Massachusetts Medical Society: Massachusetts Medical Society joins in Coalition to Protect Patient Safety in Opposition of Question 1

Massachusetts Medical Society joins in Coalition to Protect Patient Safety in Opposition of Question 1

The Massachusetts Medical Society, while recognizing and appreciating the critical role fulfilled by our state’s exceptional and compassionate nurses, stands with the Coalition to Protect Patient Safety in opposition to ballot Question 1.  We understand that nurses have concerns about staffing workloads.  We agree that health systems need to address the issue of burnout for all members of the health care delivery team.  However, this is not the right solution.  While we agree that improvements can be made in nurse staffing, it is critical for physicians and nurses working in a team-based environment to have and to deploy decision-making authority that yields appropriate and safe care for each patient.  Arbitrary, one-size-fits-all approaches to staffing erode that authority.  

Our patients, whether seeking maternal, surgical, behavioral, emergency, nursing home, home health, school based, community health center based or routine medical care, will have their access to care jeopardized if Question 1 passes.   We cannot let our patients be put in harm’s way.

Question 1 mandates minimum nurse staffing levels at all times, in all units, in all hospitals with no flexibility. *1    Ratios would be the same in every hospital, regardless of their size, location or the unique needs of their patients. Staffing decisions would be taken out of the hands of experienced nurses and doctors at the bedside and put in the hands of a bureaucratic government mandate.  Mandated ratios would disregard the professional judgment of qualified healthcare professionals in each hospital, threaten the quality of care, and increase costs to patients.

California V. Massachusetts

Comparisons to California Staffing Law are often made:

  • Fact:  Massachusetts supersedes California in Quality Comparisons including mortality, infections, patient safety, ED Wait times, Patient Satisfaction. *2

Increased hospital costs and disproportionally affected safety net hospitals. *3

Led to cuts to non-nurse staff. *4

Impact of Cost *5

Aggregate Statewide Cost of Implementation: $1.3 Billion in Year One / $900 million annually going forward.

Current number of hospitals with FY 16 negative operating margin: 14.

New number of hospitals that would have a negative operating margin because of implementation would be 25 bringing the total hospital with negative operating margins to 39.

The burden is greater for smaller hospitals with lower patient acuity.

Impact on Nurse Workforce *6

Estimated Total Registered Nurses needed would be at a deficit of 5,911.

Impact on Community Health Care Settings *7

Law would drain nursing care from community care settings including nursing homes, rehabilitation, home care, schools and community health centers.

Impact on Maternal Care *8

Potential reduction in ability to conduct deliveries in MA from 5,300 to 7,850 fewer deliveries.

Potential reduction in ability to conduct high risk deliveries in MA from 1,190 to 1,930 fewer delivers.

Impact on Behavioral Health *9

Behavioral Health Care Facilities would see a reduction of service by up to 38%.

Impact on Emergency Department Care *10

Increasing wait times before a patient can be seen by a clinician.

Potentially worsening patients’ critical illnesses due to delayed access to emergency care.

Prolonged wait times for inpatient beds when patients require admission from the ED since floor staffing ratios will dictate the number of beds available for new admissions. This will delay care for admitted patients and delay care for new ED patients who require evaluation.

Exacerbating the current crisis of ED boarding of admitted patients, when patients must wait in the ED until an inpatient bed is available.



*1 The proposed ratios are as follows:

  • Step-down, intermediate care units: 3 patients per registered nurse.
  • Patients under anesthesia: 1 patient per RN.
  • Patients post-anesthesia: 2 patients per RN.
  • Operating room patients under anesthesia: 1 patient per RN.
  • Operating room patients post-anesthesia: 2 patients per RN.
  • Critical care or intensive care: 1 patient per RN (An RN may accept a second CCU or ICU patient if the nurse assesses that each patient’s condition is stable).
  • In the Emergency Room:
  • Critical care or intensive care patients: 1 patient per RN.
  • Urgent, non-stable patients: 2 patients per RN, defined as those needing prompt care in 15-60 minutes.
  • Urgent, stable patients: 3 patients per RN, defined as those able to wait 3 hours for care.
  • Non-urgent, stable patients: 5 patients per RN, defined as those for whom time is not a critical factor in care.
  • Maternity in active labor: 1 patient per RN.
  • Post-partum up to 2 hours: 1 RN for mother, 1 RN for baby.
  • After both mother and baby are stable: 1 RN for both mother and baby.
  • Intermediate or continuing baby care: 2 patients per RN.
  • Well-babies: 6 patients— can be 6 mothers, 6 babies, 3 pairs of mothers or babies, or if multiple babies, no more than 6 total between mothers and babies.
  • Pediatric: 4 patients per RN.
  • Psychiatric: 5 patients per RN.
  • Medical-surgical or telemetry: 4 patients per RN.
  • Observational outpatient: 4 patients per RN.
  • Rehabilitation: 5 patients per RN.
  • All other units: 4 patients per RN.

*2 Commonwealth Fund

*3 The Financial Health of California: A looming Crisis, Harrison and Montalvo: Health Affairs

*4 Serratt, 2013 Systematic review of the literature on California Ratios

*5 Coalition to Protect Patient Safety

*6 Local Choices v. Statewide Mandates in Massachusetts, Mass Insight and BW Research

*7-*10 Coalition to Protect Patient Safety


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