Important Points About MA Ballot Question 1

September 23, 2018

In November 2018, Massachusetts residents will vote on Ballot Question 1. This proposed law would limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities.

What is this proposal?

Question 1 on the November ballot would impose rigid, expensive, and scientifically unproven registered nurse-to-patient staffing ratios in all units, at all times, at every hospital across Massachusetts. Ratios would be the same in every hospital, regardless of their size, location, or the unique needs of their patients. 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 government mandate.

Mandated ratios would disregard the professional judgment of qualified health care professionals in each hospital, threaten the quality of care, and increase costs to patients.

An independent study by two respected research groups, Mass Insight Global Partnerships and BW Research Partnership, concluded that the staffing proposal would cost an additional $1.3 billion in the first year and over $1 billion each year after that (including $100 million in additional state spending). This would increase taxes and raise copays, out-of-pocket spending, and other insurance increases for families and small businesses at a time when the focus should be on controlling cost.

Treatment at McLean
Statewide, it is projected that we would experience a 38% reduction in available inpatient mental health services

Who opposes this proposal?

Concerned by the many negative impacts this scientifically unsound and costly law would have, Massachusetts hospitals, nurses, doctors, and other health care professionals have come together to form the Coalition to Protect Patient Safety. This organization is growing by the day and already includes: Massachusetts Health & Hospital Association; Organization of Nurse Leaders; ANA Massachusetts (the state chapter of the American Nurses Association); Conference of Boston Teaching Hospitals; and Massachusetts Council of Community Hospitals.

Will psychiatric care be affected?

Yes. Question 1 will reduce access to critically needed psychiatric beds statewide.

There is already a nursing shortage in Massachusetts and an even greater dearth of psychiatric nurses. If behavioral health facilities are unable to recruit the additional registered nurses required to meet the mandated ratio, an estimated 1,000 beds (of the approximately 2,900 beds currently in service) would need to be closed. Some institutions providing behavioral health services would need to close entirely.

Statewide, it is projected that we would experience a 38% reduction in available inpatient services, limiting the ability to provide crucial acute care for those in crisis.

How would this affect my local hospital?

Question 1 would have a severe, negative impact on every hospital in Massachusetts.

The one-size-fits-all ratios, imposed regardless of a hospital’s size, location, or the individual needs of its patients, would result in longer wait times, reduced patient services, and higher operating costs within every hospital across the state.

Our health care system can’t afford the price tag for this unproven proposal, projected at over $1 billion annually. If this ballot question is approved by voters, many of our state’s financially vulnerable community hospitals will be forced to close.

To meet the staggering cost of this unfunded rigid 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.

Would this affect the cost of my health care?

Yes. The cost of this expensive unfunded law would be passed along to consumers through higher insurance premiums, copays, deductibles, and taxes. Massachusetts families and businesses are already struggling to pay for health care and are facing additional federal cuts to Social Security, Medicare, Medicaid, and other critical health care resources. This ballot question will make things worse.

Is there any evidence this would improve the quality of my health care?

No. Massachusetts is home to some of the highest-ranking hospitals in the world and consistently tops national rankings for health and quality of care. 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.

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.

Is there any evidence that nurse-to-patient ratios really work?

There are no scientific studies or reports that demonstrate the effectiveness of this government-forced, one-size-fits-all nurse staffing in improving quality of care. None of the studies that address nurse staffing recommend a specific formula that would improve patient outcomes or validate any arguments for this proposal.

In California, the only state that has imposed mandated ratios, there is no evidence it has improved the quality of care. In fact, Massachusetts hospitals already equal or exceed California hospitals in nearly every meaningful measure of patient care.

How would this affect wait times, including in the emergency room?

Question 1 would dramatically increase emergency room wait times and delay services throughout the hospital, including those that are time-sensitive and lifesaving. Even more disturbing, hospitals would be penalized if they don’t turn patients away or stop admitting them during busy periods.

What would happen when smaller rural and suburban hospitals are faced with local emergencies?

There are no exceptions to this mandate. The law would prevent hospitals from having any flexibility to make essential and last-minute changes, even in the event of an unexpected influx of patients due to a multi-car crash, large fire, shooting incident, or multiple opioid overdoses. By penalizing hospitals if they admit more patients when the number of nurses on duty at that moment does not meet the statewide mandate, this ballot question would force people to seek care elsewhere—costing precious time that is crucial to lifesaving care and personal health.

Where can I learn more?

McLean has come out in opposition to Massachusetts ballot question 1. Read the article now.

Read the paper written by experts across Massachusetts regarding the implications of mandated nurse staffing ratios.

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