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Trying to sort out Question 1 - the one with all the nurses on both sides

WGBH tries to answer questions about the referendum question that would mandate certain nurse/patients ratios in hospitals.

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Comments

Just listen to the everyday, at your bedside, helping you out, taking care of your child, changing your diapers nurse. They are saying yes on 1. The managerial nurses, doctors, and hospital execs are mostly saying no. I side with the working class nurses on this issue. You should too.

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This is definitely NOT universal and clear-cut. I polled a number of my friends, all of whom are fresh RNs on floors at the Brigham, Tufts, Children's, Boston Medical, and smaller LTAC/rehab facilities. They are all pretty equally split between the question.

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If the most important factor is quality of care, why not mandate a 1 to 1 ratio?

Everything is a trade off. More nurses makes healthcare more expensive. More expensive healthcare makes it available to less people.

I'd rather mandate that hospital executives can not be paid more then 10x the lowest paid nurse in their system.

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Nope! The majority of bedside nurses (myself included) ARE NOT voting for Question One. It’s a poorly composed piece of legislation that will cost billions and actually jeopardize patient safety with the staffing issues that it will cause. VOTE NO!

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A bad "at-all-times" law. Treats med/surg floors at MGH the same as similar floor in Fairview Hospital with 25 beds. Institutes 4 different ratios in the ED that change minute-by-minute as patient's needs change. Mandated ratios have only been tried once in California, and Mass. patient outcomes are equal to or BETTER than CA in almost every measure -- including mortality. MNA releases bogus cost study saying ratios will cost only $47 million at ALL hospitals but Comm. of Mass. says ratios will cost $46 million only in SEVEN state run hospitals. Annual ratio costs is closer to $900 million, meaning higher premiums/co-pays for all. Bogus proposal from one union representing less than 25% of nurses. Vote no on Question 1.

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And was told that they can decide on their own what the appropriate ratio is for a given situation and nursing team. They generally don't need anyone's help [or laws] doing so. So while that is an anecdote and I didn't ask ALL the nurses what they thought... I'm leaning towards a No vote, out of respect for the opinion of those nurses I did ask.

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I have been a nurse for the last 6 years (I know not that long in some eyes) but have been in the medical field since I was 14 and can say I whole heartedly NEED everyone to please say yes on question 1 I beg of you all. Do not listen to the ones lying to you pulling this numbers out of their bums it is all lies!!! The truth of the matter is I am left day in and day out in almost tears and back breaking work because I have a “full house” of sick patients who need my help. I want to give them my best. I believe I do. My please forgive me because my best isn’t always enough. I don’t get to sit, pee, eat, and TMI but I can’t tell you how many female problems have ruined my scrubs. I go many many evenings without eating my supper or drinking my water because my patients need me and I am the only one. We NEED more nurses. And there are many nurses out there that need jobs!! Please vote yes on question 1! I am a great nurse and I know my skills. My coworkers all have the same routine as me. Don’t eat pee or sit during our shifts. If you talk to other nurses it is simply truly the norm. This needs to change. Please vote yes on 1. We need help and I am a young fit nurse that has been seasoned for while I know what I am doing please understand this is a usual problem. Please please please vote yes on 1!!! Thank you!!!

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Let Hospital administrators run hospitals, not voters.
Are we going to start voting on how every profession operates?
This sounds like something nurses and Hospitals need to negotiate, not me.

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We shouldn't tell hospitals to follow any public health laws that interfere with administration goals and objectives.

How big is your backyard, again? How much to use this medical waste as fill?

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There are limits on how long people can be on shift.

There are restrictions on handling and disposal of medical waste.

There are rules about how hot the water has to be in the heating tanks to prevent legionella and anti scald devices in the showers.

There are regulations to protect worker safety, patient safety ...

In other words, bullshit. Hospital administrators have to follow lots of regulations - this is a regulation.

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This is a workplace negotiation issue and should not involve voters voting based on TV commercials.
Should we weigh in on how many packages a UPS driver should deliver per hour or leave it to UPS?
Regulations are passed by politicians with input from experts on both sides of an issue.

