Ahead Of Ballot Question, Familiar Combatants Debate Staffing Ratios In Massachusetts

Oct 4, 2018

Question One on the Massachusetts ballot has sparked furious debate between hospitals and the state’s largest nurses’ union.

In just over a month, Bay State voters will decide whether to approve a ballot question that would set ratios on the number of patients a nurse can be assigned to. The ratios would be determined by the hospital department and the kind of patient the nurse is attending to. Hospitals would face a $25,000 fine for violating the new law. On Wednesday, the Massachusetts Health Policy Commission, an independent state agency, released a report that claimed the proposed ratio would increase state spending on health care from between almost $700 million to around $950 million.

“This was one of the big issues I was concerned about when the question originally came up,” said Massachusetts Governor Charlie Baker when asked about the report during a visit to Springfield. The Republican, who is seeking re-election, said he hadn’t read the report, but suggested he had doubts about the ratios.

“The one thing I’ve heard from many folks in the nursing community is they’re concerned about not practicing up to the top of their license — that one of the things this legislation would do would be to have nurses do many of the tasks and functions that are now done in many hospitals by techs," said Baker. "And most of the nurses I know want to practice to what I call the top of their license.”

Doctor Dan Doyle, the chief of staff at Pittsfield’s Berkshire Medical Center, says he and the leadership of Berkshire Health Systems — one of the county’s largest employers — have more than doubts about Question One.

“We’re concerned about its impact on the care teams that take care of patients in the hospital," Doyle told WAMC. "We’re concerned about the implications it’s going to have for access to care if we have to meet the requirements of these nurse ratios at all times as is mandated as written, and we’re also concerned about the financial impact it’s going to have on the Health System were we to be mandated to add all these additional RNs to our staff.”

Doyle says BMC’s current ratios comply with American Nurses Association guidelines, and that the comparatively stringent ratios proposed by Question One would hamper the hospital’s ability to assemble specialized care teams for patients.

“Patients in Massachusetts deserve the best care possible based on research and evidence and best practice," said Mark Brodeur.

Brodeur, a nurse at BMC, belongs to the Massachusetts Nurses Association, the state’s largest nurses’ union. It says it represents around 23,000 nurses.

“I think it really comes down to state patient care," Brodeur told WAMC. "There’s tons of research and data that says the more patients a nurse has, the worse their outcome will be.”

As far as the fear of a steep rise in hospital expenses, Brodeur points to a study released in mid-September by a Boston College professor that showed some Massachusetts hospitals are already in compliance with Question One’s ratios.

“Hospitals like Fairview, Mass General, Brigham and Women’s, Dana-Farber — so there are hospitals already doing this successfully,” he said.

The researcher in question, Judith Shindul-Rothschild, is herself a registered nurse and formerly served as the president of the Massachusetts Nurses Association.

On the other side, David Phelps — the CEO of Berkshire Health Systems — is on the board of trustees for the Massachusetts Health and Hospital Association. The group represents Massachusetts hospitals on Beacon Hill and in Washington, and has donated more than $7 million to the Coalition to Protect Patient Safety group, one of the main voices in the “No on One” camp.

The debate over Question One has some echoes of the two years of bitter contract negotiations between the nurses’ union and Berkshire Health Systems, which concluded with the union signing new contracts in late June.

“I think this is an effort put forth by the Mass Nurses Association to try to achieve through the ballot box what they can’t achieve through collective bargaining,” said Doyle.

“In our contract negotiations, we were able to get some minor improvements, but really not what evidence says is best practice," said Brodeur. He sees the ratios as good for nurses and hospitals.

“It’ll take a lot of pressure off of hospitals," Brodeur told WAMC. "As you’ve seen just this past couple years, several hospitals have gone on strike over staffing issues.”

Voters will decide on Question One on November 6th.