Letter: Yes on Question 1

by beth on October 29, 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 nurse and I am voting YES on Question 1.

My thoughts on this issue are shaped by 30 years of practice in acute care hospitals. I directly cared for patients in intensive care units, step-down units and medical-surgical units. I served in nursing and hospital leadership positions where I oversaw clinical care units and quality of care within both community and academic medical centers. I directly experienced caring for more patients than I could safely manage. I also directly experienced managing nurses who have been impacted by being assigned too many patients, and the trepidation they experienced that is rarely seen by others.

It is understandable that unless you practiced as a RN, it is difficult to fully understand the ethical-legal choices with which RNs are confronted when trying to balance care, assessments, and teaching to all your patients.

It is a risk to both the patients and the nurse when the nurse is assigned too many patients. Nurses directly care for patients 24 hours a day, 7 days a week. Nurses are the primary health profession that has oversight to ensure patients and their families are provided the best care for recovery and to sustain health after their hospital stay. Nurses have an ethical-legal responsibility to fulfill this role in society. If nursing is unable to provide safe care because of understaffing, they cannot sit by idle and let this happen. Nursing has an ethical obligation to alert society. For several decades and currently, nurses have expressed concerns about understaffing that impairs their ability to provide adequate, safe care. The concerns of front line, staff nurses in this regard has long been disregarded by hospital executives and other administrators.

It is also important to understand there are dynamics that make understaffing even more egregious today. The patients are more sick, the medications more potent, and technology more sophisticated within the hospital, with the patient moving in and out of the hospital more quickly than ever. Ballot 1 is asking the people of Massachusetts to help support the nurse to be able to provide the best care to you and your loved ones when needed. Ballot 1 is asking for nurses to be allowed to control their practice by having enough nurses to face the complex process of care for patients and families.

Health care management is complex with many factors that influence costs in this $28 billion industry in this state. Fear is being generated about unintended consequences if the ballot is passed—but what are the unintended consequences occurring now resulting from understaffing. We, the health care professionals, the Commonwealth, and its people are in control of the decisions that are made and together we will meet the challenges of staffing hospitals safely. A YES vote on question 1 will provide the nurses with an equal voice to ensure appropriate, safe care as we continue to strive to make health care in Massachusetts the best for all.

Please join me in voting YES on question 1 along with many of my colleagues. We ask the public to give us a chance to provide the best care that you and your loved ones deserve and are paying for.

Mary Antonelli, RN, PhD, MPH

1 Publius October 29, 2018 at 2:45 PM

The proposed law would require a covered facility to comply with the patient assignment limits without reducing its level of nursing, service, maintenance, clerical, professional, and other staff. This is reason alone to reject question 1. It is poorly written legislation, one size fits all with dangerous consequences.

2 Frank Crowell October 29, 2018 at 8:36 PM

“It is poorly written legislation, one size fits all with dangerous consequences.”

Which means it will be defeated by voters but immediately taken up by Beacon Hill and passed into law.

3 Jack Canzoneri October 31, 2018 at 11:46 AM

Make no mistake about it, in context of this ballot question 1, nurses are telling you point blank—There has been unsafe staffing (that nurses don’t tell you about when you are in a bed being treated), and that it poses an significant safety peril to you as a patient in the hospital. The front line nurses of Massachusetts are also telling you point blank— We have articulated this to hospital executive management and it has been ignored, that it has fallen on deaf ears. Those front line nurses urge you to make a decision based upon what those nurses are directly telling you—and not based upon the fact that you listened to “no” commercial that has been crafted by media consultants to scare you. Good luck to you when you are blissfully ignorant of this in a hospital and you are the 6th patient assigned to a nurse that should have only been assigned 4—you’ll never know the jeopardy you were in. You ignore those nurses at your peril if you vote no.

4 North Sider October 31, 2018 at 3:28 PM

Jack, so if this passes with a ‘no’, are hospitals going to be forced to hire more nurses to ensure no one is waiting for care? So much confusion about this particular ballot question. I think the worry is that if nurses are capped with their number of patients, the same lack of care will happen, as in patients will just sit and wait until a nurse is ‘free’ on their quota. And if the law doesn’t pass, a nurse could have too many patients and the care would still be poor.

