“Nurses unions are split on the initiative. The Massachusetts Nurses Association has endorsed it. The larger American Nurses Association opposes it.”
This line in a recent news story about Senator Warren’s support of nurse staffing ratios and Question One caught my eye. To me, this was an incredibly counter-intuitive claim. Are nurse’s unions really “split” on Question One? Is the American Nurses Association “larger” than the Mass Nurses Association? Is it even a union? The reporter who wrote the story clearly came to share my confusion and, after a conversation with me about it, corrected the record in his online piece to the following:
“Nurses disagree on the initiative. The Massachusetts Nurses Association has endorsed it. The American Nurses Association of Massachusetts opposes it.”
The corrected formulation is certainly accurate, but it doesn’t help clear up at least two implicit mischaracterizations. First, unlike the Massachusetts Nurses Association (MNA), neither the American Nurses Association (ANA) nor its Massachusetts chapter (i.e. the nurse’s organization that opposes Question One) are unions. They do not represent members in collective bargaining. Also, the ANA-Massachusetts (ANA-M) is not larger than the Massachusetts Nurses Association. It appears to have 1000-2000 members, while the MNA has more than 20,000 dues paying members. Of the nurses that would be impacted directly by Question One, more than 70% are represented by labor unions that have endorsed Question One. So the above claim, despite correction, still leaves readers to assume that the two organizations both represent the nurses impacted by Question One and that the “American” organization is larger than the “Massachusetts” organization.
Am I splitting hairs? Maybe, but given the fact that opponents of Question One are portraying themselves as representing the interests and opinions of laborers in what looks to me like a pretty conventional labor – management disagreement, I think some clarity on the exact role, function, and membership of the American Nurses Association of Massachusetts, which bills itself as “the voice” of Massachusetts nurses, is called for. I think such clarity would go a long way toward understanding just how “split” the state’s nurses are on Question One. Voters deserve to know which nurses are for it and which are against it, and why. It also seems to me that an important detail about the two nurse’s associations making headlines on both sides of this issue is not getting enough press attention, namely that the MNA, the state’s largest nurse’s union, separated itself years ago from the American Nurses Association (which was and is NOT a union) because of the ANA’s perceived anti-labor and pro-management posture.
When you cut through the opponents’ efforts to muddy the water, the “split” among the state’s nurses on this issue looks pretty unsurprising. Unionized bedside nurses appear to be solidly supportive of Question One. Others, such as nurse-managers and nurse educators, and non-unionized bedside nurses may very well be split on the issue, but to date no one has adequately probed that divide. In other words, the nurses most impacted by Question One who are protected by their unions from management coercion are, just as one would expect, supportive of a law that would prevent their employers from assigning them too many patients at one time, while some unclear number or proportion of non-unionized and/or non-bedside nurses are not supportive of Question One.
This simple, logical assessment of the interests and identities of the two sides on Question One is bolstered by simply “following the money!” Only a tiny fraction of the money behind the “No on One” campaign comes from working nurses. The lion’s share comes from the Massachusetts Hospital Association, individual hospitals, and other pro-management groups. The organization claiming to be the voice of the state’s nurses, the ANA-Massachusetts has put up less than 500 bucks of the $10 million plus raised by opponents. By contrast, the State’s leading nurse’s union, the MNA, has provided more than $2 million of the $5 million plus raised by the “Yes on One” committee.
The substantive merits of nurse staffing ratios are well above my pay grade, but the ways and means of ballot initiative campaigns are right up my alley. The opponents of Question One (understandably) do not think average voters would agree with them on the substance of the matter and (also understandably) expect average Massachusetts voters would side with with nurses if proponents of Question One succeed in framing the issue as a David versus Goliath battle between overworked bedside nurses and profit hungry hospitals and well-financed trade associations. Therefore, the tactic of confusing voters into thinking that the nurses who know best and who have the power to make their voices heard are opposed or are at least “split” on Question One is a “no brainer” for the hired guns working for the Mass Hospital Association’s cause this fall. Will it work? Hard to say. Should it work? Hell no!
