Ballot initiative would mandate nursing ratios

Gardner News: Question 1 on the Nov. 6 ballot was developed by the Massachusetts Nurses Association to require certain nurse-to-patient ratios for safety’s sake.

According to Secretary of State William Galvin’s office, the proposed law would limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities. The maximum number of patients per registered nurse would vary by type of unit and level of care.

The proposed law would require a facility to comply with the patient assignment limits without reducing its level of nursing, service, maintenance, clerical, professional and other staff.

The law would also require every facility to develop a written patient acuity tool for each unit to evaluate the condition of each patient. This tool would be used by nurses in deciding staffing levels.

The state Health Policy Commission would be required to devise regulations to implement the proposed law, and could conduct inspections to ensure compliance with the law. The commission could report violations to the state attorney general, who could file suit to obtain a civil penalty of up to $25,000 per violation, as well as up to $25,000 for each day a violation continues after the commission notifies the facility of the violation.


Lisa Sullivan is a registered nurse who works on the medical surgical floor in Heywood Hospital. Dominique Muldoon is a registered nurse from St. Vincent Hospital in Worcester and co-chairwoman of the nurses union. The two agreed to speak about the rationale for nurse-patient ratios.

Sullivan said she has noticed a division within Heywood Hospital between those intending to vote “yes” and those intending on casting a “no” vote. She revealed that she personally felt uncomfortable.

“I noticed when I had my button on, my bosses weren’t even talking to me. Usually they come in and say hi, and are pretty friendly. All of a sudden it was pretty quiet,” she said.

Sullivan indicated that it is tough to go to work every day.

“I feel it is our right to wear those buttons (supporting Question 1). We live in a free society. I don’t agree with them not letting us wear them.”

The question of cost for added staff was raised. Sullivan was asked if she knew that last year, in 2017, the hospital ran at deficit of $1,413,961. Sullivan was surprised but added that as a floor nurse, she sees a lot of waste, including money for paper, products, and even food.

“There are so many other ways for the hospital to save money,” she said. “They always just want to save it on staff, which, in the end, hurts the patient.”

Sullivan explained that for a floor nurse, it is a challenge to take care of patients properly.

“It is physically and mentally impossible to take care of more than five patients. Sometimes five patients can push you over the edge. Unless people have walked in the shoes of a nurse, they are never going to understand it,” she said.

“After working a couple of shifts going at that pace, I thought to myself that I would never be able to continue as a nurse. It is going to take too much of a toll, and the hospital is going to start losing nurses,” Sullivan said. “That’s what I fear.”

Sullivan also says that administration is top-heavy.

“What we need is nurses to pitch in on the floor, because that is where the activity is,” she said.

Muldoon said her experience at St. Vincent Hospital is similar to Sullivan’s.

“I wanted to also point out that studies have shown that re-admissions go down with more nursing staff. I think that alone would save the hospitals a lot of money. Right now Massachusetts is 39th in re-admissions, meaning that we are terrible, absolutely terrible. I’m not proud to say that,” said Muldoon.

Muldoon said that as a nurse she is often pressed for time as far as educating patients before they go home on what they will need for home care. She said some things that were once considered a three-day hospital stay have been shortened to one-day surgery and out.

Sullivan agreed that people end up coming back to the hospital with major complications.

Muldoon said some training can take 45 minutes to an hour to make sure the person understands what to do and do it well.

“Very often we don’t have that time, and it contributes to the re-admission rate,” she said.

Muldoon said California has used somewhat less-rigid staffing ratios for the last 10 years, and according to the Massachusetts Nurses Association’s research, their rates went down and outcomes improved.

“So the science is there,” said Muldoon. “It does save a lot of money and health care costs when a patient doesn’t have to be re-admitted.”

Muldoon said she has been working for the last 14 years, going to the State House in Boston and pushing for a law to protect patients through the legislators.

Sullivan said supporters went knocking on doors for signatures to get the law on the ballot.

“One thing that we wanted to be included on the bill was that no ancillary staff gets cut,” said Muldoon. “We recognize the need for our respiratory therapist, our nurse’s aids and our techs, the whole health care team, and we took that all the way to the Supreme Court. We were challenged that that language should not be in there, and we won it. That language is in there that they cannot cut.”

Sullivan said all the ancillary staff are afraid they will not have a job come Nov. 7. She said they are already on bare staff at Henry Heywood.

“It is mostly a cry for help,” added Sullivan. “That is what this comes down to. We are not trying to close services and freak everybody out. It is a cry for help from the nurses because we cannot do this job properly if we have too many patients.”

Muldoon said they have fought for patient-to-nurse ratios at St. Vincent Hospital, and the ratios were included in the nurses’ contract, but the ratios are not being adhered to.

“That’s why we need a law,” she said.

Heywood Hospital has no set ratios. Sullivan said she takes as many patients as they tell her to take.

By law, every intensive care unit has set ratios.

“This law will be an extension of it,” said Muldoon.

She said the only hospitals that would be fined would be habitual offenders.

Muldoon also said there would be more than 37 days to get it right because the law would go through a regulatory process before it is implemented.

Sullivan said that the TV commercials make people believe they will have to hire an army of nurses. She said that there are plenty of nurses to fill the positions required. She said staffing would be flexible.

The two agreed that the Patient Safety Act would help hospitals cut back on patient injuries, would cut back on medication errors, and would, in the long run, save money.

“I also believe there is such a thing as ethics in business, just like there is ethics in nursing,” Muldoon said. “I believe that providing safe patient care is a very ethical question. If you are telling me that you are going to provide me with a service in your hospital, and you can’t do it safely because you can’t figure out how to do it in a cost-effective manner, is that ethical?”

Read the full article, here.

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