As the debate over nurse staffing levels continues, the Massachusetts Ballot Question 1, the Nurse-Patient Assignment Limits Initiative, is being followed very closely.

Up before the voters in November is the issue of assigning patient limits for registered nurses working in hospitals. A “yes” vote approves of establishing limits and a “no” vote opposes the limits. Essentially, a “no” majority would leave things as they are in the state now.

The issue is hotly contested in the state and will be closely followed by the nation. As hospitals, nurses, and patients seek to provide and receive the best care possible, there are still increasing costs, more complex patient conditions, and staffing challenges to face.

Is this ballot question proposing a legal establishment of Massachusetts nurse staffing limits what it takes to provide that?

In Massachusetts, the Committee to Ensure Safe Patient Care is supported by the Massachusetts Nurses Association and seeks to limit the number of patients one registered nurse in a hospital setting may care for.

The Coalition to Protect Patient Safety is in opposition to Question 1 and is backed by the Massachusetts Health and Hospital Association. They seek to make no changes to Massachusetts’ legislation.

Both sides of the issue have several well-known associations, organizations, and individuals behind their stance. Both sides have also spent millions of dollars to call attention to their views. With similar campaign names and representative colors, the messaging is similar for two distinct messages.

According to information supplied by the Massachusetts Secretary of State William Galvin’s website, limits would include the following:

  • In units with step-down/intermediate care patients: 3 patients per nurse;
  • In units with post-anesthesia care or operating room patients: 1 patient under anesthesia per nurse; 2 patients post-anesthesia per nurse;
  • In the emergency services department: 1 critical or intensive care patient per nurse (or 2 if the nurse has assessed each patient’s condition as stable); 2 urgent non-stable patients per nurse; 3 urgent stable patients per nurse; or 5 non-urgent stable patients per nurse;
  • In units with maternity patients: (a) active labor patients: 1 patient per nurse; (b) during birth and for up to two hours immediately postpartum: 1 mother per nurse and 1 baby per nurse; (c) when the condition of the mother and baby are determined to be stable: 1 mother and her baby or babies per nurse; (d) postpartum: 6 patients per nurse; (e) intermediate care or continuing care babies: 2 babies per nurse; (f) well-babies: 6 babies per nurse;
  • In units with pediatric, medical, surgical, telemetry, or observational/outpatient treatment patients, or any other unit: 4 patients per nurse; and
  • In units with psychiatric or rehabilitation patients: 5 patients per nurse.
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Taylor Maher, a media spokesperson for the Committee to Ensure Safe Patient Care says the issue is a matter of patient and nurse safety. “The negative consequences of not having staffing limits are clear,” she says. “Patients are sicker and nurses have too many patients to care for. There’s a detrimental effect on patient outcomes.”

The Coalition to Protect Patient Safety did not respond to Minority Nurse’s repeated requests for comment. According to their website, a “no” vote would keep hospitals from closing or sliding into longer wait times for patients.

California is the only other state in the nation that has passed legislation and imposed limits on nurse staffing. In Massachusetts the issue is not entirely new, but the scope is. ICU nurses in the state do have staffing limits that were prompted by a past ballot question although the limits were agreed to, not voted upon.

As a nurse, what are your views of establishing legal patient limits?

Julia Quinn-Szcesuil
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