Archive 2008 - 2019

Editorial: Vote YES on Q. 1

by Dianna Vosburg

Vote Yes on Question 1 for Safe Patient Limits
Some years ago, I ended up in the ER with excruciating pain. My gallbladder needed to go…scary enough, but I did not anticipate the ensuing ordeal. I had to wait through the night in pain for an ultrasound and then through the entire next day for surgery, a harried nurse almost injected me with a drug to which I have a life-threatening allergy, and I was not prepped for the OR when they finally took me in. I won’t even go into the nightmarish recovery. The nurses told me that they were critically short-staffed. A lack of nursing staff has real consequences for patient care. Conversely, reducing ratios lead to better outcomes. Massachusetts scores pretty badly on hospital readmission rates, ranking the 6th worse in the nation. This significantly raises healthcare costs as well as endangers patients. Nurses have been telling us for 20 years that we do have a problem, trying, through collective bargaining and pursuing legislation on Beacon Hill, to establish safe patient limits. We should support nurses and make hospitals safer by voting Yes on Question 1, The Patient Safety Act, which would provide reasonable limits for how many patients a nurse can care for at the same time.

It is chilling to see hospital executives, hiding behind the ironically named front group, The Coalition to Protect Patient Safety, arguing against patient safety. Apart from ICUs, there is currently no limit on the number of patients per nurse at all. Meanwhile, hospital executives are pocketing outsized million-dollar salaries while the majority of hospitals in Massachusetts are reporting healthy profits, even tax-exempt “non-profit” hospitals. The mania for mergers and acquisitions also drives up their profits, and this raises costs for taxpayers and all of us who have to pay gigantic premiums. Collectively, hospitals in Massachusetts stash nearly a billion dollars a year in offshore tax havens. They certainly have enough funds to spend over $13 million dollars to oppose safe limits. I would prefer that the money paid to hospitals goes nursing care and not bloated executive pay…and deceptive ads.

Speaking of deceptive ads, one group that opposes Question 1, the Massachusetts chapter of the American Nurses Association (ANA) is not a union and they are not generally bedside nurses. They are registered nurses at the executive and administrative level. The ads touting ANA opposition have actually featured administrators posing in nurse’s scrubs. The Yes on Question 1 side is made up of the Massachusetts Nurses Association, a union of mostly bedside nurses who provide direct care. People understandably wonder why some nurses oppose, and some nurses support, Question 1. This issue is not evenly split between two equal groups. It is primarily between labor and management.

Dark money strategies are a cancer in our democracy. Whenever profits are at stake, you can be sure the paid-for propaganda machine and deceitful tactics will not be far behind. Opposition ads trot out fear-inducing arguments to paint a dystopian medical future: hospitals will close, services will shut down, costs to patients will rise, ERs will turn away patients (which is actually illegal), and so on. By the way, the reason ER waits are so long is due primarily to a shortage of nurses to treat patients in the ER, and a shortage of nurses on other floors to move patients out of ER beds. That is precisely what happened to me. As logic might suggest, more nurses mean less wait time for care. California is the only other state to have successfully established safe patient limits. In compliant hospitals, ER wait times have improved. No hospital in California has gone out of business due to establishing safe patient limits, and healthcare costs have not skyrocketed. In fact, costs have come down. Studies show that California now experiences better outcomes, including much lower numbers on surgical patient mortality. Make no mistake, this is a life-and-death issue.

Hospital executives have also spread confusion by commissioning a study warning of economic devastation (1.3 billion dollars) and other negative outcomes to influence the debate. Clearly, this study suffers from a certain amount of funding bias. In contrast, this study by Judith Shindul-Rothschild, an associate professor at BC, predicts a 47 million price tag. To put this into perspective, the new Partners headquarters (which provides no direct patient care) alone cost $464 million to build. The Massachusetts Health Policy Commission (HPC), on the other hand, predicted that passing this measure would cost over $676 million, but they apparently held private meetings with the main opposition, the Massachusetts Health & Hospital Association, while writing the analysis. They also used hospital industry data, and not third-party data. The hospital industry has a large sway in Massachusetts politics, which is one reason we need this ballot measure. Shindul-Rothschild, interviewed by The Intercept, said that the HPC’s model assumes that nurse staffing limits will produce big wage inflation (over 6%) for all nurses, whether or not they work in hospitals. That number appears highly questionable, given that Massachusetts actually has a surplus of nurses.

