Haas, Horton, Perry & Ouellette: Here’s why we’re voting ‘no’ on Question 1

  • A large “NO on 1”€ sign at a private residence across High Street from the Baystate Franklin Medical Center, Oct. 24, 2018. GAZETTE FILE PHOTO/PAUL FRANZ

Published: 11/1/2018 8:36:47 AM
Here’s why we’re voting ‘no’ on Question 1.

Little has been said about the impact of Question 1 on inpatient psychiatry units in the Massachusetts. The mandated round-the-clock 5:1 nursing ratio in psychiatry ignores two important facts. Inpatient psychiatric care is less dependent on nurses than other inpatient settings. In one of our psych units, the daytime direct care nursing ratio is 7:1. However when you add the occupational therapists, social workers and mental health counselors who conduct groups and meet with patients and families, that ratio is 2:1.

Question 1 discounts the critical contribution of all disciplines who are part of the psychiatric care team. Secondly, psychiatric care is provided for the most part during waking hours. Whereas med/surg floors may have round-the-clock treatments and close monitoring, psychiatry RN staffing is reduced at night to the number required to process late admissions and care for the few patients who may not be able to sleep. Identical day and night RN ratios make no sense for treatment, nor for responsible fiscal management of scarce health care resources. The net effect of these ratios on inpatient psychiatry in Massachusetts would be devastating.

The Massachusetts Association of Behavioral Health Systems estimates Question 1 would require hiring over 900 nurses for inpatient psychiatry alone. Psych units would have to reduce their maximum census to comply with the ratio measure and avoid crippling fines, and some of the state’s private psychiatric hospitals predict they would need to close their doors altogether. The result would be a loss of over 1,000 inpatient adult and child psychiatry beds in the state.

Psychiatric boarding is already a critical problem for Massachusetts emergency departments across the state. These psychiatry bed closures would have a ripple effect negatively impacting access to care in emergency rooms for all patients. The nursing shortage and RN staffing in Massachusetts are real issues requiring creative, collaborative solutions that bring together hospital nurse leaders, staff nurses and state regulatory bodies. Question 1 is not that solution. It is poorly conceived and has immediate unintended consequences that will do far more harm than good. We urge you to vote “no” on Question 1.

Matthew Haas, LICSW, Senior Director of Behavioral Health, Baystate Health

Robert Horton, RN, MSN, Nurse Manager, Inpatient Psychiatry, Baystate Medical Center

Melissa Perry, RN, Director of Behavioral Health Nursing, Holyoke Medical Center

Jacqueline Ouellette, RN, Director, Behavioral Health Unit, Cooley Dickinson Hospital

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