“The reality is, in the Emergency Department we’ve always been able to shift our resources of nursing care to be able to care for very sick patients as well as very stable patients at the same time. This bill will tie our hands and change how we care for patients.” 
– Bridget Garabedian, RN, Emergency Department, left

“For the ER to function at its best, we need to be able to make critical decisions in a timely manner and be able to relocate staff in a moment’s notice.” 
– Abby Fleisig, RN, Emergency Department, right

The MGH has announced its opposition to mandated nurse staffing ratios, citing the devastating impacts the rigid government requirements would have on nurses’ ability to provide emergency care to patients. On the Massachusetts ballot this November as Question 1, these unnecessary and unfounded staffing requirements also would dramatically increase emergency room wait times and delay lifesaving services in hospitals across the state.

“I worry that this will really increase wait times for our patients in the Emergency Department,” says Ali Raja, MD, vice chairman of Emergency Medicine. “Nobody should have to wait for care just because a mandated ratio – rather than the professional opinion of an ED nurse – says they should.”

The enormous costs and operational hurdles associated with implementing the nurse staffing ratio would set the MGH back $9.4 million in the Emergency Department alone – $34.1 million a year across the institution – and would translate to severely negative impacts. Wait times in the emergency room would dramatically increase, causing delayed services throughout the hospital – including those that are time-sensitive and lifesaving. Question 1 would limit capacity in the MGH Emergency Department by more than 100 patients a day.

“Voters – future patients nearly all – have every reason to reject Question 1.”
– Oct. 18 Wall Street Journal Opinion: “Bad Bedside Manner in Massachusetts: Nurse-to-patient ratios would drive up costs and cut health-care access”

There are no exceptions to this mandate, even in the event of an unexpected influx of patients – such as a multi-car crash, large fire or tragedies such as the Boston Marathon bombing. According to an independent study by MassInsight and BW Research Partners, mandated nursing staffing requirements would exacerbate the current nursing shortage, which is highest in psychiatric units at 7.8 percent, and in emergency departments at 7.5 percent.

The ballot question would require that hospitals across the state, no matter their size or specific needs of their patients, adhere to the same rigid nurse staffing ratios within all patient care areas at all times. The petition does not make allowances for rural or small community hospitals, holding them to the same staffing ratios as major Boston teaching hospitals.

If Question 1 passes, the MGH would be required to hire more than 170 new nurses to meet the ratios, leaving only 37 business days to hire, onboard and train these new nurses. If the staffing ratios are left unmet on Jan. 1, 2019, beds, units or even whole hospitals may have to close or suspend services.

For more information, visit Apollo, the MGH intranet, (for employees only) or the Coalition to Protect Patient Safety at www.protectpatientsafety.com.

“Question 1 is too rigid, imposing fines on an already difficult-to-access health care system. I’m voting no because nurses understand patients’ needs better than the government does.” – Donna Tito, RN, staff nurse

“Voting no on Question 1 is very important to me to make sure we can still use our judgement and flexibility as nurses to provide safe care for our patients.” – Stevenson Morency, RN, Med-Surg Unit


This article was originally published in the 10/19/18 Hotline issue.