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Question 1 on nurse-patient ratios: one side says to vote no

I am a Lynn resident, an emergency department bedside nurse, and up until last month, a member of the Massachusetts Nurses Association (MNA). I am voting No on Question 1 and respectfully ask that you do the same.

From the day I started my nursing career, experienced colleagues helped me understand the needs of complex patients. We were nurses working together with other medical professionals to make decisions that ensured the highest quality of care. Even in the most chaotic of emergency situations, we made sure our patients were treated with the highest possible care.

Question 1 forces voters in Massachusetts to approve nurse staffing ratios that strip decision-making from registered nurses. If it passes, a rigid law will determine how many patients a nurse can handle, regardless of skill, experience, or a patient’s specific needs. Our flexibility will be stripped away, leaving inexperienced nurses on their own with patients of varied complexity, increasing emergency room wait times, and reducing access and quality of care for all.

For all RNs, patients come first. We look out for both the people in our care and the other nurses and medical staff on our teams. We value our autonomy but rely on one another. We adjust to changing circumstances and make staffing decisions based on patient need and the skill level of our team. When we need help, we ask for it, and other nurses and care team members come to our aid.

When I work overnight shifts in the emergency department, my floor colleagues and I are the ones determining admissions. If Question 1 were to pass and patients were waiting at a time where all of the nurses in the department had reached their quota, we would be in an impossible bind: either not admit a patient that we know our team is ready and able to treat, or break a law and subject our hospital to up to $25,000 in fines each time that we do.

Hospitals will have to rapidly recruit and hire RNs to ensure that their units are in compliance with the ratio law by Jan. 1, pulling from outpatient care settings such as nursing homes, community health centers, and home care providers. I am extremely concerned about what Question 1’s passage would mean for my friends, family, and neighbors who rely on these types of services to keep them healthy and out of hospital beds. In a community that has been devastated by the opioid epidemic, access to behavioral health services is critical. Question 1 would result in the closure of nearly 1,000 inpatient psychiatric beds statewide, forcing these patients to rely on hospital emergency departments for mental health and substance use services.

Question 1 is being pushed by the MNA, which represents less than 25 percent of nurses in Massachusetts. I come from a long line of union members; I am certainly not anti-worker. However, I am concerned about what Question 1 would mean to the future of my profession and the non-RN members of the care team that make such valuable contributions to the care we deliver every day. Question 1 will threaten this culture that has made Massachusetts hospitals the best in the nation and has ensured that when you need emergency services, you receive them.

When I finish a 12-hour shift, I know that the quality of care I provided was contingent on the coworkers that supported me, whether through an extra set of hands to calm a scared toddler or an extra set of eyes on a test result. This flexibility and collaboration is what we depend on, as no two shifts are alike. Trying to break down nursing into numbers is near impossible, and passing a law that says all nursing shifts are identical is dangerous and irresponsible. Please vote No on Question 1.

Noelle Dulong lives in Lynn and has worked for two North Shore emergency departments during her four years as a nurse.

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