Why We Oppose Question 1: Thoughts from a Psychiatric Nurse

By Frank Joseph, RN

October 13, 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.

Health care is unpredictable in any setting. We must consider patient census, diagnosis, acuity (the intensity of care required by a patient), unit acuity, and staff experience when deciding staffing needs. It is not a one-size-fits-all situation.

Treatment at McLean
Staff at McLean SouthEast, like Frank Joseph, RN, are committed to high-quality patient care

Question 1 sounds good on paper—less patients per nurse—but, in reality, this bill limits our ability to evaluate the needs of our individual patients and the needs of the unit to determine the safest staffing ratios. Strict patient limits are not the answer for patient care and safety.

If passed, this bill would possibly force smaller hospitals, medical centers, and clinics to close and increase wait times as patients are diverted to units or hospitals with more staff. McLean, meanwhile, may lose much-needed beds to meet the rigid and unnecessary staffing ratios.

I am a psychiatric nurse. I serve one of the most vulnerable and underserved populations in health care. A “yes” vote on Question 1 will deprive thousands of people of the care they desperately need.

This bill will decimate the availability of beds for psychiatric patients. With insurance reimbursement rates that are lower for psychiatric care, thousands of beds will be lost in psychiatric hospitals in Massachusetts, as it will no longer be cost-effective to keep them open if this bill passes.

The Massachusetts Nurses Association, a union representing only 23,000 of the 151,000 nurses in Massachusetts, crafted and sponsor this bill. However, the American Nurses Association, the premier organization representing 4 million nurses across the United States, is against this bill and any other means to undermine a nurse’s sound critical thinking and involvement in patient care.

In 1999, California passed the country’s first mandated staffing legislation, which was implemented in 2004. Since that time, studies have repeatedly shown that there have been no evident changes in patient length of stay or adverse patient safety events, both of which were reasons given for implementing the staffing mandate in the first place. Patient safety and overall quality of care are important to every single one of us. But strict government-mandated patient limits will not improve our health care system. In my opinion, it will do more harm than good. Massachusetts hospitals’ quality of care is ranked #4 in the country. This is due, in part, to the critical thinking of the nurses who use their judgment to plan for and provide the best possible outcomes for patient safety and effective care. That is why I will be voting “no” on Question 1. I encourage others to do the same.

Frank Joseph, RN, is a staff nurse at the McLean SouthEast Adult Psychiatric Inpatient Program in Middleborough, Massachusetts, which provides intensive mental health care and resources to patients and families in the southeast region of the state, including Cape Cod and the Islands.

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