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Nurses: Ballot Initiative on Patient Limits Would Hurt Care

June 23, 2018 GMT

CONCORD -- Lunenburg nurse Tommi Gill-Sammet says a day in the Emerson Hospital emergency department requires flexible staffing and timing to make sure patients get the treatment they need.

Nurses often care for multiple patients and medical situations dictate how many nurses are needed.

A proposed state ballot question aims to increase safety by setting limits for how many patients one nurse can treat. It may seem like a good idea, Gill-Sammet said, but it could hurt her ability to help patients and the quality of care she can provide.

“It would make a patient a number,” she said during an interview at the hospital. “It would make a nurse a number.”

The initiative sponsored by the Massachusetts Nurses Association would set nurse ratios for the various units including maternity, pediatric, or psychiatric and in the operating room.

In emergency departments, the ballot measure would set the number of nurses caring for patients depending on whether they need critical care, whether their condition is stable, and if their care is considered urgent.

The initiative cleared a hurdle from the state’s Supreme Judicial Court Monday to appear on the ballot in November. It needs additional certified signatures by July 3 to make that happen.

If approved, the law would apply to community, teaching, private and state-owned or operated hospitals, and would go into effect January 2019.

Brenda McCurdy, an emergency department nurse who works with Gill-Sammet, said under the proposal, nurses would not be able to make adequate judgment calls for a patient.

Federal law says emergency departments must examine everyone who comes in seeking treatment. The state initiative could prevent nurses from seeing patients once they have reached their ratio maximum, she said.

“This would ask nurses, ‘What law would you like to violate?’ ” McCurdy said.

To hold the proposed ratios in place, hospitals would need more nurses to treat patients, she said.

She said the law would view all nurses the same regardless of their experience.

Hiring more nurses doesn’t necessarily translate into better care, Gill-Sammet said.

As a charge nurse who assigns nurses to areas in the emergency department, she knows to balance how many patients to give a nurse based on whether they have the experience to handle them.

Other groups from the medical community including the American Nurses Association, Organization of Nurse Leaders, and the Massachusetts Health and Hospital Association oppose the ballot question.

The initiative would also set up fines for hospitals that violate the nurse ratios.

Institutions could face up to $25,000 per violation and up to $25,000 per day after the first violation. There would also be civil penalties between $250 and $2,500 per day for not posting the law in units, patient rooms and waiting areas.

Gill-Sammet said it is not just nurse ratios that could be affected by the ballot measure.

If hospitals need to spend more money to hire nurses to follow the law, programs could face cuts, she said. The worst-case scenario is that an institution could close down.

When the state Legislature considered a bill to set patient limits for nurses in 2006, Gill-Sammet rallied at the Statehouse against it.

This time around she is talking to people in her community one-on-one to show them the other side and educate them about what could happen under the ballot measure.

Gill-Sammet said nurse ratios should be looked at in a different way that includes way to understand the problem, plan accordingly, and be collaborative.

“The way (supporters) want to go about doing it is not realistic,” she said. “We don’t need the public to suffer.”

Follow Mina on Twitter @mlcorpuz.