Mclean Hospital

Why We Oppose Question 1: Staff Nurse Shares His Perspective

By Scott Young, RN

October 16, 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 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 staff nurse at an inpatient psychiatric program, I feel strongly that Question 1 will have a significant negative impact on our ability to provide safe, quality, patient-centered care to our patients.

Treatment at McLean
Watch Scott Young share his thoughts on Ballot Question 1

The population we serve requires us to be very flexible in how we allocate our resources. The needs of our patients can drastically fluctuate at any given moment. In periods of crisis, a single person may need the assistance of several nurses. We are often called in to help in emergencies on other units within the hospital. If we are forced into a predetermined staffing ratio, we will be unable to provide the necessary support to one another or to our patients.

Question 1 would also require that we always uphold these predetermined ratios and therefore would have an excess of nurses during the night shift when most of our patients are sleeping. If someone is out sick, a nurse would be forced to stay all night to meet the guidelines even though their presence may not be needed. This is a very poor use of valued resources. This preset fixed number does not consider the acuity of the unit and hinders a nurse’s ability to apply good clinical judgment in how the care environment is managed.

Another downfall of this numbers-centered approach is that due to available workforce, we will be forced to reduce the number of available beds to balance our nurse-to-patient ratio. I cannot understand how decreasing access to mental health care is in any way helpful to our patients. A government mandate that prevents people from getting the mental health services that would otherwise be available does not seem like a responsible choice.

As a taxpayer and resident of Massachusetts, I am greatly concerned about how this ballot question will affect our overall health care as well. We have some of the best hospitals in the nation, and we are putting many institutions at a substantial risk of having to limit the number of people they can serve or closing altogether, all while increasing the cost of operation for hospitals and cost of care for patients.

I think it is important that we help educate the public about the detriments this ballot question will pose. I have seen a lot of misinformation and inaccurate statistics used in support of this legislation. Question 1 does not make sense for everyone, especially not our hospital. I will be voting “no” on Question 1 in support of my patients and my coworkers.

Scott Young, RN, is a staff nurse at McLean Hospital’s Schizophrenia and Bipolar Disorder Inpatient Program, which provides short-term, acute mental health care for adults with psychotic disorders who are in crisis and need stabilization.