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Question 1: Even nurses are divided on mandated patient ratios

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  • Julia Lynch, left, and Molly Moody. PROVIDED PHOTOS



Staff Writer
Monday, November 05, 2018

Question 1, a ballot question about registered nurse-to-patient staffing ratios in Massachusetts hospitals, has sparked a lot of debate over the past few months. These two nurses, Julia Lynch and Molly Moody, told the Gazette why they’re voting for and against the ballot measure. 

Julia Lynch

Julia Lynch, a registered nurse at Cooley Dickinson Hospital, transitioned into nursing from a successful career in communications because she wanted to help people and make a difference in her community. If Question 1 doesn’t pass, Lynch is afraid she won’t be able to effectively do her job.

“I support it. It boils down to being able to take care of sick people the best you can and give the best attention to anyone in need,” Lynch said.

Depending on the day, Lynch, 53, works on the telemetry, cardiac, and medical-surgical floors. She has a master’s degree in history from Smith College and left her job at The Williston Northampton School in Easthampton at age 40 to go back to school at Springfield Technical Community College for a two-year associate’s degree in nursing. It’s a calling she finds fulfilling.

“I like the clinical part. I like the problem-solving, and this will sound cheesy, but I feel like it’s our duty to witness humanity. You see the whole breadth of humanity,” Lynch said. “It’s a basic human right to be cared for.”

If today’s ballot question passes, hospitals would be required by law to limit the number of patients a nurse can care for at one time.ucing medical errors.

Within the medical field, Lynch said that one of her concerns is medical errors. A 2016 study by researchers at Johns Hopkins Medicine estimated there are 250,000 deaths per year due to medical errors in the United States — the third leading cause of death in the nation. She noted that nurses sometimes make medical errors when they have too many patients.

Over the past several months, Lynch says that those opposed to the bill have taken a “scorched earth” approach by presenting worst-case scenarios as a scare tactic. 

And while there will be costs associated with hiring more nurses — more staffing will be required in order to ensure compliance — Lynch says hospitals have enough money to absorb the increases. One practical way to offset the costs might be to decrease the salaries of hospital executives, she continued.

Over the past decade, Lynch has worked in critical care at Berkshire Medical Center in Pittsfield, hospice at the Northampton-based Visiting Nurse Association and on a medical surgical unit at Baystate Medical Center in Springfield.

Nursing is demanding mentally, emotionally and physically, she says.

“You get hit. You’re in all kinds of situations,” she continued. “How many people have jobs where they cry because they’ve been stretched too thin? Nurses are tough.”

These days, she works three or four 12-hour shifts per week at Cooley Dickinson, a unionized hospital, and is usually responsible for about four or five patients — less than she’s had in past jobs. At Baystate Medical Center, Lynch says she was sometimes responsible for six to seven patients during the busy winter season.

Typically, Lynch arrives 30 minutes before her shift is set to start to familiarize herself with her patients’ charts and prepare for the day, she says. She clocks in 10 minutes before the beginning of her shift and hits the ground running — checking in with the nurse from the previous shift, visiting each patient, preparing medication.

Between documenting vital signs, administering medication, updating online patient charts, cleaning up vomit, stabilizing emergency medical situations and responding to alarm bells, “it can be like a game of whack-a-mole,” Lynch said.

Sometimes, Lynch says her efforts feel futile because she doesn’t have enough time to sit down with her patients and find out what’s really going on with them. As an example, Lynch says there are some patients who “cycle through the system and no one takes the time to talk to them about their expectations or goals.” They leave the hospital with their symptoms treated only to return a short while later in worse condition.

“You end your day sometimes wishing you had been able to provide better care. Sometimes you feel like you’re set up for failure,” Lynch said.

While not everyone is a nurse, everyone will eventually end up in a hospital, Lynch says. And when they do, Question 1, and the quality of care they receive, will be relevant. Regardless of whether or not the question passes, though, Lynch says she’ll show up and work for the foreseeable future.

