What’s Will’s position on Question 1 (patient-to-nurse limits)?

Will,

Do you have a position on Question 1 on this November’s state-wide ballot, which would place limits on the ratio of patients to nurses in Massachusetts hospitals?

I think it’s accurate to say that hospital nurses are often burdened with too many patients at a time and that this compromises patient care. Having said that, I have some concerns with the law that would be enacted if this ballet question were to pass. In particular:

  • I’m worried that the deadline for hospitals bringing themselves into compliance is too soon, and they won’t be able to do it.
  • I’m concerned that there are no provisions in the bill for adjusting the limits in the future; I think it’s inadvisable to require action from the legislature to make such adjustments.
  • The provision of the law saying that hospitals aren’t allowed to adjust staffing in any other area to hire more nurses seems unreasonable to me. I am not sure it will be financially feasible for hospitals to follow the new law without reducing staffing elsewhere.

I’d like to hear your thoughts on these concerns in particular and about this ballot question in general.

Thanks,

Jonathan Kamens

Will’s Answer, updated 10/17/2018

I’m uncomfortable with what I perceive to be a focus on one particular component of staffing. Care in hospitals today is a team process where many professionals are essential.

More generally, I don’t believe in legislating staffing ratios in any industry — the world is just more complicated than that. One could make an argument for particular numbers in any industry, but we need to stay flexible.

Patients per doctor, per orderly, per cafeteria worker? Operators per MBTA train? Rigid staffing ratios do not belong in law. Circumstances vary too much. Technology and conditions change too fast.

/w.

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4 Comments

  1. I haven’t studied the proposition carefully, but I’m uncomfortable with what I perceive to be a focus on one particular component of staffing. Care in hospitals today is a team process where many professionals are essential.

  2. Will,

    I appreciate your position on this. It certainly makes sense. And I know healthcare professionals who oppose the question as written, for a variety of reasons, practical and in principle.

    On the other hand, isn’t health care a little different from many other service industries, in that staffing has a very direct relationship to outcomes, outcomes that are a matter of public interest? The increasing privatization of health care (hospitals, in particular) is pushing us further and further into a profit-driven model, without significant competition. (How many people are really in a position to shop for the best in-patient care?) Is there not a public role for government in protecting patients from the profit motive? If so, and if it is not through staffing regulation (which I will concede for the moment), is there not some other way to protect patients?

    I would also add, in response to your point about the “team process,” that the majority of work performed by any team in a hospital setting is done by nurses. So for me, “team process,” while lovely as an idealization, misses the point in practice.

    Keep up the good work!
    David

  3. I have been really undecided about this question, but just feel legislation is not the correct way to go on this. Somehow capping top salaries, would be so much better. Cap CEO salaries at a ration of the lowest paid employee.

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