Cast your vote for safe staffing in Massachusetts

November 5, 2018

David Wood and Ben Taylor assess the final stretch of the Massachusetts Nurses Association’s campaign to make hospitals stop putting patients’ lives at risk in order to cut costs.

AS THE 2018 midterms began heating up in Massachusetts, lawn signs for the three initiatives on the ballot popped up in front of houses and along roadways across the state. “Nurses say yes on 1” and “Nurses say no on 1” have been among the most common signs displayed this election season.

Question 1 would establish a safe-staffing ratio for nurses in all Massachusetts hospitals. This initiative is modeled on a similar safe staffing law passed in California in 1999.

The Massachusetts Nurses Association (MNA), the union that organizes 23,000 bedside nurses across the state, spearheaded the effort to get the measure on the ballot. The MNA has been lobbying state legislators to implement safe-staffing legislation since at least 1995 — and even gone on strike over the issue.

Nurses have been pushing for safe staffing for one major reason: the systematic understaffing by hospital management in order to cut costs and increase profitability. As a result, nurses report working extended shifts, in some cases as long as 16 or 17 hours, and coming in on their days off to cover holes in the schedule.

Nurses rally in Boston for a safe-staffing ballot measure
Nurses rally in Boston for a safe-staffing ballot measure (Massachusetts Nurses Association | Facebook)

Nurses at Baystate Franklin Medical Center in Greenfield documented hundreds of text messages from hospital administrators asking nurses to come in on their day off to patch these holes in the schedule. After a multiyear struggle involving several strikes, the MNA won safe-staffing language in the contract at BFMC. Statewide, however, the struggle continues.

It should go without saying that asking someone responsible for keeping sick people alive should not be asked to work long past the point of exhaustion. It’s dangerous for nurses and patients — and it should be considered bad for business. Too few nurses means too many patients per nurse. According to the MNA:

For every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5 percent per patient.

For children recovering from basic surgeries, each additional patient assigned to a nurse increased the risk of readmission by a shocking 48 percent.

There is a 20 percent higher risk that a patient will die within 30 days of having general surgery at hospitals that don’t have patient limits.

Every additional patient assigned to an RN is associated with a 7 percent increase in the risk of hospital-acquired pneumonia, a 53 percent increase in respiratory failure, and a 17 percent increase in medical complications.

Short staffing is therefore quite dangerous. And a recent survey of Massachusetts nurses shows that it is getting worse:

Two-thirds, or 65 percent of nurses, said that not having enough time is a major challenge, which was up from 52 percent in last year’s study. Likewise, 61 percent of surveyed nurses said that having to care for too many patients at once is a major challenge, which was up from 54 percent in the previous year. Additionally, 77 percent of the surveyed nurses said Massachusetts RNs are assigned too many patients to care for at one time. Only 18 percent thought RNs are assigned the appropriate number of patients. Zero nurses said RNs could safely be assigned more patients, according to the survey.


THE SOLUTION is obviously to hire more nurses — a remedy that hospital executives strenuously oppose.

Polls show a substantial (and perhaps growing) layer of voters are undecided on Question 1. The apparent split between nurses and the resulting confusing advertisements is often cited as the reason for this dwindling support. This confusion is by design — and reflects the duplicity of the No on Question 1 forces.

The No on 1 campaign has deliberately mimicked the MNA’s Yes on 1 campaign — with similar signage, twitter handles and television ads, knowing full well that deception is their only hope. After all, nurses are the most trusted profession in the U.S. and hospital executives among the least.

Roughly 30 percent of Massachusetts hospitals are non-union. In those workplaces, management has intensified its disinformation campaign in mandatory meetings, in hospital newsletters, and with countless “No on 1” signs and banners adorning their parking lots and buildings.

Harassment by hospital management of vocal Yes on 1 health-care workers, in union and nonunion hospitals alike, has become so intense that the MNA has created an anti-intimidation hotline (413-475-0895) — which according to MNA state board member Donna Stern has been receiving hundreds of calls per week.

No on 1 is outspending Yes on 1 by roughly 80 percent — about $19 million compared to the nurses’ $10.5 million.

While the No team frequently describes itself as a coalition of nurses and community members, about 94 percent of the No team’s funds are coming from the Massachusetts Health and Hospital Association, the trade group representing the interests of the corporate hospital industry, which in Massachusetts generates $28 billion in revenue each year, according to the IRS.

Many of the nurses featured in the No on 1 ads are actually nurse managers — that is, they are not bedside nurses who actually perform the labor impacted by Question 1. Instead, they are administrators, bureaucrats and executives. Their material interests are directly tied to the hospital’s bottom line, and they are not directly subjected to the working conditions that bedside nurses must endure.


THE AMERICAN Nurses Association (ANA) is also part of the No on 1 coalition. They’ve staked out a truly bizarre position: “ANA Massachusetts believes that strict staffing ratios undermines a nurse’s critical thinking and involvement in patient care.”

This is, of course, astoundingly manipulative. It is precisely nurses’ “critical thinking and involvement in patient care” that has produced Question 1, because they know that otherwise, the hospitals will continue to try to save money through understaffing while telling nurses to “do the best you can.”

The MNA was at one time affiliated organizationally with the ANA, but voted to disaffiliate in 2001. Why? Here’s the MNA’s press release explaining its decision back in 2001:

While the MNA is pushing for legislation to regulate nurse-to-patient ratios, the ANA has proposed weak regulations that call upon the industry to develop a patient classification system, with no requirement that the industry adhere to that system. They have also promoted legislation granting the industry the ability to experiment with staffing models that replace nurses with unlicensed personnel, something the nursing community has opposed for years.

