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What to Know About Ballot Question One

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The group behind Question One is a labor union called the Massachusetts Nurses Association. They want hospitals to limit the number of patients nurses can take care of at a time – with the limits varying depending on the unit.

For example, nurses with maternity patients would be limited to one patient in active labor – while nurses on pediatric floors would be limited to four patients. Hospitals could get a fine of up to $25,000 each time they break those limits.

The proposed law also states hospitals can’t lay off other staff if they have to hire more nurses to comply.

Beth Piknick is an MNA board member and recently retired from her job at Cape Cod Hospital after 46 years as a registered nurse. She says the limits were designed to help nurses take better care of people.

“We feel that when this law passes it will be the best thing for patients. And it’s just all about safety,” Piknick said.

Piknick also said that hospital patients today require more intensive monitoring – and being overwhelmed with patients can make it harder for nurses to do the observing and double-checking the job requires.

“When we have too many patients, we miss those subtleties.” 

She added that nurses’ working conditions are difficult, and that they try to hide the stress that they're under. “You’re not seeing that we’re not going to lunch or dinner, you’re not seeing that we’re not going to be able to go to the bathroom.”

The Massachusetts Health and Hospital Association is the group leading the opposition against this ballot question – along with the Massachusetts chapter of the American Nurses Association.

The groups say that if nurses have already hit their patient limits, they will have to turn away new patients seeking care.

Spaulding Cape Cod executive Stephanie Nadolny says if her rehab facility is forced to reject new patients, it could create a backlog in the whole system of Cape hospitals – and possibly put Spaulding’s future at risk.

“This is a very small hospital. We have 60 beds. And for us to be viable, we really need to keep those beds as full as possible. And were a really important resource to the community, and if we have to turn patients away or eventually close bed, we’re really not going to be here for the long haul,” Nadolny said.

Deborah Byrne, the director of nursing at Spaulding Cape Cod, says patient limits would rob nurses of their flexibility.

“What this bill does is it takes away the critical thinking nurses have worked so hard to establish. We have acuity tools. We have the ability to change assignments to make sure that our patients are getting excellent care. And this is really going to change that,” Byrne said.

The Massachusetts Health Policy Commission – a state agency in charge of tracking health care spending – analyzed the ballot question and predicted it could cost hospitals anywhere from 650 to 950 million dollars a year in added costs like hiring.

The Massachusetts Nursing Association disagree with these figures, saying hospital executives “grossly exaggerated the costs to implement the initiative.” The MNA cites a separate study from Boston College that shows it would cost Massachusetts acute care hospitals around 47 million dollars if the ballot question passed.

If passed, the law will go into effect January 1, 2019.

Also check out: Nurse staffing ratios already exist in California. How's that working? 

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