10.15.2018

ED Doctors and Nurses and EMTs Slam Question 1

Emergency Department (ED) wait times will go up and care will be compromised if Question 1 passes – that’s the collective conclusion of ED doctors and nurses, as well as the EMTs who treat and transport patients.

Last Thursday, the emergency caregivers came together at Pro EMS, which provides emergency medical services and advanced life support to Cambridge and eight surrounding communities.

“In California, the only state in the nation that has imposed nurse staffing ratios, there’s a term – it’s known as holding the wall,” said Lisa Nasuti, the paramedic field supervisor for South Shore Health System. “This is when emergency medical personnel sit with their patients in a hall, in an ambulance, in a parking lot until a nurse is free to care for them. That is what we will face if Question 1 passes – EMTs waiting long periods with patients on stretchers. And just think of the trickle-down effect; that ambulance can’t turn around and go back to the community it serves as a 911 provider, or transfer critical patients to Boston or other areas.”

Question 1 mandates four different ratios for a hospital ED, depending on the acuity of the patient. That means that the ratio – and the number of nurses required to fill it – can change minute by minute.

Nicole Arnold, R.N., a bedside nurse and a member of the Emergency Nurses Association – Massachusetts Chapter, detailed how an ED nurse faces an ever-changing population seeking urgent care.

“All flexibility and decision-making will no longer be ours as nurses,” she said. “Who will care for that cancer patient if me and my team are already at our legally binding ratio? Who will care for that stroke patient? The sexual assault victim, the tragic car accident, the overdose, or suicide attempt? These are the realities we face; all things in the ER are unknown. These are your family members and mine and they do not fit into a rigid, cookie cutter plan. They fit into a demographic that requires my professional decision-making as the need arises.”

The reccurring theme from the ED personnel was that if there is one area of a hospital that requires caregivers to be nimble, it’s the ED.

Scott Weiner, M.D., president of the Massachusetts College of Emergency Physicians, said, “My biggest fear is for disaster situations. We need the flexibility to take as many patients as we can possible care for the next time a gas line explodes or a bus crashes or we are again victims of terrorism – or it is simply an unplanned, crazy-busy day. If you are a patient in any of these situations, how would you like to hear that your hospital emergency department stands ready with doctors, technicians, labs and x-rays all ready to care for you, but we can’t let you through the door because the nurses have met their arbitrary ratio – even when the nurses’ own expert clinical judgement says that they too have the bandwidth to safely care for you?”

The state’s Health Policy Commission recently released a study showing that Question 1 will cost up to $950 million annually. But in reaching that figure, the HPC did not factor in the additional costs to hospital EDs. At the cost trend hearings this week, the HPC is expected to have the ED cost number available and that additional cost should push the annual cost of government-mandated ratios contained in Question 1 past $1 billion, which Dr. Weiner noted last Thursday would most likely result in community hospital closures.

Ali Raja, M.D., the executive vice chair of Massachusetts General Hospital’s department of emergency medicine, cautioned that Question 1 will harm access and lead to increased boarding.

“When we’re full [at MGH’s ED], our nurses – who are professionals in every sense of the word, and have the judgment to care for our patients exceptionally well – will be limited in the real-time decisions they can make on the fly to move patients around and equalize the work load. This proposition will take that ability away from them.”

The ballot question is opposed by the American Nurses Association - Massachusetts, Emergency Nurses Association - Massachusetts Chapter, Organization of Nurse Leaders, Infusion Nurses Society, Massachusetts Association of Colleges of Nursing, Academy of Medical-Surgical Nurses’ Greater Boston Chapter, the Western Massachusetts Nursing Collaborative, the Massachusetts College of Emergency Physicians, the Massachusetts Medical Society, the Massachusetts Health and Hospital Association, the Massachusetts Council of Community Hospitals, the Conference of Boston Teaching Hospitals, and other healthcare and business leaders across the state.  You can watch the entire press conference here.