CHATHAM – It is arguably the most contentious issue facing Massachusetts voters this November. Ballot question 1 – “Nurse-Patient Assignment Limits Initiative” – is creating a response in the public that is contradictory and confusing. Competing ads claiming to represent the same people yet holding different positions appear regularly in the media, trust-worthy information on the proposal and its effect is scarce, and many potential voters simply do not know what to think. One writer to a local newspaper told of seeing two signs – one for and one against Question 1 – on the same lawn.
To try to shed light on the question, the Chatham-Harwich Newcomers Club held a forum on the Initiative at the Eldredge Public Library last Thursday. Speaking for the proposal was Donna Kelly-Williams, RN, a nurse from Cambridge Hospital and president of the Massachusetts Nurses Association, chief sponsor of the initiative. Speaking in opposition were Jeffrey Dykens, vice president for finance and operations at Cape Cod Healthcare, Inc., and Judith Quinn, RN, director of nursing at Cape Cod Hospital. The three offered different perspectives on the proposal, its origin, purpose, and potential effects, and responded to questions and comments from an audience of some thirty people.
In her comments, Kelly-Williams said that a similar law has been in place in California for two decades, and that the Commonwealth already has limited the nurse-patient ratio to no more than one to four in hospital ICUs for four years. The MNA asked the legislature for a similar law governing other nursing situations, but when that effort failed the union turned to a ballot initiative, bypassing the State House.
She also argued that, contrary to many recent ads, the proposal does not turn over to the Commonwealth control of local hospital staffing, though it does give government regulatory authority to ensure that the process outlined in the initiative for setting the ratio of nurses to patients by a local facility is followed. While its overall goal is to lower the current ratio to no more than one to five and cap it at lower figures depending on the hospital unit, determining the actual ratio will be based on the use of a locally developed “patient acuity tool” that will assess the actual staffing needs for any given unit or group of patients.
Several audience members shared their personal hospitalization stories, both on Cape and off, stating that they found nurses to be available and responsive to their needs. Kelly-Williams responded that the problem is not what happens after the nurses respond to a call-bell, but how long it may take for them to respond at all. The higher the ratio of nurses to patients the longer the wait-time.
Because patients hospitalized today tend to be have more acute conditions that require greater skilled professional assistance from the nursing staff, Kelly-Williams said the ultimate goal of Question 1 is better patient care.
A different perspective was given by Quinn and Dykens. Quinn said that while Cape Cod Hospital has been able to establish a nurse-patient ratio of one to five for days and evenings, as opposed to the lower ratios envisioned by the initiative, Cape Cod Healthcare, Inc., now needs another 250 nurses (50 of whom would be at Cape Cod Hospital), even if Question 1 is not passed. While there are several reasons for shortages in medical staff, voter approval of the initiative will further aggravate the situation once it is implemented in January 2019. To this Dykens, who is also a Chatham selectman, added that if the voters approve Question 1, Cape Cod Hospital and Falmouth Hospital will need an additional $39 million in annual income to offset the cost of the additional nursing staff they will have to hire to meet the law’s requirements. Across the Commonwealth the cost of healthcare would increase by $1 billion dollars a year, he said. If it the measure is approved, Massachusetts hospitals and other medical institutions will have to curtail services or close. Further, given the aging population here, the large number of Medicare and Medicaid patients being treated by Cape Cod Healthcare, Inc., a non-profit corporation, limits its ability to meet those increased nursing staff costs.
“Hospitals determine how their resources are used,” Kelly-Williams said in response to those comments, though the initiative the MNA supports will somewhat limit their ability to do that. Dykens suggested that the purpose of the initiative is to benefit the 23 percent of nurses who belong to the union, a claim Kelly-Williams disputes. Even the initiative itself, a six-page single-spaced document full of legalese entitled “Initiative Petition For A Law Relative To Patient Safety and Hospital Transparency” and known as “The Patient Safety Act,” can be used to support the positions of both its supporters and opponents.
When asked if there is evidence that passage of the Initiative will improve the health and health care of patients, all the speakers replied in the negative.