In November 2018 Massachusetts residents were asked to vote on Question 1, a ballot initiative to enact strict nurse to patient staffing ratios in every hospital across the state. We had a significant conflict on our hands, while all of us agree that having more nurses equates to better patient care, those of us opposed to implementing a rigid law could see that if Question 1 passed there would be unintended consequences that could lead to terrible patient outcomes. Within the ballot initiative in Massachusetts, nurses were considered an interest group, but there were two subgroups, for and against. Both sides of the question believed that they were advocating for nurses, the nursing profession, and better care for patients. (Huston, 2020) However, we were severely divided, and a social media battle ensued.
I had never been involved in health policy or politics before and it took some time for me to feel comfortable with getting involved. I spent a significant amount of time reading the ballot question, researching the California ratio law (they are the only state to have a mandated nurse to patient ratio law) and developing my stance. Despite the large body of evidence that supports minimum nurse-to-patient ratios, the reality of nursing care is that two patients admitted to similar units will often differ significantly in terms of acuity levels. (Livanos, 2018) I felt a need to get involved to try to educate the public about the facts that many nurses readily understood, no two patients, nurses, nursing units or hospitals are the same, we should not implement regulations that effectively states that they are.
I utilized both social media and traditional media to bring awareness to the risks imbedded in the proposed law. I posted on Facebook and Instagram to share my concerns with the public and to help facilitate a dialogue with the folks who would be voting on this initiative. I used my voice within the social media platforms to share the nuances within the question 1 language that could lead to devastating results and put patients and hospitals at risk. Additionally, I took the time to write a letter to my State Representative and Senator to voice my concerns that we were asking the public to cast a vote on an intricate topic that the lay person may not truly understand. I also wrote an editorial that was published in my local and district newspapers that clarified my concerns and urged the readers to do their research and understand that although the bill seemed to be a no-brainer at first look, the rigidity and consequences of non-compliance would be devastating to some hospitals.
In the end, Question 1 was not passed and hospitals were left to deal with their staffing plans independently, without government regulation. Although this was an emotionally charged topic that created differing opinions between colleagues who worked side-by-side in the same units, it was an opportunity to open up the dialogue about how we could do better together. It also allowed nurses to learn more about health policy and to use their voices in the political arena to advocate for nursing. This was a great opportunity and I learned so much from being involved. Going forward I will look for more ways to increase the nursing voice to improve the care of patients.
Huston, C. J. (2020). Professional Issues in Nursing. Philadelphia: Wolters Kluwer.
Livanos, N. (2018). A broadening coalition: Patient safety enters the nurse-to-patient ratio debate. Journal of Nursing Regulation, 68-70.