Nurse Staffing Ratios Up for Public Decision? Ballot 1 in MA
Massachusetts will be the second state in the United States to put a vote to a mandated nurse staffing ratio, behind California in 2004. This ballot support and opposition has been highly contentious and this vote may set a precedence for other states to support a similar law. The ballot measures are very strict, and the general public seem to be very confused as to the impact of the law on healthcare in the state of Massachusetts as a whole.
The ballot question 1 in Massachusetts (Nurse Patient Assignments Limit Initiative) which will be voted upon November 2018 was designed to establish patient assignment limits for registered nurses working in hospitals, with limits determined by the type of unit or patient with whom a nurse is working, and the maximum numbers of patients assigned would apply at all times. Massachusetts is a hub for medical advancement. In Boston specifically, there are 6 major medical centers within a few feet of one another. Most are teaching hospitals of Harvard University, so staffing, technology, and innovation to support patients and safety are at the forefront of care. Despite that, there has been a push by the Massachusetts Nurses Association (a union) to enact a similar law for over 20 years. It was brought as a ballot question in 2014 but tabled after allowing for a change in ICU staffing ratios (which showed no change in patient mortality or complications, in a study from Beth Israel Deaconess Medical Center). Now it's more stringent and on the ballot for November 2018.
Why does this ballot question face so much opposition? It seems like more nurses is a good thing, right? No one disagrees that nurses are good, and its beneficial for us to take care of our patients. That being said, attached to this proposed bill is not only tighter staffing ratios than California, a 37-day window to comply (to which California had five years), but there is also a $25,000 fine for each time there is not that exact nursing ratio on the unit. The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay. What about leaving the unit for a lunch break, or getting coffee? Not if it means the nursing ratio will be off for any period of time. Shared governance or interdisciplinary meetings? Sorry, you will have to schedule those on your days off. Because of the quick turnaround time to become compliant, and the few numbers of nurses in MA, any resource staff, unit based educators, and/or clinical nurse specialists will be pulled into staffing. There will not be anyone extra to help and "cover" a patient for a quick break. In California, the law allowed for Licensed Practicing Nurses (LPNs) to be hired to assist with upstaffing, but not in MA; RNs only. Differences also include that MA law has higher RN numbers to start and the bill in MA has a prohibition against reducing levels of other healthcare workers (CA did not). MA does not allow any exemptions, whereas in CA 25 hospitals sought and obtained an exemption from the law.
These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city. Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services. Currently, according to the 2017's Best & Worst States for Healthcare Massachusetts is ranked #9 overall for Best hospitals (#1 being the best), with California ranked at #25, despite these ratio laws being fully compliant since 2009. Furthermore, Massachusetts has a current ranking of #3 for access to care, meaning access to healthcare is readily available throughout the state. California is ranked #48, meaning the public has less access to healthcare. It's pretty telling that despite making nursing ratios legally required, the state of California has not improved the patients access to care and their overall satisfaction with care.
On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day. If I have 4 patients, 3 of which are ready for discharge, I cannot take a new PACU admission to help out the unit. A nurse who may have three heavy patients, one requiring a Rapid Response and eventual transfer to the unit, may have to take that patient, or it negatively impacts throughput and the patient has to sit and back up the PACU waiting until someone can admit them. That scenario may seem extreme, but it is something staff face every day, and if I am willing to take that extra patient to support my colleagues and support patient care, my hospital can be fined $25,000? That makes no sense. However, it is the reality of this bill. 4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up.
The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole. This is not to say lay people don't understand good care, they are our customers and they deserve the safest and best care possible and their input is invaluable. However, they do not know how to run a hospital, how it is budgeted, how we currently run staffing matrix, and what this bill means not only to their care but the state of Massachusetts. It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible). It is an estimated $900million annually to maintain these new staffing ratios, without any revenue to the state, and more headaches and difficulty for the public to access care. No other field asks laypeople to make a decision on how they guide their business/care (think Medicine). It is bad policy-making for nurses to do the same; we all believe that highly trained nurses at the bedside, with an appropriate number of patients, benefits not only patients but the work/life balance of our staff. This bill is not the way to do it. We don't want hospitals to close, and patients to have to search for care. We want the best care possible for all of the residents of Massachusetts, and eventually, all patients in all states, as this will set a precedence for mandated ratios in all states in the future!
I really hope the original poster and others that are against MA 1 respond to you and the other California nurses that say it's been a really good thing.
It's just amazing that nurses would drink the management Kool Aid and vote against something that is clearly in their (and their patient's) interest.
Hospitals are passing out news letters, and sending emails with statistics and why people should vote no. Even holding rallies. So are some nursing orginaztions.
Specializes in Surgery,Critical Care,Transplant,Neuro.
