Timmer Explains Question 1 on MA Ballot

The controversy surrounding the first ballot question on the upcoming ballot has split Massachusetts nurses and residents alike. Before voting on the issue it is important to understand the arguments from each side.

I am not an expert on Question 1, and I am not yet a registered nurse. Many people, however, have approached me and my peers seeking advice on how to vote, hoping that we will have some insight as nursing students or nursing assistants. While I will not tell you how to vote, here is a summary of the research I have done, and the things I have observed in the hospital setting to help you make an informed decision on Tuesday.

Question 1 on the November 6th Massachusetts ballot is proposing a plan to implement safe staffing for nurses by limiting the number of patients in each nursing assignment. The ballot question was added in an effort to improve patient safety by reducing the prevalence of human error in nursing care. Aside from in Intensive Care Units (ICUs), there is currently no set patient limit for nurses in Massachusetts.

There is no question that unsafe staffing is an issue in many hospitals and that nurses are often overwhelmed by their patient assignments. Many argue, however, that a “one size fits all” approach is not the correct way to solve this issue, leading to a confusing and vast controversy.

Arguments in Favor of Question 1:

The argument supporting Question 1 is heavily union-backed, as it’s supported by the Massachusetts Nurses Association (MNA). The MNA argues that mandating a maximum patient quota will improve patient outcomes and decrease readmission rates.

In a survey conducted by the MNA in April, 77 percent of nurses reported being assigned too many patients with an average of 6-8 patients per assignment (with the exception of the ICU). 86 percent of the nurses who completed the survey said that they plan to vote “yes” on Question 1. An article in the Boston Globe, however, states that the survey “appears to have been weighted towards MNA members”.

There is no debate that nurses are overworked and are frequently asked to juggle heavy patient assignments, and many of the nurses questioned stated that they did not have enough time with each patient to provide the best standard of care. Understaffing not only puts patients at risk for error but also increases liability among nurses. While many nurses and the MNA are largely in support of Question 1, the nursing population as a whole seems to be split on the issue.

Arguments Opposing Question 1:

Most nurses would agree that measures need to be taken to improve unsafe staffing issues but many also agree that Question 1 is not the correct solution to the problem. The patient limits set by Question 1 would vary depending on the type of unit and the stability of the patient (an Emergency Room nurse could be assigned one urgent unstable patient OR two urgent stable patients).

The ballot question, however, does not take into account the experience or skill level of each nurse. Those opposed to Question 1 argue that experience and skill level is largely what determines what is a reasonable patient assignment, for example, a recent graduate or novice nurse should not have the same expected patient quota as a nurse with twenty years of experience.

The mandated patient assignments would cause a loss of autonomy among hospitals and individual units to create a staffing plan tailored to their employees.

There is also the issue of cost. According to the Boston Globe, Massachusetts Governor Charlie Baker was undecided on the ballot question until seeing a cost analysis stating that the passing of Question 1 could cost anywhere from $676 and $949 million per year.

The president of Massachusetts General Hospital, Peter L. Slavin, brings to light the additional financial strain that would be put on each hospital in a newsletter to hospital employees that can be found online. Hospitals could be fined up to $25,000 per day for not complying with the necessary ratios, however, the cost of hiring hundreds of new nurses would be an even greater expense.

These increased costs could cause a huge financial burden on small community hospitals, potentially causing closures of certain departments or even the hospital as a whole. This could create a significant barrier to patients who are dependent on these hospitals for long-term care without the financial burdens associated with commuting or relocating.

There is already a significant shortage of mental health facilities and nursing homes in Massachusetts and many argue that the financial impact of Question 1 would only worsen this issue. The financial impact of Question 1 would put these facilities in jeopardy and prevent our society’s most vulnerable populations from receiving care. Slavin also states that there is not a sufficient quantity of new nurses to satisfy these quotas among the many Boston hospitals and community health centers, meaning that the $25,000 per day fine is a likely reality among many organizations.

Those planning to vote “no” state that, while Question 1 could improve some individual errors in the clinical setting, it would create a vast barrier to patient care by limiting the number of available patient beds in all facilities.

Many nurses are still undecided about how they plan to vote on the ballot question tomorrow. Many nurses believe that patient safety risk and overworked nurses is an issue that must be addressed. Others are worried that Question 1 is not the correct way to solve the persistent un-safe staffing issue but they still feel that it is at least a step in the right direction to improve working conditions and patient care.

Many nurses, however, also believe that the potential consequences of the increased costs are too great to risk and that the changes will result in poor access to healthcare among patients who are reliant on community hospitals, mental health facilities, or nursing homes for care. The information above is compiled from a variety of news articles, union statements, hospital newsletters, and issues that I have observed throughout my clinical experience as both a student and a nursing assistant.

For more information on Question 1, there are links articles of varying opinions and the full ballot question below.

The Ballot Question

In Favor: https://safepatientlimits.org/

Opposed: https://www.boston.com/news/politics/2018/10/09/massachusetts-ballot-questions-2018-question-1-nurse-staffing

Cover image from Don Treeger of The Republican.

