission to commission a study analyzing and delineating the existing cadre of services provided by the state's acute care medical and psychiatric hospitals based on the need for those services in all regions of the Commonwealth, with recommendations as how to ensure access to those services.

"By allowing these closures, our public health system demonstrates to already vulnerable and marginalized groups that their interests do not matter," Murphy said. "The Commonwealth must put patient and community needs at the forefront of this decision-making process."

2.      Addressing the Hospital Staffing Crisis

The hospital staffing crisis is often described by healthcare executives as if a black hole suddenly emerged during the pandemic and nurses started disappearing. We know empirically this is not true. For example, according to the Board of Registration in Nursing, the number of registered nurses in Massachusetts went from 119,626 in June 2019 to 148,518 in February 2022. Massachusetts is gaining nurses but losing them at the bedside because of the exploitative conditions they face.

According to the 2022 State of Nursing in Massachusetts survey, more than 8 in 10 registered nurses said the quality of patient care in hospitals had gotten significantly worse over the previous two years as they described being emotionally exhausted, increasingly disengaged and more likely to leave the profession or reduce their hours.

"I have never seen nurses so demoralized by conditions at the bedside and how difficult it is to provide the kind of care our patients deserve," Murphy said. "The coronavirus has made it even harder to be a healthcare professional dedicated to safe patient care, but the pandemic alone did not create these problems. For many years, healthcare executives have focused relentlessly on profits, executive pay, and expansion at the expense of maintaining necessary community-based services and making sustainable investments in frontline staff and patient care quality."

Tackling the hospital staffing crisis will require a multi-pronged approach. The MNA has proposed solutions in several areas to help address the underlying problems and looks forward to overcoming these challenges and future issues as they arise with Governor-elect Healey:

Patient Limits and Staffing

• For decades, the MNA has advocated for safe staffing levels and enforceable patient limits at the local, state, and national level. The impact of how many patients a nurse is assigned at one time is one of the most studied topics in healthcare. Voluminous peer-reviewed evidence shows maintaining a safe patient limit helps shield nurses from burnout and protects the quality of patient care.
• In the 2023-2024 legislative term, the MNA is putting forward An Act Relative to Patient Safety and Frontline Nurse Retention. This bill would require a limit on the number of patients a nurse can care for at one time. Limits would be set by unit and determined by the Department of Public Health following a series of public hearings.
• The MNA calls for the restoration of regulations on the use and distribution of temporary agency staff. MNA nurses and healthcare professionals are concerned healthcare executives are using this crisis as a rationale for pursuing failed strategies to replace nurses with lesser qualified unlicensed staff. We saw the same failed policies implemented in response to a similar crisis in the 1990s with devastating consequences for patients in our acute care hospitals.
• The government and industry must listen to frontline healthcare workers on the solutions to the staffing crisis and not simply adopt the strategies put forward by the very industry that continues to create the environments that lead to repetitive crises.
• The current staffing crisis and others were created by healthcare leaders. The solutions to retention and recruitment therefore should rest with those on the front lines.
• Failure to center front line healthcare workers inevitably leads to healthcare leaders hiring consultants who then propose "new models of patient care delivery" that ignore or even make worse the problems that lead to these crises. Seeking solutions from those who create the problem environment is an invitation for failure.

Workplace Violence Prevention

• Earlier this year, Massachusetts lawmakers recommended that legislation filed on behalf of the MNA – An Act requiring health care employers to develop and implement programs to prevent workplace violence – be passed favorably out of committee and sent to House Ways and Means. The House bill was very similar to Senate legislation bearing the same name that lawmakers advanced to the Senate Ways and Means committee on March 31. The MNA will be filing similar legislation for the 2023-2024 legislative term.
• In the 2022 State of Nursing in Massachusetts, nurses said they were increasingly concerned about workplace violence. There was an 11-point uptick in nurses calling violence a "major challenge" from 2021 to 2022 and a 16-point increase from 2019. 38% of nurses said workplace violence was such a challenge that it would impact their decision to leave the profession sooner.
• An April 2022 survey by National Nurses United found a 119% increase in reports of violence from nurses between March 2021 to March 2022.
• On average, 44 workplace homicides to private healthcare workers occurred each year from 2016 through 2020, according to the Bureau of Labor Statistics.
• Nurses and nurses' aides are assaulted more than police officers and prison guards, according to a 2017 OSHA report.

Enforcement of the Mandatory Overtime Law

Despite a law against mandatory overtime for nurses in Massachusetts, every year hundreds of nurses are required to work overtime by hospitals because of sick callouts and other issues that clearly do not rise to the level of an emergency or catastrophe. The MNA at the local and state level is pushing back against this violation of the law and its exploitation of nurses.

• Gov. Deval Patrick signed into law a ban on mandatory overtime for Massachusetts nurses in August 2012. The law prohibits mandatory overtime, which is defined as "any hours worked by a nurse in a hospital setting to deliver patient care beyond the predetermined and regularly scheduled number of hours that the hospital and nurse have agreed that the employee shall work, provided that in no case shall such predetermined and regularly scheduled number of hours exceed 12 hours in any given 24 hour period."
• The law explicitly states, "Mandatory overtime shall not be used as a practice for providing appropriate staffing for the level of patient care required."
• Health Policy Commission guidelines issued in 2013 further clarified the legal exceptions under which hospitals can use mandatory overtime for nurses. There are only three exceptions: a government-declared emergency, a catastrophic event such as a natural disaster and a hospital emergency.
• HPC explicitly says, "A hospital emergency shall not include a situation that is the result of routine staffing needs caused by typical staffing patterns, expected levels of absenteeism, or time off typically approved by the hospital for vacation, holidays, sick leave, and personal leave."

