On the surface, Question 1’s proposal to implement nurse staffing ratios seems like a good idea. Assigning fewer patients per nurse sounds good, but the reality is that the provisions of this proposed mandate would have devastating unintended consequences for our community hospitals and patients.

Should this measure pass, hospitals in Massachusetts would be held to rigid, no-exceptions nurse staffing ratios imposed by the government that would have a profound impact on their ability to provide care.  Just imagine what would occur under these mandates if an emergency department were to reach its full legal allowance of patients.  New arrivals would be sent to alternative hospitals, compromising their care and risking their safety in the process.

Of the 50 states, only one, California, has adopted mandated nurse staffing ratios and that was over ten years ago.  If government mandated nursing ratios were such a good idea, why haven’t more states adopted them since then?  The reason is that there is no evidence that it has led to improved care.  According to 2018 Leapfrog patient safety data, the gold standard for assessing quality outcomes, California hospitals rank 25th for patient safety.  Massachusetts ranks fourth.  Likewise, United Health Foundation ranks California seventeenth nationally in terms of statewide health, while Massachusetts ranks first.  Our hospitals equal or in many cases exceed California’s in nearly every meaningful measure of quality patient care and safety.

If voters pass Question 1 it would also raise costs substantially for hospitals and patients.  The independent, non-partisan Massachusetts Health Policy Commission has estimated that passage of Question 1 would cost the state up to $949 million annually.  Patients, employers and taxpayers will end up footing the bill for these new government mandates through increased taxes and higher premiums.  Most of our community hospitals operate now on razor thin margins. UMass Memorial HealthAllianceClinton Hospital reports that this will add $8.9 million more to their cost structure year over year moving forward.  Likewise, Heywood Hospital will see $5.6 million in additional costs and Athol Hospital an additional $1.9 million.  The pressures on them to break even are immense, and it is likely that they will be forced to make deep cuts to critical programs, such as opioid treatment and mental health services, in order to implement these mandates.  In some parts of the state, local community hospitals could close altogether, creating a significant hardship for those dependent upon them.

Staffing decisions should be left to the experienced doctors and nurses who operate our hospitals, and not imposed upon them by the state through a rigid set of mandates.  Nursing is a well-organized and respected profession, whose members are protected by their elevated skillset and long established union representation.  Concerns about working conditions and patient loads should – and regularly are – negotiated at the hospital level and should not be imposed via the ballot box.  This produces the best results for each institution, and is perhaps why many doctors and nurses have come out openly in opposition to this ballot proposal.

On November 6, voters will decide whether to tie the hands of our experienced health care professionals by voting ‘Yes’ or allow them to make the right decisions for patients with the flexibility in staffing that is essential to their important work.

On behalf of the North Central Massachusetts Chamber of Commerce, we urge you to vote “No” on Question 1.  For more information, please go to www.protectpatientsafety.com.

Roy M. Nascimento, CCE, IOM

President & CEO, North Central Massachusetts Chamber of Commerce