Letter: No on Question 1

by beth on October 24, 2018

[Ed note: My Southborough accepts signed letters to the editor submitted by Southborough residents. Letters may be emailed to mysouthborough@gmail.com.]

To the Editor:

I am a physician and the President of the Medical Staff at UMass Memorial – Marlborough Hospital. I am a pulmonologist and critical care physician and the director of the Intensive Care Unit at the hospital. I am voting NO on Question 1. The medical staff at the hospital is also in full support of voting NO on Question 1.

In 2014, strict ICU nurse ratios went into effect in Massachusetts. The impact at Marlborough Hospital was significant. We were forced to close two of our ten ICU beds to comply. The cost of hiring nurses to staff our ten ICU beds under this new law was prohibitive. Caring for sick patients from our community became a challenge. Patients were transferred to other hospitals when we were unable to meet the rigid ICU staffing law. These are patients who would have been well cared for in our ICU. Mandated nursing ratios do not take into consideration the medical condition of other patients in the unit, the skill and expertise of the nursing staff, the availability of other caregivers such as respiratory therapists, aides and other physicians in the hospital.

I, along with my medical colleagues at the hospital, fear mandating ratios across the entire hospital will have a similar negative impact on our ability to meet the needs of our patients. We have already experienced this in the ICU on a much smaller scale. What other services will the hospital have to eliminate to implement the rigid staffing ratios? Patients will have to travel far from home for medical care when their local community hospital cannot meet the proposed staffing laws.  This will result in increased costs for patients, families who need to travel to visit loved ones, and the overall health care system.

Recent research has shown that the ICU nurse ratio law did not improve outcomes as intended but rather resulted in adverse consequences such as transferring patients and delaying care.  Mandating ratios in all hospital units may have a similar result. We can expect long wait times to be seen in an emergency department and delayed admissions to a hospital bed.

Kimberly Robinson, MD, MPH
Southborough

{ 6 comments… read them below or add one }

1 southsider October 24, 2018 at 5:23 PM

I agree. This law seems ill-conceived, focusing on only one particular job title ( nurse ).
Some hospital employees I’ve spoken with have expressed concerns about significant staff reductions in other areas to help fund the mandate.
I thought the Boston Globe recently did a good job of explaining their opposition to the proposal while also noting the independent research suggesting that in-state medical costs could increase by hundreds of millions of dollars each year if Q1 is approved.
I’m not sure if the folks behind the Question are well intentioned but crafted a poorly thought-out proposal or is this simply a power grab to mandate more nursing positions, even at the expense of many other jobs… Either way, I plan to vote NO on Q1.

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2 Rob October 25, 2018 at 7:03 AM

Why is this posted here???

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3 beth October 25, 2018 at 7:55 AM

I know it isn’t a “Southborough issue.” But, it is posted here because a Southborough resident submitted a signed letter to the editor.

It looks like the policy began in 2012 (perhaps that was the first time Susan was asked.) At that time Susan posted a letter with a note that the blog accepts letters to the editor. That eventually changed to letters from Southborough residents. When I took over the blog, I continued that policy. (I twice allowed exceptions for non-residents: a Northborough resident concerned about an issue related to our shared school district and for the Southborough Police Chief.)

The policy doesn’t specify that the letter has to be related to Southborough-specific issues, though that has been the norm. If the blog starts to be inundated with letters, especially on non-local issues, I may have to re-evaluate the policy. But, so far, this is only the 77th letter since the policy began about 77 months ago.

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4 John Kendall October 25, 2018 at 6:05 PM

Actually, a lot of our residents use Marlborough Hospital, as well as Metro West Medical Center, and UMass/Memorial Medical Center. Everyone will be affected no matter what hospital you chose. A very important issue!

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5 Gerri October 26, 2018 at 10:50 PM

I believe it is very important for residents in any town to read both sides of this ballot question to make an informed decision.
As an RN at Marlborough Hospital for 35 years, I have not seen nursing care in such dire straits at any point in my nursing career than right now. It is disturbing and heartbreaking to know there are patients at our mercy not getting the care and attention they need and deserve because nurses have too many, acutely ill patients to care for.
In the ICU I am fortunate to have patient limits. These limits have afforded us to give safe care to our most vulnerable patients. Nurses in the ICU are relieved to have ratios in which we can provide safe 1:1 or 2:1 care, care that our most critical patients deserve.
We do not find our ratios to be “rigid.” We find our workflow to be somewhat more manageable and patients are less at risk for adverse outcomes.
There are a variety of reasons for us to have to turn away patients or transfer them to other ICUs. In my opinion, the primary reason is due to a management “restructure” of our unit and an overall decrease in nursing hours. All of the ICU nurses have been hired for only part time work. Many have sought employment in other departments and hospitals thus not being available to work in our ICU when needed for an increased patient census. This has created an inability to staff our unit and close us to admissions. An ongoing, cyclical issue.
Like many nurses all around Massachusetts, the majority of nurses at Marlborough Hospital have asked for safe patient ratios. For several years through negotiations, labor/management meetings and staffing collaborative, we have tried to come up with solutions. It has been management that has not followed through with providing the staff needed. Bedside nursing judgement and input, have not been given a consideration when staffing our units.
We ask you, the public, to help us. If admitted to the medical/surgical floor, would you want your nurse to be caring for you and 3 other patients or would you like to be 1 of 5, 6 or 7 patients? It is as simple as that.
So please, consider both sides of the issue, educate yourselves and make the best decision for YOU, and if you please, vote YES on 1.

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6 Jerry C. October 26, 2018 at 7:09 AM

Beth,

Thank-you for posting this. Many people are confused about Question 1, and the more information the better.

Kim…thank-you for giving us important information from the perspective of an ICU Director. Anything that could affect the ability of the ICU to perform it’s mission…which is to save the lives of patients..should be brought to the attention of the public.

Finally, I want to than Marlborough Hospital, Kim Robinson, and the rest of your staff for the wonderful job you are doing servicing our town…making people healthy and saving lives. Your ICU is outstanding, and all of us should do whatever we can to support your mission.

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