There are way too many arguments out there to deal with them all. But let me just make two points:
1. I read a letter to the editor of the Globe recently that said that if nurses just had fewer forms to fill out, there would be plenty of time to deal with however many patients they have.
This kind of argument comes up frequently. While I am not in the medical profession, I believe it is very likely that every one of those forms was introduced because someone died unnecessarily. And the same holds for building codes, gas line standards, and all sorts of other “burdensome government regulations”.
And when a bridge collapses, and people die, the governor and a great number of legislators wake up from their slumber and decide that maybe it’s time to stop cutting infrastructure maintenance and maybe put a bit more money back into it.
But when nursing staff is cut, it’s impossible to tell who died because of it, or whose life was shortened, or degraded. The nurses tend to know, though, and we should believe them.
When my wife was suffering from cancer, she spent a lot of time in Beth Israel Deaconess Hospital in Boston. This is a hospital that as a matter of fact has a good nurse-to-patient ratio, and that was evident to me, as it again was a bit later when I had back surgery in the same hospital.
I spoke to one of the nurses there. She was at the beginning of her career — it was her second job. Her first job had been in a small hospital in a nearby state, which was grossly understaffed. She said that she spent her whole time performing what she called “nursing tasks” — e.g., handing out pills — but no real nursing.
I know that the nursing care my wife received — while it didn’t save her life — contributed vastly to her well-being and made her last year humane. That to me is priceless.
2. The hospital administrators (and yes, some of them have R.N. degrees) have claimed that studies done in California (which passed a similar resolution some time ago) showed that there was no real positive effect due to hiring more nurses.
On the other hand, I have read that nurses in California believe that they can do their jobs much more effectively now that they are not massively overworked.
Again, while I am not in the medical profession, this does remind me of my years as a public school teacher. The classes were generally larger than they should be, and after Prop. 2 1/2, they were much larger than they should be, because 25% of the teachers had been laid off. Our local union (and virtually every other local union, for that matter) always raised this issue. Every teacher — and probably virtually every parent — knew that lower class sizes would make a material difference in how well we could reach our students.
But administrators (and yes, they all held teaching certificates) loved to tell us — and they told us this again and again, over many years — that studies had been done that showed that class size made absolutely no difference in student performance.
There were in fact such studies. They turned out to be flawed to the point of being useless. When new studies were eventually performed, which for the first time took into account parent income, it became obvious that class size was a powerful determiner of student performance.
Now at that point, you might wonder how many of those administrators told us, “Oops — I was wrong. Sorry about that.” Well, there were exactly none who did that. They just stopped talking about it. Like it had never happened.
I think if 86% of the nurses in this state believe that better staffing levels would enable them to do their jobs — which are crucially important jobs — better, then we would do well to listen to them.
And that’s why I voted yes on Question 1.
Common sense says that the fewer charges you have the more attention you can give whether it is nurse/patient, teacher/student, or even millgirl/looms in historic Lowell. I also assume common sense will prevail in emergency rooms and that if there is a huge influx of patients all of a sudden they won’t be turned away because it will temporarily throw the letter of the law ratios out of whack.
I’ll be voting “yes” on one next Tuesday.
Your comparison to teacher-student ratio is interesting. I remember several studies at the time that showed that class size was not high on the list of contributors to better outcomes. Interestingly, those same studies showed — compellingly, I thought — that teacher quality was far and away the most important factor in better outcomes. They also showed that teacher quality was highly correlated to teacher compensation.
The bottom line of those studies, as I recall, was that the money that some school systems were spending on decreasing class sizes (by hiring more teachers) would be better spent by dramatically increasing teacher compensation and therefore attracting a smaller number of higher quality teachers. Not surprisingly, I know of no school districts who have actually pursued this alternative.
Several of my wife’s siblings are retired teachers in Germany and Austria. They were well-compensated while they were working, have enough retirement income to enjoy a very comfortable retirement, and they were treated with enormous respect by their communities then and now. It is not surprising to me that today’s German and Austrian young people are so much better educated than today’s American young people. The Germans and Austrians treat their public school teachers a great deal better than we treat ours.
I agree that we should listen to our nurses.
I already early voted YES on 1. As the son of a public school union teacher and cancer survivor who owes his life to nurse Lindy.
