Respect Nurses’ Professional Judgment: Vote NO on Question 1

I have been a registered nurse for over 25 years.  Making a difference in the health and wellbeing of patients is at the core of why I became a nurse.  I chose the nursing profession because it allows you to care for patients and their families, helping them during their most vulnerable times.  It is a privilege to care for patients.

Having experienced the challenges bedside nurses face delivering quality patient care, I take my role very seriously in working to create an environment that supports their needs. I have the highest level of respect for our nurses at MRMC who demonstrate true compassion and commitment to our patients each and every day.

I would never compromise the care of my patients, nor would the nurses I respect and have worked beside throughout all these years. We use our professional judgment daily to deploy resources at the bedside where life-and-death decisions are made, often in seconds, based on the unique and ever-changing needs of each patient. The individual assessment of our patients has always determined our course of action and approach to ensure the very best care is delivered. This is why I oppose the mandated nurse staffing ratios proposed by the Massachusetts Nurses Association.

Fixed nurse staffing doesn’t allow for on-the-spot adjustments needed to effectively serve the changing medical conditions of patients. It would undermine the response to an immediate need of a patient on the floor whose condition suddenly deteriorates. This proposed “at all times” fixed ratio would prohibit nurses from using their professional judgement in managing care of their patients. In addition, adherence to the strict nurse staffing ratio would impact access, both with patients entering the ER and holding patients in the ER that should be admitted. In some cases, patients would need to be turned away or transported to another hospital.  It’s also important to understand the downstream effect of the mandated nurse staffing ratio creating much longer wait times in the ER because of patients being held there who would normally be moved out and admitted. Ultimately, the mandated nurse staffing would negatively impact patient care and reduce access.

In addition, a “yes” to Question 1 in November would require implementation within an improbable seven week period adding 4,500 more RN positions in Massachusetts. The staffing proposal would cost an additional $1.3 billion in the first year and over $1 billion each year after that (including $100 million in additional state spending). At Milford Regional, to meet the requirements of the nurse staffing ratio would cost our Medical Center over $5 million a year. Plus, each time a nurse violates the staffing ratio based upon meeting a critical patient need or if, for some unexpected reason, the ratio is not met on any given day, the hospital would be fined $25,000. By penalizing hospitals if they admit more patients when the number of nurses on duty at that moment does not meet the statewide mandate, this ballot question would force people to seek care elsewhere — costing precious time that is crucial to life-saving care and personal health.

Unfortunately, this financial impact would result in the difficult decision to eliminate programs, services and reduce the number of patient care units that could remain open, which would severely affect access. Realistically, if the nurse staffing ratio ballot becomes law, it could threaten the future existence of Milford Regional’s healthcare system.

You need look no farther than California that passed a nurse staffing ratio ballot in 2004 to see its failure to improve patient outcomes and shorten hospital stays. Instead, it increased costs to patients and hospitals significantly leading to hospital and emergency department closures. After 14 years of this failed law and negative impacts, studies show that California ranks behind Massachusetts in five of six mortality prevention measures and in all 11 patient satisfaction categories.

Massachusetts hospitals are known to be leaders in healthcare worldwide. They consistently rank among the best states in the U.S. on hospital quality and patient outcome measures. Our

state has earned national acclaim from several top tier ranking systems including the Commonwealth Fund’s State Health System Performance,1 that placed Massachusetts 2nd overall in the nation. Passage of Question 1 would not be good for Milford Regional and wrong for patients.

Please leave the decisions up to those who know best and Vote No on Question 1 in November.