Massachusetts Nursing Ballot Question is Bad for Our Health

Author: Louis J. Woolf

The Massachusetts Nurses Association— a labor union representing less than 25% of professional nurses— has petitioned the State Legislature to place a question on the ballot in November that would mandate nurse to patient ratios that hospitals would have to meet if it passes. On the face of it—sounds like a good idea. Who isn’t for greater patient safety? But take a closer look, and I know you’ll agree that it’s not such a great idea after all. In fact, it’s a very bad idea and nurses themselves don’t all agree that this is the best way to optimize patient care and safety.

Health care decisions should be made by health care professionals.

The American Nurses Association of Massachusetts and the Organization of Nurse Leaders oppose this ballot question because it strips decision-making power from nurses themselves. Our hospitals vary in size, specialize in different services, and serve different patient populations. Having the same staffing plan at every hospital, for every patient, at all times makes no sense and many nurses agree.

Health care teams need – and want – the ability to determine the best staff levels required to care for their patients and to adapt to different circumstances. And making that call is about more than a number. It requires flexibility.

For example, a new nurse may need support from a more experienced nurse. A fixed ratio would discourage “teaming up,” effectively eliminating an important opportunity for collaboration and training that benefits both nurse and patient.  An experienced nurse is generally well-equipped to balance their own patients’ care with helping out a less experienced colleague.

This mandate will negatively impact access to emergency rooms, delay needed patient transfers from community hospitals to trauma centers, and delay or eliminate elective surgeries.

It may seem counter-intuitive that mandating more nurses could have a negative impact on patient care, but consider the following repercussions.

A mandate could dramatically increase emergency room wait times and delay other life saving services.  The law would prevent hospitals from making essential and last-minute changes, even in the event of an unexpected influx of patients.

Imagine a hospital faces an emergency due to a multi-car crash, large fire, or shooting incident. Will patients have to wait in the ER because the nurse/patient ratio is disrupted—even though resources could safely be diverted from stable patients to care for an influx of critically ill or injured patients? Even worse, a hospital could be forced to send patients to other hospitals, or turn them away.

 When it comes to scheduling surgery, nurses currently have autonomy to review their assignments and accommodate surgeries based on complex decisions only they can make. They can consider acuity, the experience of the team, and the timing of surgeries to ensure each patient receives the best care. With this mandate, surgeries could be unnecessarily delayed or canceled.

And finally here is another example of how ratios can place an unnecessary burden on hospitals, and it hits especially close to home for me. This past March we experienced back-to-back nor’easters. Hebrew Rehabilitation Center teams rallied together to make sure our patients were well taken care of during the storms. When blizzard conditions make traveling difficult, we don’t always have full staffing.  Yet as a team, our nurses determined where we needed critical resources and utilized other team members to support the nurses. And, the outcome was excellent. With this law we, and other hospitals, could face penalties if enough nurses are unable to report to work under severe weather conditions.

This mandate will cost close to a billion dollars every year, and take funding away from vital services like mental health care.

If this measure passes, it would take away funding from other important health care services. Hospitals would have to follow these regulations at all times, and would suffer severe financial penalties if they fail to do so.

In a recent Globe article a top leader at a community hospital stated his hospital would be forced to hire up to 63 additional nurses putting the funding of critical programs in jeopardy. In some cases this mandate would even force some financially vulnerable community hospitals to close completely.

Many Massachusetts families are already struggling to pay for health care. This proposal will drive costs up even more.

Higher costs will be felt across our state’s health care system if this bill is passed. The additional costs will ultimately be passed on to you and local businesses in the form of higher insurance premiums, copays, deductibles, and taxes.

Congress has already begun to talk about cutting Social Security, Medicare and Medicaid to pay for the new tax bill. Federal cutbacks and this staffing mandate will put new financial burdens on families that cannot afford it.

I urge you to carefully consider what a yes vote on this question will really mean for patients if it passes. Many of us who have devoted our careers to providing the best quality health care in Massachusetts have grave concerns on what passage of this bill would mean for the health of residents of our Commonwealth. I urge you to vote NO.

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About Louis J. Woolf

President and Chief Executive Officer, Hebrew SeniorLife

Louis J. Woolf is president and CEO of Harvard Medical School-affiliate Hebrew SeniorLife, an integrated system of health care, senior living, research, and teaching that serves more than 3,000 Greater Boston seniors each day and is committed to redefining the...

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