Besides the confusion over costs, arguments like “rigid”, “government-mandated”, and “starts too soon--in January!”, and “huge fines of $25,000” appear frequently. The measure does allow the HRC to provide safety protections for appropriate hospital care. These protections are not rigid, as the number of patients to nurses varies by the condition of the patient and the level of care they are receiving; that is, by a defined level of acuity, which the hospitals will set themselves with input from RNs. If by government mandate, one means setting reasonable boundaries on excessive and dangerous profiteering through a democratic ballot measure, that seems like a great idea. As for the quick start, it will take months and months, if not a whole year, for the rules to be drawn and implemented. Hospitals must create a written plan, submit it, create acuity tools, and so on. Also note that the $25,000 fine is the maximum fine, not a set fine, with a fair investigation and an escalation procedure pursued before the maximum fine were to be imposed.

Everyone is rightly concerned about the ever-increasing cost of healthcare insurance and the ceaseless gouging on medical bills. The ultimate solution is strengthening and expanding Medicare to include all of us, not endangering patients by cutting back on nursing care. Until then, we can’t allow profit interests to risk unnecessary pain, suffering, and even death for financial gain through spreading disinformation. We all deserve safe patient limits.

Dianna Vosburg


Comments (12)

Great article, Diane. I, too, found the argument for No to be misleading and confusing. I have two very good friends who are nurses and I have heard for years how little time they have to tend to their patients. I did vote yes on this question and encourage anyone who is interested in patient safety to vote YES.

Ginny Keniry | 2018-10-31 19:01:35

Annette Casco please google Jeanette Clough and Boston Business journal. In 2015 the CEO of Mt Auburn Hospital received a 6.5 million dollar bonus on top of her 2 million dollar salary and 401K contribution. I think this hospital has about 160-180 pt census. So I don't think your statement is accurate about community Hospitals.

Sheila Quinn | 2018-10-26 03:11:33

Bravo ?? ????the ballot initiative remains about patients and safe care , not about nurses, yes we want safe assignments, it remains about patients!!! Please vote yes on question 1

Lyn Flagg | 2018-10-25 18:50:49

Here's a link to a 2012 study that shows Massachusetts having an "A" rating in 2009 in sufficient nursing staff. This study projects out to 2030, where MA does best relative to other states with a C+ rating.

Dianna Vosburg | 2018-10-25 13:54:47

It would be ignorant for anyone to assume that the executives of small community hospitals are receiving million dollar salaries. How can you assume funding bias on the behalf of the hospitals in their study and accuse the Massachusetts Health Policy Commission of questionable practice all while failing to point out the fact that Judith Shindul-Rothschild associate professor at Boston College is past president of the MNA. Educate yourself on both sides; make an informed decision. Patients and nurses are not just numbers!

Annette Casco | 2018-10-25 13:36:11

Well written and to the point. Helps with the confusion going on. I am disappointed that nursing execs will deceive the public about their true working titles . Yes they are RNs but they do not deserve that title if they do not advocate for patient safety. Nursing is voted one if the most trusted professions. We will always advocate for our patients. Bedside nurses say Vote YES!!!!! On question 1

Diane Holt RN | 2018-10-25 10:46:39

Ms. Vosburg: would you please cite your source for your statement that "Massachusetts actually has a surplus of nurses?" Please folks, do not narrow your focus only on the acute care hospital setting. Staffing ratios is an important topic. This bill does not take into consideration the Long Term Care and Skilled Nursing Facilities. If this bill is enacted our growing population of seniors who require long term care will be negatively impacted. LTC and SNF depend heavily on Medicare reimbursement and struggle at this moment to find nurses to care for their residents. This is not the right bill to ensure quality care for Massachusetts Residents.

Susan Sobolewski | 2018-10-25 09:47:36

Great article! I have two phenomenal nurses in my immediate family and always intended to vote YES. I find the arguments put forth by the NO side (hospital administration side) to be some of the most disingenuous I have ever heard. The hospital administrators CREATED the huge understaffing issue and they argue that patient safety propels their position? Huh? There is something propelling their position - PROFITS. Year after year, there are thousands and thousands of "unsafe staffing incident reports" filed by nurses - and the NO people have done NOTHING to fix the problem. Now, it is the NURSES and the MASSACHUSETTS NURSES ASSOCIATION who have proposed this solution, which works so well in CA. And the NO people resist it, citing patient safety and a host of other scare tactic-type arguments??? See through their BS, support the real "bedside" nurses, and vote YES! Again, great article Dianna!

Jim Barry | 2018-10-25 08:34:28

This article is comprehensive and "right on the money!

Catherine Hogan, RN, MSN | 2018-10-25 07:55:16

Brilliantly written! I wish I saw more reporting like this by major media outlets. This is information that is critical for voters to have. Thanks Dianna!

Bill Blinstrub | 2018-10-25 07:29:43

Thanks for this well-written article, Dianna. I appreciate the evident research you put into this, and that you argue with actual facts, as opposed to unsubstantiated assertions. This helps to shift the balance for me. I'm voting yes.

Patrick Bolger | 2018-10-25 02:31:33

Well said and to the point. Safety is all important.

Yvonne Giargiari | 2018-10-24 06:41:32