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Government Determines Number of Registered Nurses in Hospitals.
Here in ultra-liberal Massachusetts, there is a question number 1 on the
ballot of the upcoming 2018 November election. The voters here in the bluest of blue states get to
vote on the 6-page initiative posed by question 1 which “would place a limit on the number of
patients a single nurse can be assigned at a time and impose a $25,000 fine on hospitals that
violate those ratios.
“The exact ratios would vary depending on the hospital department and the
type of patients for which the nurse is caring. For example, the maximum number of patients a nurse
could be assigned in the pediatric department would be four, while the limit in the emergency
services department would range between one and five, depending on the seriousness of the patients’
conditions.
“As . . . recently reported, {some} nurses unions say the initiative, if
passed, would result in increased safety and better overall outcomes for patients, while the
hospital industry says it could result in longer wait times and even the closing of some
hospitals.” (Ref. 1)
Some Say Vote Yes
“When RNs have too many patients to care for, we see a dramatic and
dangerous impact on safety and patient outcomes. Study after study shows that there is an absolute
need to set a maximum limit on the number of patients that can be assigned to each registered
nurse in order to avoid serious complications, mistakes, and preventable readmissions. Recent
studies have shown that patients in Massachusetts receive less time with their nurses, resulting
in higher rates of complications and readmissions and longer wait times than in California.
“. . . a spokesperson for the Committee to Ensure Safe Patient Care,
stated, ‘Outside of ICU, there are no laws or standards in existence for the number of patients
assigned to nurses, and there are no requirements for hospitals to provide an adequate level of
nursing care in the emergency department, medical-surgical floors, maternity units or psychiatric
units. That’s dangerous, pure and simple.’
“. . . {a} president of the Massachusetts Nurses Association, said,
‘Setting maximum patient limits will put patients before profits — where they belong. Right now,
decisions about patient assignments are made by hospital executives focused solely on reducing
costs and increasing profits.’ . . . ‘Hospital executives are the reason that we need safe patient
limits in the first place. Hospital executives are the ones who have ignored nurses’ concerns,
claiming a lack of resources for safe patient care, while pocketing seven-figure salaries.’
“(Ref. 2)
Some Say Vote No
“. . . For many reasons, the mandated staffing ratios being proposed on the
November ballot are not going to improve healthcare.
“Professional autonomy is a cornerstone of professional nursing practice.
Nurses are the ones in the best position to determine the needs of their patients. Staffing is
complex, dynamic, and multi-faceted. It is important for professional nurses to have the
flexibility to determine how to best meet the needs of their patients under frequently changing
circumstances. This proposed law would take away that autonomy and flexibility that is so crucial
to patient care.
“Research on nurse staffing and quality measures has been conducted for
many years, both before and after California instituted mandatory ratios in January 2014. The
evidence from this research shows that there has been no improvement in patient safety, quality
of care, or patient satisfaction as a result of implementing RN staffing ratios.
“But there have been unintended consequences that mandated ratios
have contributed to which include increased wait time in emergency departments, cuts to
non-nurse staffing, reductions or elimination of services, decreases in the number of available
beds, and even closure of hospitals. These types of consequences seriously impact access to the
health care system, the make-up of the health care team, and the additional responsibilities of
the nurses.
- - -
“Leave the decision making to the nurses who know the work – it is more
than a numbers game!” (Ref. 3)
Here’s What I Say
“The proposal is poorly conceived and ill-advised, and would transfer critical
decision-making out of the hands of healthcare professionals and into inflexible government
formulas.” (Ref. 2) If it makes sense for the government to
determine the number of nurses to be employed in a hospital, why doesn’t it also make sense
for the government to determine the number and type of doctors that the hospital should employ?
After all, it seems to me that doctors are at least as important as nurses in providing the best
health care to the hospital’s patients. And while we’re at it, let’s have the government decide
on the salaries to be paid to doctors and nurses. After all an underpaid employee is likely to be
an unhappy employee and who would want to be cared for by a disgruntled doctor or nurse?