Ryan Departure Spells Bad News for GOP

On the national political landscape, the talk for nearly two years now has been about the oncoming Democratic wave in the 2018 midterms. Fueled by historically low approval ratings for President Donald Trump, a massive surge in Democrat-related activism, and the historic trends of poor performances by the President’s party in his first set of midterms, the thinking has been that the Democrats have a strong chance to take the House of Representatives for the first time since 2006 and they have a decent shot at making the Senate 50-50. The outlook for both chambers has become far brighter for the Democrats this week.

Just days ago, Speaker of the House Paul Ryan (R-WI) joined a growing list of Republican lawmakers announcing they were not seeking re-election. These retirements are often seen as a concession of the harsh political landscape facing the GOP in November. Ryan is the 38th Republican member of the House to stand down, according to a list published by Pew Research Center. This is the largest number of retirements for a single party since 1992, when 41 Democrats chose to retire. In the 1992 Congressional elections, Democrats lost a net-total of 9 seats but were able to maintain their overall majority in the lower chamber. Thirty-eight retirements, a number that still has time to grow, is the highest total for the Republican Party since 1930, according to the same research from Pew.

This is a very concerning sign for the GOP. Many long-time leaders of the party do not trust their chances for reelection, most of which have historically been considered safe seats, and are choosing to retire than fight on and go out in the disgrace of defeat. The current Generic Congressional ballot, according to FiveThirtyEight.com, puts Democrats at 46.2% and Republicans at 39.6%. This has become closer in recent weeks but is still a wide margin that should encourage Democratic candidates, voters, and donors.

Early on in the election cycle, it seemed like the Republicans would at least be safe in the Senate, simply because the list of seats up this year forces Democrats to defend 10 seats in states that Trump carried. Recent polling seems to indicate that, while Senators like Heidi Heitkamp (D-ND), Jon Tester (D-MT), and Claire McCaskill (D-MO) may be in tough races, Democrats are performing well in contests for seats that Republicans hold.

Representative Marsh Blackburn (R-TN) is having troubling holding on to the U.S. Senate seat in Tennessee for Republicans.

A poll from Middle Tennessee University this week found former Democratic Governor Phil Bredesen with a 10% lead over Republican Congresswoman Marsha Blackburn in the race to replace Senator Bob Corker (R-TN), who this week said that voting for the GOP tax bill may have been one of the worst votes he’s made in his decade in office. While it’s unlikely that Bredesen, 74, will manage a double-digit win in Tennessee, the victory of Democrat Doug Jones in Alabama late last year shows it is possible for moderate Democrats to find success in former Republican strongholds.

In Arizona, Republicans may be forced to defend two Republican-held Senate seats at the same time. Senator Jeff Flake (R-AZ), who recently railed against President Trump at the NHIOP’s Politics and Eggs event, announced his resignation in 2017, sparking a three-way battle for the Republican nomination between an establishment candidate, Congresswoman Martha McSally (R-AZ-2), and two Tea Party or Trumpist candidates, former State Senator Kelli Ward and former Sheriff Joe Arpaio, whom President Trump pardoned last year for defying court orders protecting undocumented immigrants from illegal profiling.

McSally should be able to hold off Ward and Arpaio and win the nomination for Flake’s seat, but there’s a serious chance that Senator John McCain (R-AZ) could pass away or resign soon, due to complications from brain cancer, and open up another seat that Ward or Arpaio would likely have a strong chance of winning. Either Ward or Arpaio would enter the race with severe baggage; Ward has been endorsed by fascist former White House Chief Strategist Steve Bannon and Arpaio was pleased to compare a prison he ran to a “concentration camp.” If McCain remains in office through the election, it is unlikely that he will be able to serve out his complete term, which ends after the 2022 elections. This would open up another opportunity for Ward or Arpaio to run for the seat and, probably, endanger Republican chances in the same manner that Alabama Chief Justice Roy Moore did in his race in 2017.

Paul Ryan (R-WI) became the 54th Speaker of the House on October 29, 2015.

Ryan is the most senior Republican to announce his retirement, but he  likely won’t be the last. A recent poll found that Cathy McMorris Rodgers, the highest-ranking Republican woman as the Chair of the House Republican Conference, with a neck-and-neck race in her Spokane-based district against Lisa Browne, the former Chancellor of Washington State University-Spokane. McMorris Rodgers has held her seat safely since 2005. With two of the most senior House Republicans choosing to either step-down or face a far-closer-than-normal election, combined with extreme swings towards the Democratic Party in nearly every special election since President Trump took office, there should be real fear in Republicans about losing control of Congress altogether.

Up and down the country, Republican lawmakers are feeling the pressure for their relationship with the White House – and the wrath of their constituents. It’s worth noting that some of the most popular Republicans in the country are the Northeast Republican Governors who have gone to great lengths to distance themselves from the toxic Trump Administration, especially Charlie Baker (R-MA) and Phil Scott (R-VT), as well as New Hampshire’s own Chris Sununu.

Batten down the hatches, it looks like there’s more than a blue wave coming in November. It’s shaping up to be a tsunami.

The cover image is taken from vox.com. Blackburn image is taken from CNBC. The third image is taken from PBS.