"Mandatory overtime erodes the morale of nurses and jeopardizes patient safety," Murphy said. "By routinely failing to schedule enough nurses and forcing nurses to work past the end of their shifts, hospital executives are making it even more difficult for exhausted, overworked nurses to provide the best care for patients."

3.      Investing in Public Healthcare Services

Public services are the foundation of our healthcare system. These state facilities and services ensure our most vulnerable residents have access to essential care. For public healthcare to work, the state needs to be able to recruit and retain nurses and other healthcare workers. This means providing a competitive wage, strong benefits, and positive working conditions.

"We encourage the new administration to invest in public healthcare services and forego the previous administration's efforts to privatize public services," Murphy said. "Privatization has proven disastrous for the quality and safety of patient care provided and the failure to constrain costs."

• The state closed more than 200 public mental health beds during the Gov. Deval Patrick administration.
• The Department of Mental Health's allotment of beds, both in number and geography is based entirely on the DMH's attempt to provide services based on limited funding driven by political not clinical decisions.
• We face a 40% or higher vacancy rate at many state-operated facilities.
• Many of the state's current beds are operated by for-profit providers with a history of providing substandard care. For example, Arbour Health System has been ordered in the past by DMH to take immediate corrective action on "significant patient care and life safety violations" at four facilities. The company was also the target of a U.S. Justice Department billing fraud investigation in Massachusetts.

4.      Eliminating Healthcare Inequities

In January 2021, the MNA announced an organization-wide effort to educate and mobilize its membership to confront structural racism and its impact on the nursing/health professions, the health care workplace and in the broader society. The MNA encourages Governor-elect Healey and all relevant stakeholders to join us and other equity minded groups in this ongoing effort.

The MNA's initiative is summarized in its Anti-Racism Position Statement, developed by its Diversity Committee. The statement, which provides a detailed rationale for the campaign as well as a series of recommendations to be undertaken to address the issue, was approved by the Board of Directors at the end of 2020.

"As the pandemic evolved in the U.S. it revealed that African American, Black, Latino(a), and Native American communities were more likely to contract the COVID-19 virus and were also more likely to die from complications resulting from the virus (Yancy, 2020; The Joint Commission, n.d.; Office of the Attorney General, 2020). These health disparities, while shocking in the moment, are unfortunately not new," according to the MNA statement on anti-racism. "Research has consistently shown that minoritized groups/people of color, indigenous people and individuals in vulnerable communities have greater difficulty accessing needed health care services, are more likely to be uninsured, and are overrepresented in publicly-funded health systems."

The document concludes with a list of recommended actions to be undertaken, including:

• Development of educational programs for nurses on these issues.
• The establishment of a process for nurses and union members to report and document instances of racial discrimination, along with mechanisms within the union to address these violations.
• The creation of an electronic library of resources for nurses and union members to access regarding these issues.
• The establishment of relationships and participation with other groups and activists working on addressing these issues.

"We believe it is vital that we do our part to educate and mobilize our members to both understand and begin to more aggressively address the crisis that is racism," Murphy said. "We also know it will take a multitude of government and community stakeholders to eliminate inequities in the healthcare system. We look forward to building those relationships and doing this important work for the common good."

Healey's History of Support for Front-Line Nurses and Healthcare Professionals

Governor-elect Maura Healey, the daughter of a union nurse, has long been a supporter of MNA nurses and healthcare professionals. She was the keynote speaker at the MNA Labor Leader Summit in 2016, was an early and stalwart ally of St. Vincent Hospital nurses during their historic 2021 strike, and as Attorney General has worked closely with the MNA and its members through the Policy & Government Relations Division, the Health Care and Fair Competition Bureau, and the Fair Labor Division on a variety of issues.

Healey also strongly supports workers' collective bargaining rights. When the U.S. Supreme Court opened the door to "right to work" status for public employees, Healey ensured workers were fully protected under Massachusetts law, declaring in July 2018, "My office will always act to protect working families, ensure safe working conditions, and defend the right of workers to organize." Healey has also fought for greater transparency in situations where employers hire third-party anti-union contractors.

Healey has a strong record of opposition to hospital consolidation when it would increase costs or compromise quality. She released a report on how the proposed Mass General Brigham expansion would drive up costs – an expansion that the MNA also opposed as part of a coalition to protect community care. In addition, Healey opposed the proposed merger between then Partners Healthcare and South Shore Hospital in 2015.

When the COVID-19 pandemic struck Massachusetts, Healey was quick to act, helping coordinate resources for frontline healthcare workers and first responders including personal protective equipment guidance, priority testing, alternative housing options, free and discounted meals, self-care and emergency childcare.

Healey has also been a powerful advocate for equality, before and during her time as Attorney General. She brought the first successful challenge to the anti-LGBTQ+ Defense of Marriage Act, and has worked to fight bullying in schools, protect women's rights to accessible, reproductive healthcare, and combat discrimination in lending and housing. Healey has advocated for legislation to protect transgender people from discrimination in public places, a campaign that MNA nurses and healthcare professionals joined as well.

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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

SOURCE Massachusetts Nurses Association