LETTER: Local RN Says 'Vote No On Question 1'

The following was submitted by Lynn Donatelli BA,RN, VA-BC. Want to get in on the conversation? Email your letters to charlene.arsenault@patch.com.

I am a Registered Nurse and have been one for close to 30 years. In that time, I have worked at numerous hospitals in several different states. My experience has been in step down units, intensive care units, neonatal intensive care and emergency rooms. I am concerned for my fellow nurses and my profession in general if the nurse staffing ratio bill is passed. Following is my attempt to solidify those of you who are voting no and to hopefully persuade those who are voting yes to change your vote.

The Mandated Nurse Staffing Proposal is an attempt to force a single model of uniformity on a system, robbing it of its adaptability. It suggests that there is a panacea approach to healthcare. The reality will inevitably create an environment of low standards for both patients and staff. Many healthcare professionals believe that the decisions on how medicine should be delivered should belong to those actually in the profession. It is therefore not a criticism by opponents of the “nurse ratio” but of the FORCED mandate of these ratios. The mandate suggests that hospitals are unaware how patients need to be treated and that imposing this universal standard will improve the industry. In fact, it will instead over regulate and stymie care and progress.

The cascade of consequences by this mandate includes strangling hospital budgets and obligating them to sever important and highly specialized ancillary departments and staff. These employees cannot be replaced by simply “hiring more nurses” because nurse education and training is highly varied and individuals accumulate skill sets over the course of their careers. The responsibilities of these specialized tasks would then fall to the people available and not the people qualified for the position.

As a nurse, I rely on ancillary staff to help care for my patients. The certified nurse assistant will get blood sugars, help a patient out of bed to go to the bathroom, get a food tray, and clean up an incontinent patient. All of these tasks, as well as many, many more, are incredibly helpful to an already busy nurse. Those of you who have been in the hospital for a knee replacement know the value physical therapy plays in your recovery. From the perspective of the nurse caring for the patient, the task that physical therapy performs allows the nurse to tend to other developing issues from her other patients. An all-RN model reduces specialization and therefore decreases the quality of care for the patient as well as over burdening the RN with an excess of unmanageable tasks.

The success of a hospital is based on cooperative teamwork. We all work directly or tangentially with one another to effectuate a positive outcome for the patient.

In addition, if the ballot passes, the number of nurses needed statewide to fill the fixed ratio is 4,500, and it requires that all hospitals meet this requirement within 60 days! First, this is an impossible feat because there simply aren’t enough nurses out there; and second, the qualifications needed to fill these positions make the task insurmountable. It is important to recognize the nuanced and multifaceted aspects of the nursing profession. The roles of nurses seem interchangeable, but most assuredly they are not. To assume that a maternity nurse can easily slide into the role of a telemetry nurse (or visa versa) is to invite poor patient care and over-stress a nurse trying to perform in an area they are not experienced in.

I support the idea that nurses should have fewer patients, but I object to how this poorly written nurse staffing ratio ballot wants to force it on hospitals. For those of you don't know, the ballot wants to charge hospitals $25,000 per violation per day. So that means that if a nurse has a patient who codes and must be at the patient’s bedside until the patient is stable, the hospital will be fined $75,000— $25,000 for each of the other three patients the nurse has. The hospital’s best efforts to maintain the correct ratio will be thwarted as the nurse now will have to concentrate all her efforts to the one patient that was fine at eight o’clock in the morning but now is a code blue. I feel as though the ballot is setting up hospitals for failure.

If you're still unsure, please do your own research. I can't stress enough how important this is to EVERYONE in this state! The ripple effect will be felt by all who need health care. Please join me and the multitudes of health care professionals in VOTING NO. Nursing has come too far to be catapulted backwards!! Speaking as a seasoned registered nurse, we stand to lose the autonomy we worked so hard to gain!

A NO vote will ensure that MASSACHUSETTS will continue to deliver the highest quality of care to all who need it.

Donatelli is from Douglas and Douglas and works at Milford Regional Medical Center