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Massachusetts Ballot Question #1

The Massachusetts General election on Nov 6th is just around the corner and with Boston being our hometown, we are watching the discussion around ballot question #1 closely.

If passed, Question 1 would establish ratios limiting the number of patients that could be assigned at a time to individual nurses at Massachusetts hospitals and health clinics.
According to a report put out by the Massachusetts Health Policy Commission, there would be an estimated annual cost impact of $676 million to $949 million, requiring hospitals to hire an additional 2,286 to 3,101 nurses.

A similar law, passed in California in 1999 and implemented in 2004, did not have a negative impact on the skill level of nurses in hospitals [1] , and hospital leadership reported there was also no change in quality of patient care [2]. The California law differs from the proposed Massachusetts bill across several categories -- including how patient ratios were determined and the scope and level of the each ratio --, according to the same MHPC report.

However, a study published in 2017 by the Annals of Intensive Care journal found that higher nurse staffing ratios were tied to decreased survival likelihood. The analysis of 845 patients found that patients were 95 percent more likely to survive when nurses followed a hospital-mandated patient-nurse ratio. [3] The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality has also acknowledged the link between nurse staffing ratios and patient safety. [4]
While it is apparent that nursing ratios have an impact on quality of life for both nurses and survivability for patients, The Journal of Hospital Medicine found that mandated nurse staffing ratios without mechanisms to help achieve ratios, may force hospitals, especially safety‐net hospitals, to make tradeoffs in other services or investments with unintended negative consequences for patients. [5]

The variables influencing the decision on ballot question #1 are nuanced and complicated. At its core, this debate is about finding the balance between acceptable working conditions for hospital staff and optimal health care for hospital patients. Hospitals already use ratios to determine nurse and other staffing assignments. The question is whether these ratios should be decided on by hospital leadership, or by elected officials and administrators at the state level. Most of us cannot judge the specifics but rather need to judge which participating entity we trust the most to determine the right balance.

Whether Massachusetts will follow California's lead and if that will spread to other states remains to be seen. What is clear is the proposal put forth under ballot question #1 on November 6th is very specific to Massachusetts and could dramatically affect nurses, hospitals, and patients in a variety of ways. Every voter needs to carefully consider these nuances to make an informed decision.
Regardless of the outcome, Edaris stands behind our commitment to support hospitals and healthcare systems with the workflows they need to treat patients.

For a detailed breakdown of the issue on ballot question #1, we recommend this article on As well as their information on recent poll results.


Sources & Additional Reading


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