Ballot Question on Nurse-staffing Limits Provokes Range of Reactions Across State

“Legislating nurse staffing ratios is an illogical, unproven approach to providing nursing care to hospitalized patients. In essence, this practice broadly assumes that professional nurses and their nursing leadership are incapable of determining and providing the levels of nursing care required by the patients in their care at any given day or time. It also assumes that lawmakers know better how to care for patients than the professionals to whom these patients entrust their lives.
“A far deeper concern is that, if nurse staffing ratios are enacted, nurses will be rendered powerless to step in and do what they know is right — what they know is needed — in caring for patients. A nurse will not be permitted to exceed the legislated nurse staffing level by assuming the care of another patient arriving on unit, even if the nurse determines that it is feasible and necessary to do so. How can that be considered safe or high-quality care?
“Professional nurses are prepared and committed to coordinating and providing the care of seriously ill patients. I hope to give voters the assurance that nurses do not need a government-regulated staffing ratio to provide excellent care. As the dean of a long-standing and well-respected nursing program, I can confidently report that nurses are educated to be flexible, quick, and competent thinkers, and are capable of independent decision making based on the immediate situation and the circumstances presented.”
—Kathleen Scoble, dean of the School of Nursing at Elms College
“This has been a long time coming, and nurses have been advocating for a ‘yes’ for patient safety for decades. As an active bedside nurse, I see it every day on the hospital floor, and I hear it every day from my colleagues across the state. It’s time for hospital executives to put patient care over profits.
“The need for safe patient limits is one that is shared by nurses in every state and in many countries. We are proud and empowered that so many organizations and so many nurses have endorsed our initiative, particularly because these organizations represent front-line nurses, those who actually provide direct care to patients and understand what it means to have human lives in your hands, and what it means for those vulnerable patients when you are forced to care for too many at one time.”
—Donna Kelly-Williams, RN at the Cambridge Hospital Birth Center and president of the Massachusetts Nurses Assoc.
“At Mercy Medical Center, we strive every minute of every day to provide the best patient care. But Question 1 will severely hinder our ability to serve the Springfield community and lead to a decrease in access, longer wait times, and decrease in services offered. This ballot question will negatively affect our entire community.”
—Frances Marthone, vice president of Patient Care Services and chief Nursing officer at Mercy Medical Center
“As a nurse, I know first-hand how complex staffing is and how quickly the needs of a patient can change. Question 1 provides us with zero flexibility — even when there’s an emergency situation. Staffing decisions should be made by the bedside, not by a rigid government mandate.”
—Erin Daley, director of Emergency Services and interim director of Outpatient Cardiology Services at Mercy Medical Center
“The overwhelming number of signatures gathered across this process has been a clear signal that voters want to weigh in, and when voters hear our message — that nurses are saying ‘yes’ for patient limits — they are immediately on board, recognizing the impact for them and for their families. It’s crazy to think that there are no limits the number of patients that managers can assign to a nurse at one time, and the negative consequences are so clear.”
—Kate Norton, spokeswoman for the Committee to Ensure Safe Patient Care
“We know that, when it comes to healthcare, the people on the front lines providing care know what is best for their patients. The government cannot mandate decisions that are owed to our experienced and skilled professional nurses. This ballot question will negatively affect the quality of care we are able to provide, and seriously limit access to care throughout our community.”
—Molly Gray, vice president and chief Nursing  officer for Baystate Wing Hospital and Baystate Mary Lane Outpatient Center
“Residents in our community rely on our hospital for safe, high-quality care. If Question 1 were to pass, it would be devastating for our hospital, and more importantly, our patients. It will limit access to care for our most vulnerable community members, forcing them to wait longer or travel further for care.
“This ballot question is against everything I stand for as a nurse. If a patient comes in that needs treatment, we shouldn’t have to worry about potentially breaking a law if we are at an imposed legal ratio. Our priority is our patients.  Question 1 would override the professional judgment of nurses who are trained and committed to making the right decisions at the right time for each patient based on their individual needs.”
—Deb Provost, chief Nursing officer and chief administrative officer at Baystate Franklin
Medical Center
“We strongly support the Patient Safety Act because the limits called for under this law will ensure that nursing professionals can provide optimum care for the varying needs of their patients. Establishing these limits is well overdue, and Massachusetts must pave the way for professional standards being set, especially at a time when patients need us most.”
—Jalil Johnson, national director of the Show Me Your Stethoscope Foundation
“Government-mandated, fixed approaches to meeting the changing needs of hospitalized patients would have severe consequences. Currently, staffing decisions are made by nurses and managers. Together, they consider many factors, such as the acuity of patients, admission/discharge/transfer activity, availability of support staff, and the experience level of nurses to provide the most appropriate care to each patient.
“If the legislation passes, Massachusetts hospitals would need to hire and train more than 5,000 registered nurses in a seven-week period. Many hospitals will have to consider reducing patient care units in order to comply. It’s inevitable that some programs will close. It is predicted that some community hospitals would close.”
—Angela Belmont, chief Nursing officer at
Cooley Dickinson Hospital
“A nurse possesses a vast amount of knowledge and skill, but it can only go so far. They represent years, if not decades, worth of training but all that is worth nothing if they simply are forced to care for too many patients. That is why safe patient limits are critical, and I encourage a ‘yes’ vote on this initiative.”
—Dr. Laura Vonfrolio, president of Education Enterprises
“For the past five years, Holyoke Medical Center has strategically implemented new services and increased the number of providers in the Pioneer Valley to improve access and decrease barriers to healthcare in the community. The impacts of Question 1 will negate that progress. As an independent, nonprofit, community hospital, the financial impact to our organization will put us at great risk in continuing to provide the care our community demands.” 
—Spiros Hatiras, president and CEO of Holyoke Medical Center and Valley Health Systems
“As a labor and delivery nurse serving our community for the last 20 years, I know how hard it is to predict or control when active labor patients will arrive on our doorstep. I fear this one-size-fits-all bill will negatively impact our ability to care for every patient that arrives on the unit. Imagine having to turn away patients or tell them they will have to wait to be seen. This is not just about how many patients a nurse should be assigned. I care about the community we serve, which is why I will be voting no on ballot Question 1.”
—Megan Mayo, RN at Holyoke Medical Center
 “Nurses work hard to take care of all of us when it matters the most, and we should do the same for them by establishing standards to ensure they have the help they need to do their job safely. I stand with our nurses and support a ‘yes’ vote on Question 1 in November.”
—U.S. Sen. Elizabeth Warren
“There are no scientific studies or reports that demonstrate the effectiveness of government-mandated, one-size-fits-all nurse staffing ratio for improving quality of care, patient outcomes, or professional nursing practice. In fact, no studies evaluating nurse-staffing ratios reported a magic number as the single factor to affect patient outcomes or job satisfaction. This ballot question is ignoring scientific fact around what is best for nursing practice, decision making, and quality patient care.”
—Donna Glynn, president of the American Nurses Assoc. and a nurse scientist for the VA Boston Healthcare System
“It is urgent that Massachusetts pass the Patient Safety Act to set safe limits in our hospitals. We can do this at the November elections. Patients deserve quality healthcare and need to understand that they just aren’t receiving it.”
—Dr. Catherine DeLorey, president of the Women’s Health Institute