5 southsider November 1, 2018 at 9:30 AM

North Sider… If this passes with a ‘yes’, that’s when hospitals will be forced to hire more nurses. It’s unclear what other cost-saving measures they’ll need to implement to offset those hirings or maybe medical costs will just go up. One supposedly independent study estimates that cost increase to be approx. $900million/year. https://www.telegram.com/news/20181003/question-1-could-cost-up-to-949-million-says-health-policy-commission
I’m not sure that medical care in MA is so bad as to need such government mandated staffing requirements. I’ve always believed medical care around here was virtually second to none.
I’m voting against this poorly worded ballot question.

6 Eileen November 1, 2018 at 2:35 PM

if the Question passes, yes, hospitals will be forced to hire enough nurses for patients to be adequately cared for. Our for profit health industry can certainly afford it.

The mailings have been designed to confuse and scare people, to make them think they are endangering people by voting Yes. They are not.

7 Eileen November 1, 2018 at 4:34 PM
8 geo November 2, 2018 at 9:45 PM

I agree that leaving nurses with too many patients effects wait times just as much The effect that adequate nurse staffing will have is that patients will get the timely, quality, safe care that they deserve and pay for. And nurses won’t be too exhausted. Hospitals care more about money than their nurses. What a shame

9 Full Disclosure November 1, 2018 at 11:32 AM

Interesting post by Jack Canzoneri. It would have been more informative if he had added this information which I found when I googled his name because he didn’t identify himself as a nurse or doctor:

“Attorney Jack J. Canzoneri has practiced labor law exclusively on behalf of unions since joining the firm in 1993.”

Hmm. So his post which includes this statement “…. “no” commercial that has been crafted by media consultants…” doesn’t say that this post was also artfully crafted by a labor lawyer who exclusively represents unions. Nice!

I’m still undecided how I will vote and I have neighbors who are nurses; – one says vote yes and one says vote no.

10 Frank Crowell November 1, 2018 at 1:20 PM

I was suspicious that the post was from a union official or associated with the union. Where are the usual “Troll” police when you need them? Nice detective work Full Disclosure.

11 Kelly Roney November 1, 2018 at 11:08 PM

There’s no irony in a pseudonym complaining that someone else who used his name is failing full disclosure, no irony at all.

12 Frank Crowell November 2, 2018 at 3:36 PM

There’s no use pointing out that Full Disclosure discovered a fact. Say hello to Jack at the next SDTC meeting.

13 Kelly Roney November 5, 2018 at 8:55 AM

Frank can use Google, too!

We’d love to have him at a meeting. We meet on the first Wednesday of each month, but this month’s meeting may be cancelled since we’ll all be hung over, hopefully from celebrating taking back the House of Representatives, despite a huge gerrymander that means we need 55% of the votes to get half the seats.

But I’ve never met Jack Canzoneri, not yet.

14 Publius November 1, 2018 at 4:08 PM

Remember as well this this covers all facets of hospitals and “other covered facilities.” If anyone thinks this is a good idea read the text and if there is a single word or phrase you do not understand commonsense says you must stop and vote no. Unless one is a medical expert involved with hospitals and “other covered facilities” they have no business creating laws that they have no idea of the consequences. One could rationally argue that even hospital nurses are not qualified to vote on this issue since they are likely only seeing one small piece of what the legislation will cover. We are “unsure” but after reading the actual law are now definite NO.

15 Matthew Brownell November 3, 2018 at 10:51 AM

Question 1, if approved, only benefits nurses, the nurses’s union, union officials, labor attorneys, and the patronage politicians depending on their union machine votes.

Question 1 is a complete loser for everyone else, and I’m not aware of a single hospital in Massachusetts that supports it.

The extra cost and tax burden is staggering.

16 Barbara Braccio November 5, 2018 at 3:40 PM

Hospitals do not support this bill because they will be held accountable for their under staffing of the floors. As well as upper management will no longer be able to get their bonuses throughout the year. Question 1 most certainly benefits patients and their care. Look at the wait time in the ER now because of under staffing . It is all about patient safety but now the hospitals have taken to scare tactics and bullying people and staff into voting no. Talk about dirty politics hospitals are sending letters to staff and patients urging them to vote NO yet they do not sign the letter.
Barbara Braccio RN

17 Eileen Prefontaine November 6, 2018 at 1:44 PM

Yes, Question 1 is all about patient safety.

