Question 1 divides nurses in Massachusetts

From left to right, Donna Kelly-Williams, Shannon Mulaire and Karen Moore during the The Nurse Staffing Debate, Friday, Oct. 24 in Boston, Mass. Photo by Shauna Golden / BU News Service.

By Anqi Zhang
BU News Service

Two registered nurses clashed over rigid ratios, status quo in hospitals and cost on the new initiative on Oct. 24, at a debate on Massachusetts ballot Question 1, organized by Suffolk University with NBC10 Boston and the New England Cable News.

Massachusetts Question 1 refers to the Nurse-Patient Assignment Limits Initiative, which aims to limit the number of patients a nurse can treat at a time. A Yes vote supports enacting the initiative, which would become effective on Jan. 1. A No vote means maintaining current laws, under which hospital executives have the power to decide over safe staffing.

The debate was held at the Modern Theater at Suffolk University in front of an audience of 80 people and it featured some of the questions citizens posted on social media, emails and street interviews. Around 10 members of the Massachusetts Nurse Association(MNA), wearing the blue uniforms with slogan badges, came as audience members. MNA has been pushing for nurse staffing laws for about 20 years and wrote the ballot question this year.

It was not a typical debate that featured intense arguing, witty counterarguments and personal attacks. The moderator, Shannon Mulaire, did not have to make an effort to maintain discipline. When either of the advocates was speaking, the other listened quietly and never interrupted. The audience was concentrated and quiet, except for several rounds of applause that cracked the peace in some moments. 

No vote advocate Karen Moore, Senior Vicepresident of Operations at Lawrence General Hospital, addressed the issue of rigid ratios in her opening statement. She stated that rigid ratios would cause “declines, delays and dilemmas” for hospitals, which would lead to longer waiting times in patient beds and already crowded rooms.

Moore spoke about the dilemma she met at an intensive care unit, in which nurses could only be assigned a maximum of two patients at one time, according to a bill passed in 2014 in Massachusetts. “A family said they would never forgive us for letting their loved one spend the last 12 hours of his life wondering when he was going to get care,” Moore recounted. 

Moore’s opponent was Donna Kelly-Williams, the Yes vote advocate and president of the MNA.

Kelly-Williams argued that it was hospital executives who made choices to decrease the critical care beds and facilities. She thought executives made decisions depending on profit rather than the need of the community. Williams also pointed out that ratios were not as strict as Moore said, because they were determined by assessment of the nurse and the acuity tool.

The most intense moment of the debate occurred when Kelly-Williams said to Moore: “Hospital executives like yourself have not taken necessary measures to ensure appropriate nursing care.” She argued that nurses were forced to take care of more patients than they could, which in turn increased risk of infection, medical errors and complications.

“If you or your loved one is in the hospital, do you want to be one of four patients assigned to a nurse, or one of eight patients?” Moore asked the audience.

Moore responded that MNA members did not manage hospitals and they were not responsible for regulators, but existing executives had made hospitals in Massachusetts some of the finest in the world.

The cost of implementing the initiative was also an issue at the debate. The independent Health Policy Commission has said that the cost of hiring extra nurses to cover the number of patients in hospitals in Massachusetts under the new measure could reach $950 million a year. According to Moore, that was a “conservative number” and the costs could end up being higher.

However, the $950 million estimate has been contested by avocates of the Yes vote, who argue that implementing the initiative would only cost between $35 million and $47 million. “Hospitals can well afford this,” Kelly-Williams said at the debate. “They are a $28 billion industry.”

Lynne Starbard, a registered nurse and a member of MNA, said she came to the debate to support Moore. She thought highly of Moore’s performance. “We trusted her to speak for us, because she knew what we said to her and what we had done for years,” Starbard said. 

A Boston Globe/ Suffolk University poll conducted from Oct. 24-27, 2018, found that of a total of 500 respondents, 59 percent opposed the measure, 32 percent supported it, and 9 percent were still undecided.

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