Nurse staffing decision has far-reaching impact for health care

Following a bitter and costly campaign, Massachusetts voters have rejected Question 1 on the ballot, which would have set strict limits on the numbers of patients assigned to hospital nurses.

The Massachusetts Nurses Association, a union representing about 23,000 nurses, sponsored the ballot question. Union members argued that limits were needed to ensure that patients were receiving safe care.

Donna Kelly-Williams, president of the Massachusetts Nurses Association, conceded the loss Tuesday night, but insisted the ballot question was needed.

“We know that right now — as I speak to you here — there are nurses caring for too many patients, and those patients are unnecessarily being put in harm’s way,” Kelly-Williams said, according to her prepared remarks. “And the problem continues to grow every year. The status quo is not a solution here.”

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A coalition led by the hospital industry fought the question, saying the ballot measure was overly rigid and would come with an enormous cost. Hospital representatives argued that hospitals would have to scale back on important medical services — or perhaps, close altogether — if the question passed.

An independent state agency, the Massachusetts Health Policy Commission, estimated that Question 1 would have required hospitals to hire as many as 3,101 additional nurses and could have cost the state health care system more than $900 million a year.

Nurses were divided on the controversial issue. Some believed mandated caseload limits would allow them to take better care of each patient. Others argued the ballot measure would strip them of the ability to use their professional judgment.

Hospitals spent nearly $25 million to try to defeat the ballot measure, more than double the roughly $12 million spent by the union to promote the question.

Volunteers and staff for both campaigns spent the final days before the election making calls and knocking on doors to make their case to voters.

Kate Norton, a spokeswoman for the “Yes” campaign, said 1,850 volunteers were working to get out the vote on Tuesday.

“The support is enthusiastic and strong,” Norton said. “We feel good going into Election Day. We have a great operation.”

Over the weekend, campaign volunteers found that many voters were still undecided, Norton said. “When they talk to us . . . they say ‘yes,’ ” she said.

Polls suggested that support for the question had been dropping, and most voters planned to vote “no” on the ballot measure.

“We’re cautiously optimistic,” said Dan Cence, a spokesman for the coalition opposing Question 1. “We know we’ve put in the work.”

Hundreds of “No on 1” volunteers were scheduled to go to polling locations across the state on Tuesday.

Each campaign said it had distributed more than 30,000 lawn signs.

Voters were divided at the polls Tuesday.

Michelle Resendes, 46, a registered nurse at Norwood Hospital, wore a sticker on her shirt in support of Question 1 as she made her way to the polls at North Attleborough High School.

“I think it’s the safest thing for patients,” she said.

Brockton voter Windsor Lindor, 34, said the nurses issue was the hardest one on the ballot for him — and his wife is a nurse. After seeking input from her, he said, he voted no.

“I just didn’t want to change the status quo,” Lindor said at the War Memorial building on West Elm Street.

The nurses union has been pushing for legislation to set patient limits for two decades. In 2014, the union won a compromise: limits in intensive care units. ICU nurses are now restricted to one or two patients a time. But Massachusetts lawmakers never backed a broader nurse staffing bill.

Governor Charlie Baker, a Republican who won reelection, opposed Question 1. Some Democrats in the Legislature also came out against the ballot question.

Baker’s opponent, Democrat Jay Gonzalez, supported the ballot measure, as did other prominent Democrats including Boston Mayor Martin J. Walsh and Senator Elizabeth Warren.

Hospital officials say they need flexibility to staff their units because it’s hard to predict when patient numbers are going to rise or fall — particularly in the emergency room. But union officials say nurses are routinely saddled with too many patients, increasing the likelihood of delays and errors.

California is the only state that mandates patient limits, also known as nurse-to-patient ratios. The California law, implemented in 2004, is less strict than the Massachusetts ballot question, and studies about the effect of the law are mixed. Some studies found improvements in outcomes after the patient limits went into effect, while others did not.

Question 1 would have required hospitals to adhere to patient limits at all times of day and night, including when nurses take meal breaks.

Watch live results from the 2018 midterm election here.

View complete election results here.

Correspondent Morgan Hughes contributed to this report. Priyanka Dayal McCluskey can be reached at Follow her on Twitter @priyanka_dayal.

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