Three Reasons to Vote ‘No’ on Question 1

Because I’m a nurse, and I work in a hospital, I’m asked every day how I feel about Question 1.  I’m beyond concerned.  I’m scared—for patients and nurses—and I’m voting “No.”  Question 1 highlights an important topic, but it is a dangerous approach to something as vital as our healthcare.

Question 1 is confusing.  There are bedside nurses for and bedside nurses against. Everyone on both sides wants quality care and safe staffing.  The difference lies in how we make that happen. Question 1 proposes fixed nurse-to-patient staffing ratios for every type of patient care unit (e.g., General Medical, Emergency).  These exact same ratios would be required by law throughout every hospital in Massachusetts, at all times and under all circumstances.  If the prescribed ratios aren’t met, a fine of up to $25,000 would be assessed per incident, per day.

It sounds simple.  A closer look reveals many unintended consequences.

First, nurses should make decisions about patient care, not the government.  On the same care unit, a patient just out of surgery has very different needs than a patient who is stable and sitting up waiting for a ride home.  Yet ratios prescribe the same level of care.  It doesn’t make sense.  Nurses at the bedside are uniquely-skilled and highly trained to manage each patient’s individual needs, allocate resources, make judgment calls, and triage as needed.  They need the flexibility to adjust the plan of care in the moment, based on the changing needs of the patient.  Caregiving-by-ratio would replace the judgment and decision-making of nurses with a government requirement.

Second, there’s a hidden domino effect: Patients would have trouble accessing the care they need when they need it.  There are not enough qualified nurses within Massachusetts to meet these arbitrary staffing ratios.  Without enough nurses to meet these mandated ratios—by law—care units could not accept more patients.  Beds would have to lie empty. Patients in the ER would have long waits until a bed opened up.  Outside the ER, EMTs would have to wait with their patients until space inside became available. The national shortage of behavioral health and ER nurses makes this all worse. While we grapple with the current opioid crisis, an estimated 1,000 behavioral health beds would close; these hospitals currently have waiting lists.

Third, while we can’t put a price on safety, there is a cost.  If passed, the estimated price tag on Question 1 is upwards of $1 billion—every year.  Question 1 is unfunded; there is no identified way of paying for it. So this cost will be passed on to all of us as patients, either through higher insurance premiums, increased medical bills, and/or reduced services.

There is more that concerns me about Question 1, much more.  If passed, it has the potential to dismantle our healthcare system as we know it.  Why would we ever experiment with something that puts us all at risk?  Please join me in voting “No” on Question 1.

Debbie Burke, RN, DNP, MBA, grew up and lives in Charlestown, and is senior vice president of patient care and chief nurse at Massachusetts General Hospital.

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