I am very angry to hear about the letters sent to staff and patients. That is shameful, and very dirty politics indeed.

My husband and I have voted Yes, but I fear this may not pass because of all the deceptive mailings that have been sent to residents.

18 Matthew Brownell November 4, 2018 at 12:21 PM

A major challenge and factor that Question 1 completely ignores, is the manner in which most hospital nurses are paid. Unlike many other skilled hospital and nursing home heath practitioners,- who are paid by agreed fees and procedures by diagnostic codes, the costs and pay for the vast majority of nurses are baked into the per-day hospital room rate.

Enter Medicare reimbursement to hospitals, clinics, and specialty medical practices.

By this time next Fall, Medicare is cutting reimbursement to hospitals and nursing homes by 25% – 40% for hundreds of diagnostic codes, across many medical specialties- including physical therapists, respiratory therapists, occupational therapists, and so on.

Healthcare practitioners- like any other business facing revenue shortfalls, have a limited number of options to deal with this shortfall:

1) They increase productivity per headcount, or by technology shift
2) They cut or ration services
3) They reduce salaries and /or eliminate benefits, and accelerate the “early retirement “ incentives of older, higher-paid employees.

My opposition to Question 1 is that the business model for paying nurses is not grounded d in any way to market reality; i.e. there is no effective measure of their efficiency or productivity. . . nurses make the same $$$ , regardless of how many beds they are assigned to. There is, therefore, no incentive for nurses to provide better, more efficient care. They benefit from the same flawed, dopey , union-inspired payment system as public school teachers, and tenured college professors . . . an anachronistic, century-old payment system that compensates not on merit or performance, but on how long an employee warms a seat –

This is why No hospital or nursing home in Massachusetts supports Question 1.

Please **VOTE NO** on Question 1.

19 Kelly Roney November 5, 2018 at 9:19 AM

Wait, you’re against Question 1 because hospitals won’t let nurses bill patients separately the way doctors do?

That makes no sense at all.

20 Matthew Brownell November 5, 2018 at 12:54 PM

Kelly Romney-

Pretty lame attempt on your part to deflect accountability and adherence to common sense business practice and realistic health care delivery.

Question 1 doesn’t benefit patients, Massachusetts taxpayers, or Health care providers. You are aware, Mr. Roney, that even conservatives peg this poorly disguised union graft at a price tag of $800 million to Massachusetts taxpayers ( Buehler? )

21 Eileen November 5, 2018 at 1:28 PM

Matthew Brownell-

The conservatives especially are against it. That is because they are afraid it would dip into the high salaries of the CEOs who run our now mostly for profit healthcare system. Most, or all, of the democratic politicians in Massachusetts are for Question one. I hope it passes.

22 Kelly Roney November 5, 2018 at 3:25 PM

So, Matthew, you didn’t like my terse summary of your position. Not surprising that my cutting through all your verbiage left you wounded. Maybe you need a nurse!

Question 1 is not about how nurses are paid. It’s about how many are paid.

You can’t see nursing productivity because it doesn’t fit into your simple-minded business model? Really? That seems like an admission on your part that you have no insight at all.

One related question: So many people hate unions because of the misbehavior of a few, but they love corporations despite a much larger and more costly pattern of crime. Why is that? Why wouldn’t we take the good of each and prosecute the bad?

23 Matthew Brownell November 5, 2018 at 6:04 PM

Kelly Roney –

So, you think I’m simple-minded?

Again, you’re deflecting, Mr. Roney , I’d wager a a fair amount that I’ve spent about 1000% more time in direct care medical facilities facilities in Massachusetts than you and your labor attorney (nurse’s union lobbyist) combined.

And though you seem to love putting words in other people’s mouths, I don’t necessarily *hate* unions for their misbehavior; rather, I despise them because they make a lifelong pursuit of erecting fake, government-mandated, artificial, monopoly pricing floors that (again), have no basis in competitive market reality.

The nurses are encountering job and productivity demands that are no different than any other employee in **ANY** direct healthcare facility. . . . all of whom have stepped-up to the plate, and gotten stronger, better, and more efficient.

