I am an emergency room doctor, and I am concerned that Measure 1 will be harmful for patients.
First of all, I am deeply indebted to emergency nurses. I depend on them, and we function together as a team. I want them to be happy in their jobs and not feel overwhelmed. I think the intent of this measure is sensible.
But this is a bad bill. It puts patient care at risk. Emergency rooms have been getting steadily busier for years, and as the baby boomer generation continues to grow older, this will only increase. There are times when ERs are overrun, and we have long waits for patients to be seen, which we know already can lead to worse outcomes, as time-sensitive conditions get more advanced and some patients who are genuinely ill choose to go home rather than wait for hours to be treated.
The last thing we need is to impose more limitations on caring for patients at these times. And that is exactly what this bill does. It will generate multiple bottlenecks in moving patients both into and out of the ER; patients admitted to the hospital will need to wait longer to go up to beds until the staffing ratios allow it, and patients in the waiting room will have to wait longer to come back to exam rooms, even if those rooms are open and clean.
This measure puts nurses in a position where they have to literally choose between caring for a patient who is critically ill and subjecting their employer to a potential fine of $25,000, every day that they show up to work. I don’t think this is fair to nurses, who have chosen their profession to help patients. Nor is it fair to patients, who need emergency care when they need it, and not when the numbers allow it.
Nursing staffing is not so easy to fix that passing this measure will solve it. There has been a nursing shortage in the U.S. for years, and a recent report by the Mercer Foundation projects serious gaps in the supply of qualified healthcare workers by 2025, both in Massachusetts and nationwide. My emergency department has had openings for night-shift nursing positions since I started there two years ago. Some get filled and then others will leave or move to the day or afternoon shifts. It is not easy to fill these positions and keep them filled, and our nursing administration has been trying. If Measure 1 passes and the hospital needs to immediately higher twice as many nurses, where are they going to come from? Are they going to be qualified, competent nurses who want to be there?
And when is this going to happen? The speed of implementation of this bill is another major issue. The measure would take effect less than two months after being voted on. California had at least 14 months between the approval of their bill and the rollout. I think such a fast turnaround would create a lot of difficulty with hiring and training to get hospitals ready by January. I don’t think this is nearly enough time for such significant changes, and this is another threat to patient safety in my eyes.
I am not an administrator. I have nothing personally or financially at stake in this, and I was not asked by anyone in my hospital to write this. But as someone who will see the effects of this up close, I am extremely concerned about what this measure will do to impact patients, and I feel it will make our jobs in the ER harder than they already are.
Please educate yourselves, talk about this to people who work in health care, and vote in November.
Benjamin Steinberg, MD
Northampton