Massachusetts Ballot Question 1: Nurse-Patient Ratios, Against | Connecting Point | Oct. 25, 2018


QUESTION ONE IS A BALLOT
INITIATIVE THAT CALLS FOR THE LIMITS ON THE NUMBER OF PATIENTS
ASSIGNED TO ONE NURSE AT A TIME. SUCH A MEASURE WILL ENSURE
PATIENT SAFETY BUT NOT EVERYONE IN THE MEDICAL COMMUNITY AGREES. LAST NIGHT WE HER FROM THOSE IN
FAVOR OF QUESTION ONE AND TONIGHT WE HEAR FROM THOSE
AGAINST IT. THEY SAY IT WOULD DO MORE HARM
THAN GOOD. CAROL JEA
— CAROL McGRAFF TO FIND OUT WHY THEY ARE OPPOSED TO QUESTION
ONE.>>WE HAVE RATIOS, ONE-TO-ONE,
ONE TO SIX. DEPENDING ON THE SEVERITY OF THE
PATIENTS. THIS RIGID LIMIT IS WHAT REALLY
IS AN ISSUE FOR HOSPITALS LIKE HOLYOKE MEDICAL CENTER, SMALL
HOSPITALS, BECAUSE WE HAVE FEW RESOURCES TO PAY FOR THE
ADDITIONAL NURSES REQUIRED. FRANKLY, FROM A PATIENT SAFETY
STANDPOINT WE DON’T SEE THE NEED FOR IT. THERE IS NO NEED TO SAY, AT
NIGHT, WHEN PATIENTS ARE RESTING TO HAVE A LIMIT THAT’S AS STRICT
AS THE ONE TO FOUR THAT’S BEING PROPOSED. IT’S REALLY A LAW THAT COULD PUT
HOLYOKE MEDICAL CENTER OUT OF BUSINESS. IT’S FINANCIALLY UNSUSTAINABLE
FOR HOLYOKE MEDICAL CENTER, AND, IN ADDITION TO, YOU KNOW, FACT
IT WILL COST $6 MILLION THAT WE CAN’T AFFORD IT WILL PUT
PATIENTS AT RISK.>>HOW WOULD IT PUT PATIENTS AT
RISK? THOSE IN FAVOR OF IT SAY THAT IT
WON’T. THAT IT WILL IMPROVE PATIENT
SAFETY.>>THE WAY IT WILL PUT PATIENT
AT RISK IS ALL THE HOSPITALS IN MASSACHUSETTS WOULD HAVE TO RAMP
UP AND HIRE MANY NURSES. HOLYOKE MEDICAL CENTER ALONE HAS
63 OR 64 NURSES THAT IT WOULD HAVE TO HIRE AND THERE IS A
NURSING SHORTAGE. WE’RE TRYING VERY HARD TO KEEP
ALL OUR POSITIONS FILLED. IT WOULD BE LITERALLY IMPOSSIBLE
TO DO THAT AND THE WAY THEIR TIMES AND THE BACK-UP WOULD BE,
IT WOULD BE SIGNIFICANT.>>HOW WOULD THIS IMPACT YOUR
JOB? SO THE RATIOS THEY ARE TALKING
ABOUT IS ONE-TO-ONE IN MATERNITY. ONE TO FOUR IN SURGERY, THAT
MAKES SENSE FOR THE LAY PERSON BUT WHAT WOULD THIS MEAN, YOU
KNOW, FOR YOU, AS A NURSE?>>YOU KNOW, QUITE A BIT. WE HAVE RATIOS ALREADY, SO TO
SPEAK. WE HAVE PATIENT LIMITS ALREADY,
SO TO SPEAK. IT’S A COMPLEX DECISION-MAKING
PROCESS. THERE IS NO SPECIFIC RECIPE THAT
WORKS. IT DEPENDS ON DIFFERENT
SCENARIOS ON DIFFERENT DAYS. AND SO TO THINK ABOUT THIS BEING
A RATIO THAT’S SO STRICT AND RIGID AND WITHOUT FAIL IS
DIFFICULT, FROM A CHIEF NURSING PERSPECTIVE, TO STAFF FOR THAT,
AND TO MAKE SURE THAT THERE IS COVERAGE IS A PHENOMENAL
CHALLENGE. THERE AREN’T BANKS OF NURSES
THAT WANT TO TAKE PER DIEM CALL JUST IN CASE PEOPLE WANT A
