Many Massachusetts voters find themselves stumped by what Question One on the November ballot is asking them to decide. I;m one of the stumped. We’re asked to weigh in on a question few of us have any expertise to opine upon : should nurses be limited, by law, in the number of patients assigned to them ?

Before I discuss what I’ve concluded, I link you to Ballotpedia’s survey of what Question’s proponents are trying to do, as well as the full text of the question and details of both the Yes and No campaigns : https://ballotpedia.org/Massachusetts_Question_1,_Nurse-Patient_Assignment_Limits_Initiative_(2018)

Once you read the full text of the measure, you see clearly that it calls for very detailed hosp[ital management expertise that I sure don’t have and neither, most likely, do you. Yet there is one point that you and I can figure : why should a state law govern such a quintessentially management decision ? A few hospitals are under State management. and for them, management by state statute might work. For the vast majority of hospitals, which are run by hospital corporations (profit or non-profit), management decisions are made by the management, not by the state. Why should corporate management not have discretion to decide its staff to patient numbers on the basis of its own, corporation, real time experience ?

As you read the text of what Question One seeks to do, it immediately strikes you, that the details asked come directly from “the shop floor,” where very few of us work. Nurses and other hospital employees have that knowledge (and from my encounters, they re almost evenly divided on which way to vote), but you and I don’t. Perhaps this is one reason why the legislature has declined to enact the law Question One’s proponents seek to win. Perhaps the legislature views this matter outside its jurisdiction.

One wants also to ask why collective bargaining by the Massachusetts Nurses Association has failed to win these rules in its contract negotiations.

Those opposing the Question often cite its financial cost to small businesses and small hospitals. Their argument has a place, but to me it’s not the decider. The deciding factor, as I see it, is managerial discretion. As long the vast majority of our hospitals — or any hospitals at all — are run not by the State, those hospitals must be accorded the liberty to make their own managerial decisions.

On that basis, I think the No side has the netter argument.

This may not be the final word. I remain open to persuasion opposite. It will not be an easy task, but I am willing to listen. Voting day is still 45 days away.

—- Mike Freedberg / Here and Sphere