But the real kicker that precipitated the split was that the ANA had set up a boss’s union, the United American Nurses, where the “ANA Board of Directors, which is comprised of nurse managers, as well as the ANA executive director, have decision-making power related to the UAN [which] makes those who belong to the national union subject to legal changes by anti-union management attorneys.” The ANA had just enacted policy aimed at forcing affiliates like the MNA to join this union and abide by its decisions. The MNA membership wasn’t having any of it.

So don’t believe the hype: Actual nurses say “vote yes on 1,” and hospital administrators say “vote no on 1.”


IF WE are to believe the alarmist reports from the hospital industry, Question 1 will require hiring an additional 5,911 nurses statewide and cost more than $1 billion annually.

While this is a startling admission from the bosses about just how much they’ve been structurally understaffing our hospitals, it’s also an egregious distortion designed to frighten voters. A Boston College study pegged the cost of implementing Question 1 at $47 million, a mere fraction of what the Chicken Littles of the hospital board room would have us believe.

The reason hospital administrators are opposed to Question 1 is obvious, and it has absolutely nothing to do with “a nurse’s critical thinking and involvement in patient care” and everything to do with maximizing profits.

The MNA has been filing safe staffing bills with the Democratic Party-dominated state legislature since 1995, where the bill sat and died each year.

It’s no surprise why. The majority of hospitals in Massachusetts, which receive at least 60 percent of their funding from public sources, spend huge sums to defeat such bills. For example, Partners HealthCare, the largest employer in Massachusetts, last year became the state’s largest corporate spender on lobbying firms.

The dynamic of bipartisan opposition to safe staffing largely continues in the current fight around Question 1. While politicians like Bernie Sanders and Elizabeth Warren have endorsed Yes on 1, the industry-funded opposition campaign, rallying under the Orwellian slogan “The Coalition to Protect Patient Safety,” is being led by the Dewey Square Group, a powerhouse Democratic Party consulting firm.

So after years of coming up short at the state legislature, the MNA shifted its strategy to a ballot initiative, a stark admission of how effective corporations are at blocking progressive legislation.


TWENTY-FOUR STATES allow the direct participation of the electorate in the making of their own laws through ballot initiatives. Twenty-four states in the U.S. allow citizens this power, and an additional two permit citizens to veto existing laws through the ballot.

The experience in struggling directly for a reform is qualitatively different than passively hoping that elected officials will “do what’s right.” Ballot initiatives force people to think politically about what kind of world they want to live in — and force politicians to actually engage with the popular will.

And in the case of Question 1, despite the hospitals’ attempts to monopolize the debate (especially inside the workplace), nurses across the state have been able to engage in the process of deciding how their floors should be organized, a right normally reserved as the sacred realm of hospital management.

The recent history of marijuana legalization in Massachusetts demonstrates the potential of ballot measures. Despite decades of Democratic Party dominance on Beacon Hill, medical and recreational marijuana languished in the state house. It was only through ballot initiatives — decriminalization in 2008, legalization of medical marijuana in 2012, and legalization of recreational use in 2016 — that legalization was finally won.

Voters forced the hand of reluctant lawmakers and in the process transformed the political terrain. A key pillar of the racist “war on drugs” has been shattered in Massachusetts, laying the basis for struggles that push farther.

Approaching politicians to request reforms has historically proven to be an ineffective way to win change. However, by appealing to the broad public and involving nurses in a campaign to directly demand reforms, the MNA has shown how it’s possible to shift the terrain around reform struggles in our favor — and in the process advance the battle for democracy.

The nurses, understanding the power of solidarity and seeing the fight of the oppressed as a health care issue, have also endorsed Yes on Question 3, which asks voters whether they oppose repealing a law prohibiting discrimination of transgender people in public spaces.

Other labor leaders who support Yes on 1 — such as former Massachusetts Teachers Association President Barbara Madeloni and former national deputy director of SEIU’s health care division Jane McAlevey — have connected the fight for Yes on 1 to the women’s movement, writing:

In the past 12 months, a movement originally concerned with sexual abuse has become a broader movement for gender equity. The #MeToo movement calls for women to be heard and taken seriously not only when they speak out on sexual abuse but also when they speak out on other issues.

On Question 1, women who do the hands-on work in hospitals have amassed a formidable body of real-world experience, of longitudinal studies, of extensively researched data on the benefits of safe patent limits. The opinions of the organization representing 70 percent of all registered nurses in this state are strong, but the evidence that backs them is stronger still. The Massachusetts Nurses Association, like the Massachusetts Teachers Association, is one of the largest organizations of women in the state. They have spent years coming together in meetings all across Massachusetts to write this ballot question. They know what they are doing, day in and day out, in the hospitals, and they know what they are talking about in this crucial policy debate. Are we going to listen to them?”

Make no mistake: getting Question 1 passed is only the next of several steps in this struggle. Hospital administrators have threatened layoffs of auxiliary personnel and closures of community hospitals if this ballot initiative is approved, and they will blame their economic violence on the nurses. This will have to be fought with subsequent mobilizations.

Organizing solidarity with the nurses — at the polls, on picket lines and with co-workers and friends — will be essential, whatever the outcome of the November 6 vote.

Every time administrators complain about hiring enough nurses to safely staff their hospitals, we should counter with the idea that health care is a right and that the profit motive should not endanger patients’ lives. After all, we are all of us eventually patients, too.

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