RELIABLE PAYCHECK AND CONSISTENCY. THOSE LOGISTICS ARE TOUGH AND
FOR NURSES AT-THE-BEDSIDE I FEAR MOSTLY ABOUT THEIR AYUTONOMY AN
PROFESSIONALISM BEING TAKEN AWAY.>>TALK A LITTLE BIT ABOUT THAT. YOU WERE TALKING ABOUT AWAY
TIMES AND SERVICES BUT WHAT WOULD THAT MEAN FOR PEOPLE?>>IF I HAVE TO CAP ON THE FLOOR
OR ON THE INPATIENT SIDE BECAUSE THERE AREN’T ENOUGH NURSES,
WE’RE AT OUR MAXIMUM RATIO IT FLOWS DOWNHILL THAT MEANS
PATIENTS HAVE TO BOARD IN THE EMERGENCY DEPARTMENT AND WE SEE
THAT TODAY WITH OUR ICU LAW THAT’S ALREADY IN EFFECT. TO THINK ABOUT THAT BEING
MAGNIFIED TO MORE AREAS IS FRIGHTENING. IT’S LOUD IN THE EMERGENCY ROOM,
CROWDED, IT’S NOT THERAPEUTIC. FAMILIES CAN’T VISIT AND THEN
THE PEOPLE IN THE WAITING ROOM, IT BACKS UP MORE AND THEY CAN’T
BE SEEN AND THAT’S TERRIFYING.>>AND LET’S TALK A LITTLE BIT
ABOUT THE NUMBERS BECAUSE I KNOW THERE IS A DISPUTE ABOUT HOW
MUCH THIS WOULD COST HOSPITALS IN MASSACHUSETTS. I KNOW THERE WAS AN INITIAL
REPORT BY THE COALITION TO PROTECT PATIENT SAFETY WHICH
SAID $1.3 BILLION, AND THOSE IN FAVOR OF QUESTION ONE SAID NO,
IT MIGHT BE AROUND $50 MILLION, AND THEN THERE WAS ANOTHER
REPORT THAT JUST CAME OUT BY THE HEALTH COMMISSION THAT SAID IT
WOULD BE AROUND $900,000. WHAT ARE WE TALKING FOR NUMBERS? WHAT’S THE REAL STORY?>>THE REPORT THAT CAME OUT IS
PUTTING A NUMBER AT $950 MILLION. $949 MILLION, NOT THOUSAND. I JUST WANT TO MAKE SURE. AND REALLY, ESSENTIALLY, IT
VALIDATES WHAT THE COALITION TO PROTECT PATIENT SAFETY HAS BEEN
SAYING ALL ALONG, WHAT THE HOSPITALS HAVE BEEN SAYING,
WHICH IS, IT’S A VERY COSTLY BILL, AND WE DON’T QUITE
UNDERSTAND WHY THE — WHERE THE VERY LOW NUMBER OF $50 MILLION
COMES FROM. FOR HOLYOKE MEDICAL CENTER THE
NUMBER IS $6 MILLION. IT CAN’T BE THAT LOW. NOW WE HAVE VALIDATION BY AN
INDEPENDENT AGENCY THAT SAYS IT WILL COST NEARLY A BILLION
DOLLARS TO IMPLEMENT.>>DO YOU THINK PEOPLE REALIZE
THAT BECAUSE, YOU KNOW, — ON S FACE IT SEEMS LIKE IT’S A GREAT
IDEA. THAT THERE ARE PLENTY OF PEOPLE
SURROUNDING THEM, GIVING THOSE WRAPAROUND SERVICES IN THE
HOSPITAL AND IT SOUNDS LIKE THIS IS THE RIGHT MOVE. HOW DO YOU CONVINCE VOTERS WHO
WILL GO OUT THERE AND TRY AND MAKE THIS DECISION, THAT THIS IS
NOT GOING TO MAKE THINGS BETTER FOR THEM?>>OH, I THINK, I THINK IT’S
IMPORTANT FOR VOTERS TO TUNE IN LIKE THEY ARE TODAY AND TO HEAR
THE DIFFERENT SIDES. I THINK IT’S IMPORTANT FOR
PEOPLE TO READ THE LANGUAGE. AND I THINK IT’S IMPORTANT FOR
PEOPLE TO THINK ABOUT WHAT IT MEANS FOR THEM AND THAT