Want to see Regional Hospitals, nursing homes, and medical inpatient facilities in Massachusetts close by the **hundreds** ?? Want to be saddled with an additional $800 million in Massachusetts healthcare expenses, premiums, and taxes? Then, by all means, have at it, and vote “Yes” on Question 1.

24 Rose Mauro November 5, 2018 at 3:31 PM

Matthew, you need to read the Commonwealth Magazine articles, particularly this one:

The researchers that were cited on the estimated cost were interviewed and have a lot of clarifications regarding how their conclusions were used. You did not get beyond the headlines on this topic. In general, it does not make sense to approach health policy questions through too thick of an ideological lens — the system is extremely complex and it’s difficult to model all the moving parts without using well-designed scientific procedures.

25 Karen Muggeridge November 6, 2018 at 2:23 PM

There are quantitative measures by which to gauge patient outcomes based on nurse sensitive care standards. I prefer health care providers who value quality and safety standards as opposed to money, numbers driven ones.
I proudly voted Yes on Question 1, for the health and safety of all of you, my family and myself.
Karen Muggeridge BSN, RN

26 Rose Mauro November 5, 2018 at 11:46 AM

Commonwealth Magazine has a lot of good information on Question 1, on both pro and con sides.

Note as well that Massachusetts allows legislative alteration to ballot initiatives.

I decided to vote yes on this measure after a state legislator assured me that they can make changes if bad effects are observed. There are a limited number of studies, and there are so many variables that it’s hard to draw definitive conclusions about the future from existing data. In general, I tend to trust the people on the ground when it comes to doing their own jobs effectively.

27 Matthew Brownell November 5, 2018 at 6:12 PM

Rose Mauro –

“Hard to draw definitive conclusions” (??)

Who is the “State Legislator” to whom you refer? I can only imagine that the legislator would not want to wade very far into the water with definitive conclusions of any sort.

28 southsider November 6, 2018 at 8:33 AM

Do we really think that medical care in Mass is so bad that it requires government staffing mandates? I’m born and raised in this area and have always felt we had access to some of the best medical care on the planet.
Based on some comments, I may steer clear of Marlboro Hospital unless absolutely necessary but I’ve always felt as though I was receiving good and considered care around here.

29 John Kendall November 6, 2018 at 12:20 PM

Where are these comments about Marlborough Hospital that you mentioned?

30 southsider November 8, 2018 at 11:21 AM

a nurse named Gerri wrote to this blog about a week ago, saying that she felt patients were at risk in Marlboro Hospital because of their staffing levels.

31 concerned_resident November 6, 2018 at 2:37 PM

Question 1: More (of anything) is better, right?

Unfortunately, the $$ resources only go so far, so we need to make sure that the problem(s) we strive to correct and approaches (places to invest $$) have the biggest impact on the ‘root causes’ of the problem.

First we need fairly reliable data to understand the problem, roots causes, and anticipated benefits. Let’s assume that the Center for Disease Control (CDC) is among the most unbiased sources of data. Could the root causes to higher morbidity and/or mortality be nursing staff (patients / ns)?. Or would better diagnostic or treatment equipment and facilties better meet the goal? Certainly nobody is suggesting that we need more Administrators to enhance M/M success.

The CDC 10 year study (2000-2010) indicates that the top 8 causes of hospital death (by initial diagnosis) have ALL declined substantially over that period (% change -33% reduction, when the outlier sepsis [+17] is factored out).

these results would indicate that nursing staff levels are not impeding health and recovery as the current status has resulted in lower M&M findings.


Table. Inpatient hospital death rates, by first-listed diagnosis
Rate per 100 persons hospitalized for diagnosis
Diagnosis 2000 2005 2010 Percent change
Total 2.5 2.2 2 -20
Resp. failure 25.3 19.3 16.5 -35
Pneumonitis 17.4 15.2 13.6 -22
Septicemia 13.9 19.3 16.3 +17
Kidney dis. 9.9 6.5 3.5 -65
Cancer 8.1 6.8 4.4 -46
Stroke 6.4 6.5 4.7 -27
Pneumonia 4.9 3.3 3.3 -33
Heart disease 3.7 2.8 3.1 -16

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