How MA Ballot Question 1 Negatively Affects South Shore Health System


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As the Massachusetts Health Policy Commission recently confirmed, taxpayers are looking at a cost of nearly a billion dollars to implement the proposed measure. Mandated nurse staffing ratios will cost South Shore Health System alone $33 million per year; a cost it could not afford, without making reductions in both staff and programs. Patients would experience barriers to access, longer wait times and the reduction or elimination of key specialty services. Furthermore, there are absolutely no studies that prove that mandated nurse staffing ratios would improve quality of care for our patients; care that they need and deserve within their own community.

Many bedside nurses are opposed to this harmful ballot initiative because they understand the catastrophic impact it would have on patient care, on hospitals, and on their own professional practice. Nurses value having the autonomy to use their professional judgment to weigh sometimes rapidly-changing factors while caring for patients. Nurses understand patients are not one-size-fits-all and should not be treated that way.

“When deciding on a treatment plan for our patients, nurses take into account multiple factors — it is never just a ratio,” said RN Sue Clancy, of Scituate. “A yes vote would give the government the power to simplify complex decisions down to a single number. This bill would wipe away the work we have done to empower our profession.”

The reality of Question 1 is that rigid ratios will determine the number of patients that can be seen at any given time. Patients will be forced to wait hours — or days — in the emergency department if the number of patients needing treatment falls outside the mandated ratios. The proposed law does not make exceptions of any kind. In this scenario, patients seeking immediate treatment can only be admitted if additional nurses arrive or if patients are discharged, and every instance of a hospital treating additional patients will lead to fines of $25,000 per infraction. Those fines will not go to improve healthcare but be put back into the general fund for elected officials to spend as they see fit.

In California, the only state in the country to impose ratios years ago, hospitals reported increased wait times in the emergency department and a 2016 study showed that some hospitals were forced to close because of the tremendous financial burden. Why, if this was such as good idea, is there only one state in the nation that has adopted it?

There is no magic number as the single factor to affect patient outcomes or job satisfaction. That is why Question 1 is opposed by leading nursing, physician and healthcare organizations, including:

  • American Nurses Association - Massachusetts Chapter
  • Emergency Nurses Association - Massachusetts Chapter
  • Organization of Nurse Leaders
  • Infusion Nurses Society
  • Massachusetts Association of Colleges of Nursing
  • Academy of Medical-Surgical Nurses’ Greater Boston Chapter
  • Western Massachusetts Nursing Collaborative
  • Massachusetts College of Emergency Physicians
  • Massachusetts Medical Society
  • Massachusetts Health and Hospital Association
  • Massachusetts Council of Community Hospitals
  • Conference of Boston Teaching Hospitals
  • Many other healthcare and business leaders across the state.


For more information on the negative impacts of Question 1, and to become involved in defeating this measure, please visit the Coalition to Protect Patient Safety website.