OP, where did you get the data on state performance in terms of healthcare quality and access? California doesn't lead the US in healthcare quality and access but it surely isn't in the bottom. We also have our share of top institutions here albeit they are not concentrated in one metro area alone like Boston does.
It's noted in the article with a link....2017's Best & Worst States for Healthcare (retrieved from walllethub.com) Massachusetts is ranked #9 overall for Best hospitals (#1 being the best), with California ranked at #25, despite these ratio laws being fully compliant since 2009.
Specializes in Surgery,Critical Care,Transplant,Neuro.
Some of the things on that ballot measure might need some work
THIS is the whole point. NO ONE opposes changing nursing ratios, but the bill, as it stands, is written poorly and in bad policy. That is the bottom line.
Godspeed this bill to pass. In awe that any nurse would vote no. Sounds like brainwashing. Why would anybody side with a hospital. They don't care about nurse's working conditions, and yet fail to realize the hospital would cease to operate if it wasn't for nurses. So yes, we deserve ratios and safety for our patients.
Boo hoo the CEO gets a smaller bonus because of it. No more taking advantage of nurses. This needs to pass and be settled.
Heck, at a majority of hospitals, it's profit before patients. That's the bottom line. Healthcare is run by greedy admin. People wake up, open your eyes and vote YES. Stand up for your profession.
Big applause to the MA Nurse Association and the hard work they do.
Specializes in Diabetes, Transplant, CCU, Neurology.
Nurses are so worried that their salaries will go down if this is passed. That's what Administrations would like you to believe. They won't. Hospitals will 'compete' for nurses more. They have to have the nurses to avoid being fined. Do you think the nurses in California are low. Some make as much as $65/ hr to start, plus full benefits. I don't think the salary range goes that high at any hospital in Virginia for bedside nursing. North Carolina is worse. We don't have unions here either. We would be fired if we started talking about bringing in a union. So, if you're planning to vote 'no' on the measure, you need to read some books on supply and demand. Their will be a big demand for more nurses to keep the ratios up, and the only way to meet demand is to raise wages and improve working conditions so that nurses will come and stay.
You are wrong by saying California is only 25th in the Best State for Healthcare despite the patient to nurse ratio law and MA is the best at number 1. Where did you get your facts and figures? I would tell you about my facts and figures through my own observation and experience as a nurse who had the chance to work in different states aside from California but most of the time I've been practicing here in California continuously over the past 9 years. But then when situation arises I will work as a strike nurse in between that service. Like for example when Washington DC had a strike in one of the hospital there sometime in December of 2014, I went to work as replacement nurse for 10 days and it really surprises me that for a 12 hour shift we would hear from an over page about 6 code blues. But as compare to any hospital here in Southern California, I would only hear calling for code blue once in every 5 days. I don't think that California is that worst state for healthcare because as a nurse here, we really take care of our patients accordingly and sufficiently that all medications, treatments, bedside care, Accu cheks, pre op checklist, consents, blood transfusions, vital signs, lab works etc were being administered and fulfilled immediately without delay. When I worked in Ohio, Arizona or Texas in the past, my nursing care to the patient is below of a quality value expected to a normal professional nurse would do. It is simply because, I would get so many patients like 7 or more as compare with only 4 to 5 here in California. As such, I would always come back to California to practice instead of staying in other states without the patient ratio because it's not fair for patient to receive less quality care. At all times, me and my co-workers in other states will always feel that we don't provide quality nursing care that the patient deserves. However, it's not our fault and even it's not our choice because of so many patients to take care but our efforts are miles miles away already. But still, it's not strong;y enough to lessen the call for code blue, patients falling from hospital bed or much more death because there's a delay of interventions and nursing care that needs to be provided to sick patients. On the other hand, if the hospital is not earning that much, it's not the nurses fault and it's beyond our scope because we only provide nursing care aspects. It's the responsibility of the management, accounting or business department and CEO to make sure that the earning potential of the hospital is being met with different avenues that they can think of and relay on. That's why they are in that position to take care of the business side of the healthcare in the organization.
""THIS is the whole point. NO ONE opposes changing nursing ratios, but the bill, as it stands, is written poorly and in bad policy. That is the bottom line.""
I agree that there are flaws with the bill, that is the fault of whom ever wrote it. That doesn't mean that passing this bill still isn't a good first step. In my previous post I stated I have worked in Calif, and yes it is no by means perfect, but the ratios do help with the care of the patients by giving nurses more time with patients. I am not in Mass but I would vote yes to get the ball rolling in the right direction. The hospitals/admins will figure it out, I am sure they are already preparing.
PWA98
11 Posts
Hospitals are passing out news letters, and sending emails with statistics and why people should vote no. Even holding rallies. So are some nursing orginaztions.