Creating substantive confusion for political gain is not noble, though it’s also not easy to resist when complex policy issues are put to a public vote, but intentionally trying to distort voters’ understanding of who is for and who is against a proposed ballot measure, crosses an important line in my book.
I am a nurse in an ER and many Bedside nurses union or not are opposed. I find your statement misleading. Talk to all nurses.
Janice, of the 70,000 plus nurses in MA just how many is “many” in your view? I can assure you that the folks running the “No” campaign will put every unionized nurse who agrees with them on TV. My analysis is perfectly consistent with both common sense and available evidence. Obviously, “speaking to all nurses” is both impossible and unnecessary. The only survey of nurses so far puts support among them at 86%.
I’m an ED nurse in a level 1 trauma center that accepts the sickest of the sick from multiple out lying facilities. We also are a stroke and Stemi ( cardiac center) offering life saving cardiovascular care to those having heart attacks and those having strokes . These critically ill patients require and deserve appropriate care. As ED nurses in this facility we have no limits on the amount of patients we are responsible for. We remain habitually understaffed inhibiting our ability to provide safe , effect life saving care !! I will be voting yes on question 1 , yes on improving care !! We are a unique breed of nurse that work as a team to get the care done !! Unfortunately we remain short staffed , I fill out unsafe staffing forms daily to protect my patients and my license !!! Yes on 1 would require hospital administrators to supply more nurses for better care !!! I love emergency nursing, I hate that I cannot provide the care I want !!!
After years of working as an ICU RN, I worked for an agency that staffed local 70 bed ER. That experience made me appreciate the ICU because an ICU does not admit patients to the hallway. In an ICU, if there is no bed available, a patient is not admitted to the ICU. To quote one ER nurse I worked with, she stated “We are the backed up toilet of the hospital!” The ER is also one of the most dangerous places to work in the hospital! Illegal drug usage, gang violence, and microbes that have yet to be diagnosed. Safe patient limits is a must for the patients survival and the healthcare providers!
Exactly. It is this simple. Corporate have taken over hospitals. Less nurses more patients. Bigger profit.
Yes on 1 will force hospitals to staff properly. Which in turn, patients better attention.
86%=260 RN’s. That’s right – MNA has on record that less than 1% (0.2% to be exact) of the RN’s in Massachusetts are voting Yes on question 1, yet their television ads say that 86% of nurses are voting Yes. MNA only surveyed 302 nurses out of >130,000 RN’s – and half of those surveyed were their own members! Any nurse who uses evidence-based practice knows that this is bad practice and wouldn’t make a decision to treat a patient based on this kind of evidence – why would you make a decision affecting your nursing practice based on this survey?
Please take the time to critically think and read the data and information. Strict mandated ratios as set forth in ballot question 1 are wrong for Massachusetts!
The Mass Health Commission, which the MNA chose and wrote into the ballot initiative as the organization to implement and enforce mandated ratios, released their findings today:
1. There was NO IMPROVEMENT IN PATIENT OUTCOMES post-implementation of ratios in California
2. As of 2016, Massachusetts had higher hospital RN staffing levels (FTEs per 1,000 inpatient days) than California and the U.S.
3. Massachusetts hospitals performed better than California hospitals on 5 of 6 nursing-sensitive quality measures reviewed
4. The HPC’s analysis of mandated nurse staffing ratios estimates $676 to $949 million in annual increased costs once fully implemented
5. Costs could also lead to higher commercial prices for hospital care, potentially leading to higher insurance premiums
5. Mandated ratios would impact Emergency Departments… significant impacts on: Access to emergency care – Wait times – Patient flow – Boarding – Ambulance diversion.
Vote NO and use evidence based practice!
I will confine my critique to your effort to make the survey in question appear defective and your choice to disguise your identity. Your criticism of the survey is sloppy and betrays ignorance (possibly willful) of survey research methodology. Your anonymity can and should limit readers’ confidence in your credibility.
