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Question 1 on nurse-patient ratios: one side says to vote yes

Every day in Massachusetts, patients in our hospitals push a call button and wait … and wait … for a registered nurse to come to their aid. You could be one of those patients. You might be in severe pain, or frightened or disoriented. You need help, but you wait, sometimes for hours, to receive the care you need. Thankfully, in some cases the wait causes no serious harm. But with some frequency, the lack of a quick response from a nurse can trigger a downturn in a patient’s condition; or lead to a serious and costly complication. And a two-day hospital stay turns into a six-day stay.

Today, you are only admitted to a hospital if your medical condition is severe enough that you require around-the-clock monitoring and care from a registered nurse. However, hospital executives assign nurses too many patients to safely care for at once, a dangerous practice that leads to more patient infections, bedsores, medication errors, and worse.

Don’t be fooled by the millions of dollars on deceptive advertisements from the hospital industry making false claims and stoking fear among the public. Massachusetts’ hospitals can afford to invest in better patient care. This is a $28 billion industry, almost exclusively comprised of large, top-heavy corporate healthcare networks. But hospital executives make choices about what to do with their vast resources, and they should be choosing to make this investment in patient care for the safety of you and your loved ones.

Currently, there is no limit on the number of patients hospital executives can assign to a nurse at one time, except in intensive care units. Question 1 would set maximum patient limits for nurses that varies based on the type of unit and severity of patient needs. It would mean better care for hospital patients.

Today, decisions about patient assignments are made by a hospital executive whose focus is on the bottom line and increasing profits. Question 1 will put patients ahead of profits — where they belong.

Dozens of independent scientific studies, including those published in the New England Journal of Medicine and the Journal of the American Medical Association, have consistently found that the quality of care decreases dramatically when nurses are forced to care for too many patients at once. According to Matthew McHugh, a leading researcher on nursing and patient safety from the University of Pennsylvania, “The evidence on the relationship between nurse staffing and patient outcomes is one of the most robust in the health services literature.”

Massachusetts has ample numbers of nurses ready to fill the void should Question 1 pass. We are one of two states without a nursing shortage and have a projected surplus of RNs through 2030. We also produce more than 3,500 nurses each year through our many nursing programs.

More than 14 years ago, California established maximum limits on the number of patients assigned to a nurse at one time and the results have been universally positive. Studies show that patients in Massachusetts receive less time with their nurses, resulting in higher rates of complications and average emergency department wait times that are 11 minutes longer in Massachusetts than in California.

According to Linda Aiken, the nation’s leading researcher on nursing and patient outcomes, who has studied the impact of limits in California, “When it was implemented on January 1, 2004, the hospitals that were not in compliance to the staffing ratios had to change on that day and they did. Our research has shown that staffing did change substantially in California hospitals — even in safety net hospitals which have been very difficult to get to change on hospital nurse staffing. Almost 15 years later, California still has the best nursing-staffed hospitals in the country. The state has seen steeper declines in mortality and improvements in other indicators than other states.”

Not only is care better, but spending on health care in California is significantly lower, they have lower insurance premiums than here in Massachusetts and no hospital or service has closed as a result of the law.

When hospital managers assign too many patients to a nurse and the nurse objects, the standard response from hospital executives is “deal with it.” These managers aren’t the ones who have to face the patient or their family when something goes wrong — it’s the nurse who is legally and ethically accountable for the safety of your care.

Hospital executives have had two decades to address this issue. It’s 2018, and hospital executives still haven’t fixed the problem. The time has come for the citizens of Massachusetts to make sure every patient has access to safe nursing care. Vote “Yes” on Question 1.

Karla Robles is a Lynn resident and nurse at Beverly Hospital.


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