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One side of the negotiations doesn't seem to want to do any negotiating about this, and they have powerful lobbyists on Beacon Hill.

We have voted on proposed laws presented as referenda in the past that would have been best done in the General Court, and these have passed because the General Court would not act. (see all marijuana reforms as a prime example of this.) Despite the fact that I have a definite opinion on this issue, I can see pros and cons to this proposed law. That it has come to an initiative petition shows how the typical legislative process has broken down.

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Maybe they can get on to this... I still think this is best handled by careful study not by trying to convince us with emotional TV ads.
If the vote screws things up they will have to fix it anyway ,so I say until then I think a hospital should run things as they see best.

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But political consultants are good at realizing that being honest about the pros and cons of an issue (or candidate) is not the best way to go. It's better to scare people one way or the other. I'll give as a prime example close at hand the most recent Democratic primary for Secretary of the Commonwealth. I don't think I saw anything about what the Secretary of the Commonwealth actually does or how either side could do the job best.

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It's clear that we need more nurses, but is the issue that hospitals will not hire them or that they're simply not out there? My understanding is that the issue is the latter. Unless hospitals can magically create a whole bunch of new nurses to hire, this basically means that our hospitals will have to turn patients away because they don't have enough nurses to meet the new law. This also seems like a very rigid solution to workplace situations that are very fluid. The example of some kind of localized incident that creates a need for a whole bunch of people to need medical treatment (that's not a statewide disaster) would mean that the closest hospital would have to turn patients away, spreading them out among hospitals further away, because they don't have enough nurses. This proposal seems well-intended, but I fear that it may have MANY negative unintended consequences.

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You know, if there aren't enough nurses there's a traditional, market driven way to fix that. Offer more money and they will come.

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California had 5 years to implement, this requires by this December. I’m not interested in being a patient who needs a nurse and can’t get one due to ratios because there has been NO time to get the logistics figured out.

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And you expect that hospitals will be able to recruit, hire and train all these new nurses by January 1st, 2019 as Question 1 would require?

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The issue is that hospitals, like a lot of other private sectors that are crying "shortages", don't want to put any investment in their workers. The collective Massachusetts educational system churns out SO MANY new nurses every year - many of which can't get jobs at Boston hospitals, because the system only wants senior, experienced nurses who don't need any further training, supervision, or investment. Several young nurses I know have gone to NH/Maine/Western Mass after school because it was the only way to get a job as a first year nurse and they're planning on moving back after getting the experience. Meanwhile, Hospitals cry shortages as a way of keeping staffing ratios low in order to improve the bottom line.

Force rational ratios, hospitals will hire more young nurses. Keep Boston graduates in Boston.

(note: there is a genuine shortage of nurses, young/old/new/experienced, in other parts of the country, mostly shitty hellhole places where nobody with better options wants to live anyway. this is not the case in MA.)

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Let the Libertarianism flow through you. No on 1.

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Voting yes almost certainly make healthcare more expensive. Voters have voted No to automatic gas tax increases (we sure could use that extra money for bridges and the T) and have voted to rescind a tax on alcohol (which funded alcohol treatment programs.) If you want to raise the hit to your pocketbook, then vote yes.

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  • How long did you have to wait for a nurse to actually appear at your bedside after they said they'd be there?
  • How long does it take to get discharged in the morning? Ever get out before lunch arrives?

    Sorry, hospital administrators, but I fail to see how arguing against a certain nurse-to-patient ratio is gonna improve those sorts of things. So it costs more? Fine. Maybe you could save some money by eliminating the middle-people and implementing single-payer healthcare. I'd rather pay for more nurses than paper-pushers.

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    it is supreme hubris to believe you can fix the problems you will cause by "implementing single payer."

    Newsflash, comrade: single-payer will
    1. Turn into a bigger political football than it is now
    2. Will cut costs by cutting pay, thereby discouraging people from going into healthcare to begin with
    3. Will turn everything into the VA--a perfect example of what government-run and government-administered healthcare looks like. You remember...the health system that can't fire poor performers even after having gotten caught fabricating wait times and patient outcomes.

