Mandated Staffing Ratios Would Have a Detrimental Impact on Emergency Care at BID–Needham

Date: October 11, 2018

If passed, Ballot Question 1 would negatively affect patients’ access to care in the BID-Needham Emergency Department (ED), significantly increasing wait times. Mandated nurse staffing ratios could also lead to possible bed closures. 

NEEDHAM, Mass. - If approved on Election Day, Question 1 would impose government-mandated, inflexible nurse staffing ratios at every hospital in Massachusetts, regardless of a hospital’s size, location or unique patients’ needs. Currently, nurse and patient assignments are made by nurse managers on the patient floors or in the Emergency Department and are based on the severity of a patient’s illness or injury and their current needs.

“Rather than improving access to care, this proposal would actually impede it,” said John Fogarty, president and CEO of BID–Needham. “The number of patients needing care, particularly in an emergency room, is unpredictable. Staffing to an inflexible ratio when the number of patients spikes is simply not possible. In situations when volume increases unexpectedly, nurses from inpatient floors and other areas will be reassigned to the emergency room to maintain the ratio. Those other areas, to maintain their ratio, would need to downsize or even close. The cumulative effect would be longer waits for admissions and non-emergency cases, resulting in disruption to care that is unacceptable for our community.”

“This mandate would take away our ability in the ED to make real-time decisions, react swiftly and deploy staff where and when they are needed, which is the foundation of emergency medicine,” says Peter Smulowitz, MD, MPH, Chair of Emergency Medicine and Assistant Professor of Emergency Medicine at Harvard Medical School. “These rigid standards have the potential to lead to long wait times for patients needing emergency care. There is a real possibility that this mandate could lead to harmful delays in patient care.”

“This ballot question is particularly devastating for patients with behavioral health needs,” Smulowitz added. “We struggle every day with accessing appropriate placement for patients with mental health and substance use challenges. The rigidity in this mandate will surely put a severe financial strain on the vital behavioral health facilities at a time when there is already an existing shortage of psychiatric nurses.”

The enormous costs and operational hurdles associated with the nurse staffing ballot question would set BID–Needham back $2.8 million. According to a recent reportfrom the independent Massachusetts Health Policy Commission, the proposal is conservatively estimated to cost Massachusetts a total of $900 million to implement.

Question 1 would also result in the need for the state’s hospitals to hire more than 2,000 registered nurses by January 1, 2019. Experts question the ability of hospitals to hire this many nurses and predict that a resulting nursing shortage would cause hospitals to reduce the number of staffed beds due to a lack of nurses, leading to longer Emergency Department wait times, cancellation of elective surgeries and the elimination of hospital services and community programs.

All of the state’s hospitals and more than 70 health care organizations, including the Massachusetts College of Emergency Physicians, the American Nurses Association-Massachusetts and the Emergency Nurses Association-Massachusetts, have publicly opposed Question 1.