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MA Ballot Question #1: Quotas for nurses.

 
 
Reply Tue 16 Oct, 2018 07:43 pm
Next month I am going to vote on Question 1. If this measure passes it puts a limit to the number of patients to each nurse (depending on department, etc.). I am pretty sure I am going to vote no. It is being pushed by unions, but a lot of nurses oppose it, including an acquaintance.

The argument for it is a union argument (good for overworked nurses) and better care for patients.

The argument against it is added bureaucracy preventing hospitals from having flexibility in managing staff. It seems that many people in California (with a similar law) feel it is a bad idea.

Does anyone else have an opinion on this?
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Type: Question • Score: 4 • Views: 1,184 • Replies: 13
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laughoutlood
 
  2  
Reply Wed 17 Oct, 2018 06:11 am
@maxdancona,
Unions bah humbug, overworked nurses and inadequate patient care, is that all they care about?

And they have the unmitigated gall to call themselves liberal.
tsarstepan
 
  2  
Reply Wed 17 Oct, 2018 06:20 am
@laughoutlood,
I love it when my ER nurse is so exhausted, frustrated, and shell-shocked from working a week's worth of double shifts because of staffing cutbacks that he or she ... ya know... ends up administers me the wrong injection. It's fun to see what random side effects I can suffer while simultaneously NOT help relieving the medical problem that brought me to the hospital in the first place.

Damn them fatcat nurses and their ... six? Seven figure salaries?
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maxdancona
 
  1  
Reply Wed 17 Oct, 2018 07:00 am
@maxdancona,
The issue of salaries is different than the issue of quotas. You can raise salaries without patient restrictions.

The question is whether taking flexibility from hospitals is a good thing. Is there any evidence that this policy benefits patient care?
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maxdancona
 
  1  
Reply Wed 17 Oct, 2018 10:32 am
I would like to have a fact based discussion looking at actual data and considering the pros and cons of both sides. I am spending time to consider this question. The responses so far are partisan propaganda.

This measure in California clearly increased the hours of Registered Nurses. The salary for Registered Nurses did go up after the bill was passed. Tsar asked if "fatcat" nurses make six figure salaries... I was amused to find out that in fact, Registered Nurses do commonly make six figures (as they should).

The non-biased studies don't find any significant decrease in patient outcomes (the partisan propaganda says otherwise). There is a minor increase in emergency room wait time (since patients can't be discharged until there are nurses available).
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Linkat
 
  2  
Reply Wed 17 Oct, 2018 12:20 pm
@maxdancona,
My brother who is a nurse at one of the large hospitals in Boston (been a nurse for over 15 years) says to answer "No". I trust his opinion his is a smart guy and a dedicated nurse who cares for excellent patient care.

Some of his points - requiring a minimum number of nurses per patient does not make sense. That would mean you would need x number of nurses during the day and the same amount at night. Typically at night there is minimum work that a nurse needs to do so you would have several nurses just reading a book or on their phone.

Also, it leaves out other decision making that these intelligent nurses should be more than qualified to do. Say for example there is an emergency on another floor - the nurses on other floors will not be able to respond as they will need to stay where they are - they couldn't send one from each floor to the emergency room if something huge happened to help out - and in Boston we know that can happen - Boston Marathon.

My personal opinion - those that say to vote no - are probably the ones not thinking this through or are naive or lazy (hoping this means less work for them).

I think a huge thing on this like many regulations - is it takes decision making from those best in the position to do so - the medical team - to bureaucrats.
maxdancona
 
  1  
Reply Wed 17 Oct, 2018 12:37 pm
@Linkat,
Thank you Linkat. Are you as sick of the ads on both side of this issue as I am? They are both pounding on meaningless talking points.. I feeling like voting against the last ad I see.
Linkat
 
  1  
Reply Wed 17 Oct, 2018 02:13 pm
@maxdancona,
I feel that way about most of the political ads on any issue or candidate. I tend to just ignore them.

