Vote NO on Question 1

nurses say no square

I am a Registered Nurse and have been one for close to 30 years.  In that time I have worked at numerous hospitals in several different states.  My experience has been in step down units, intensive care units, neonatal intensive care and emergency rooms.  I am concerned for my fellow nurses and my profession in general if the nurse staffing ratio bill is passed.  Following is my attempt to solidify those of you who are voting no and to hopefully persuade those who are voting yes to change your vote.


Lynn Donatelli BA,RN, VA-BC

The Mandated Nurse Staffing Proposal is an attempt to force a single model of uniformity on a system, robbing it of its adaptability. It suggests that there is a panacea approach to healthcare. The reality will inevitably create an environment of low standards for both patients and staff. Many healthcare professionals believe that the decisions on how medicine should be delivered should belong to those actually in the profession. It is therefore not a criticism by opponents of the “nurse ratio” but of the FORCED mandate of these ratios. The mandate suggests that hospitals are unaware how patients need to be treated and that imposing this universal standard will improve the industry. In fact, it will instead over regulate and stymie care and progress.

The cascade of consequences by this mandate includes strangling hospital budgets and obligating them to sever important and highly specialized ancillary departments and staff. These employees cannot be replaced by simply “hiring more nurses” because nurse education and training is highly varied and individuals accumulate skill sets over the course of their careers. The responsibilities of these specialized tasks would then fall to the people available and not the people qualified for the position.  As a nurse, I rely on ancillary staff to help care for my patients.  The certified nurse assistant will get blood sugars, help a patient out of bed to go to the bathroom, get a food tray, and clean up an incontinent patient.  All of these tasks, as well as many, many more, are incredibly helpful to an already busy nurse.  Those of you who have been in the hospital for a knee replacement know the value physical therapy plays in your recovery.   From the perspective of the nurse caring for the patient, the task that physical therapy performs allows the nurse to tend to other developing issues from her other patients. An all-RN model reduces specialization and therefore decreases the quality of care for the patient as well as over burdening the RN with an excess of unmanageable tasks. The success of a hospital is based on cooperative teamwork. We all work directly or tangentially with one another to effectuate a positive outcome for the patient.


In addition, if the ballot passes, the number of nurses needed statewide to fill the fixed ratio is 4,500, and it requires that all hospitals meet this requirement within 60 days! First, this is an impossible feat because there simply aren’t enough nurses out there; and second, the qualifications needed to fill these positions make the task insurmountable. It is important to recognize the nuanced and multifaceted aspects of the nursing profession.  The roles of nurses seem interchangeable, but most assuredly they are not.  To assume that a maternity nurse can easily slide into the role of a telemetry nurse (or visa versa) is to invite poor patient care and over-stress a nurse trying to perform in an area they are not experienced in.

I support the idea that nurses should have fewer patients, but I object to how this poorly written nurse staffing ratio ballot wants to force it on hospitals.  For those of you don’t know, the ballot wants to charge hospitals $25,000 per violation per day. So that means that if a nurse has a patient who codes and must be at the patient’s bedside until the patient is stable, the hospital will be fined $75,000—  $25,000 for each of the other three patients the nurse has.  The hospital’s best efforts to maintain the correct ratio will be thwarted as the nurse now will have to concentrate all her efforts to the one patient that was fine at eight o’clock in the morning but now is a code blue.  I feel as though the ballot is setting up hospitals for failure.

If you’re still unsure, please do your own research. I can’t stress enough how important this is to EVERYONE in this state! The ripple effect will be felt by all who need health care.  Please join me and the multitudes of health care professionals in VOTING NO.  Nursing has come too far to be catapulted backwards!! Speaking as a seasoned registered nurse, we stand to lose the autonomy we worked so hard to gain!

A NO vote will ensure that MASSACHUSETTS will continue to deliver the highest quality of care to all who need it. 

