Our view: Vote NO on Question 1

Of the three ballot questions before voters in November, none has generated quite the level of passion as Question 1. Depending on whom you believe, the measure will either provide a desperately needed enhanced level of nursing care, or it will create a cataclysmic situation that will force hospitals to lay off hundreds of employees or, in some cases, to close altogether.

Not surprisingly, the heated and inflammatory rhetoric on both sides of the question has left more than a few voters scratching their heads, and in truth it is difficult to separate the hype and hyperbole from the facts of the matter.

However, after weighing all of the factors, we recommend a no vote on Question 1. Although the intent behind the question has merit, the one-size-fits-all approach to this measure seems roughly akin to using a chainsaw to trim hedges; it will get the job done, but you could easily end up doing more harm than good.

The proponents behind Question 1 make the argument that low nurse staffing levels inevitably lead to poorer health outcomes, and there is some logic to that notion, although there is little agreement over just what that magic ratio should be. Still, as anyone who has been overworked can attest, exhaustion never produces a higher caliber of work, regardless of the field, and in the case of medical care, that lack of attention to detail can be a life-or-death matter.

Furthermore, the predictions by opponents to Question 1 of catastrophic financial collapse seem, at best, alarmist. Yes, hiring nurses will obviously cost more money, but such apocalyptic scenarios were also predicted in California, where a similar measure passed, but the fiscal sky has not fallen there.

Still, it may be a bit early to call it a complete success. While research has shown improvement for nurses’ work experience, there have not been improvements to patient outcomes. Plus, the wording of Question 1 is more constraining than the measure in California. Specifically, the language of the Massachusetts ballot measure places more restrictions on how hospitals can fund the resulting increased staffing levels. It also fines hospitals $25,000 per day for failing to staff at the mandated levels, something that is not part of the California law, and has a shorter window for hospitals to hire the necessary nursing staff.

Not surprisingly, hospitals are pulling out all the stops in opposing the passage of this ballot initiative. Hospital officials have said there would be longer wait times in the emergency room, as well as cuts to beds and services. Nursing homes, primary care doctors and other health care facilities that rely on nurses, could see a staffing shortage as hospitals consume a larger portion of the labor market.

In addition to the potentially exorbitant costs that hospitals will incur, this approach, if successful, could open a Pandora’s Box when it comes to the public service sector. How long would it be before we started hearing about the need for similar increases to staffing at fire and police stations?

It is also worth noting that several nursing organizations oppose the measure, including the Massachusetts chapters of the American Nurses Association and the Emergency Nurses Association, as well as the Massachusetts Medical Society and a host of hospital associations.

We hope that hospitals will not misread this as an endorsement for business as usual. Nurses have pushed for increased staffing for 20 years, with little success. If hospitals hope to stave off such efforts in the future, they would be well advised to take a more constructive approach with various nursing constituencies, showing that they can be a partner as well as a boss. Perhaps all parties could agree to a more narrowly focused scope, such as increasing the number of urgent care nurses, instead of increasing nurse staffing levels across the board.

This ballot initiative raises an important issue, but the cost – financially and otherwise – would be too large for the Bay State’s health care system, which is already one of the best in the nation. We urge a no vote on Question 1.

MetroWest Daily News Editorial
Sunday, October 21, 2018