By Gregory Volturo, MD, and Demetrius Litwin, MD, FRCSC, FACS
As physicians and department chairs at UMass Memorial Medical Center, we understand more than most the valuable role nurses play in the delivery of care to our patients. They are the backbone of UMass Memorial. While supporting our nurses, we strongly oppose Question 1 – the ballot initiative that calls for a strict nurse-to-patient staffing ratio. Question 1 will require every hospital in the state, regardless of the specific needs of their patients, to adhere to the same rigid nurse staffing ratios within all patient care areas at all times.
In an independent cost analysis of Question 1 implementation, the Health Policy Commission (HPC) – a state agency – found that the California law that is a basis for the Massachusetts ballot measure, resulted in no systematic improvement in patient outcomes. In fact, Massachusetts scores better than California in 5 out of 6 nursing-sensitive quality measures.
The HPC also expressed concern that this law will result in the closure of services that will affect all of our patients. Community hospitals will be especially hard hit and might be forced to close, and wait times in emergency rooms across the state will get longer which is not desirable from a patient safety perspective. In addition, the cost of implementing this measure will be nearly $1 billion.
Why would Massachusetts strive to become only the second state to mandate staffing ratios when our healthcare is already amongst the best in the country? We believe that we – and most of the other Massachusetts hospitals – already have safe nurse staffing levels.
As physicians, we would never accept any environment that puts our patients at risk. Over the past decade since California established mandatory ratios there has been “no systematic improvement in patient outcomes,” according to the HPC analysis. This explains why other states have resisted the measure.
Equally troubling, the timeline for implementation is unreasonable. California hospitals had five years to implement the prescribed nurse staffing ratios. Our hospitals would have 37 business days to comply with the law. Just 37 days for Massachusetts hospitals to hire and train additional registered nurses to meet these strict ratios. This is simply not possible.
This proposed law is trying to solve a problem that we do not have in Massachusetts. It would make nursing a commodity and would override the professional judgment of the care team at the bedside. In that respect, it is inconsistent with our model of patient-centered care. This ballot initiative is not a reasonable solution to any problem facing our hospital or others in our state. If passed, it will create chaos and send shockwaves that will reverberate throughout the healthcare industry in Massachusetts.
Gregory Volturo, MD, of Princeton, is chair of the Department of Emergency Medicine, UMass Memorial Medical Center in Worcester; Demetrius Litwin, MD, FRCSC, FACS, of Westboro, is professor and chair of Surgery, UMass Memorial Medical Center. Their “As I See It” was written in collaboration with and signed by all 19 department chairs at UMass Memorial Medical Center.