Lynn Donatelli  BA,RN, VA-BC

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11 Comments on Vote NO on Question 1

  1. Catherine Fallon // September 26, 2018 at 7:27 am // Reply

    I am
    a Registed Nurse since 1952 so I have lived through all the changes in health care. My view is health care has been taken over by Business People and Insurance Companies. Medical people are doing crisis care which is every day under enormous stress to care for our Patients .Staff Nurses have been advocating for Patients over 20 years without success because of power and money. As a last straw Nurses have to turned to laws that demand what is morally right and common sense . Please support Staff Nurses by voting YES on ballot question 1 Thank You

  2. This nurse says yes on 1!

  3. Bill Vitale // October 1, 2018 at 9:14 pm // Reply

    This ballot question is based on years of research that shows higher ratios equals poor patient outcomes. Hospitals have chosen to ignore the research. So nurses came together to place this on the ballot to protect their patients from harm. As nurses we pledge to do no harm. Being asked to care for to many patients put all our patients at risk

  4. I’m so confused…a code becomes a 1:1 & is usually taken over by a float or rapid response nurse…& then transferred to ICU. So the hospital shouldn’t be fined. Also, who would you have an “all RN model?” That’s silly. We have ratios & PCTs here in Cali…& my old hospital also incorporated safe staffing. We love our ratios in California. Are you saying no to ratios overall or how the bill is written?

  5. Vanessa Machado // October 5, 2018 at 8:33 am // Reply

    Hospitals will not be charged $25,000 each time. You did not read the bill. Fines would be $250 – $25,000 and that’s a huge difference!

    Nurses’ voices are stronger in numbers! Finally we have a possibility to be able to provide the care that our patients need and deserve and you’re voting no?

    It is time to make a change. Noone said it would be easy but it is not only worth it in the long run (fewer patients deaths, fewer complications, better outcomes-all research proven), it is NECESSSARY!

  6. this bill will create low standards for patients?! This bill is common sense. How could caring for 4 patients rather than 5-7 on a med/surg floor be better? please. And just because a patient codes and becomes a 1:1 does not mean the hospital will get fined.

  7. I vote yes my dad might still be here His CC pregnant nurse did not have so many patients but instead he was code blue about 3 hours after we left him and passed by the time we got back did not have the care he should have you need to evaluate all and do not overwork nurses disappointed in MWRH

  8. Obviously the author of this post has not taken the time to read the proposed bill. One should educate him/herself before posting/speaking.
    I have had 5-6 patients in an ER while I share a bay with another RN who has 5-6 patients. When a priority 1 patient comes in who requires 1:1 ratio, who do you think takes my other patients? My bay partner who already has 5-6 patients giving them a total of 10-12 patients. Where is this safe? Fair for the patients, let alone the nurse? Please read the bill and think outside of your own perceptions…. They aren’t correct.

  9. I’m a healthcare administrator at local hospital and Professor at several universities in nursing departments. I say NO.

  10. To the RN who posted this long plea to vote NO;
    You are incorrect on many aspects of your comments.
    You stated you have been a nurse in “step down, ICU,
    Neonatal etc., well those areas have always had
    Safe stafffing limits, you couldn’t have had 4-6 patients like most of us on Med-surg floors. Also I have had a 5,6
    Pt load and one of my patients did code, after pt was stabilized and transferred off the floor (of course who do you think transferred and filled out the necessary paperwork and gave a hand-off to the next nurse
    (Yup that would be me!) THEN I was expected and did go back to the other 4-5 patients to complete their care
    and give a hand-off to the next shift for each. No one took my assignment during the Code. So I stayed and made my 12 hour day 14+ hours, go home totally exhausted then do it all over again the next morning at 7 am. That’s reality and where were those professionals
    Who have my “profession in their hands”? If the Government didn’t step in for Air Traffic Controllers and what about the reduction of hours interns and residents are made to work. Not all limitations are bad, they are necessary. Burnout of Nurses is REAL. You speak of autonomy, you were in Units with 1-2 patient ratios. This bill also states that hospitals are NOT allowed to decrease other staff in other areas in order to hire more nurses Orientation and Mentoring will always be there, the new nurse isn’t considered in the staffing numbers until they are off orientation. In a court of law a nurse will be judged “as any prudent nurse with the same experience”
    Help Our Profession, VOTE YES! Patients’ lives depend on it and we all could be patients one day.

  11. (To the prior post): OF COURSE YOU ARE VOTING ‘NO’ !!! WHY ARE YOU VOTING ‘NO’? You just said it yourself!!!! >>>. “I’m a Health Care Administrator at a local hospital’. !!!!!! THAT IS EXACTLY WHY YOU ARE VOTING NO!!!!

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