In Tuesday’s midterm election, approximately 70 percent of Massachusetts voters selected “no” on the first ballot question that proposed to limit nurse-to-patient ratios. As a result of the election, the issues nurses face in the Commonwealth have been brought into the spotlight, and now both sides of the issue are on the hunt for solutions.
Question 1 proposed a law that would limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and other health care institutions, with the specific maximum number of patients varying depending on the type of care. For most medical departments, the maximum ratio would have been approximately four patients per nurse.
According to a survey conducted by the Massachusetts Nurses Association, 77 percent of registered Massachusetts nurses believe they are currently assigned too many patients.
Some risks included a 5 percent decrease in cardiac arrest survival for every patient added to a nurse’s workload, an increase in mortality rate when the patient-nurse ratio was greater than 2.5 and a 20 percent higher risk that a patient would die within 30 days of having general surgery at hospitals without patient limits, the survey reported.
David Schildmeier, director of public communications for the MNA, said the defeat is a setback for all the patients and nurses in Massachusetts.
“What it means is that patients in our hospitals are going to continue to receive substandard care because the nurses are being continued to and forced to take care of too many patients at once,” Schildmeier said. “It’s a real disappointment and a real blow, again, not only to the nurses who fought for this, but for the patients who they fought for to protect.”
What prevents the opposing side, particularly the hospitals and medical institutions, from accepting the patient limits, he said, is that the proposal is drastically expensive and could force smaller hospitals to close.
A study conducted by Boston College professor Judith Shindul-Rothschild estimated the need for roughly 128 additional registered nurses per day, or between 539 and 1,617 full-time nurses annually, to the current 24,544 full-time nurses in the 67 Massachusetts hospitals cited in the report. Such a demand would cost somewhere between $35.1 million and $46.8 million per year, the study found.
The result of the elections and the ongoing debate that has stemmed from the defeat has informed hospital leaders of the stakes and sacrifices made by nurses, Schildmeier said. The debate has also addressed broader workforce issues, such as stress and burnouts. Schildmeier said the fight is not yet over.
“We are, right now, evaluating all our options,” Schildmeier said, “and we’ll be developing whatever strategies are necessary to continue this fight.”
Steve Walsh, president of the Massachusetts Health and Hospital Association, which supported voting “no” on Question 1, wrote in an email that voting on the ballot question is only the beginning of the conversation surrounding the issues nurses face.
“Question 1 forced some difficult and necessary discussions about the future of health care and the future of our workforce going forward,” Walsh wrote. “These conversations with our care teams and in our communities have been critically important and will continue in bargaining sessions, legislative debates, board rooms and newspapers.”
Walsh explained that Massachusetts hospitals want to hear the concerns of their nurses to improve the experience for their staff and their patients.
“We will continue to have these conversations because these are conversations we owe to the voters,” he wrote. “Most importantly, these are conversations we owe to our patients.”
New England College of Optometry student Alexa Caruso, 25, said she supported voting “no” on the first ballot question because she had heard her friends, who are nurses, describe their stressful experiences managing many patients and once.
“It’s too much one size fits all, and every hospital should make their own decisions based off of … how many patients come through, based off their nursing staffing,” Caruso said. “They probably know better than the government about how many nurses should be assigned to a patient.”
India Smith, 47, of Dorchester, said she thinks it is “really messed up” that Question 1 did not pass, especially because she is a former certified nursing assistant and has faced the struggle of having to care for too many patients.
“I feel like that bill should have passed,” Smith said. “There should be more nurses to one patient, about two to three nurses to one patient.”
Clarissa Garza and Alex Lasalvia contributed to the reporting of this article.
