I Am an Emergency Medicine Physician Voting No on Question 1

Published on October 31, 2018

I am an Emergency Medicine Physician and I will vote NO on Question 1 on November 6.

Dr. Brian KellyThe evidence is clear that Massachusetts is doing a great job on patient care. We are at the top of national rankings and there is not a clinical issue that requires additional nursing staff. Furthermore, those extra nurses don’t exist. We can’t suddenly create the thousands of extra nurses that would be needed if Question 1 passes.

The fallacy of “a nurse is a nurse is a nurse” is inaccurate and leads to bad care. They may share an RN degree, but nurses develop different skills depending on where they work, just as doctors do. Emergency care, labor and delivery, and critical care nursing are entirely different fields. Inexperienced nurses are more likely to make errors, so if you flood the hospitals with nurses without proper clinical experience in a short amount of time, healthcare will deteriorate.

Our nurses alert me when there are changes that require my intervention. An inexperienced nurse, whom the other nurses would no longer have time to properly train if this mandate passes, may not be able to gauge when intervention is needed. I won’t know if nurses assigned to my Emergency Department can take care of direly acute patients. From the Emergency Department standpoint, experience is everything. Question 1 would result in the opposite of clinical care improvement.

I am confident in our nurses and their skills. I believe that with their knowledge and expertise they can safely determine how many patients they can care for. The nurses in my department are well aware of what a disaster Question 1 would be. Just as nurses are not interchangeable, neither are patients. A patient assignment could be too much for one nurse and a breeze for another. Having a veteran nurse assigned the same number of patients as an inexperienced nurse makes no sense at all: experienced nurses should be able to take on some of the less-experienced nurse’s workload. This mandate would prohibit that.

Right now we staff safely and our patients rarely wait longer than a few hours, but Question 1 would create enormous Emergency Department backups. The Emergency Department can go from 0 to 60 in seconds—acuity and volume fluctuate dramatically. Under state law, we cannot divert ambulances when they arrive at our Emergency Department and regardless of this fact, there is nowhere else to send these patients if we could. If Question 1 passes, our patients will end up waiting hours upon hours in an increasingly overcrowded room.

The expense to our healthcare system will be dramatic and hugely impact hospitals’ ability to provide care. Some hospitals won’t be able to stay afloat, and all will have to cut services.

The public needs to know that Question 1 would severely impact their ability to be treated during an emergency.

Brian Kelly, M.D.

Vice President for Medical Affairs, Medical Director, & Chief Quality Officer

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