Question 1 bad for care, nursing education

Measure will lead to cutbacks, closures at hospitals

IMPROVING PATIENT CARE and supporting healthcare workers should always be the top priorities when making changes to today’s health care system. I am a nurse and educator with 40 years of experience, and I am convinced the Question 1 ballot initiative does neither–and will in fact cause lasting damage to our entire healthcare system.

As a nurse, I agree with many opponents that expanding the mandate to cover all patients is dangerous and unnecessary for two reasons. First, an inflexible mandate takes decision-making away from the physicians and nurses specifically trained to make patient care decisions based on real-time staffing and patient needs. Second, a mandated ratio prohibits consideration of how sick the patient is, the experience of the assigned nurse, and the availability – or unavailability — of nursing assistants, occupational therapists, social workers, and other members of the care team likely to be treating the patient.

However, as an educator, my main concern is that if Question 1 is passed, it poses serious issues for the future of nursing education in Massachusetts and could cause lasting damage to the profession. Projections from 2009 cited by the American Association of Colleges of Nursing forecast a shortage of registered nurses in the US that is expected to reach 260,000 by 2025. With the American population aging and living longer with chronic medical conditions, we urgently need as a country to attract and educate as many nurses as possible.

In Massachusetts, should Question 1 be approved, hospitals will immediately need thousands of additional hospital nurses. A bidding war for registered nurses would likely ensue, leaving many hospitals in the Commonwealth financially and practically unable to hire as many nurses as will be required by Question 1. Many of these hospitals — faced with either the prohibitive costs of unnecessary staffing, the $25,000 daily fines imposed for not meeting the new requirements, or simply the unavailability of capable nurses – could be forced to close programs, or even their doors.

A decrease in the number of hospital programs — or hospitals – would have severe ramifications not only for Massachusetts residents, who would have fewer choices for their health care needs and have to travel farther for care, but also on our ability to educate future nurses.  A critical element of nursing curricula is hands-on practice with patients in a clinical setting.  Massachusetts’ academic nursing programs are already struggling to find enough clinical placements for nursing students to complete their education.  In fact, many schools of nursing in Massachusetts could accept more students if there were more openings for these vital clinical opportunities. The shuttering of health care facilities or programs would have a dire and irreversible effect on the quality of nursing education that would resonate for many years into the future.

Finally, research on patient outcomes and nurse job satisfaction have shown that both are significantly increased with a well-educated nurse who uses his or her professional judgment in caring for patients – an accurate description of today’s professional nurse.

Meet the Author

Judy Beal

Registered nurse, dean, and professor, Simmons College
Ultimately, passage of Question 1 is a lose-lose-lose-lose proposition: Worse care for patients, cutbacks and closures for hospitals, loss of professional autonomy for nurses, and a dire threat to the future of nursing education in Massachusetts.

Judy A. Beal, a registered nurse, is a dean and professor in the college of natural, behavioral, and health sciences at Simmons University. She is also the chair-elect of the American Association of Colleges of Nursing.