While I understand the frustration of nurses who get slammed when the hospital is busy or on holidays and weekends, there are still several reasons that solving that problem with a ballot question is a bad idea.
First, all of us in the medical care system get slammed occasionally. It is the nature of the business that there is no predicting patient flows and needs. When I worked on weekends, sometimes I would be home in two hours and sometimes I would be there for 18.
Do patients suffer when it is super busy? Probably. But not as much as the promoters of this question would have you believe. Mostly it is the lower-priority requests that take time to get fulfilled, not the life-threatening concerns. Patients can sense the hectic activity and generally understand.
Secondly, it is no exaggeration that if this passed, to keep the required nursing ratio, the hospital would have to turn away people even if they had beds. It is very troubling for patients to be shuttled off to a distant hospital when there is a bed shortage. Sending them away for a nursing shortage would be worse. The hospital system has grown up to be “right sized” with just about the right number of beds to fulfill the needs of the community without being overly large and too expensive to run. This proposal would abruptly change that balance by effectively making the hospital smaller, based on the number of available nurses instead of beds. This would work itself out over time but it would likely take years.
Third, the requirements of this bill are draconian, with an imposition date of January 1, 2019—a mere two months from the election. This is reminiscent of the recreational marijuana bill that required an absurdly short timeline for implementation, resulting in the chaos that towns continue to face two years after its passage. Adding $25,000-a-day fines to the hospitals is an unreasonably severe penalty.
Fourth, this directive injects unprecedented meddling of government into the daily workings of a hospital. Mandating staffing ratios is only the first layer of workload. It is likely that a nurse will feel much less stressed with six patients who are relatively well than with four who are sick as could be. Acuity is the biggest wildcard, not patient numbers, and it is almost impossible to quantify and predict.
Fifth, the bill covers all hospitals, including for-profit systems that, as a business model, overwork their staff and not-for-profit and academic centers that treat their staff much better. As much as unions for medical professionals such as nurses are strange entities, they are a better way to address some of these staffing issues than state law, which is too inflexible and insensitive to local needs.
Which brings up the final objection, that ballot questions in general are a poor way to make laws. In contrast to the legislature which, admittedly, is agonizingly slow in its deliberations, ballot questions have very little deliberation, do not seek alternate plans, employ no expert opinion, are often confusingly worded, are frequently emotional and ask a public that has little insight into the subtlety and unintended consequences of a given piece of legislation to make decisions that should be made by the Congress.
This is bad governance. Vote no on Question 1.
Dr. Thomas Sbarra, Elm Road, Falmouth