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Massachusetts Votes No for Nurse to Patient Ratios

Gabrielle Daley, Editor-in-chief

On November 6th, 2018, Massachusetts citizens voted on whether to establish staffing ratios for nurses in hospitals and health clinics. This question was the most expensive and closely watched question on the ballot. No other state besides California has implemented a law like this, however, these Massachusetts nurse-patient ratios were much more strict than those on the West Coast. The election decided that hospital staffing practices will stay the same and the ratios will have no effect. 70.38% of people voted “no” which would make no change and 29.62% of Massachusetts residents voted “yes” which would’ve put the ratios in place.

If it had gone into affect, any hospital or medical facility that didn’t follow the ratios would’ve been fined up to $25,000. There is still no set ratio for nurses. In intensive care, however, there was a ratio put in place in 2014 for a nurse to have one or two patients at a time due to unsafe practices in the ICU. The ratios that were going to be put in place in 2018 all depended on what unit certain nurses worked in. For example, in intermediate care, nurses could only have three patients each; psychiatric or rehabilitation units called for five patients per nurse; and pediatric, surgical and telemetry unit nurses could only have four patients.

The state’s largest nursing union, the Massachusetts Nurses Association, was advocating for the ballot question for a long time. They founded a campaign under the Committee to Ensure Safe Patient Care. The committee said that the staffing room ratios were needed to ensure that nurses can adequately and safely care for all their patients. A survey made by the nurses union in April said that a nurse has six to seven patients on average. Higher number ratios were found in hospitals that are known for longer hospital stay, increased issues in patients, medicine errors and deaths. Nurses get sued for not effectively monitoring someone, however, it’s very hard to monitor patients when they have so many. Another survey by the Massachusetts Nurses Association reported that 77% of nurses reported medicine errors due to having too many patients, 64% said injuries were inflicted on patients and 86% reported not having enough time to educate patients and provide adequate discharge planning (this can lead to readmission). Baystate hospital floor nurse, Deborah Newell, stated, “We are working with short staffing all the time. I know if I work with more than six patients I cannot guarantee safe care for my patients – I just can’t do it. I will try, I can put bed alarms on them, and check on them as often as possible. But there are some times that I go two to three hours without being able to check on a patient – which could be life or death for them… You know, we don’t go into nursing for money. There are some people that do, and they don’t stay. If someone goes into nursing it is an expression of who they are. They go into nursing because they want to take care of people. We need these ratios to carry out those intentions.”

The nursing population is also aging, and the hospitals aren’t retaining new nurses. Young nurses come into the job and get too overwhelmed with very difficult assignments and they are given too many patients. They leave and find less rigorous jobs as a nurses in physicians offices, healthcare facilities, etc. Newell continued, “In order to retain new staff, we need to make it a decent work environment for them. And it’s not decent when everybody is running around crazy with six or seven patients and they can’t even help any of their colleagues because they’re drowning in their own work.”

The Massachusetts Health and Hospital Association opposed this change and created a committee called the Coalition to Protect Patient Safety. It had support from other hospital groups, executives and nurses associations like the Massachusetts chapter of the American Nurses Association. Based on an independent study, the annual cost of the ratios would’ve been around $676 million to $949 million and hospitals would’ve needed to hire 2,286 to $3,101 nurses. They claimed the new nurses would be inexperienced, and could possibly harm patients. “Implementing the law would mean mandatory budget cuts to healthcare programs. Hospitals are barely scraping by these days and mandating these ratios would force small hospitals that are financially struggling to close and that wouldn’t help anyone,” stated cardiologist Yvonne Paris at Baystate Medical Center. Longer wait times would’ve resulted with this change. According to the Coalition to Protect Patient Safety, “emergency room wait times will increase and could be forced to limit capacity – some by more than 100 patients a day.” This change the would also keep rigid staffing ratios in place in time of local emergencies like large-scale incidents like a gas explosion.

The Massachusetts Health and Hospital Association funded the “no” position in this ballot question. The committee had raised $26.48 million and spent $26.41 million, according to Ballotpedia. The Massachusetts Nurses Association, a nonprofit and privately funded organization, headed the “yes” campaign. It had raised $11.07 million and spent $11.77 million.The Massachusetts Nurses Association had far less money to spend and help people understand their cause than the the Massachusetts Health and Hospital Association. “Hospital executives are making it more difficult for nurses to care for patients and are ignoring nurses’ concerns about safe staffing while pocketing seven-figure salaries,” said Donna Kelly-Williams, president of the Massachusetts Nurses Association. The “no” campaign was able to spread the word more effectively – making this loss very disappointing and frustrating to many nurses. Due to the many years nurses put into pushing this law and all of the many unsafe hospital practices occurring, this may not be last time we see this on the ballot.

Yes Vote on Question Three Protects Against Discrimination

Mikayla Kudron, A&E Editor

On November 6, 2018, Massachusetts voted yes on question three. Question three kept the current law in place that prohibits discrimination on the basis of gender identity in places of public accommodation. A no vote would have repealed the law. The majority of voters chose to vote yes on question three in support of transgender rights. So what does this mean for the citizens of Massachusetts?

Transgender individuals will use whatever facilities they are most comfortable in, and harassing them because of their gender identity is punishable by law. A transgender person is someone whose biological sex differs from their gender identity. Sex refers to biological factors, such as an individual’s reproductive system. Gender refers to an identity. People who identify with a different gender than they were assigned at birth are called transgender. These people typically feel as though their bodies do not reflect how they feel on the inside.

So why does it matter which bathroom they use? Many transgender people experience something called gender dysphoria. Someone with gender dysphoria may experience distress and problems functioning socially because of their sex, according to psychiatry.org. Gender dysphoria is a recognized medical condition. Basically, using the bathroom assigned to one’s sex rather than gender identity can cause stress and anxiety in transgender people. Now that the law protecting transgender people from discrimination will remain in place, they can avoid discomfort by using the bathroom corresponding to their gender identity. While some people advocate that this is a right transgender people must have, others disagree.

Those who oppose the law feel that by allowing people who are biologically male in female bathrooms (or vice versa), they will only exacerbate problems such as rape. They feel that their children won’t be safe from predators, they won’t have the privacy they are entitled to, and everyone involved will be made uncomfortable. According to those beliefs, since gender is only identifiable by the individual, opening bathrooms to gender identity means predators could pretend they are transgender to enter the bathroom. Others simply believe transgender rights are not an issue in society today. In summary, those supporting yes on question three believe transgender people have the right to use the bathroom they are most comfortable in, and those who voted no typically believe the law is unnecessary or dangerous.

Now that question three will remain enacted, transgender people will use the bathrooms and locker rooms they feel most comfortable in. Feelings of anxiety, depression, depersonalization, and other discomfort may be lessened. Those who voted yes on question three hope to improve the quality of life in transgender individuals.

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Ballot Breakdown