Mandatory staffing ratios

Top 10 reasons to vote No on 1

  1. There is not one credible scientific study that shows that government-mandated nurse staffing ratios improve patient care. Not one.

  2. Health care is dynamic - patients' care needs can change from minute to minute. Critically-important patient care decisions should be made in real time at the bedside by each unique, individual patient's care team. Rigid, one-size-fits-all nurse staffing ratios treat every patient (regardless of age, illness, injury or sickness level), every nurse (regardless of skills or experience) and every hospital (regardless of an academic medical center in Boston or a small community hospital in Western Mass) exactly the same. Patients are not numbers in beds. A nurse may have fewer very sick patients who require much more care than another nurse who has more, but less sick, patients.

  3. Government-mandated nurse staffing ratios have existed in Massachusetts ICUs since 2014. But there is no evidence that those nurse staffing ratios have improved patient care. They have, however, increased costs and reduced flexibility.

  4. The Health Policy Commission – the independent Massachusetts health care watchdog – conducted an in depth analysis of Question 1 and determined that it would cost the Massachusetts health care system up to $949 million per year. They noted this was a "conservative” estimate, as it did not include estimates on the cost to ERs, which is likely upwards of $100 million per year. Learn more >

  5. There are maybe a handful of hospitals in Massachusetts that can afford this tremendous cost. As a result, hospitals will be forced to close beds and end services in areas that are critically important and serve a patient population in great need (i.e. mental health care), but are not well-reimbursed, as this will be less costly than hiring the nurses required by Question 1. Hundreds and hundreds of dedicated, hard-working clinical support staff – including social workers, child life specialists, clinical care techs, medical assistants and many others – will lose their jobs, as they will be replaced with all the new nurses required by Question 1, even though nurses do not have the training or experience to do these jobs effectively. This is why SEIU1199 - the union that represents about 60,000 hospitals workers in MA - has not supported Question 1. They are well aware that their members are the ones that stand to lose their jobs if Question 1 passes. And it is very likely that a number of struggling community hospitals (13 of which already lost money in the past year) would close altogether. California’s government-mandated nurse staffing law led to hospital and Emergency Department closures due to the tremendous financial burden from the nurse staffing law. All these ramifications would result in decreased access to care and reduced quality care for Massachusetts patients.

  6. The exorbitant costs of Question 1 would also hit Massachusetts patients and taxpayers hard financially. The extreme financial burden will be passed down to virtually all Massachusetts citizens through higher taxes, larger health insurance premiums and higher hospitals co-pays.

  7. California is the only state in the country with government-mandated nurse staffing ratios. And there is no evidence that they have improved patient care. In its analysis, the Health Policy Commission noted that in California, "There was no systematic improvement in patient outcomes post-implementation of ratios." (page 10). California ranked 25th in the 2018 Leapfrog Hospital Safety Grade Ranking; Massachusetts ranked 4th. The Commonwealth Fund (which assesses every state on “more than 40 measures of health care access, quality, efficiency, health outcomes and disparities”) ranked Massachusetts 2nd in the nation in its 2018 Scorecard on State Health Care System Performance; California was 14th. And Massachusetts outranks California in the majority of quality measures, including most metrics on mortality, infections, patient safety indicators and patient satisfaction. Massachusetts patients receive better, safer care than California right now, despite the fact that California has had rigid nurse staffing ratios for more than a decade.

  8. 23 newspapers - big and small, city and community, across Massachusetts and beyond - have all come out with editorial endorsements of a NO vote on Question 1. Not one publication has given an editorial endorsement of a yes vote on Question 1.

  9. A recent WBUR survey found that Massachusetts nurses are almost evenly split on Question 1. Many, many nurses understand the catastrophic implications should Question 1 pass and are vehemently opposed to it.

  10. 9 nursing organizations, 90 leading health care organizations and every single hospital in Massachusetts have endorsed a NO vote on Question 1 because of the damage it would inflict on patient care, access to care and health care costs. Learn more >

Question 1 would be devastating to the Massachusetts health care system. It would have a tremendously negative impact on patient care, access to care and health care costs

A person voting

We must defeat Ballot Question #1 this November

The nurse staffing initiative would have a devastating effect on every hospital’s ability to provide the kind of care you want and deserve.

Learn more about the initiative