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Why This RN is Voting No on Q1

by Claire Bresnahan

Why This RN Is Voting No on Q1


As I was researching how to vote on the upcoming Patient-to-Nurses Limits question on the ballot, I want to share what I found and why I have decided to vote NO on Question 1.

I  am an experienced Registered Nurse (RN) of 42 years.  I spent 13 years caring for my patients on a 60-bed surgical unit (with no staffing ratios), and 29 years in recovery following the American Society for PeriAnesthesia Nurses (ASPAN) Standards for staff ratios.  I am no stranger to what staffing ratios can and cannot do for you. Through my research, here are the reasons why I am voting NO.

First, a scenario: Imagine taking your ill loved one to the ER and the Patient-to-Nurse Limit has been passed. This would mean that an RN caring for three stable patients who are waiting for transfer to another unit WILL NOT be able to care for your acutely ill unstable loved one until a bed becomes available on the medical unit. The judgment, and years of experience, of the individual RN would prove irrelevant in a situation where staffing limits have been imposed.

The purposed ratios would be the same at all hospitals, from the larger Boston hospitals to the smaller community hospitals that provide more accessible care throughout Massachusetts. This could potentially add a billion dollars in mandated costs, crippling our smaller community hospitals, forcing some to close. This would force many Massachusetts residents to seek care in the cities, further from home because programs would be cut in our local Massachusetts hospitals.



  • Support for Q1 is misleading: You may have seen the political ad stating that 86% of nurses are in favor of question 1.  What this ad fails to mention is that 86% of UNION nurses plan to vote yes. Let me clarify: 75 % MASSACHUSETTS RNs are not in a union, and have not been polled.  I say this with confidence since my colleagues and myself working in a non-union hospital did not receive this survey.

  • Services that hospitals now provide at any given time, 24/7 would be decreased or eliminated if the hospital is unable to provide enough RNs to fulfill the rigid ratios.

  • Health care costs will rise: In early October of this year, the Massachusetts Health Policy Commission, an independent watchdog that monitors health care costs, released estimates that the mandate would create costs between $676--$949 MILLION for the hospitals,  other care providers, as well as the state (Goldberg, 10/3/18). That is just a beginning quote; historically, projects in Massachusetts run over budget.

  • Costs will likely be passed onto the patients: Per the Massachusetts Information for Voters 2018 Ballot Questions, “there will also be an impact on MassHealth, the state’s Medicaid program, and state-funded employee and retiree health care obligations to the extent that the initiative increases hospital costs or causes hospital closures”.

  • Improved health care quality is not guaranteed: You may have heard that California has already implemented mandatory nurse staff ratios. Massachusetts hospitals, along with hospitals in 24 other states without mandated ratios, ALREADY deliver safer patient care than California.

  • Lack of available staffing: There is a country-wide shortage of RNs. Where would the Massachusetts hospitals find and recruit more than 3,000 additional nurses to meet the mandates??

Do you want more government control dictating how nurses care for patients rather than the PROFESSIONAL, EXPERIENCED RN deciding how to care for YOUR LOVED ONE??  Does the government dictate to the teachers how to teach, the police how to police or the firefighters how to combat fires?? Disasters??

Please don’t let political red tape tie my hands. My colleagues and I have the advanced educational degrees, certification and experience to continue to provide high quality care for all our patients.

PLEASE JOIN ME in voting NO on Question 1, along with:


American Nurses Association Massachusetts

Massachusetts Medical Society

Organization of Nurse Leaders

Emergency Nurses Association

Massachusetts Association of Colleges of Nursing

Western Massachusetts Nursing Collaboration

Infusion Nurses Society

Massachusetts Association of Behavioral  Health Systems

Massachusetts Ambulance Association

Massachusetts Psychiatric Society

Massachusetts College of Emergency Physicians



Claire Bresnahan RN BSN CAPA CPAN


Further reading:

Goldberg, C. (October 3, 2018). Nurses Ballot Initiative Could Cost Over $900 Million A Year, State Panel Estimates. NPR: Accessed at

Comments (5)

Thank you Claire for taking the time to research this question and pass that info along.

Kris Heavner | 2018-10-22 14:18:42

I am undecided at this point and I am open to arguments on both sides. I would love to see an op-ed here from a nurse on the "yes" side. In the meantime, this article has a great deal of information: There is also a wealth of information on the MNA site: This is an important question and I think we all need more information - from both sides - to make an informed decision.

John Yeoman | 2018-10-22 03:11:36

Funny, I was talking about this ballot question today, remaking on how the "Nurses'NO" and "Nurses'YES" signs look misleadingly familiar and how the bill is also misleadingly familiar. I was quite interested in a second medical industry employees opinion after talking to one nurse (union) that was going to obtain from the question because SHE was to unfamiliar with it. Know I know. Thanks a bunch for the unbiased info. Cheers! Alex R. Wheaton, CHS

Alex Wheaton | 2018-10-21 16:19:08

Claire and Linda ~ Carmen and I found your article [and comment]to shed light on this ballot question. The TV ads muddy the waters. Common sense and your facts clarify the issue. You have provided a much needed perspective. Thank you.

Ann Chiango | 2018-10-21 15:19:00

Thank you Claire for this concise, clear review of question 1. I have been an operating room nurse for 43 years and I also plan on voting NO on question 1. Many friends and relatives have asked me to explain this question to them. As you said in your article, there are many advertisements on the TV that mislead voters. The biggest question that voters need to ask themselves is this: Do you REALLY want the government to imposed limits for skilled nurses? There is no question that there needs to be a limit on how many patients a nurse can care for - but those limits need to be decided by the profession nurse, NOT politicians. FYI - there was a debate on the show On The Record It's worth watching: So, get out and vote NO on question 1 to keep our patients safe and to keep the decisions about care in the hands of the professional nurse. Linda Rossini

Linda Rossini | 2018-10-21 06:28:59