Massachusetts nurses are currently debating Ballot Question 1—whether or not the state should establish patient limits in hospitals. The debate has divided the nursing community in half and could result in a narrow vote..
If passed, the limits will vary between different types of nurses and care facilities. According to the full text of the referendum (available on the Secretary of the Commonwealth’s website), the law will require facilities to adhere to the limits without cutting staff. The law will also mandate the creation of “written patient acuity tool[s],” which will allow nurses to decide whether or not patient limits should be lower at any point.
“It is not fair to the nurse to be expected to…safely care for 8-10 patients,” said Kerri Nixon, a labor and delivery nurse from Bridgewater. She believes that heavy workloads negatively affect nurses’ mental and physical health.
“I’ve worked in situations where there’s too many patients,” hospice nurse Kristen Vu of Easton described. “Nursing homes are understaffed. It’s not safe.” Other nurses like Nixon and Vu agree with the “Nurses Say Yes on 1” campaign, which is paid for and authorized by the Committee to Ensure Safe Patient Care according to their website.
Many nurses, however, oppose the bill.
“I believe that the bill will drastically negatively affect patient safety,” claimed Catherine Eaton, a neurosciences ICU nurse from Wellesley. “Nursing is a very delicate science and we are highly trained to triage, delegate, and provide care to our patients. This bill proposes an extremely rigid and inflexible mandate, and anyone who works in healthcare knows that it is in no way rigid.” According to their website, the “Nurses Say No on 1” campaign is funded by the Coalition to Protect Patient Safety.
Massachusetts is one of fourteen states to enact some form of patient limits. California was the first to do so, and Vu stated that California has since experienced “decreased mortality and [increased] nurse retention rates.” A study conducted by Health Services Research validates her claim. Eaton argued, however, that California’s patient safety and overall hospital ratings are lower than Massachusetts’. According to the Leapfrog Hospital Safety Grade, Massachusetts ranks fourth in the nation while California sits at twenty-fifth.
Nurse retention is a concern for supporters of a yes vote. “When nurses feel they’re overworked and in unsafe conditions, they leave,” Vu explained. “[They] have to have malpractice insurance, because the hospital will blame them [for mistakes].” She believes that the passage of this law will lead to “fewer medical errors and lawsuits.”
Cost is an issue for many opposers. “Small community hospitals will be unable to afford the specified number of staff and will be forced to close,” Eaton stated. “Above and beyond taking nursing judgement out of our hands, this bill will negatively impact citizens across the state and be extremely detrimental financially.” Nixon argued that the paychecks of upper management, such as CEOs and CFOs, could be cut to help fund the change.
Limits include three patients per nurse in intermediate care units, one patient under anesthesia and two post-anesthesia, one critical or intensive care patient, one mother and baby per nurse for up to two hours after birth, five psychiatric or rehabilitation patients, and more.
Eaton described how she would incur a 25,000-dollar fine for taking on another nurse’s patient if she had to leave in an emergency. Without patient limits, she said, “What would happen is [the other nurse] would discharge her patient and I would happily absorb her transfer patient so she could leave…Patient safety is in no way compromised and we used our nursing judgement to fill a unit need.”
Question 1 will appear on the ballot this November alongside Question 2, regarding campaign spending, and Question 3, which addresses gender identity discrimination in places of public accommodation.
