Care Dimensions: I'm a Nurse and Voting No on Ballot Question 1

Voices of Care

I'm a Nurse and Voting No on Ballot Question 1

Posted on October 11, 2018 by Patricia Ahern, RN, MBA, FACHE

vote-no-on-massachusetts-ballot-question-1-hospital-nurse-staffing-ratiosI am CEO of Care Dimensions, the largest hospice organization in Massachusetts, and a nurse who worked for nearly 30 years in the emergency room and critical care units of a hospital, and I’m voting No on Ballot Question 1.

Like anyone, and most especially as a nursing leader, I have a responsibility and a desire to make sure that the work of nurses is protected and revered. While on the surface this proposed legislation may seem like it would bring benefit for nurses and patients, fixed staffing approaches to meeting the changing needs of patients would have severe consequences without improving care. Staffing decisions are made by nurses and managers together considering many factors such as the acuity of patients, admission/discharge/transfer activity, availability of support staff and the capabilities and experience of the nurses. All of these elements would wash away in a pure ratio-only model. Consider what a nurse would do when a patient condition deteriorates on a floor or a trauma patient arrives in the emergency room where nurses are at their number limit. Fixed ratios decrease access to care and prohibit nurses from using professional judgment in managing care of patients. If the ballot initiative were passed, the fixed ratios would need to be followed “at all times” and steep fines will be applied if violated even if there were serious outcomes as a result of the lack of access to care.

Question 1 is an important issue to those of us who deliver post-acute care in non-hospital settings. If hospitals are forced to hire nearly 6,000 nurses in just 37 business days to comply with the law, they will have no choice but to pull from organizations like ours. There will be no nurses left out in the community. There is already a dire nursing shortage. Hospitals could hire every nurse in the state and still not have enough. Being left without nurses would be catastrophic for our patients.

We currently employ more than 500 people, the vast majority of whom are nurses. Most of them travel and see patients in their homes. Nationwide, health care has moved toward keeping patients out of hospitals, which is what home care, hospice and community services do. If we can’t recruit nurses, we can’t keep patients safe in their own homes. Question 1 would unwind our progress in transitioning to comfortable, home-oriented community care.

I have another worry about the impact on our community hospitals. One of our nearby community hospitals estimates the impact at over $7.9 million per year and would require the hiring of 48 full time RNs. This will result in having to make serious decisions regarding programs and the number of patient care units that could remain open. From a personal standpoint, I don’t want my own community hospital to close; that would be damaging and dangerous to communities and patients. Additionally, many hospice patients are referred from community hospitals, meaning this law would directly impact our work. Patients would hear about hospice and palliative care options even later than they do now, causing hardship for families.

Finally, there is only one other state in the nation that has mandated hospital nurse staffing ratios: California. There is evidence that quality and satisfaction scores have gone down since ratios were introduced there. After 14 years of the ratio-rule in California, that state ranks behind Massachusetts in five of six mortality prevention measures and in all of the 11 patient satisfaction categories. In reality, Massachusetts consistently ranks among the best states in the U.S. on hospital quality and outcome measures. Our state has earned national acclaim from several top tier ranking systems including the Commonwealth Fund’s State Health System Performance that placed Massachusetts second overall in the nation, versus California’s 14th place finish.

This law would harm everyone, everywhere, and incapacitate Massachusetts health care. I plan to vote no – not because I don’t care about nurses – but because I care very deeply for all of them, wherever they work.

I encourage you to examine this issue more closely, and welcome you to join me in voting NO on Question 1 on Nov. 6.

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Since 1978, Care Dimensions has provided comprehensive and compassionate care for individuals and families dealing with life-threatening illnesses. As the non-profit leader in advanced illness care, we offer services in more than 95 communities in Eastern Massachusetts.