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Today, you are only admitted to a hospital if your medical condition is severe enough that you require around-the-clock monitoring and care from a registered nurse. However, hospital executives assign nurses too many patients to safely care for all at once, a dangerous practice that leads to more patient infections, bedsores, medication errors, and worse.

Nurses put Question 1 on the ballot to protect patients. The truth about Question 1 is that it ensures when your loved one hits the call button, there will be a nurse ready to respond when they are most critically needed.

Don’t be fooled by the millions of dollars spent on deceptive advertisements from the hospital industry making false claims and stoking fear among the public. Massachusetts’ hospitals can afford to invest in better patient care. This is a $28 billion industry, almost exclusively comprising large, top-heavy corporate health care networks. Hospital executives make choices about what to do with their vast resources, and they should be choosing to make this investment in patient care.

Currently, there is no limit on the number of patients that hospital executives can assign to a nurse at one time, except in intensive care units. Question 1 would set maximum patient limits for nurses that varies based on the type of unit and severity of patient needs. It would mean better care for hospital patients.


Today, decisions about patient assignments are made by a hospital executive whose focus is on the bottom line and increasing profits. Question 1 will put patients ahead of profits — where they belong.

Dozens of independent scientific studies, including those published in the New England Journal of Medicine and the Journal of the American Medical Association, have consistently found that the quality of care decreases dramatically when nurses are forced to care for too many patients at once. Massachusetts has ample numbers of nurses ready to fill additional staffing needs should Question 1 pass. We are one of only two states without a nursing shortage and have a projected surplus of registered nurses through 2030.


More than 14 years ago, California established maximum limits on the number of patients assigned to a nurse at one time, and the results have been universally positive. Studies show that patients in Massachusetts receive less time with their nurses, resulting in higher rates of complications and average emergency department wait times that are 11 minutes longer in Massachusetts than in California. Spending on health care in California is significantly lower, they have lower insurance premiums than here in Massachusetts, and no hospital or service has closed as a result of the law.

When hospital managers assign too many patients to a nurse and the nurse objects, the standard response from hospital executives is “deal with it.” These managers aren’t the ones who have to face the patient or their family when something goes wrong — it’s the nurse who is legally and ethically accountable for the safety of your care.

In 2001, the Globe’s editorial page wrote that if the hospital industry did not correct understaffing in Massachusetts hospitals, then regulations would be needed. It’s 2018, and hospital executives still haven’t fixed the problem. The time has come for the citizens of Massachusetts to make sure every patient has access to safe nursing care. Vote yes on Question 1.


Donna Kelly-Williams, a registered nurse at Cambridge Health Alliance, is cochair of the Committee to Ensure Safe Patient Care. Judith Shindul-Rothschild is a registered nurse and associate professor at Boston College’s William F. Connell School of Nursing.