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Wednesday, May 1, 2019 is MACEP's Annual Meeting to be held at the Massachusetts Medical Society Conference Center, Waltham, MA

Action Alert



Research finds mandated nurse staffing ratios will dramatically disrupt emergency departments across the state, worsening the ED boarding crisis and decreasing quality of care

Boston, MA – September 10, 2018 – A white paper released today by the Emergency Nurses Association – Massachusetts Council (ENA) and the Massachusetts College of Emergency Physicians (MACEP) found that mandated nurse staffing ratios, the subject of Question 1 on the Massachusetts ballot this November, will prolong wait times in emergency departments causing delayed care for patients in need. With Massachusetts already suffering from an opioid crisis and lack of behavioral health beds, these negative impacts will lead to extended boarding in emergency rooms, decreasing the accessibility of care and threatening patient safety and quality of care.

“Emergency physicians are deeply concerned that mandated staffing ratios will make it harder to deliver the care people need, worsen the boarding crisis, and prevent us from responding to emergency situations,” said Massachusetts College of Emergency Physician President Scott Weiner, MD. “Patients should never have to worry that they will need to wait hours—or days—in their hospital’s emergency department because of a poorly designed law.”

According to the report, passage of Question 1 will radically disrupt the way care is provided in emergency departments (ED) by:

  • Increasing wait times before a patient can be seen by a clinician;
  • Increasing the risk of worsening patients’ critical illnesses due to delayed access to care;
  • Prolonging wait times for inpatient beds when patients require admission from the ED since floor staffing ratios will dictate the number of beds available for new admissions; and
  • Exacerbating the current crisis of ED boarding of admitted patients, when patients must wait in the ED until an inpatient bed is available.

Patients’ conditions in an emergency department change very quickly, sometimes with little warning. Additionally, there is no way to predict a mass casualty event, a national disaster, or the number of opioid related overdoses that will occur on a given day. If Question 1 were to pass and a crisis were to happen while each nurse was at their legal ratio, patients would either sit in the waiting room or in ambulances for hours until additional nurses arrive to provide care, or the hospital will be fined $25,000 per incident of a nurse treating an additional patient who desperately needs it.

“Nursing in an emergency situation is extremely dynamic and requires the flexibility to make decisions in life or death situations,” said Dan Nadworny DNP, RN and Government Affairs Chair for the Emergency Nurses Association – Massachusetts Council. “In a emergency, every second counts, and utilizing a team approach is key to the best patient outcomes. If Question 1 passes, it will tie the hands of nurses and the team that relies on them, and seriously threaten the safety, quality and access to emergency care in Massachusetts.”

The rigid staffing ratios limit the number of patients that can be treated in a hospital’s ED based purely on the number of registered nurses on duty. Care teams within an emergency department are interdisciplinary, and include nurses, physicians, licensed practical and vocational nurses, certified nursing assistants, healthcare technicians, patient observers, security and others. Ignoring these critical team members that regularly provide emergency services undermines the team approach to patient care and weakens Massachusetts standing as a national model for patient care.

Question 1 will force emergency departments at the maximum nurse-to-patient ratios to turn patients away, leaving some of the Commonwealth’s most vulnerable populations without the crucial care they need.

The ballot question proposed by the Massachusetts nurses’ union, which represents less than a quarter of nurses in the Commonwealth, requires that hospitals across the state, no matter their size or specific needs of their patients, adhere to the same rigid nurse staffing ratios within all patient care areas at all times.

The Massachusetts Colleges of Emergency Physicians and Emergency Nurses Association’s report is clear: Question 1 will force residents across Massachusetts to wait hours in the emergency department for care with absolutely zero evidence that mandated nurse to patient ratios will improve quality of care.

The Massachusetts College of Emergency Physicians is dedicated to advancing excellence in emergency care, and advocating for emergency physicians, their patients and the health of the community.

The Massachusetts ENA provides a unified voice for the interests of Massachusetts emergency nurses and is dedicated to providing current emergency nursing information, education and opportunities to Massachusetts’ emergency nurses.

Nursing Staff Ratios White Paper



Tanya Pearson

Executive Director, Massachusetts College of Emergency Physicians