HEALTHCARE COST THAT’S BEING QUOTED AS CLOSE TO A BILLION
DOLLARS IS GOING TO TRANSLATE TO PAYERS, AND THE COMMUNITY, SO
THAT’S ONE THING. MORE IMPORTANTLY, THOUGH, I
THINK IT’S REALLY IMPORTANT FOR FOLKS TO UNDERSTAND THAT THEIR
ACCESS TO CARE WILL BE LIMITED. THERE WILL BE WAIT TIMES IN
EMERGENCY DEPARTMENTS, AND THAT UNKNOWN DIAGNOSIS IS RISKY, AND,
BOY, THAT HITS HOME. THAT’S WHAT I THINK IT MEANS TO
THE PUBLIC THAT’S MOST IMPORTANT.>>AND FOR THE SMALL COMMUNITY
HOSPITALS IN PARTICULAR, WHAT ARE YOU HEARING FROM OTHER
HOSPITALS IN WESTERN MASSACHUSETTS?>>THE IMPACT IS ESSENTIALLY THE
SAME ACROSS THE STATE. IT’S JUST ON A BIGGER SCALE IF
YOU’RE A BIGGER HOSPITAL. SOMETIMES, YOU KNOW, SYSTEMS
CAN — BIGGER SYSTEMS CAN ABSORB COSTS A LOT EASIER. FOR COMMUNITY HOSPITALS IT
LITERALLY IS A DIRE SITUATION. I MEAN, OUR BOTTOM LINE LAST
YEAR WAS MUCH SMALLER THAN THE NUMBER, THE $6 MILLION IT WILL
COST US TO IMPLEMENT IT. IT’S DIRE ACROSS THE STATE.>>WHAT SERVICES, OFF THE TOP OF
YOUR HEAD, WOULD BE GONE IF THIS WENT INTO EFFECT? YOU SAID IT’S A PRETTY QUICK
TURNAROUND IF IT WENT INTO EFFECT THAT YOU WOULD HAVE TO
MAKE THOSE ADJUSTMENTS?>>IN FAIRNESS TO FOLKS WATCHING
AND OUR PATIENTS, I WOULDN’T WANT TO PUT OUT SPECIFIC
SERVICES THAT WE MAY HAVE TO SCALE BACK. IT’S NOT FAIR TO HAVE THESE
DISCUSSIONS BEFORE WE KNOW IF WE HAVE TO, BUT THE REALITY IS, WE
CAN’T CONTINUE TO DO EVERYTHING THAT WE’RE DOING TODAY AND COME
UP WITH $6 MILLION. AT SOME POINT WE’LL HAVE TO
DECIDE WHAT ELSE WE NEED TO ELIMINATE OR CUT BACK IN ORDER
TO PAY FOR THIS BILL. AND, AT A TIME WHEN HOLYOKE
MEDICAL CENTER HAS DONE A LOT OF WORK OVER THE LAST FIVE YEARS TO
GROW SERVICES AND PROVIDE MORE SERVICES IT WOULD BE VERY
UNFORTUNATE TO HAVE TO CUT BACK.

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Comments

  1. This bill is a solution looking for a problem. Patients are not dying in hospitals due to nursing issues now. The well-publicized complication rates in hospitals are not due to nursing to patient ratios as the root cause. The current state of hospital oversight, including nursing ratios, is well established by Center for Medicare and Medicaid, Amer. Hospital Assoc., etc. Adding more regulation will increase the cost of health care at larger hospitals that can absorb it, and cripple charitable and not-for-profit hospitals (e.g. Catholic hospitals) that serve the needy and who are already working with a shoestring budget.

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