Nurse Staffing Ratio Mandate Rejected by Voters in Massachusetts

Dynamic staffing needed to support safe care and high-quality outcomes

November 13, 2018

Massachusetts, a state characterized as having a heavy regulatory hand and a significant nursing union presence, rejected a state mandated hospital nurse-to-patient staff ratio during last week’s election. Media coverage of the ballot initiative cited voter concerns regarding the impact on access to health care, particularly in rural communities, as well as the additional health care costs associated with the law—estimated to be between $676 million to $949 million per year. 

It was estimated Massachusetts hospitals would have had to hire more than 2,000 nurses—with 936 additional registered nurses on night shift alone—provide pay hikes, and purchase new software to track patient acuity. 

Higher costs, finding more nurses to comply with staffing mandates, and creating redundant processes to track and report staffing levels were among the challenges at issue. “Mandated staffing ratios would require additional layers of managing, monitoring, and oversight within hospitals and health systems, as well as the state,” notes Ann Zenk, WHA Vice President of Workforce and Clinical Practice. “These layers would take resources away from local efforts to provide the staffing and support needed to deliver safe, high-quality care to their communities.” 

In California, the only state with mandated nurse-to-patient ratios, the number of patients per nurse has decreased and the number of worked nursing hours per patient day has increased, but associated improvement in hospital nursing quality and safety indicators could not be demonstrated. 

“Delivering high-quality, high-value health care depends on a sufficiently supplied, high-quality and dynamic workforce; a workforce able to create value through innovative best practices and flex to patient need,” said WHA President/CEO Eric Borgerding. “I would hate to see a fixed quota system interfere with the flexibility and creativity of Wisconsin’s nursing and health care workforce—a workforce that has made the quality of Wisconsin’s health care system consistently rank among the best in the nation.”  

This story originally appeared in the November 13, 2018 edition of WHA Newsletter