    The difference between a liberal and conservative is that a conservative is at peace with the fact that bad things sometimes happen, while a liberal is under the impression that this fundamental fact of life can be changed by hiring more and more six figure bureaucrats and granting the power of life and death over ordinary citizens.

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    The Mass. Nurses Association hasn't been able to secure this perk for their members at the bargaining table, so they're appealing to the voters through a misleading campaign.

    There's a reason hospitals resist this so strongly. It's not because they're greedy soulless corporate machines; almost all hospitals in MA are non-profit. It's just not feasible in the real world, financially or practically.

    https://en.wikipedia.org/wiki/Featherbedding

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    This isn't pulled from thin air - CA experience proves that it saves lives.

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    The Ca. data is mixed and does not support that outcome. Safe and high-quality patient care is much more complex and nuanced than rigid ratios. There are a multitude of factors that affect patient outcomes.

    I am a front-line nurse ( not an executive) with over 40 years of experience, including 20 years at the bedside in a safety-net hospital. I am voting NO on Question #1. There will be negative, unintended consequences, if it passes. This is a bad piece of legislation.

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    You could login as "front line nurse" or something - this sounds like a Classic Talking Points Drive By - especially since you didn't bother to even link to the "data" and "studies" that you cite.

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    Sorry, I was actually taking a break from patient care when I made my initial remarks. But, I would have thought that you, being an expert on all things possible, could have easily found this:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626342/

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    Right. Sure.

    Who cares who is asking when they are right to ask? No need for ad hominem attacks - Mention a survey, add a link. Simple.

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    It's not because they're greedy soulless corporate machines; almost all hospitals in MA are non-profit.

    Those are in no way mutually exclusive. Many would argue that "greedy, soulless, and corporate" describes Partners (nonprofit, with $13.4 billion in revenue) to a T.

    Other famous non-profits include the New York Stock Exchange (prior to merger) and Major League Baseball (until 2007), the NRA, the NFL, etc.

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    But aren't they still struggling like most hospitals?

    This whole system is baffling.

    Single payer is not the solution either.

    Mind numbingly complex.

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    Not for Profit is a Tax Status, NOT a Mandate From God.

    *anon meaning again, not anonymously. (sp?)

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    "Not for profit" means the money has to stay in the organization/system, broadly. But it doesn't mean they can't pay administrators a lot more than ICU nurses, or hire assistant administrators instead of nurses or lab techs--or, in other contexts, pay assistant football coaches more than tenured math or science teachers.

    Of course hospital administrators think they'd do a better job at making the decisions than you or I would. The question is whether the hiring decisions they're making now are better than the ones they'd be making in this context.

    The strongest argument I've seen against this is the short time frame for implementing it. There's an obvious fix: if this passes, can the governor and state legislature amend it to give them an extra six months or a year to put it in place, the way they did with marijuana legalization?

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    You know, the dirge-like music behind the scary baritone funeral director narration:

    "If Question ______ passes/fails then all the puppies in Eastern Massachusetts can be expected to die a slow painful death. The colors pink and sky blue will fall from the spectrum. Small children will universally adopt MAGA hats..."

    Which ever side has the scariest doomsday commercials is lying the most. I will vote based entirely on that, going the opposite way,

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    I almost always find that the side running the most ads - and especially if filled with "scary" things - is the one with the weakest argument. I don't decide solely on that basis, of course, but if I'm undecided after doing my research, that's my tiebreaker.

    Suldog

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    after reading the articles and these comments, I'm even more confused.

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    One side wants things to be good. The other side wants things to be bad.

    It’s pretty obvious.

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    I dont believe that. Not from what I've seen. Nurses are clearly yes on 1.

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    Lots of nurses are opposed.

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    Come to a busy ED or med/surg floor and you will realize that most of us are NOT in favor of Question 1; in fact, we fear it. Read the comments on this page, as many understand why. The consumer will suffer in the end.

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    Surveys say 87% of nurses support this measure.

    The same law is in effect in California, and they seem to be doing okay. But hey, if you are okay with your workload of patients doubling, vote as you see fit. As a consumer, I’ll err on the side of patient safety.

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    Love all these fact free posts from purported nurses.

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