On its surface, referendum question #1 sounds terrific.  Require minimum number of registered nurses per patient in Massachusetts hospitals. Why wouldn’t that be better for patients?  Well, not so fast.  Here are some things to think about.

Rigid ratios do not take into consideration the ongoing assessment of a patient’s needs, which may change not only from shift to shift but from hour to hour. Hospitals –  the  doctors, nurses, and others responsible for patient care – need the flexibility to assign staff to the areas where they are most needed when they are most needed.

Rigid ratios are bad for patient care, arbitrary, and financially irresponsible. A recent Mass. Health Policy Commission study of projected costs if this referendum passes is $900 million, which gets passed on to all of us in higher premiums. (Another study puts the cost at $1.3 billion, while the Mass. Nurses Association claims it is a fraction of that.)  But increased costs may be less important than the sense that mandating a ratio is a Draconian substitute for good hospital management, bolstered by ongoing input from nurses and other staff.  Rigidly imposed staffing ratios could force hospitals to close wards and move patients in order to meet an arbitrary standard, actually reducing patient care.

Imagine it’s three a.m.  Patients on a hospital floor are generally asleep.  Several miles away, there’s a train crash, and ambulances are roaring toward this hospital’s emergency room with survivors. Physicians and administrators would need to pull nurses from all over the hospital to respond to the crisis or have to turn ambulances away. If this referendum passes, the hospital could face a civil penalty of up to $25,000 per violation of the staffing pattern formula mandated by Question 1.  There would be an additional $25,000 per day if the hospital continues the practice after being notified of an infraction by the Attorney General. This is nuts!

Mere numbers don’t ensure the best care for patients.  What also counts are nurses’ and doctors’ education, experience, skills and empathy, availability of necessary resources and the effectiveness of communications among different practitioners.  Strict ratios have been tried in California and haven’t fulfilled their promise of improved care. 

The bottom line is that complex medical care should not be decided at the ballot box.  A No vote is the way to go on Question One.

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