Nurses File Ballot Initiative for Safe Patient Limits

Nurses File Ballot Initiative for Safe Patient Limits
Sandy Eaton, RN, Labor Notes, September 2013

Up to 98,000 patients die unnecessarily in US hospitals annually, including 2,000 in Massachusetts. Bay State nurses have launched a campaign to end this travesty once and for all through a November 2014 statewide ballot question that would put safe limits on nurses’ patient assignments.

Falls, infections, medical and surgical errors - all result from the transformation of health care into an assembly line. Dozens of scientific studies published in the last decade have shown how many preventable deaths are attributable to one simple fact: patients are forced to share their nurse with too many other patients at one time.

Nurses know that adequate numbers of RNs and support personnel would prevent most of these mishaps. California nurses in 1999 convinced their legislature to mandate that hospitals hire enough nurses to create safe RN-to-patient ratios, and battled on to full implementation in 2004. Studies done in 2008 and 2010 reveal marked improvements in California patient care. Nurse-researcher Linda Aiken found that “if they matched California ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths.”

Guided by the California model, the scientific research and their own collective experience, the Massachusetts Nurses Association/National Nurses United began fighting for similar limits on the number of patients per nurse. But years of legislative campaigns have been repeatedly frustrated.

So MNA members are sidestepping the legislature - where hospital companies, staunch opponents of staffing ratios, wield so much power - and taking the question straight to the people.


Cutbacks in services, supplies and personnel make speed-up the order of the day - and tragedies all too common. State and federal attempts at “health care reform” on a corporate-based, marketplace model have only made the problem worse.

“Patients are indeed suffering preventable infections such as drug-resistant staph infections and pneumonia,” said Lynne Starbard, a labor and delivery nurse in central Massachusetts. “They are also at increased risk of blood clots, heart attacks and post-operative complications. Laboring mothers in our high-risk tertiary center are not receiving the focused attention they need from their nurse. This puts mothers and babies in further jeopardy.”

The bottom line? “There are not enough of us to safely care for our patients!” she said.

Kathy Logan, a veteran intravenous-therapy nurse, put it this way: “No one should have to wait for pain medication, treatments, timely chemotherapy, and be subject to the threat of a mistake because their nurse has too many patients to care for.”

Starbard and Logan were among 2,000 nurses who voted to strike last May for safer staffing levels. Strikes and threats of strikes by thousands of Massachusetts nurses have secured contractual limits in some units, in some facilities - but patients deserve safe care, no matter where they find themselves.

Under the ballot initiative, maximum safe patient limits for nurses would be established for different types of units/departments in a hospital. The proposed law calls for one nurse for every four patients in medical/surgical units, where most patient care takes place. In emergency departments, the proposed regulations require nurses to care for between one and three patients depending on the severity of the patient conditions, and for nurses in critical care units to have between one and a maximum of two patients based on the needs of those patients.
To provide flexibility in staffing and to account for patients who require more care, the bill calls upon a state agency to establish an “acuity” system, which is a standardized formula for rating the illness level of patients (a tool to measure how sick the patients are on a particular unit). Based on the acuity of the patients assigned to a nurse, the maximum safe patient assignment would be reduced if those patients require more intensive care. Right now, there is no law or regulation that requires hospitals to adjust RN staffing based on patients needs


Getting the measure onto the ballot will require the collection of about 70,000 signatures from registered voters over two months this fall. Once these are obtained, if there’s no legislative action on the measure, it will appear on the November 2014 ballot - and the battle for votes will be on.

With its 86 bargaining units and more than 23,000 members  from one end of the state to the other, the nurses union is ideally situated to bring this solution home to the voters with local outreach and the sweat equity of its membership collecting signatures in their neighborhoods, among their family and friends. The MNA/NNU is also reaching out to other labor, social justice and health care advocacy groups for support in gathering signatures. Members, allied unions, seniors’ organizations, churches and health advocacy groups will have to overcome fierce opposition from hospital companies.

In July 2008, on the cusp of victory in the Senate, the Massachusetts Hospital Association pledged $21 million to help close the state’s Romneycare budget deficit on condition that the safe staffing bill be killed. And so it was. But nurses and their allies will not let that happen again.

An enforceable staffing standard has become the overarching goal of union nurses around the world. The nurses of Australia’s state of Victoria won ratios in their public hospital system in 2000. In the US, National Nurses United is proposing federal legislation, and nurses in more than a dozen states and Washington, DC, are pushing their legislatures to set safe patient limits.

Eyes are now on Massachusetts to see how the ballot measure strategy works, and pledges of support from seniors, friends, neighbors, allied unions and organizations, including the Massachusetts Senior Action Council and Jobs with Justice, are rolling in.

Sandy Eaton, RN recently retired as a staff nurse at Quincy Medical Center in Quincy, Massachusetts. He is a member of the Board of Directors of the Massachusetts Nurses Association (MNA), an affiliate of the National Nurses United/AFL-CIO.