Having taken away the prerogative of deciding on doctor and nurse staffing
levels, the government might just as well take over the function of determining laboratory staffing
levels, as well as staffing and salary levels for other hospital departments. Who would want a
laboratory understaffed or staffed with overworked or underpaid technicians to provide their
critical test results?
It seems to me that the next logical step, after the government has taken
control of all these essential aspects of hospital care, is to do away with now unneeded hospital
administration and to take total control of operating the hospital. Who needs an administrative
staff without any administrative control?
When all this has taken place, we will find that we have marched down the
road to socialized or collectivized medicine. Socialism, collectivization, or whatever name you
want to give to it has proven to be such a disaster everywhere it has been tried that it has been
or is being rejected just about everywhere in the world. But why should the advocates of socialism
pay any attention to historical results? Don’t they, the liberal elite, know better than everyone
else what is good for us, the ignorant masses? According to these advocates of socialism, what is
needed are commissars to run our nation’s hospitals.
It would seem to me that the best way to determine how to run a hospital
is to have the hospitals’ operation and control determined jointly by an independent hospital
administration, the hospital staff, and the patients it serves. Here in the United States, hospital
administrations and staffs are free to negotiate working conditions and compensation. Hospital
staffs and employee unions ensure that workers have safe working conditions, are not overworked
and are fairly compensated. Patients decide on the quality of care and can take their business
elsewhere if they feel that hospital conditions are unsafe, if costs are too high or if quality
of care is inadequate. The hospital administration must balance all of these factors in
determining how the facility is to be run. If they do an inadequate job, the hospital will
fail and cease to remain in operation. Under government control, none of this happens.
Government run operations keep on existing, no matter how poorly run or how inefficient they are.
If you don’t believe me, ask those who have lived (or are currently living) under socialism in the
former Soviet Union, Eastern Europe, Communist China, North Korea, Cuba, Venezuela, etc. which
they would prefer – socialism or a free market.
Government should not be messing up and interfering with the free market
system the exists here in the United States. Government’s role should be restricted to being a
referee, an arbitrator, and an overseer to guarantee and protect the rights of the concerned
parties: management, labor and the consumer. Government involvement should be limited to ensuring
a level playing field for these concerned parties.
It’s fundamental to the American concept of democracy and capitalism that
our government lets the free market system operate in the manner that has proven to be the envy of
the rest of the world. American capitalism has been and still is the success story of modern
civilization. It may have some deficiencies and inequities, but, by far, it been the most
successful economic system that the world has seen. Unfortunately, there are still those who
refuse to see the truth in this fact and are constantly attempting to replace our economic
system with systems that have repeatedly been shown to be failures. It is up to the majority
of Americans to ensure that the discredited socialistic systems of government managed economies
remain in the dustbin of failed utopian dreams, concepts and illusions.
For those who remain convinced that socialism fosters better medical care
than the free market medical system practiced here in America, they are free to travel abroad to
enjoy the benefits of socialized medicine in any of the managed economies of the world – conspicuously,
very few do. Those among you, who believe in the dream of better medicine through socialism, may
want to do your homework and research the satisfaction of those who are forced to accept socialized
medicine for their care and treatment. It may be cheap, but compare the satisfaction and results
with that of the U.S. You may want to look at some examples of the results of socialized health
care as practiced in Canada and Great Britain that are presented in Single Payer Health
Care. (Ref. 4) Included therein is some information about
a government run health care system that operates right here in the United States - the Veterans
Administration or VA. If you like the way the government runs that system, then you’ll love having
the government dictate how our hospitals are to be operated.
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References:
- Here are the 3 ballot questions Massachusetts will vote on this November,
Nik DeCosta-Klipa, boston.com,
9 July 2018.
- Massachusetts Question 1, Nurse-Patient Assignment Limits Initiative (2018),
ballotpedia.org,
Accessed 17 September 2018.
- LETTER: Vote No on Question 1; Leave the Decision Making To the Nurses, Sue Scott,
Framingham Source,
17 September 2018.
- Single Payer Health Care, David Burton, Son of Eliyahu; Article 289,
11 May 2017.
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