Get the Scary Skinny on Question 1

The general midterm election is finally here and with it comes more than simply electing the next wave of lawmakers, with it comes an opportunity for voters to have the power to help shape policy for our state. Here in Massachusetts, we’ve all seen loads of Question 1 signs scattered throughout neighborhoods across the state. The signs for and against the proposed mandate look insanely alike and the platforms each one is running also sound confusingly similar—patient safety being at the heart of each. Because quality healthcare is important to me, my family, and my community, I needed to learn more about this to see if the healthcare quality I’ve come to love and trust would somehow be at risk.


Here are the five basic truths I’ve learned about the proposed mandate that helped me go from confusion to clarity:

  1. Fact: Simple Is As Simple Does

At first glance the question sounds quite simple. After boiling it down, however, you realize that is exactly where the problem lies. Such a simplistic formula does not take into account the numerous factors that impact the level of staff a patient should receive. Mandated ratios without structure to help achieve ratios will undoubtedly force hospitals to make trade-offs in other services or investments with the end result being unintended negative consequences for patients.

This simple plan hasn’t been fully baked and like most half-baked, bankrupt ideas that come from a government mandate, Question 1 comes with oodles of caveats. It’s a frightening move that would impose rigid, exorbitant, and scientifically unproven nurse-to-patient staffing ratios.

Staffing is a collaborative process. While not always perfect, there are processes in place to appropriately staff each unit based on individual patient needs and the training, expertise and capabilities of the nurses, nursing assistants, case workers, nurse managers, physicians, and other caregivers on that unit. Hospital staffing models are continuously adjusted to ensure safe, high-quality care on the basis of patient need and the experienced judgment of nurses on the floor. A mandated, fixed ratio does not allow that flexibility and innovation in a care team.

  1. Fact: Quality of Patient Care and Safety will NOT Be Improved

I am proud to live in a state that is home to some of the highest-ranking hospitals in the world—many of which are consistently ranked nationally for health and quality of care. These hospitals are already held accountable and are consistently delivering a high standard of quality, safety AND adequate staffing levels by national and local organizations such as The Joint Commission, the Centers for Medicare and Medicaid Services and the MA Department of Public Health. Many hospitals in the state (if not all) also voluntarily pursue additional accreditations and certifications from national organizations, such as the American Heart Association, the American Stroke Association and the National Accreditation Program for Breast Centers, to name a few.

There are no scientific studies or reports that credibly show that this mandate will improve the quality of care for patients in Massachusetts. There are also no studies that support or recommend specific, at-all-times ratios for nurses. Mandated ratios have unintended consequences and have not substantiated any improvements in patient safety outcomes. California—the only state to implement mandated nurse staffing ratios—is a prime example of how this mandate has caused more harm than good. Hospitals and nurses all over California have seen the harm it has caused including:

  • Increased safety concerns
  • Limits in technology and innovation
  • Increased costs and budget cuts
  • Poor Emergency Room experiences
  • Dismissal of key ancillary staff

Setting arbitrary, rigid ratios ignores the many variations in patient care, including differences in nurses’ education and experience, ever-changing patient conditions, the composition of the entire care team, and the varying technologies and physical attributes of different facilities.

  1. Fact: One Size Does NOT Fit All

The simple formula of this proposed mandate would apply to every hospital, in every unit, at all times—across Massachusetts. So regardless of the size or location of the hospital or the unique needs of each patient—staffing decisions would be taken out of the hands of experienced nurses and doctors at the bedside and put in the hands of a bureaucratic mandate. That means across the board: longer wait times, reduced patient services, and higher operating costs within every hospital across the state.

It’s seems fair to say the safest and best patient care is when staffing decisions are made in real time… not by union leaders and rigid government mandates.

Widespread implementation here in Massachusetts will slowly bankrupt the nursing profession as nurses become underpaid and overworked, some nurses at the top of their field even doing work in areas that were designed for non-nursing staff—making confidence and morale that much worse.

  1. Fact: Our Healthcare Costs WILL Go Up and Vital Community Programs will Go Down

This mandate is literally unfunded. That means more costs will be passed on to the consumers in the form of higher taxes, insurance premiums, copays, and deductibles. Don’t let anyone fool you into believing otherwise. So many people I know in this state are already struggling to pay for healthcare. This would make it far worse.

Additionally, to meet the staggering cost of this unfunded mandate, hospitals would have to cut vital community health programs such as cancer screenings, opioid treatment and prevention, early childhood intervention, domestic violence programs, and pre- and post-natal care.

  1. Fact: This will be Catastrophic for Behavioral Health

The number one issue affecting our state is behavioral health which includes the opioid epidemic. Statewide, it is projected that we would experience a 38 percent reduction in available inpatient mental health services. This will further reduce access to critically needed psychiatric beds statewide. There is already a nursing shortage especially for behavioral health nurses and recruiting the numbers of nurses required to meet the mandate means an estimated 1,000 of the approximate 2,900 beds currently in service, would need to close. Other hospitals and facilities providing behavioral health services would need to close entirely.

The overarching fact is: Question 1 would have a severe, negative impact on every hospital and community in Massachusetts.

Instead of taking steps to threaten the quality of care, increase costs to patients, and blatantly disregard the professional judgment of qualified healthcare professionals in hospitals throughout the state…

we should stay focused on implementing sustainable, thoughtful and proven solutions in an effort to make significant improvements to patient care and healthcare as a whole.