While I do not find your substantive arguments on the merits of NSRs particularly persuasive, debating the substantive merits of NSR is beyond the scope of my analysis.
Critique away! Would you care to discuss selection bias – when the sample chosen is not representative? As a political science professor, you know that using surveys have selection bias result in misrepresentation of the facts – kind of when the Literary Digest predicted Landon beat FDR or when the Chicago Tribune predicted Dewey beats Truman. The MNA sample was clearly NOT representative of the RN population in Massachusetts, being heavily weighted with it’s own membership at best. To claim that “86% of nurses in MA are voting Yes” based on flawed methodology with selection bias is not only misleading, it’s blatantly lying to the public and should make everyone stop and think about why the MNA has to lie.
By the way, your figures are also incorrect; there are 130,000 RN’s in Massachusetts according to the Massachusetts Board of Nursing (who actually licenses the RN’s).
And yes, I chose to use a pseudonym because as a MNA member I have been subject to retaliation and bullying on a very personal level when I expressed an opinion not consistent with the union’s position.
“RN=RealNurseforNo!” wrote the followng after a sloppy effort to throw shade on the survey showing 86% of MA nurses support Q1:
“I chose to use a pseudonym because as a MNA member I have been subject to retaliation and bullying on a very personal level when I expressed an opinion not consistent with the union’s position.” Of the MNA and the survey she writes that the union is “blatantly lying to the public and should make everyone stop and think about why the MNA has to lie.”
Unfortunately for “RN=RealNurseforNo!” she is not as anonymous as she thought. Her stated reason for not using her real name is NOT TRUE. She is NOT, in fact, an MNA member as she claimed, nor is she a member of any nurse’s union. She is an RN, at least, but she is not a bedside nurse.
No, the commenter who calls herself “RN=RealNurseforNo!” is actually a longtime, active member of … wait for it… the American Nurse’s Association-Masachusetts! I’m shocked!
So it’s seems pretty clear that its the American Nurse’s Association-MA that is “blatantly lying to the public.” I think this “should make everyone stop and think about why the [American Nurse’s Association-MA] has to lie.”
I am voting yes because only “those in the trenches” understand the pressure and the fear of making a mistake because you are so overloaded with patients.
I’m voting yes also, but I don’t necessarily agree with your statement that only those in the trenches understand. I’m not in the trenches, I am simply a patient, but I totally understand that the more time you have to spend with me, the better my care is. Limiting the amount of patients you can care for seems like basic common sense, and I’m a bit confused as to why it even needs to be a ballot question. Yes, patients need to be limited so that “ those in the trenches” can care for us the best way they know how. I am. Hoping you get the much needed “common sense “ solution, and that you continue to help those that need it.
Yes dear, if you are a patient you too are in the trenches . Hope you get the care you need. Profits before patients make very good sense to some.
First thing to keep in mind is not all hospitals are unionized and when I mean not “all” I am not referring to small out of the way facilities in the Berkshires or Cape Cod. For example Mass General is famously a non union facility for nurses while sister hospital Brigham and Women’s is represented by the MNA.
Additionally I believe that the ANA just like the American Medical Association has a long standing bylaw against supporting collective bargaining.
Cape Cod and Falmouth hospitals are MNA unionized
I give you a counterpoint.
http://www.massmed.org/Q1MA2018/
Interesting. Thanks.
I am a former nurse and later a hospice chaplain. My sister who works at a Boston Hospital who is a YES on One! advocate after seeing her and her co-worker RNs mismanaged and subject to a hospital which cares nothing for the nurse’s welfare.
I ask you to watch this interview program with Joan Ballantyne, RN who advocates for a YES vote. She’s a bedside nurse of 27230…. years and addresses these issues and more. It’s 28 minutes and I am the host.
http://aacs15.com/WeHaveTalk1118
The ANA is essentially made up of Managers, Administrators, and Executives. These are the people who are responsible for budgets and don’t want to pay to keep you, your friends and family safe in the hospital. If these folks keep costs down they are rewarded financially.
