by Chaunie Brusie, BSN, RN

Massachusetts is facing a controversial ballot initiative this month, as voters will be deciding on Question 1, a proposal to legally limit the number of patients that can be assigned to a nurse on hospital units. And while at first glance, the proposal sounds like a promising solution to overwhelming and often times, dangerous patient-staffing ratios, some nurses and healthcare staff are against the proposal because they believe it will limit patient care.

For instance, a news piece by Boston.com released on October 30th noted that although Question 1 was initially favored by the public, the majority is now against it, citing their own personal relationships with other nurses in opposition for the switch. However, there are some prominent public figures in favor of Question 1, including U.S Senator and Vermont Independent Bernie Sanders.

Why Sanders supports the bill

Sanders released an official statement endorsing Question 1, saying: “Nurses are the backbone of our health care system. They are there with us when we are born, when we are sick and in the last years of our lives. They must be allowed to do the quality work that they have trained for. Question 1 would set a safe maximum on the number of patients nurses can treat, so that patients can receive the quality care they deserve. Nurses are behind this initiative, and I trust them when it comes to knowing what is best for their patients."

As Sanders suggested, supporters of Question 1 maintain that the proposal will help ensure that nursing-patient ratios are standardized throughout the state, kept at a safe level for both the patient and the nurse, and done with patient care in mind first. Opponents of the measure, on the other hand, worry that setting mandated limits will actually limit care and force hospitals to turn patients away or shut down certain units altogether. For instance, Brian Burke, an MD from Great Barrington, penned an opinion piece against Question 1, using the example of an overflowing emergency room as an instance where mandated patient-nurse ratios may simply not work and in the situation where the nurses were already maxed out, force patients in need of care to be turned away.

“…under the terms of the nurse staffing initiative, if you arrive at an emergency department at the wrong time — meaning when others are also seeking care, ambulances are arriving, and the volume of patients exceeds the limits set by the staffing ratio initiative — you may not be seen until and unless additional staff are brought in to restore the ratio,” he wrote. “Not only is this an impossible situation to remedy in a timely fashion, but it is also downright unethical, and it places emergency department staff in a disastrous double bind. To me, once an emergency physician for over 20 years, it is unthinkable.”

Concerns from the medical community

Well-known Massachusetts RN Elise Wilson, who was horrifically attacked and stabbed in the neck and arm by a patient last year in the ER, is also a public opponent of Question 1. She frequently posts informational pieces on her own Facebook page arguing against the proposal, such as articles that say that similar legislation in other states has led to increased ER wait times, staff cuts, and unit closures.

Despite the controversy over Question 1, Sanders is portraying firm support for it, under his stance as a “proud” co-sponsor of the National Nursing Shortage Reform and Patient Advocacy Act (S. 864). The Act, among other measures, which ensure the mandatory number of patients a Registered Nurse is able to take care of in the hospital. The measure would apply to all public hospitals as well as hospitals within the Department of Veterans Affairs.

Sanders’ website maintains that his support stems from the fact that “numerous studies” have shown that mandated nurse-patient ratios save lives and improve the quality of care for hospital patients. (Although Sanders’ site did not link to any such studies, there have been some studies that have found that mandated patient-staff ratios have been linked to outcomes such as higher patient satisfaction, lower mortality following surgery, and more favorable nurse workloads.) He also notes that his support for the measure comes after a long history of nurse advocacy, including pushing for more funding for Nursing Workforce Development Programs and chairing a hearing on patient safety last year.

In addition to lending his support for Question 1, Sanders’ website explains that he agrees with the Institute of Medicine’s recommendation that nurses should be full partners, with physicians and other healthcare providers, in redesigning health care in the United States. “Bernie also believes that nurses must be a leading voice in the conversation within each hospital about safe nurse staffing levels,” his page proclaims.

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