Nurses are the linchpins of our healthcare system. They are extraordinarily compassionate and hardworking. They possess acute intuition to patients’ needs and fast decision-making skills, and they are among the most intelligent people in our workforce. It is only fair that we protect their right to a reasonable workload and ensure they are able to do their jobs well. The president of the Massachusetts Teachers Association, Merrie Najimy, said, “Just as small class sizes allow teachers to give the necessary time and attention to each student, safe patient limits allow nurses to give the necessary time and attention to each and every patient so they can provide the critical care that their patients need.” Nurses are people too, and we need them to be able to provide the best care possible to every patient. In a nutshell, that’s why I’m voting yes on Question 1. That being said, Question 1 is highly complicated and nurses, hospitals and voters seem to be split down the middle. Let’s dive in.
If passed, Question 1, also known as the Patient Safety Act, would create limits on how many patients nurses can attend to at one time, depending on the medical unit and type of patient. If hospitals don’t comply with this law, they would be fined up to $25,000 per violation. Massachusetts already regulates the amount of patients nurses can see at one time in Intensive Care Units (two). The initiative would be enforced by inspections of facilities. Violations found by these inspections would be reported to the office of the state attorney general, who could file suit against the hospital. There would also be postings detailing the conditions of the initiative in all units, patient rooms and patient areas, and all facilities would be required to have a phone number and website so that patients or family members could submit complaints about violations.
The biggest opposition to the bill is, unsurprisingly, hospital administrators. They argue the mandate removes decision-making skills from the hands of hospital workers. They also argue it will force them to lose immense amounts of money. Research estimates Massachusetts hospitals would be forced to pay $1.3 billion in the first year of the mandate, and $900 million every following year. But the Massachusetts Nursing Association says it’s hypocritical for hospitals to make threats of cutting services due to these costs when they spend millions on mergers and affiliations, and I agree. All too often, hospitals function like big businesses, focusing more on where they can cut costs than how they can improve patient care. Most hospitals can afford to hire more nurses, especially when you look at the nonprofits. Partners HealthCare, which umbrellas Brigham and Women’s and Massachusetts General Hospital, had an income of $69 million in just the second quarter of 2018.
California is the only state to currently employ limitations on how many patients nurses can see at one time, and studies have shown the results are positive. A study in 2016 made a direct comparison between patient assignment limits in California and Massachusetts, and showed that patients in Massachusetts received 3.5 fewer hours of care due to lower nurse staffing and poor patient-nurse communication, resulting in higher rates of preventable complications such as pneumonia. Another study from 2010 found that emergency room wait times were shorter when limits were put in place. Currently, wait times in Massachusetts hospital emergency departments are 47 percent longer than in California.
Many nurses don’t advocate for Question One, citing the need for professional autonomy. In a letter to the editor in the MetroWest Daily News, nurse Sue Scott writes, “Staffing is complex, dynamic, and multi-faceted. It is important for professional nurses to have the flexibility to determine how to best meet the needs of their patients under frequently changing circumstances.” This is more than understandable, but it doesn’t change the fact that many nurses are overworked, seeing more patients than is feasible. In another article from the MetroWest Daily, 66-year-old nurse Nora Watts is quoted saying, “If it’s a day that I have six people I’m personally taking care of, it’s overwhelming.” ICU nurse at Brigham and Women’s Katie Murphy is also quoted, stating “Employers are telling us, ‘do the best you can.’ You just can’t say that with people’s lives.” This split between the opinions of nurses is a large part of why Question 1 is so tricky and controversial. While 48 percent of nurses support it, 45 percent oppose it. It’s important to consider that nurses who oppose the act are more likely to be satisfied with their jobs, and perhaps we should listen to the nurses who say that they’re struggling.
We live in a society where stress is glorified. The more we work, the more accomplished we feel. Taking leisure time for ourselves often comes with guilt, the feeling that we need to be doing something. Nurses are among the most hardworking and smartest people in our society. They are extremely driven and motivated to help their patients. It’s natural for us as humans to want to do more and to be empathetic. Perhaps nurses who oppose the bill are satisfied with their jobs, but it’s also likely that they want to continue to help as many people as they can. Massachusetts Senator Elizabeth Warren endorsed Question 1, saying, “Nurses work hard to take care of all of us when it matters the most, and we should do the same for them by establishing standards to ensure they have the help they need to do their job safely. I stand with our nurses and support a yes vote on Question 1 in November.” Establishing patient assignment limits would make it possible for nurses to give the best care possible to their patients without being overworked. I’ll be voting yes on Question 1 because I believe that our nurses, the people who take care of us, deserve reasonable workloads and respect.
Hannah Lieberman is a Collegian columnist and can be reached at [email protected].