My wife and I thank all of you. She is coming home from her shift right now and usually is charge nurse for 40 patients in a given night. She has great CNAs, but it’s not the same. This will reduce her burden and increase staffing in a reasonable way. Thank you all!
James : from all grateful patients, please thank your dear wife for her sacrifice and public service.
40 patients sounds crazy and that’s the kind of thing I would expect this sort of law to prevent. Thank her for putting in such work. But setting legal limits of 1-3 as this law does seems extreme. Do you/your wife think this is good policy or why do you think it was written so rigidly?
(As discussed elsewhere, I voted Yes on 1 for other reasons)
My understanding is the nurses union was close to less rigid standards and DeLeo pulled the rug from under them and they were forced to go the ballot with stricter ratios as a last resort. There is nothing stopping the legislature from implementing the law differently or tweaking it. I think the logic is that this forces them to do their job. Joan Venocchi has a good argument in today’s Globe for why the present status quo is less tolerable than the unintended consequences that we might envision with the law.
I voted no after taking advice from my wife, who is a nurse (practicing as an NP, not an RN, and not in administration). I think there are real uncertainties about the cost of the proposed law and the ability of hospitals to meet its requirement given the number of nurses who would have to be hired, and so my default rule kicks in: “if you’re not sure whether a proposal is a good idea or not, vote no.” This one should be enacted through the regular legislative process, if at all.
I’m with you on that Ted, the problem is, the legislature had golden opportunities to set a reasonable limit before and never followed through. This was a last resort from the nurses unions to force a deal. If it passes and there are unintended consequences, then the legislature will be forced to do its job.
Why is it that our Democratically controlled legislature never takes advantage of golden opportunities to help the working class? (asking for a friend)
Never been a fan of direct democracy for these reasons, but if asked my opinion I might as well give it. I strongly suspect this will have to be legislatively tweaked even if it passes, but I voted yes to register my agreement with the principle that there should be reasonable ratios.
This is a terrible philosophy for voting on ballot initiatives. Voting no doesn’t just kill the initiative itself; it tells legislators they’re better off not addressing the issue AT ALL! Voting yes forces legislators to address the issue. Example: The marijuana legalization initiative was not perfect, but does anyone think the legislature would’ve lifted a finger to legalize without it?
I’m not sure what California study is being referred to but the one I have read was conducted by the NIH and titled : Contradicting Fears, California’s Nurse-To-Patient Mandate Did Not Reduce The Skill Level Of The Nursing Workforce In Hospitals
It said : Our findings suggest that registered nurse staffing in California hospitals increased considerably as a consequence of the implementation of the state’s nurse staffing mandate. We found no evidence that the policy resulted in lower nursing skill mix, including a higher proportion of licensed vocational nurses. To the contrary, skill mix increased.
And : The costs associated with increasing the number of nurses employed in hospitals may be offset by the costs of avoided poor outcomes and adverse events
And : David Harless and Barbara Mark found that increases in nurse staffing in California were associated with reductions in overall mortality as well as in surgical failure-to-rescue rates. Julie Sochalski and colleagues similarly found that changes in nurse staffing in California before the mandate was implemented were associated with reductions in acute myocardial infarction mortality and failure to rescue.
I’d call those positive effects.
And that’s the HUGE problem I have with the vote NO people. Their ads are deceptive and mock the government. “DO you want THE GOVERNMENT to mandate patient nurse rations?” As if THE GOVERNMENT is some inept and corrupt being that must be avoided at all costs. Further, this leads the listener to the false assumption that nurses and not THE GOVERNMENT are now setting these ratios. While some in administrations that make the decisions might be nurses, the decisions they are making are administrative, not medical.
Lastly, to those who say we cannot afford it, let’s point out that Eleven CEO’s in Massachusetts Health Care’s private companies extract $25 Million a year between them. That $25 Million is part of our private and public spending on health care. That $25 Million is the result of market based privately controlled distribution of health care.
Single Payer Now.
Plus it’s even more disingenuous than usual to imply that the government is some outside controlling entity in the context of the people legislating directly through the initiative process. Though I am not a big fan of making laws this way you can’t say it isn’t government of, by, and for the people in the most direct and literal sense.