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Communication Regarding Ballot Question 1: Hospital Nurse Staffing Ratios

On November 8, 2018 (Election Day), Massachusetts voters will consider Question 1 that would institute government-mandated nurse staffing levels at all hospitals across the Commonwealth. If approved by voters, the law would require every hospital to adopt by January 1, 2019 the fixed, Registered Nurse-to-Patient ratios defined in the statute for each type of hospital unit at all times – regardless of a hospital’s size, location, or the needs of patients. Question 1 would also not permit hospitals to reduce the staffing levels of their health care workforce to offset the costs of implementing these ratios.

VNA Care strongly opposes Question 1 and encourages its clinicians, staff, patients, their family members and neighbors to Vote No on Question 1. We strongly believe Question 1 would negatively affect Atrius Health, VNA Care and our patients.

Why does VNA Care Oppose Question 1?

  • Limits Innovation and Decreases Flexibility: VNA Care supports patient-centered care and innovation, both of which require flexibility in the delivery of care. Government-mandated ratios will not account for variation in nursing skill, patient conditions, the rest of the care team, and the varying technologies and physical attributes of different facilities. Mandatory fixed staffing will also make it more difficult to develop and test new (and possibly better) ways to deliver care.
  • Threatens Access to Care in the Community: The high cost of Question 1 could require hospitals to cut services to meet increased labor costs and force some community hospitals to turn away patients or even close completely. VNA Care and our patients rely on services in our communities for high quality care close to home.
  • Increases Nursing Shortages: Nurses are needed in all healthcare settings, including ambulatory settings, home health, and hospice settings. There is already a nursing shortage in the U.S. that is projected to grow substantially. Question 1 is focused only on shifting more nurses to hospital settings, and will make it challenging for VNA Care to employ enough home health and hospice nurses to provide the highest quality care for our patients and move additional care into the home.
  • Increases Healthcare Costs: Question 1 has been estimated to cost $1.3 billion in the first year and $900 million annually(1), jeopardizing the cost of health care and health insurance for many citizens in the Commonwealth. This cost will be passed on to Massachusetts residents and employers through increased premiums, copays, deductibles and taxes. Question 1 would likely raise Atrius Health’s total medical expenses and increase staffing costs for VNA Care. This could require Atrius Health and VNA Care to reduce services to compensate.
  • Not Evidence-Based: There is no scientific study that has determined a “correct” nurse-to-patient ratio and no evidence that mandated staffing ratios improve the quality of care.

We strongly encourage you to cast your vote against Question 1 on Election Day - November 6th. If you are unsure where to vote visit the site here. Additional resources, including on-line registration and absentee ballot application information is found here.

Rita Advani, Chair, Board of Trustees, VNA Care Network Foundation 


(1) 2018 study conducted by Mass Insight Global Partnerships and BW Research Partnership and paid for by the Massachusetts Health and Hospital Association.

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