Tensions are rising as Election Day nears and Question 1 on the ballot proves to be a contentious issue for Massachusetts voters. Many Northeastern students and faculty oppose the proposal, which would implement mandatory minimum nurse-to-patient ratios in Massachusetts hospitals.  

If passed, Question 1 will go into effect on Jan. 1, 2019 and Northeastern students working in Massachusetts hospitals will enter a changed nursing environment as soon as the spring co-op cycle.

“It’s a real issue. We don’t have enough support for nurses, but this is just not the right way to go about it,” said Claire Gallagher, a second-year nursing major who does not support the measure.

The Massachusetts Nurses Association, or MNA, is a nurses union that proposed the bill in an effort to support nurses and reduce their stress by ensuring a manageable ratio of patients to each nurse. The bill will cost hospitals an estimated $949 million annually to hire enough nurses to meet the ratio, among other changes, according to the Massachusetts Health Policy Commission. The Massachusetts Health and Hospital Association, which advocates for the interests of many Massachusetts hospitals, opposes the bill in part because of its potential cost, arguing that it could force large hospitals to reduce patient beds and could cause smaller hospitals to shut down when they cannot afford to hire more nurses.

Other Northeastern nursing students echoed Gallagher’s sentiment opposing the initiative even though they feel that nurse burnout and stress need to be addressed. Many of them expressed concern that this bill could reduce patient care quality because funds might be diverted away from patient care and toward hiring nurses to meet the mandated ratios.

“The primary reason I am so against this law is for the patients,” Gallagher said.

Judith Pare, the MNA’s director of nursing education and workforce quality and safety, spoke Oct. 23 at a forum about the ballot question held by Northeastern University Law School’s Center for Health Policy and Law. Pare said nurses are concerned that they are stretched between responsibilities and give worse care when they have too many patients.

“Nurses feel often that they are in a compromised position,” Pare said.

Pare, who has worked as a nurse in Massachusetts for decades, said she advocates for mandated ratios because she believes that nurses are more likely to make mistakes and experience burnout if they are assigned too many patients.

Any member of the health care team including nurses can cause medical error, a preventable, adverse event that occurs because of health care received. A 2016 study from the British Medical Journal found that more than 250,000 deaths occur because of medical error each year in the United States.

“It is unacceptable that we are putting profits before patients,” Pare said.

In addition to the MNA, the bill has support from some Boston politicians, including Mayor Martin J. Walsh and Boston City Councilor Ayanna Pressley.

Katherine Onello, a first-year nursing major, worries the bill would force small, community hospitals who cannot afford to hire the necessary additional nurses to close. These community hospitals, like Falmouth Hospital and McLean Hospital, are often the main source of health care for large populations. Northeastern students also complete co-ops at some of these hospitals.

“If the vote is put through, it could close smaller hospitals, so potentially it could limit my co-op choices,” Onello said.

Onello also said that deciding this issue will be difficult for voters, as they will need to put themselves into the shoes of both nurses and patients.

“The pros don’t outweigh the cons and the cons don’t outweigh the pros, so you’re left with this in between,” Onello said.

The proposed law stipulates that “implementation of these limits shall not result in a reduction in the staffing levels of the health care workforce.” Nonetheless, nursing students and faculty worry the funding to hire new nurses will need to come from somewhere, meaning that hospitals units or support staff, like some co-op positions, could potentially be reduced.

Joshua Abrams, an adjunct professor of health law at Northeastern, serves as legal counsel for Partners HealthCare Systems, the largest health insurer in Massachusetts. Partners HealthCare Systems released a warning in September which stated they believe the question would reduce patient care quality and restrict nurses’ freedom. When asked if this measure would affect co-op positions, Abrams said that while it’s possible, it’s difficult to make any certain conclusions about this complicated measure.

“They could be, although those are usually relatively low-cost positions. I think in some ways those might be preserved,” Abrams said. “Since there are a lot of support positions and since there are limits on how much clinical staff can be cut, support staff would have to be cut and ultimately, in certain settings, that could start to impact co-op students as well.”

Abrams said that hospitals are working now to reevaluate their budgets before the potential change.

“There’s no doubt that the money will have to come from somewhere. This is a big cost to hospitals,” Abrams said.

Victoria McNeill, a third-year nursing major, also expressed concern that certified nursing assistant, or CNA, positions typically held by nursing students could be eliminated.

“As CNAs, the things we do are under the nurse job description, so we could be cut,” McNeill said.

Laura Mylott, a Northeastern clinical nursing professor, opposes the bill. Mylott said health care positions that students fill even outside of nursing could be affected because health care professionals work as interdependent teams.

“This will impact all areas of our health care delivery system. Which will eliminate opportunities for students in all types of programs whether it is co-op or clinical positions,” Mylott said.  

If the bill passes, Massachusetts hospitals have until Jan. 1 to hire nurses to meet the mandated ratios. Some Northeastern nursing students worry that after graduation they would be rushed into orientation as nurses under this new system.

“If this were to be put in action, [hospitals] would be required to hire more new nurses and that wouldn’t necessarily give new nurses the time that they deserve on orientation,” said Caroline Miller, a third-year nursing major.

The Northeastern University Student Nursing Association, or NUSNA, is not taking a position on this issue. Instead, they held a forum Oct. 11 to educate their members, during which speakers from both sides discussed their positions. The nursing students then voted on the ballot question. Of the 40 students who voted, 82 percent opposed the bill and 18 percent supported it.

“It’s hard because both sides have very trustworthy and very competent people on their teams,” said Julia Thompson, a fourth-year nursing major and the president of NUSNA.

Massachusetts voters are split on the issue. An Oct. 27 poll from Suffolk University and the Boston Globe revealed that 59 percent of voters oppose Question 1, while 32 percent of voters support it.

The Massachusetts voters will ultimately decide if this bill should be passed on Election Day. To register to vote or request an absentee ballot from your home state, visit  https://www.usa.gov/register-to-vote.

“I hope that this issue is still made aware of and that we can work toward better nursing ratios, but I just don’t think that posing these violations are the right way,” Gallagher said.

Updated on Nov 3. at 11:40 a.m. A previous version of this article incorrectly identified a source. The correct name of the source is Julia Thompson.