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Massachusetts Voters Say 'No' to Mandatory Nurse-Patient Ratios

Analysis  |  By Jennifer Thew RN  
   November 07, 2018

Bay State residents reject a law requiring mandatory staffing ratios, but proponents and opponents of the measure vow to continue to address the issue.

Last night, Massachusetts voters had their say on ballot Question 1, which sought to implement nurse- to-patient ratios in hospitals and other healthcare settings. 

It was met with a resounding 'no' from the electorate, with about 70% voting against the measure and almost 30% voting for it.

For months, the law has been hotly debated. Those in favor said it would improve patient safety and care. Those opposed said it didn't account for patient acuity and would create a financial burden on hospitals and healthcare systems.  

Had the law passed, Massachusetts would have joined California as the only other state to require that level of mandatory ratios.  

The Massachusetts Nurses Association, the union which represents nurses in over 70% of acute care hospitals in the state, supported of the law.

Donna Kelly-Williams, RN, president of the MNA, provided a statement after the measure failed to pass. She thanked frontline nurses for their advocacy of patient safety and high-quality care.

"We are all disappointed by tonight's results and the impact this will have on the patients we care for every day.  We know that right now – as I speak to you here – there are nurses caring for too many patients, and those patients are unnecessarily being put in harm's way," she said. "The problem continues to grow every year. The status quo is not a solution here. "

Steve Walsh, president and CEO of the Massachusetts Health & Hospital Association, which opposed the law, issued the following statement in favor of the result.

 "What we won tonight was the ability to continue providing the best possible care for patients throughout Massachusetts," he said. "This is the beginning of a conversation, not the end. Question 1 forced some difficult and necessary discussions about the future of health care and the future of our workforce going forward. These conversations with our care teams and in our communities have been critically important and will continue in bargaining sessions, legislative debates, board rooms, and newspapers. These are conversations we owe to the voters. Most importantly, these are conversations we owe to our patients."

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association, which opposed the mandatory ratio law because the organization felt it was too rigid and did not account for issues like patient acuity, weighed in with a statement encouraging discussions about patient safety and nurse staffing to continue at a national level.

"ANA has long been a strong advocate for appropriate nurse staffing in all healthcare settings. We know that providing the right nursing resources makes a critical difference for patients and the quality of their care. Many factors affect the number of patients for whom each nurse may safely care for – it's not just math. The rigid, one size fits all approach proposed by the ballot initiative failed to acknowledge the complexities of staffing and undermined nurses' professional autonomy and decision-making in determining staffing on their units," she said. "The robust debate spurred by the ballot question helped to educate consumers about the importance of nurse staffing and its impact on quality patient care. We know hospital and nursing leaders across the state are ready to work together to identify a constructive path forward to develop shared solutions and accountability to ensure staffing levels meet the needs of patient populations, and align with nurses' experience and associated resources. Only when that happens, can victory be declared."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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