Nurses, physicians and other caregivers know best what kind of care you need when you're in the hospital.

That's something on which everyone can agree. Caregivers on the front lines should have the authority to make the decisions about how to care for each of us. But, once again, a union that represents less than a quarter of all nurses in Massachusetts persists in lobbying for one-size-fits all, across-the-board care.

They would have Beacon Hill mandate a specific nurse-to-patient ratio at all times, 24/7. They would deny nurses the flexibility they need to meet each patient's varying and ever-changing needs and to adjust staffing to reflect the experience and training of individual nurses, How much sense does that make?

Not much, health-care experts say. There is no scientific data to support reducing care to a specific number. In fact, researchers at the University of Massachusetts in Worcester found that "at present there is no scientific evidence in the literature that would establish optimal nurse staffing ratios." In addition, according to a groundbreaking California study (California is the only state in the nation with mandated ratios), ratios in that state have not improved care and have caused reduced usage of other health-care professionals, including Licensed Practical Nurses (LPNs).If you've ever spent time in any hospital, you know this: Nurses on the front lines need the flexibility to respond where and when they are needed.

UMass researchers also pointed out the alarming costs associated with the government mandate. Some hospitals "would have faced very large cost increases, on a scale that could have put their continued financial viability at risk." Acute-care hospitals outside of Boston would see their registered nurse budget increase by 21.3 percent. Between Northeast Health System (Beverly and Addison Gilbert hospitals) and North Shore Medical Center (Salem and Union hospitals), that would mean a combined increase in operating costs of many millions of dollars annually.

The researchers wrote that their "conservative" estimates point to a devastating financial impact on the health-care system should the ratios become law. Others have estimated the statewide cost to be between $250 million and $500 million annually. The California Department of Health Services has estimated their actual costs to be as high as $1 billion!  With our state's health-care reform initiative off to a good start, is this the time to add hundreds of millions of dollars to our health-care costs?

As the UMass researchers noted, the real problem is the well-documented national nursing shortage. We need to train more nurses and attract more experienced nurses to faculty positions. Last year, North Shore Community College and Salem State College were forced to turn away more than 500 potential nursing students due to a lack of faculty. With such tight staffing, mandated nursing ratios would simply force local hospitals to compete for staff in the same limited-supply marketplace.

Fortunately, programs to promote nursing education are a major feature of a compromise piece of legislation — Sen. Richard Moore's Patient Safety Act (S1244). This bill would provide scholarship money for nurses and would bolster faculty at our local nursing schools. Moore's bill also puts staffing decisions where they belong — in the hands of nurses and nurse managers. But it is also tough on hospitals. Moore's bill would eliminate mandatory overtime for nurses and limit the number of hours a nurse could work. It would require the public posting of nurse staffing plans — something that Northeast Health System and North Shore Medical Center are already doing voluntarily. The legislation would also mandate the reporting of nursing care quality at hospitals, and impose stiff fines if hospitals fail to live up to the requirements.

If enacted, Sen. Moore's bill would be the toughest nurse staffing legislation in the country. It is endorsed by Massachusetts hospitals and nurse leaders, the American Nurses Association and the Massachusetts Association of Registered Nurses. Nurse staffing ratio decisions should be based on good public policy. We ask our legislators to understand what's at stake and make the right decision for patients, nurses, hospitals, and the commonwealth's health-care system.

STEPHEN R. LAVERTY, CEO
Northeast Health System
Beverly

ROBERT G. NORTON, President and CEO
North Shore Medical Center
Salem