By Roy Lincoln Karp
Special to the Reporter

Laws, it has been said, are like sausages. The more we know about how they are made, the less we respect them. As a voter, the ballot initiative process sometimes feels like watching sausages being made while trying to eat one.

On Nov. 6, Massachusetts voters will walk into their polling stations and decide whether there should be a statutory limit on how many patients a nurse can care for at one time. Until then, we will continue to be inundated with lawn signs, flyers, and commercials from the opposing camps, both of which claim to speak for nurses and to support patient safety.

It looks like it’s going to come down to the wire. A recent WBUR poll found voters evenly split with 44 percent in favor, 44 percent opposed, and 12 percent undecided.

Under the proposal, most hospital nurses would be limited to four patients at a time. Operating Room nurses could have no more than one patient under anesthesia and no more than two post-anesthesia. Emergency department limits would range from one to five patients, depending on patient acuity, while nurses providing step-down care would be limited to three patients.

The initiative was put on the ballot by the Massachusetts Nurses Association, which has been fighting for such a law for two decades. They have resorted to the ballot petition process because the legislature has proven politically incapable of addressing the issue (aside from a 2014 law that limited nurses in Intensive Care units to two patients).

Leading the charge against the measure is the Massachusetts Health & Hospital Association, although this powerful organization is not even mentioned on a “Vote No on 1” flyer I picked up recently. That little sleight of hand is, for me, where problems with the “no” campaign begin.

The “Coalition to Protect Patient Safety,” as their campaign is called, is using several poorly supported claims to scare voters. If you believe their rhetoric, there aren’t nearly enough nurses to meet with statute’s requirements, the law will “dramatically increase hospital wait times,” and it will cost hospitals over $1 billion annually to implement.

Each of these claims is rebutted by the MNA, a union representing 25,000 nurses in Massachusetts. They argue there is no shortage of nurses in the state, which graduates 3,500 new nurses every year and has one of the highest number of nurses per capita in the U.S. They also assert that wait times would decrease if hospitals had to hire more nurses and that much of the bill’s costs would be offset by gains in patient safety or absorbed by an industry that generates over $28 billion in revenue annually.

As the parent of a medically complex child who is a frequent flyer at Children’s Hospital, I know first hand the importance of good nurse-patient ratios. My daughter has been in the NICU, PICU, ICU, OR, Intermediate Care Program, and pulmonary service and has been in the care of dozens of caring and dedicated nurses.

During the last two weeks, I have spoken to many of these nurses about Question 1. One of my daughter’s NICU nurses is voting against it primarily because she feels it is too restrictive for hospitals. The others all strongly supported the proposal.

A nurse who provides intermediate level care at Newton-Wellesley Hospital describes being “stretched way too thin” during a typical 12-hour shift with five patients. Documentation alone takes her 6-8 hours, often leaving her lass than one hour per patient for physical care. At night, the limit goes up to seven patients per nurse based on the faulty premise that patients are less sick at night.

On Monday night, I listened to presentations from nurses representing both campaigns at a meeting of the Columbia-Savin Hill Civic Association. Afterwards, I spoke with a 34-year veteran of Brigham and Women’s who asked, “If we can set staffing limits for nursery care providers, shouldn’t we be able to set limits for nurses caring for people sick enough to be hospitalized?” I believe the answer to that question is yes.