Ballot Question 1 - Vote No

2018 Nurse Staffing Ballot Initiative Would Crush Community Hospitals

A one-size-fits-all government staffing mandate  would be devastating for Massachusetts hospitals.  

A union representing less than 25% of nurses in Massachusetts has filed a ballot initiative to mandate nurse staffing ratios in all Massachusetts hospitals. The initiative is scheduled for a vote on November 6, 2018, and would impose government-mandated nurse staffing ratios in every hospital across the state.  The law would also impose strict financial penalties on hospitals if they do not meet the mandated staffing ratio 24/7, across all three shifts. 

Anna Jaques Hospital will have to make difficult choices if Question 1 passes.  While we fully support the need for appropriate staffing levels -- which we have at Anna Jaques -- the tenets of this bill would make it fundamentally impossible to continue to run the hospital with the flexibility and control we believe should be in the hands of our nurses.  This bill would lead to unintended consequences, including:  

  • Takes away the real-time decision making power of nurses and puts it in the hands of the government. 
  • Decreases access to care, including cuts to community programs and services
  • Leads to longer wait times for medical care, particularly in the Emergency Department
  • Creates major nursing shortages
  • Causes severe financial impact to all hospitals

Massachusetts is home to some of the highest-ranking hospitals in the world, and consistently tops national rankings for health and quality of care.  An independent body, the Massachusetts Health Policy Commission, stated in their analysis of Question 1 in a report dated October 3, 2018, "There was no systematic improvement in patient outcomes post-implementation of ratios [in California]."  There are no scientific studies or reports that credibly show that this mandate will improve the quality of care for patients in Massachusetts. There are also no studies that support or recommend specific, at-all-times ratios for nurses.

As a non-profit, charitable organization, we are committed to advocating for public policy positions when our patient care or mission may be impacted. Given the importance of this issue to our institution, AJH has joined the Coalition to Protect Patient Safety to oppose the ballot measure. You likely will see the Coalition’s ads on TV encouraging people to vote “No” on Question 1. This ballot measure is not the answer to nurse staffing issues.

 Learn the facts below. Find out more by reading the petition on, and by visiting

This is how the government mandate would affect Anna Jaques, nurses, patients, and our community:

Real-time decision making power of nurses would be put it in the hands of a rigid government mandate.  

  • Currently, Anna Jaques nurses assess and determine patient acuity and care requirements, autonomously readjusting patient care assignments to reflect appropriate care. This would change. 

Massachusetts hospitals, including AJH, would not be able to meet the impossible requirement of hiring 3,000-5,000 additional nurses to meet the mandate.  

  • We, and the health care industry as a whole, are challenged to find experienced nurses during a nation-wide nursing shortage.  
  • New hospital nursing positions would most likely be filled by nurses from nursing homes, rehabilitation centers, community health centers and other providers, creating critical nurse shortages in these facilities.

Hospitals like AJH that are not able to hire the required nurses would likely reduce programs and services, and care for fewer patients overall. 

  • AJH will likely be forced to reduce capacity and close units, and other roles on the patient care team would be impacted. 
  • Without the flexibility to assign staff to where they are needed most, elective surgeries could be cancelled, and Emergency Department wait times would increase.

Current nursing roles at AJH would be reconfigured, and many more employees may be affected.

  • Nurses would be re-assigned from other roles to direct patient care.
  • Rapid response/Code teams would no longer be able to leave their assigned areas to help patients in immediate need.  
  • We may have no choice but to cut vital support staff, forcing nurses to take on non-nursing tasks and disrupting the entire team approach to care. 
  • Twelve-hour shifts would need to be re-evaluated, and nurses may be required to work mandatory overtime to keep patients safe. 

Wait times in Emergency Departments across the state would increase dramatically (as it did in California) because the law will limit the number of patients nurses can treat at all times. 

  • The Emergency Nurses Association – Massachusetts Council (ENA) and the Massachusetts College of Emergency Physicians (MACEP) found that mandated nurse staffing ratios will prolong wait times in emergency rooms causing delayed care for patients in need.  Watch this video for more information.  

Anna Jaques would be forced to spend approximately $3.8 million a year to staff to the mandated level.  

  • And we would risk being fined $25,000 per-violation, per-day, crippling our community hospital. 

In total, the ballot measure would cost the state up to $950 million each year, as projected by the Massachusetts Health Policy Commission. 

There is a reason only one state after all these years has adopted government-imposed ratios in the United States: It doesn’t work. 

  • After 15 years of mandated nurse staffing ratios in California, our state still performs substantially better on nearly all quality and safety measures.

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