Massachusetts has some of the best medical care in the world, but a ballot measure next month could start its erosion by raising costs and reducing access. The culprit is the Massachusetts Nurses Association.
Question 1 would limit the number of patients assigned to each registered nurse in state hospitals. For instance, in the pediatric, medical and surgery units a nurse would care for no more than four patients. Patients deemed in non-stable condition in the critical or intensive-care units would have their own dedicated nurse, as would mothers in labor and those under anesthesia.
The nurses union claims these rigid ratios will improve the quality of hospital care, which is already terrific. Massachusetts’ health care ranks second in the nation, according to the Commonwealth Fund’s 2018 scorecard. The state has some of the world’s great hospitals, including Massachusetts General and Brigham and Women’s. The state has 122.4 nurses per 10,000 residents, far more than the national average of 89.6.
California is the only state that has imposed similar nurse-to-patient ratios. But the Massachusetts Health Policy Commission, an independent state agency, looked at the research on California’s health system and found “no systematic improvement in patient outcomes post-implementation of ratios.”
Question 1’s quotas go further than California’s. The patient-to-nurse ratios would be narrower, with no waivers for rural hospitals. California gave hospitals several years to phase in the quotas, but Massachusetts hospitals would have to comply by Jan. 1 or face fines of up to $25,000 for each violation.
To meet the new mandate, Massachusetts hospitals would have to add up to 3,101 additional full-time nurses, according to the Health Policy Commission. The ratios would create an artificial scarcity of nurses, driving up wages and overtime. The Health Policy Commission estimates the annual costs of Question 1 could rise as high as $949 million a year—and that is “likely to be conservative.” The ballot initiative leaves hospitals with little room to cut back elsewhere, explicitly stating they have to meet the new ratios “without reducing its level of nursing, service, maintenance, clerical, professional, and other staff.”
Higher medical bills would be one outcome, though another way to meet the ratios would be to limit patients. Boston Medical Center, the busiest provider of trauma and emergency services in New England, estimates Question 1 would force it to treat 100 fewer emergency-room patients every day and deliver 800 fewer babies each year. More than 60 medical-surgery beds would disappear. Sturdy Memorial Hospital of Attleboro warns of longer emergency-room waits as nurses hold off on providing care to meet their ratios.
“I never want to come into work and have to deliberate whether or not I will be able to legally care for my patients,” Sturdy Memorial nurse Meghan Aldrich says. “If Question 1 passes, I will constantly be faced with a moral dilemma—to break the law and provide care outside of my ratio, or let a patient suffer.”
Ms. Aldrich’s comment points out the contradiction between a nurse’s duty to patients and the nurses union’s agenda to pad its rolls with new members. Massachusetts isn’t a right-to-work state, so more nurses means more members and more compulsory dues. The vast majority of hospitals in Massachusetts are private or nonprofit, blunting the effect of the Supreme Court’s Janus ruling against coerced dues. Voters—future patients nearly all—have every reason to reject Question 1.