Funny because when I first heard this question - my inclination was to answer yes - seems to make sense - you see nurses as someone mentioned here who seem over worked - but as in anything there is more you do not see.

When you talk with someone that is directly involved in this area you get insight you might not otherwise. I trust my brother's opinion in this - as I know where his heart is.

I wonder who on either side is funding these ads and what their particular motives are? I do know my brother's motive - yes he was a good paying job that is obvious, but he does care about giving quality care to patients.

I remember him telling me about hospitals he worked at when he did traveling nurse - some of them did not give the quality he was used to at the better hospitals we have here in Boston - he had a question about a medication for a patient so he did the responsible thing and called the doctor for clarification - the doctor yelled at him for bothering him at home. My brother could care less he got the information he needed to ensure the care of the patient.
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engineer
 
  1  
Reply Thu 18 Oct, 2018 10:58 am
@maxdancona,
Tough question. Nursing is often a very arduous profession involving a lot of physical activity and heavy lifting so providing some protections around overwork sounds reasonable. I also don't agree that this would take decision making out of the hands of nursing professionals since they don't have staffing decision making anyway. Staffing is done administrators using spreadsheets and models so the question is should the government control one of those spreadsheet cells in the name of public health. I also don't see this law restricting nurses in how they do their jobs. There is no reason several nurses couldn't work together in unusual circumstances or move from floor to floor. All that said, my take on the fly here is no. As someone above pointed out, there are lots of different patient scenarios and they require different levels of care. The ICU is going to have different requirements than post op or the maternity ward. While administrators might not have the best interests of the patients at heart when they run their models, the government might not have the expertise to set values correctly nor would I count on them to correctly update standards as the industry evolves. It also depends on what the government limit is. If a typical number is 10 patients per nurse (completely making that up) and the government sets a max limit of 15, that sounds like it is just focused on preventing abuse, but if it is set at 5, that just raises costs for no benefit. I wouldn't vote yes on this without knowing the mechanism to set the limits.
maxdancona
 
  1  
Reply Mon 22 Oct, 2018 08:07 pm
The Boston Globe has come out against Question 1.
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Linkat
 
  1  
Reply Tue 23 Oct, 2018 10:02 am
@engineer,
engineer wrote:

TI also don't agree that this would take decision making out of the hands of nursing professionals since they don't have staffing decision making anyway. Staffing is done administrators using spreadsheets and models so the question is should the government control one of those spreadsheet cells in the name of public health. I also don't see this law restricting nurses in how they do their jobs. There is no reason several nurses couldn't work together in unusual circumstances or move from floor to floor.


In the case of allowing nurses to help out on a different floor - yes it would take the decision making out of the nurses hands. They would be unable to leave the floor to help in an emergency on another floor as they need x number of nurses to be there according to law. The administrators do not decide that the head nurse on the floor would direct that.

What you are stating here "....there is no reason several nurses couldn't work together in unusual circumstances..." - this is one of the items this question would prevent - the nurses working together in unusual circumstances as they must maintain their quota for number of nurses per patient so they would be restricted.
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maxdancona
 
  1  
Reply Tue 30 Oct, 2018 04:57 am
I just heard a story about how quickly the polls have changed on this question. A few weeks ago, a strong majority supported the bill. The latest polls have a strong majority opposing it.

The story suggests that the reason for this dramatic change is that voters are talking to nurses they know personally about the measure.

I found that interesting given this discussion.
Linkat
 
  1  
Reply Tue 30 Oct, 2018 07:42 am
@maxdancona,
It is probably like my situation - when you first hear this on the surface it sounds like a good idea. This would make sure that you have enough nurses per patient.

But once you start talking with someone that actually works in this situation - and you start thinking further - it makes sense the other way around.
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maxdancona
 
  1  
Reply Tue 30 Oct, 2018 06:40 pm
Today I got phone banked twice and texted by groups in favor of question #1.

I guess I am on lefty contact lists.... I think they are getting desperate.
0 Replies
 
 

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