The voter’s dilemma: Question One

Amber LaBonte
Staff Writer

We’ve all heard it before. It is our right, privilege and duty to vote as citizens of our country and members of our community. While some may think it doesn’t matter, how we choose to vote can shape our country’s policies. However, with the midterm elections approaching on November 6th, there is one aspect of ballot this year that has many voters scratching their heads. Question One: What is it, and what would it do?
Question One was designed to establish a patient assignment limit for registered nurses. Primarily, this impacts the nurses who work in hospitals. Voting “yes” would support the establishment of this policy, whereas voting “no” would oppose it. Yet, what many voters don’t know is how their choice on Question One will affect not only the nurses, but also themselves as potential patients.
The Committee to Ensure Safe Patient Care (Yes on One) is the leading campaign in favor of Question One. This group argues that putting a limit on how many patients a nurse is assigned would allow them to spend more time with their patients, thus reducing mistakes in individual care.
In contrast, The Coalition to Protect Patient Safety (No on One) is the leading campaign in opposition to Question One. They argue that establishing limits on nurse-patient assignment would increase wait time, thus forcing hospitals to cut back on their services. They also argue that the cost to hire more nurses could result in hospitals shutting down. With two very different outlooks on this matter, voters can become even more confused if they don’t give any thought or examine the pros and cons closely.
The benefits of an established nurse-patient ratio include decreased fatigue, decreased patient mortality rates and less preventable mistakes in patient care. Studies have shown that by establishing an appropriate nurse-to-patient ratio, fatigue, irritability, insomnia, depression, weight gain and other potential health risks that could result from being overworked were significantly reduced. A regulated ratio would allow nurses to provide better value-based care to their patients while maintaining their own health as well.
After California’s law went into effect, hospitals saw a decline in procedural mistakes—including patient falls, pressure ulcers, central line infections and healthcare-associated infections. They also saw improvements in outcome. Fewer patients got sick in the hospitals, more recovered at a faster rate and fewer suffered post-treatment complications that required them to return.
In contrast, the drawbacks of establishing a nurse-patient ratio include cost, wait times, and the quality of care. Perhaps the biggest concern that accompanies Question One is that of cost. If a minimum nurse-to-patient ratio were to be established, it would impose great fiscal costs on hospitals, allowing them little say in regard to staffing decisions. The funding for nursing programs would also need to be increased, requiring hospitals to hire more nurses and increase salaries to attract them to open positions.
California’s transformation was certainly an investment, but not all states can afford to spend the money that is required to make such changes. Though some studies have shown that a minimum ratio improves patient outcome, others demonstrate that such a law has a limited impact on adverse events in hospitals and mixed effects on the overall quality of care.
Though everyone may not agree on the extent to which a nurse-to-patient ratio should be turned into law, this topic isn’t going away anytime soon. As healthcare needs are constantly being morphed in our ever-changing political, economic and social world, finding a way to provide the best possible care for both nurses and patients will always be a relevant discussion. Though there is little doubt that nurses will benefit from Question One, it is far less clear how patients will too.

Amber LaBonte, a sophomore, studies English. She is a staff writer for Le Provocateur.