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Guest columnist Joanne Marqusee: Question 1’s unintended impacts



Friday, November 02, 2018

I moved to the Pioneer Valley nearly five years ago when I was hired as President and CEO of Cooley Dickinson. I take seriously the responsibility of ensuring Cooley Dickinson delivers quality patient care with a compassionate, human touch to this wonderful community.

Over my career, I’ve interacted with thousands of physicians, nurses and all members of the health care team. These people are caring, smart, hard-working and passionate about what they do. I am inspired and humbled by my colleagues every day.

On Election Day, Massachusetts residents will vote on Ballot Question 1. The intent of the ballot question — to ensure we have the nurses we need to care for patients — is a laudable one. However, the specifics of this ballot measure, with its rigid patient-to-nurse ratios, would not appropriately address that issue and would have many unintended, negative impacts.

I believe this proposed law would actually make patient care worse. The unintended consequences would significantly compromise how health care is provided throughout Massachusetts and compromise Cooley Dickinson’s ability to meet its mission: “to serve our patients and communities with exceptional, compassionate and personalized care.”

I am often asked, “Who wouldn’t want more nurses in the hospital?” We all want enough nurses to take care of us and our loved ones, as well as enough of all the other staff who are also important to patients’ experiences and outcomes. It is also critical that we have the appropriate staff elsewhere in our community where health care is provided, including at community-based health centers, mental health agencies, home care and hospice agencies, schools and more.

Question 1 sets rigid ratios for the number of patients a nurse can care for in the hospital. While the ratios are different for different kinds of units (e.g. a medical surgical unit versus Emergency Department), they are identical across all hospitals, regardless of hospital size, location, other staffing available or time of day.

Cooley Dickinson’s position against Question 1 in no way reflects a lack of support and respect for our nurse colleagues. In fact, this issue divides nurses across Massachusetts. A recent WBUR poll shows that nurses themselves are split over this question: 48 percent support the measure, 45 percent oppose it, 7 percent remained undecided. In addition, many organizations representing nurses, mental health providers and physicians, among others, oppose Question 1, including the Emergency Nurse Association, American Nurses Association and the Massachusetts Association of Colleges of Nursing.

Currently, Massachusetts has a shortage of about 1,200 nurses. Despite our recruitment efforts, there are typically about 20 open RN positions at Cooley Dickinson. According to the Health Policy Commission (HPC), an independent government agency charged with setting regulations for Question 1 should it pass, at least an additional 3,100 RNs would need to be hired by hospitals statewide to meet the ratios proposed in the ballot measure. Cooley Dickinson would need to hire at least 50 nurses (plus the current 20 vacancies). If we cannot recruit enough nurses, we would be forced to either close beds or break the law.

Like all hospitals, our volume varies greatly. To staff to a set ratio when we have such varying numbers of patients seeking help each day and each hour is not possible. Our staff collaborate daily to consider the patients’ needs on each unit and to determine the best staffing of nurses and other clinical and ancillary staff for that day.

If Question 1 passed, there would be days when we wouldn’t have enough nurses (and likely days we would have many more than the ballot measure calls for) to take care of the ever-changing number of patients in our care. If that happened, we would not be able to admit a patient waiting in the ED to an inpatient bed if we didn’t meet these pre-set ratios, even if in the judgment of the clinicians and managers working, that patient could be appropriately cared for. This would mean less access to care, both at Cooley and throughout the other organizations that provide care locally.

I encourage voters to read the Health Policy Commission’s report, which concluded that, in California, which has mandated ratios, “there was no systematic improvement in patient outcomes post-implementation.”

While not the only reason to oppose to this bill, the costs are significant. Statewide, Question 1 would cost $676-949 million each year (per the HPC). Cooley Dickinson, like many community hospitals, is at considerable risk. We would need to find between $6.5-9 million to cut elsewhere in our budget to meet the ballot question requirements. And these costs come without evidence that quality or outcomes would improve.

Working in health care is an honor and a great responsibility. At Cooley Dickinson, we are committed to meeting the health care needs of the community. If passed, Question 1 would have many unintended consequences, which would negatively impact access for our patients and cost millions of dollars. These additional costs would impact the depth and breadth of services we can provide, and, based on the research, such mandated ratios are unlikely to improve quality.

When you cast your vote on Nov. 6, I urge you to vote “no” on Question 1.

Joanne Marqusee is President/CEO of Cooley Dickinson in Northampton.