Physician viewpoint: Mandatory nurse staffing ratios will hinder ED care

Massachusetts' ballot initiative to mandate nurse staffing ratios could hinder care quality and patient safety efforts, according to an op-ed written by three emergency medicine physicians and published in SouthCoast Today.

Here are the op-ed's authors:

  • Jennifer Pope, MD, chair of the emergency department at New Bedford, Mass.-based St. Luke's Hospital
  • Brian Tsang, MD, chair of the emergency departments at Fall River, Mass.-based Charlton Memorial Hospital and Wareham, Mass.-based Tobey Hospital
  • Matt Bivens, MD, EMS medical director of New Bedford, Mass.-based Southcoast Health hospitals

The physicians called the state's ballot initiative for mandated nurse-patient ratios "a disaster-in-waiting for Massachusetts, especially for emergency departments," according to the op-ed.

Here are four reasons they oppose the ballot initiative:

1. Existing processes prove effective. The physicians said nursing leadership effectively runs Southcoast Health's emergency departments. "Nursing leadership has the bird's eye view of the entire department, and no one knows better how to allocate staffing resources for the safest and best patient care," they wrote, arguing it is insensible to abandon a process that "already works."

2. The mandate would force hospitals to cut their workforces. The physicians argued the cost of hiring additional nurses would force hospitals to let go of support staff such as technicians, transporters and other ED workers. While the ballot initiative forbids such actions, the physicians said it would be impossible to enforce.

"If nurses will be seeing patients with fewer (or no) support staff, that means nurses will no longer be working at the 'top of their license' medically," the physicians wrote. "They might have fewer patients — but they would also have to take over every aspect of care associated with those patients, including tasks like lifting, transporting, cleaning and toileting, that are now shared with other staff."

3. Nurse-patient ratios would fuel premature discharges. "It's highly likely that patients will be rushed in and out of the hospital more aggressively … to make room for the next patient," the physicians wrote.

4. ED wait times would increase. The physicians called emergency nurses "experts at time management," saying some nurses can safely care for numerous low-acuity patients at once. "Once the government states that every nurse can only see four patients, this well-oiled machine grinds to a halt," the physicians argued.

"We worry [mandated nurse-staffing ratios] will cost jobs of ancillary staff, burden nurses with more low-skilled work, block patients in waiting rooms, rush patients out of the hospitals early and break systems across the state that are already known for high-quality patient safety and care," they concluded.

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