Nursing Staffing Levels at Heart of Massachusetts Ballot Controversy


New requirement could cost nearly $1 billion, study shows

A report from an independent state agency on the potential costs of a November ballot question on nurse staffing levels generated controversy before its findings are even made public.

Now that the answers—or at least a framework—are available, things haven’t settled down much at all.

“Question 1” on the Massachusetts state ballot in November is the name for an initiative proposing mandated nurse-to-patient ratios in all of the state’s hospitals and in other health care facilities. The ratios would vary based on levels of care required in various hospital settings.

But supporters of the initiative were taken aback when it was announced that the Massachusetts Health Policy Commission (MHPC) would be undertaking a detailed study to determine the feasibility of such a plan in terms of costs.

This plan didn’t sit well with Question 1 supporters, who felt it was unusual that a state agency would weigh in on a potential law before voters had their opportunity.

According to U.S. News and World Report, The ballot initiative proposes mandated nurse-to-patient ratios in all of the state’s hospitals and in other health care facilities. The ratios would vary based on levels of care required in various hospital settings.

For example, no more than three patients could be assigned to a single nurse in step-down/intermediate care units. The ratios would be lower for emergency room, intensive care or operating room patients, and higher for patients whose medical conditions are more stable.

“In light of these actions, and without being provided with the information on who, how and what data is being used for this report, we have little faith in any of the findings it will provide,” said Julie Pinkham, executive director of the Massachusetts Nurses Association which backs the mandated staffing ratios, in a statement.

In response, Stuart Altman, chairman of the MHPC, said the study is consistent with the Commission’s role as “an independent watchdog of healthcare costs, quality and access in state.”

The Findings

The controversy isn’t likely to slow down after the MHPC released its findings late last week.

The conservative estimates for added costs fall between $676 million–$949 million annually. The MHPC estimated the mandate would force statewide facilities to hire more than 3,000 additional full-time nurses.

Pinkham and the Massachusetts Nurses Association wasted no time in responding. She said the Association was not consulted at all during the study, and were not offered a copy of the findings in advance. She referred to the additional costs in the report as ‘bloated.’

“That is unadulterated pork being put in there,” she said to the Alton Telegraph. “To suggest that we are potentially going to see a 4 to 6 percent wage increase for every nurse … as a result of implementing safe limits is a lovely dream world, but not reality,” Pinkham said.

To date, California is the only state with mandated nursing staffing levels, the result of a law passed in 1999.


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About Author

Rob Senior
Rob Senior

Rob has 15 years of experience writing and editing for healthcare. He previously worked for ADVANCE from 2002 to 2012.

1 Comment

  1. chris caulfield on

    Great article Rob. I’m a CNO of a staffing firm that employees over 800 Nurses in Massachusetts. I’d be very interested to see if these calculation include the cost and the issues experienced by Post-Acute facilities. Such mandate will very much increase the difficulty recruit RNs to lead these facilities. As a previous MNA union co-chair, I very much support Nurse to patient ratios.. but also feel that there is repercussions that will trickle some negative implications which may affect different population groups (which there needs to be plans in place to account for).

    Chris Caulfield RN, FNP-C
    IntelyCare – CNO

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