1. Massachusetts Nurses Association Prepared by Opinion Dynamics Corporation June 2003 The State of Nursing: 2003

2. Which of the following best describes your current work situation? Q1 Provide direct patient care outside a hospital setting Staff nurse providing direct patient care at a teaching hospital Staff nurse providing direct patient care at a community hospital Work in health care outside the direct patient care area I am not currently working but might return to some job at some point Work at a teaching hospital but do not provide acute care Work at a community hospital but do not provide direct patient care Employed, but do not work in the health care area at all

3. Q2 Do you currently belong to the Massachusetts Nurses Association?

4. Q3 How many years have you been working as a nurse?

5. Q8 What is the most rewarding or positive thing about your current job? For the patients/Rewarding to help/Care 73% Staff contact/Team attitude 7 Job/Schedule flexibility 7 Pay 4 Teaching staff/Mentoring 4 Independence/Autonomy 3 Nothing - Other 4 (Not sure) 2 (Refused) 1

6. Q9 What is the biggest problem or negative thing you face in doing your job? Staffing/Short staffing/Shortages31% Paperwork/Reimbursement/Insurance12 Management – lack of respect/support11 Politics/Staff conflict – peers, physicians 9 Time/Not enough time 7 Workload 6 Bad scheduling/Long hours/Mandatory overtime 5 Pay/Benefits 4 Cutbacks/Financial resources 4 Stress/Too much responsibility 3 Nothing 3 Other 5 (Not sure) 5

7. Do feel that the amount of paperwork you do on an average shift: Q10 Not sure Is a burden but probably can't be reduced safely Is not really that much of a burden Is unnecessarily burdensome and could be reduced

8. Q11 At any time in your nursing career have you been employed as a staff nurse providing direct patient care in a hospital setting?

9. Q63 (Acute care nurses): Have you considered leaving direct patient care at the bedside?

10. Q12 What is the reason that you decided to stop practicing direct patient care in a hospital setting? Short staffed/Too many patients21% Better career opportunity/Promotion20 The long hours/Bad schedule/Mandatory overtime19 Personal reasons – raise family, home life12 Wanted different atmosphere/setting10 Injury/Age/Health reasons 8 Stress level/Burnout 6 Money/Benefits 5 Other 3 (Not sure) 1 (Refused) 2

11. Q13 What is the reason why you never decided to practice direct patient care in a hospital setting? Prefer long term care31% Working conditions23 Not enough experience15 Other23 (Not sure) 8

12. Q20,15,17,19,22,21 Do you agree or disagree with the following statements? RNs are burned out with high patient loads. Registered nurses working in hospital units have to care for too many patients. Managers schedule too few nurses per shift. Legal liabilities in case of error are too risky. Hospital managers float registered nurses without appropriate training and orientation. Hospital finances are not properly being spent on patient care.

13. Q18,16,23,24,14 Do you agree or disagree with the following statements? Working conditions in hospitals are brutal to nurses. Dealing with sick people wears you out after awhile. Hospital managers assign mandatory overtime instead of staffing properly. Hospital managers assign traditional nursing duties to non- nurses instead of hiring registered nurses. An RN can make more money in areas other than in acute care.

14. Q36,32,30,31,39,33 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". Fewer young people are choosing nursing as a career. The acute care units are understaffed and nurses working in acute care are forced to care for too many patients. Registered nurses are too often floated from one unit to another without appropriate training and orientation. RNs are forced to work mandatory overtime. Liability and malpractice lawsuits. Low pay.

15. Q38,35,37,40,34 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". Managers assign traditional nursing duties to non-nurses instead of hiring registered nurses. Managers rarely implement recommendations made by staff nurses regarding patient care. Physicians are disrespectful of registered nurses. Board of Registration does not take an active role in protecting the public's health. Workplace violence.

16. Q41 Which one of the above problems do you think is the most serious problem facing the nursing profession today? Fewer young people are choosing nursing as a career. The acute care units are understaffed and nurses working in acute care are forced to care for too many patients. Registered nurses are too often floated from one unit to another without appropriate training and orientation. RNs are forced to work mandatory overtime. Liability and malpractice lawsuits. Low pay.

17. Q42 The Massachusetts Legislature is considering a bill that would require hospitals to adequately staff acute care facilities and limit the number of patients an RN would need to care for at one time by setting minimum registered nurse-to-patient ratios. Would you favor or oppose the Legislature passing such a bill? 86% Favor

18. Q43 (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?

19. Q44 What other factor(s) would encourage you to practice direct patient care? Better hours/Scheduling/No mandatory OT21% Better pay/Benefits21 Retraining back to the workforce19 Refresher courses19 More staff/Better patient-nurse ratio14 If management listened 5 Age/Health 3 Nothing 2 Other 7 (Not sure)13 (Refused) 2

20. Q50,51,52,53,45 Nurses not having enough time to comfort and assist patients and their families Nurses not having enough time to educate patients and their families Patients having to wait for long periods of time for their medication and medical procedures The frequency of medical errors, such as improper medication or dosages Complications or other problems for a patient Are you aware of any incidents in Massachusetts hospitals that a registered nurse having to care for too many patients has led to...

21. Q48,47,46,49 Re-admission of a patient Injury or harm to patients Longer hospital stays Mortality for patients Are you aware of any incidents in Massachusetts hospitals that a registered nurse having to care for too many patients has led to...

22. Q28 Which of these statements about health care coverage is closer to your opinion: Not sure It is the responsibility of the government to ensure that every citizen has access to health care It is NOT the responsibility of the government to ensure that every citizen has access to healthcare

23. Q29 And which of these is closer to your opinion: Not sure The health care system in Massachusetts has real problems and is in need of a major overhaul The health care system in Massachusetts could use some minor changes, but overall it is in pretty good shape

24. Q25 Let's talk briefly about health care more generally. Please rate the quality of health care that you think most hospitals in Massachusetts deliver to patients. Is it:

25. Q26 Do you think the overall quality of health care in Massachusetts hospitals has gotten better, worse or stayed the same in the past 5 years?

26. Q27 Looking towards the future, in 5 years do you expect the overall quality of health care in Massachusetts to be better, worse or the same as it is now?