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Nurse Staffing Ballot: Putting Healthcare at Risk

Massachusetts is home to some of the best hospitals in the nation. People come from all over the world to receive care from our healthcare professionals. The professional judgment of nurses and doctors charged with managing caregiving teams is what makes our care the best.

But that could change.

The first question on the 2018 November ballot will ask voters to Vote YES or NO on government-mandated nurse staffing levels at all hospitals across the state.

The proposed law would require every hospital to adopt the same rigid, one-size-fits-all ratios of nurses on duty to patients at all times – regardless of a hospital’s size, location, or the needs of those receiving care.

One Massachusetts nurses’ union, representing less than 25 percent of the nurses in the state, has been pushing this proposal unsuccessfully in the legislature for more than 20 years. California is the only state that has implemented nurse staffing, and there is no evidence that those mandates have increased the quality of care patients receive. Similar efforts in other states to impose nurse-to-patient ratios have been soundly rejected.


Here are just some of the reasons why this proposed legislation is not in the best interest of hospitals and does not put patient safety first:

It will affect patient access to care. This bill would dramatically increase emergency room wait times and delay other life-saving care services as hospitals scramble to arrange nurses to fulfill each ratio. It will create a lag in transferring patients from the ER to the inpatient floors and/or may even result in needing to transfer the patient to a different hospital altogether, even if there are available beds.

It will increase health insurance premiums for every employee and employer in the state. This means higher insurance costs and taxes.

It will add over $800 million annually in mandated costs, crippling community hospitals and forcing some to close. We cannot even come close to matching this amount by reducing the salaries of current hospital executives.

It takes real-time decision-making power away from professional nurses and put it in the hands of a rigid government mandate. In the current system, nurses and nurse leaders make patient care
assignments based on the acuity of the patients and the skill set of the nurses.

There is NO guarantee these staffing ratios will improve the quality of Massachusetts hospitals. California is the only state that has experimented with government-imposed ratios and there is no solid evidence that it has improved care in its hospitals.

It will limit the services hospitals can provide at any given time, if they cannot provide enough nurses to fulfill the rigid ratios.

• There is currently a shortage of 1,200 Nurses across the Commonwealth. If this legislation passes, it will require an additional 5,400 nurses to fill vacancies in hospitals across the state. This means nurses will be pulled from long-term rehab facilities, primary care offices, etc., potentially forcing other health care facilities to close.

• The latest evidence-based, nursing-sensitive measures reported through the Centers for Medicare and Medicaid Services’ Hospital Compare website shows that Massachusetts scores the same as or higher than California hospitals in hospital quality as well as patient satisfaction.

• The proposed legislation requires 24/7 coverage, including every bathroom break, meal break, transfer of patient and other circumstance. For every violation of these staffing ratios, hospitals can be fined up to $25,000 per day.

Download the full Coalition Ballot Booklet here.

Vote NO on 1.

Members of the growing coalition against Question 1 include:

  • American Nurses Association – Massachusetts
  • Emergency Nurses Association – Greater Boston Chapter
  • Organization of Nurse Leaders
  • Infusion Nurses Society
  • Massachusetts Association of Colleges of Nursing
  • Western Massachusetts Nursing Collaborative
  • Massachusetts Medical Society
  • Massachusetts Ambulance Association
  • Massachusetts Association of Behavioral Health Systems
  • Massachusetts Senior Care Association
  • Home Care Alliance of Massachusetts
  • Massachusetts Council of Community Hospitals
  • Massachusetts Health & Hospital Association
  • Conference of Boston Teaching Hospitals
  • VNA Care
  • Atrius Health


We need your help to spread the word about the dangers of this staffing mandate. There are many ways you can get involved:

Join the conversation on social media:



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