To the Editor,

 “Nurses Revolt” in the October issue errs badly in two areas – it paints a one-sided picture of the issue of nurse staffing and recklessly calls on hospitals to “wave the white flag” during contract negotiations. Strikes by caregivers are never the answer, yet the Massachusetts Nurses Association has become increasingly willing to use this excessive tactic against hospitals.  Just as no hospital would ever wave the white flag when helping a patient battle an illness or injury, neither should hospitals allow a union to use the contract negotiation process as a testing ground for its larger campaign to impose rigid nurse staffing mandates through a statewide ballot question in November 2018. Massachusetts patients deserve better than to be a part of this experiment. 

The union leadership’s misguided attempt to impose assembly-line-like quotas takes decision-making away from nurse leaders in each hospital, where it belongs. The proposed ballot measure will hurt patients, hospitals and healthcare workers. There is no evidence that it would positively impact quality of care in our already excellent hospitals. In fact, it will increase costs for patients and wait times in emergency rooms, and cause community hospitals to cut services or close completely.

Your reporter appears to have relied on an outdated and unrelated study from the Journal of the American Medical Association that is featured on the MNA website. That study was published more than 15 years ago, obtained information about hospital staffing from opinion-based nurse surveys instead of objective data, addressed nurse staffing in a surgical environment only and was based on staffing levels larger than those proposed in the MNA ballot initiative. Using this to validate the union’s proposed mandate is a shameless scare tactic. 

This also highlights the complexity of the topic of nurse staffing.  A more recent paper from the International Journal of Nursing Studies (2016) provides an overview of the evidence base for the association between nurse staffing levels, skill mix and patient outcomes. It summarizes that the evidence does not provide clear answers and identifies serious limitations in the study designs utilized.  The authors conclude that while “the evidence supports a causal link between nurse staffing levels and patient outcomes in general hospital wards, the evidence is not sufficient to estimate either the costs or the consequences of making changes in nurse staffing with any degree of confidence.”

Hospitals in Massachusetts remain committed to providing optimal patient care and engaging in contract negotiations that are both respectful and responsible. But our state’s hospitals will not wave the white flag before the MNA’s ill-advised staffing measure. Instead, Massachusetts hospitals and their healthcare providers will do what they’ve always done: Lead in a direction that’s best for patients.