ED Physicians & Nurses Describe Harm from Ratio Law

The Massachusetts College of Emergency Physicians and Emergency Nurses Association-Massachusetts State Council released a report last week showing that passage of Question 1 – the ballot question that would impose at-all-times nurse staffing ratios in all units of every hospital – would increase wait times in emergency departments (EDs) and exacerbate the current crisis of ED boarding.

The ratio scheme in the ballot question is particularly onerous for hospital EDs, as the proposed law would require four different, ever-changing ED nurse-to-patient ratios, depending on the status of the patient being treated.

“Patients’ conditions in an ED can change very quickly, with little warning,” the ED physicians and nurses wrote. “In order to maintain compliance with the mandated RN ratios, hospitals would need to constantly assess staffing assignments and reassign available RNs based purely on unproven, arbitrary mandates, regardless of whether there are other members of the ED team … who are capable and available to help.”

According to the study, “Instead of providing care based on clinical judgment, patients’ medical needs, and the skills, experience, and availability of the entire care team, hospitals would be forced to constantly scramble RN patient assignments to try to prevent the RNs from exceeding the mandated ratios. To ensure that hospitals have the resources to hire more RNs, many of the ED team positions would have to be eliminated, which would result in RNs performing medical services below their expertise that will further delay evaluation and treatment for other ED patients.”

Only one other state – California – has imposed government-mandated ratios on its health system, and the evidence from there shows that ratios have been detrimental to hospital EDs. California studies show that ED wait times increased following the implementation of mandated ratios, despite fewer people seeking care.

The read the entire report, including citations to the studies showing the harm to the California healthcare system, please click here.