Mclean Hospital

Why We Oppose Question 1: Experienced Nurse Shares Her Perspective

By Ann Marie McCarthy, RN

November 4, 2018

In November 2018, Massachusetts residents will vote on ballot Question 1, a proposed law that would limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities. This will be devastating for behavioral and mental health facilities. Concerned by the negative impact that this proposed law would have on overall patient care, McLean has come out publicly in opposition to Question 1.

Reasons behind this opposition are detailed in a recently issued statement from McLean Hospital and a white paper prepared by the Massachusetts Association of Behavioral Health Systems. McLean nurses and other staff are also speaking publicly about why they oppose Question 1. We will be featuring these narratives during the weeks leading up to Election Day voting on November 6, 2018.

As a nurse with more than 40 years of experience, I am deeply concerned about the implications that ballot Question 1 will have on patients across the Commonwealth. As it is written, this initiative has the potential to dramatically change the landscape of health care in the state—and more specifically—access to an already overburdened mental health care system.

Treatment at McLean
“Question 1 diminishes the importance of the multidisciplinary approach to behavioral and mental health care and ... will take away our ability to be thoughtful about the needs of our patients.” – Ann Marie McCarthy, RN

We work in a unique environment, one that requires a team of skillful men and women from various disciplines to make staffing decisions based on each clinical situation, including patient acuity and need. The plan of establishing mandated registered nurse-to-patient ratios would be applied to all areas of medicine and behavioral health, implying that all our needs are the same, which they are not. It also diminishes the importance of the multidisciplinary approach to behavioral and mental health care, placing registered nurses above other disciplines, when the most effective care is delivered by a whole team.

I am resentful that, as proposed, Question 1 diminishes the importance of the multidisciplinary approach to behavioral and mental health care and that it will take away our ability to be thoughtful about the needs of our patients. Question 1 is a cookie-cutter initiative that does not take clinical judgment, patient needs, emergencies, or common sense into account.

Beyond the basic questions I have about this misguided proposal, I worry greatly about the financial burden on the hospitals, as well as the people seeking treatment. Based on independent reviews of this initiative, we know that the financial cost to implement Question 1 will be $900 million. The health care system cannot withstand this level of investment, so we know there will be a reduction in services. Where will the state’s most vulnerable people—the people we see every day in our emergency rooms and here at McLean—be treated? No one seems to have a good answer to this question. As someone who believes deeply in the mission of McLean and as someone who has dedicated her career to serving the people of our community, I cannot in good conscience do anything but vote “no” on Question 1. I urge you to do the same.

Ann Marie McCarthy, RN, is a clinical training specialist at McLean Hospital, where she provides support and training to nurses and community residence counselors at the hospital’s residential and partial hospital (day) treatment programs.