The MNA is made of bedside Nurses who care for you, your family, and friends. We do this because this is what Nurses do without any kind of compensation (excluding normal pay wages).
With safe patient limits Nurses can then provide the appropriate amount of time with his/ her patient, fewer errors, fewer infections which means patients won’t represent to the hospital for additional care.
VOTE YES ON QUESTION ONE
In the Question specifically – I found the proposed staffing ratio for maternity care troubling & excessive. The other proposed ratios seemed they could make sense. But the proposed staffing level for women and babies was unreasonable – continues to layer on the treatment of labor as a medical problem. Treating women giving birth like an illness is a huge moneymaker & horrible for women’s health.
I am a bedside nurse voting Yes on 1 & I agree that some of the limits may seem excessive but you need to consider that your experience with one speciality may not be representative of the experience of other nurses statewide. I work two jobs, one med-surg and one psych, and I am able provide care to 9 psych patients in 25% of the time that it takes me to care for 4 med-surg patients. Being capped at 5 patients for psych seems insane to me (no pun intended) but I work at a cushy hospital where we have a lot of ancillary help and I’ve never felt unsafe. A nurse working at Mass Mental or BMC may not be able to handle more than 5 psych patients without putting themselves at serious risk, so I have tried to put myself in others shoes.
On the maternity side, having more than one patient assigned to you as an L&D nurse is crazy. Are you going to care for two patients giving birth at the same time and tell them to hold their contractions so you can run room from room? America has one of the worst infant & maternal mortality rates in the developed world, and we should be taking every step we can to make this better. Pregnancy is a serious medical condition, and we are at risk for horrible complications when we give birth, as I have seen in med-surg caring for young women with terrible long term cardiac issues simply from pregnancy alone.
I agree this this nurse. All patients do not need the same intensity of 1:1 care. Maternity patients and ICU patients need that level of immediate response, while patients in psychiatric settings need close monitoring, but they need mental health services which the proposed legislation does not address. I taught student nurses. They claim that 1 instructor should be able to cover 8 student nurses. That means that 1 instructor is in effect covering 8 students and 16 patients! Med-Surg is a nightmare! I wish this legislation could be taken off the ballot until it’s fully vetted with the political and financial ties fully identified.
Could you please provide a reference for the following statement: “Of the nurses that would be impacted directly by Question One, more than 70% are represented by labor unions that have endorsed Question One.” Thanks!
Liana, fair question! That information came from the Mass Nurse’s Association, which represents the bedside nurses at 47 of the state’s 67 acute care hospitals.
Thank you for the informative piece. It would be great if you could add citations, though!
because I am not a nurse nor in medical field for any reason, I chose to default to someone I trust completely, my daughters off who is an RN. she explained how she initially wanted to vote yes, but it was simply not practical. It will not cause the hosp to all of a sudden increase their staff. Once that nurse reached the allotted number of patients, thats it. they can’t take any more. people will be turned away, emt’s will have to hang with ambulance patients until nurse is avail. thus considering what question 1 is trying to accomplish she feels as I do it is setup to backfire. Thus voting no on question 1 is what the only nurse I know prefers.
Ellen I have heard this argument against Question 1 too, and these are my thoughts on it. Thinking it through, I believe this dire prediction is not at all likely to come true.
For starters, even if ALL hospital admins ONLY care about profit, their revenue comes from patients! Turning away patients would be like closing your store because there were too many people wanting to shop. From a profit perspective it makes no sense.
And I have to assume (hope?) that there are some hospital admins who actually care about doing good in their community. They certainly would want to treat every patient who comes through the door, which means hiring more nurses. There’s plenty of money to do so, as we have seen by all the millions they’re throwing at the Vote No campaign. And there are plenty of nurses graduating every year in Mass. who right now have to look for work in other states.
So this bill would create jobs in Mass. AND give nurses the power they need to advocate for safe and effective working conditions, which directly translates to better care for patients.