Editorial: Nurses need more support, but Question 1 is not the solution

  • Cooley Dickinson Hospital.

Published: 11/2/2018 6:00:08 PM

According to a new poll by WBUR, most Massachusetts voters are now opposed to a state ballot measure proposing to limit the number of patients assigned to registered nurses.

There is no more divisive issue on the ballot than Question 1, which if passed would set new nurse-to-patient ratios in hospitals. The latest poll reveals that 58 percent of voters plan to vote “no,” while 31 percent plan to vote “yes,” and 10 percent are undecided.

Our own editorial board has been similarly divided. The majority of us reject the mandated staffing measure backed by the Massachusetts Nurses Association, but others on the board support it. And the question has been raised as to whether the issue should even be on the ballot at all. But it is, so we will cast our votes. And most of us will vote “no.”

We know that burnout is all-too-common — many nurses are overworked and underpaid, and we hope that, whatever the outcome, Question 1 galvanizes hospital executives and nurses to work together to find better solutions. The nurses’ union should never have been put into the position of having to beg voters for better working conditions. But we do not believe Question 1, with its rigid nurse-to-patient ratios and unclear timeline, is that solution. We worry that Question 1’s one-size-fits-all mandate is unrealistic.

Delivering health care inside a hospital efficiently and effectively is just too complex and intimate a process to be governed by a rule book codified in a ballot booth by voters, many of whom very likely won’t have read the three-page “question.” Rather, many of us will be inclined to act on a gut feeling that more is better when one is in a hospital bed.

But there is no guarantee that this proposal will produce the desired result. What the nurses’ union has put on the table removes common sense from the process that decides who gets what care when and how. Not all nurses have the same level of experience, patients’ conditions improve and worsen, census and circumstances can change rapidly on a shift. Common sense and flexibility will outperform a referendum-mandated rule book.

California, the only other state in the country to try to legislate staffing levels at hospitals, still hasn’t proven 14 years later whether care has improved. According to the independent agency Massachusetts Health Policy Commission, which presented a potential cost impact analysis, “There was no systematic improvement in patient outcomes post-implementation of ratios.”

And after both sides of the question have spent millions of dollars and months of campaigning, we still don’t have enough neutral, trustworthy information to make an informed decision on a proposal that would change the entire state’s health care system — a system that is a huge part of our personal finances and the state economy, and most importantly, can have huge consequence in our personal lives.

Mandating staffing ratios comes at great expense. The Health Policy Commission estimated the overall financial impact of Question 1 at $676-$949 million annually — a number the MNA disputes. But whatever the cost, it will ripple through the health care system in terms of insurance premiums, state taxes and spending priorities — likely triggering unforeseen, unintended consequences. Not to mention, where would all those nurses come from? It’s not just a financial issue, it’s a staffing issue. Massachusetts has a shortage of approximately 1,200 nurses.

Making such a significant move in the absence of little more than trust-me, he-said-she-said talking points is dangerous and irresponsible. Rather, if we believe that our health care is important enough to legislate how hospitals operate, then we shouldn’t rush to enact a referendum mandate any more than we would want our nurses to rush our bedside care.

We’d prefer that this question be rejected in favor of the governor or Legislature appointing a blue-ribbon commission, representing all the major stakeholders — nurses, doctors, hospitals, patients and so on — to thoroughly study the merits or drawbacks of state-mandated nurse staffing.

Then we, as voters, or our elected lawmakers, will have something solid on which to base a decision, something beyond our own gut feelings, some reliable information about possible outcomes.

When in a hospital bed or emergency room, who doesn’t want the best health care possible? When we are that vulnerable, we all hope to be in the hands of competent, professional doctors and nurses who are not tired or pulled in too many directions.

We will vote “no” on Question 1. Instead, we should ask for a thoughtful, thorough analysis of the idea, so that if Massachusetts ultimately follows California’s lead, it will be with confidence we are doing what makes sense and is worth the costs, rather than something that just feels right in the moment.

Would you decide to have major surgery any less carefully?




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