Debate Over Question One Heats Up
Miranda Hellmold-Stone (they/them), ’22
Question One is the first of three ballot questions that Massachusetts voters will vote on in November. It would limit the number of patients a nurse can be assigned to based on the level of care required and fine offending hospitals up to $25,000 per violation.
The passage of Question One has become a multi-million dollar debate, with heavy spending by both advocates and opponents of the referendum. The Coalition to Protect Patient Safety has been leading the opposition, with more than $7.2 million raised and an estimated $627,000 remaining as of Sept. 2. Most of their financial backing has come from the Massachusetts Health & Hospital Association, who represent many of Massachusetts hospitals. Not wanting to fall behind, the Massachusetts Nurses Association, one of the main supporters of Question One, has spent more than $1 million advocating for Question One’s passage.
Opponents of Question One believe that the patient cap would lead to longer emergency room wait times and force some hospitals to reduce programming or close entirely; if emergency room nurses reach their patient capacity, emergency rooms would not be able to accept new patients without being fined. Similarly, opponents believe the patient limit would put an undue financial burden on many hospitals. A study commissioned by the Massachusetts Health and Hospital Association estimated that Question One would cost the healthcare system $1.3 billion during the first year it is implemented and $900 million each subsequent year.
One of the driving forces behind Question One, the Committee to Ensure Safe Patient Care, reported that a new study by Judith Shindul-Rothschild, PhD, RN, a nursing economist at Boston College, suggests that hospital executives are dramatically exaggerating the cost of Question One. Judith Shindul-Rothschild's study showed the total implementation cost for Massachusetts acute care hospitals to be under $47 million.
Another main advocate of Question One, The Massachusetts Nurses Association, released similar results from their annual survey last May. Conducted by Anderson Robbins Research, the survey found that 63% of nurses surveyed reported that hospitality management only occasionally adjusts their patient assignments when nurses deem it necessary. 77% of respondents also reported medical errors that included wrong medications, as well as wrong dosages. Respondents reported that these challenges are increasing the number of complications hospitals are seeing, including readmissions, infections and patient deaths.
If Question One passes in November, Massachusetts will become the only state other than California with mandated ratios. Other states — including New York, Texas, and Illinois — have all previously failed to pass mandated staffing ratios. Successfully passing Question One in Massachusetts could pave the way for similar legislation to be passed nationwide.