“I remember a nursing professor of mine said ‘nursing is a delicate privilege,’ ” Lynch said. “It’s a privilege to take care of another human being.”

Molly Moody

Molly Moody, a psychiatric nurse and assistant nurse manager at Baystate Noble Hospital in Westfield, always knew she wanted to be a nurse: Her mother, stepmother and aunt were all nurses, and now two of her five siblings are also in the field.

“I pretty much grew up in hospital hallways,” said Moody.

At the ballot box today, Moody says she’ll vote against Question 1, because if it passes, it could limit her ability to care for patients, she says.

“This is an ill-advised ballot question. It was painted with much too broad strokes,” Moody said. “I think this will impact more people than the bill anticipated.”

Moody, 27, who lives in Westfield, went to Springfield Technical Community College for an associate’s degree in nursing and then Elms College in Chicopee for a bachelor’s degree in nursing.

At the time, she was working as an emergency room technician, and “I immediately went into the emergency room at Noble Hospital,” Moody said. “My passion was the patients who were so critically ill that something tragic would happen to them if we didn’t do something. That’s what drove me to emergency room nursing.”

While in the emergency department, Moody was responsible for four to five patients at any given time. She became a charge nurse — the nurse in charge of scheduling and managing the ward — a short while later, and more recently transitioned into psychiatric nursing.

These days, Moody works eight-hour shifts Monday through Friday on the Westfield hospital’s psych unit. She is responsible for handling any problems that arise on the unit, such as deciding the best approach to care for challenging patients and completing administrative paperwork. She also makes hourly schedules, goes on rounds with doctors, conducts staff reviews and hires new nurses.

If the bill passes, Moody fears the state-mandated ratios could handcuff her ability to flex and adapt with the flow of incoming patients during a shift. Right now, Moody says she’s able to shuffle nurses around to meet ever-changing demands. But rigid quotas — which don’t take a given nurse’s level of experience or the variability of patients’ conditions into account — hinder her flexibility as a manager to make case-specific decisions. Instead, the hospital would have to employ more nurses to meet requirements.

“I would need to hire almost 10 nurses to keep my current (average) of over 600 per year patients,” Moody said, noting, “finding experienced nurses is a huge problem. Especially experienced psych nurses. In my whole nursing graduating class I knew one nurse who said ‘I want to work in psych.’ ”

If the bill were enacted, Moody says her unit would have to cut their patient intake roughly in half.

She predicted that hospitals across the state will see wait times increase and lose some services “because hospitals aren’t going to have the funds to keep those services open,” she said. “A lot of people wouldn’t want to travel to Springfield from Huntington or Blandford. To take those service away from them would be awful.”

A study released last month by the state Health Policy Commission estimates it would cost between $674 million and $949 million to implement the bill. That is much more than the $35 million to $47 million the Massachusetts Nurses Association estimated, but less than the $1.31 billion the Coalition to Protect Patient Safety, an anti-Question 1 group, recently estimated.

While Baystate Noble has better-than-average staffing ratios, Moody says, for some nurses stretched thin by long hours caring for a lot of patients in other hospitals, the bill might seem like a solution to their frustrations.

“I’ve heard a lot of ‘this bill isn’t perfect but it’s a start,’ ” Moody said. But, she added, the bill is not the beginning of an iterative process, it creates a set-in-stone mandate that, once passed, will be impossible to walk back. “This bill will be incredibly detrimental,” she said.

Personally, Moody finds a lot of fulfillment in her job.

“A patient comes to my unit at their worst. And over the course of seven to nine days, we get to see them as they really are, not someone defined by their illness,” she said.

State-mandated staffing ratios could change her ability to help patients get better, she said.

“I’m worried about making the care even harder to receive — that some of these really ill patients will end up in police stations instead of a psych hospital where they really need to be,” Moody said.