The decision of the nursing staff has a great impact on medical care

After a bitter and expensive campaign, Mbadachusetts voters rejected Question 1 on the ballot, which would have set strict limits on the number of patients badigned to hospital nurses.

The Mbadachusetts Nurses Association, a union representing some 23,000 nurses, sponsored the ballot question. The union members argued that limits were needed to ensure that patients received safe care.

Donna Kelly-Williams, president of the Mbadachusetts Nurses Association, acknowledged the loss on Tuesday night, but insisted that the ballot question was necessary.

"We know this at the moment, while I'm talking to you here, there are nurses who care for too many patients, and those patients are being unnecessarily put at risk," Kelly-Williams said, according to her prepared comments. "And the problem keeps growing every year. The status quo is not a solution here. "

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A coalition led by the hospital industry responded to the question, saying that the measure on the ballot was too rigid and would have a huge cost. The hospital representatives argued that hospitals would have to reduce important medical services, or perhaps close them completely, if the question was approved.

An independent state agency, the Mbadachusetts Health Policy Commission, estimated that Question 1 would have required hospitals to hire up to 3,101 additional nurses and could have cost the state health care system more than $ 900 million per year.

The nurses were divided on the controversial issue. Some believed that mandatory case limits would allow them to better care for each patient. Others argued that the measure on the ballot would rob them of the ability to use their professional judgment.

Hospitals spent nearly $ 25 million to try to defeat the ballot measure, more than double the roughly $ 12 million spent by the union to promote the question.

Volunteers and staff from both campaigns spent the last days before the election making calls and knocking on doors to present their case to voters.

Kate Norton, spokeswoman for the "Yes" campaign, said 1,850 volunteers were working to get out of the vote on Tuesday.

"The support is enthusiastic and strong," Norton said. "We feel good entering the day of the elections, we have a great operation."

Over the weekend, campaign volunteers found that many voters were still undecided, Norton said. "When they talk to us … they say" yes ", she said.

Polls suggested that support for the question had decreased, and most voters planned to vote "no" on the ballot measure.

"We are cautiously optimistic," said Dan Cence, a spokesman for the coalition that opposes Question 1. "We know we've put in the work."

Hundreds of "No in 1" volunteers were scheduled to go to polling places throughout the state on Tuesday.

Each campaign said it had distributed more than 30,000 lawn signs.

Voters were divided at the polls on Tuesday.

Michelle Resendes, 46, a Registered Nurse at Norwood Hospital, was wearing a sticker on her shirt in support of Question 1 while on her way to the polls at North Attleborough High School.

"I think it's the safest thing for patients," he said.

The voter of Brockton, Windsor Lindor, of 34 years, said that the problem of the nurses was the most difficult in the ballot for him, and that his wife is a nurse. After asking for his opinion, he said, he voted no.

"I just did not want to change the status quo," Lindor said at the War Memorial building on West Elm Street.

The nurses union has been pushing for legislation to set limits for patients for two decades. In 2014, the union won a commitment: limits in intensive care units. ICU nurses are now restricted to one or two patients at a time. But Mbadachusetts lawmakers never backed a broader nursing staff bill.

Governor Charlie Baker, a Republican who won re-election, opposed Question 1. Some Democrats in the Legislature also opposed the ballot question.

Baker's opponent, Democrat Jay Gonzalez, supported the measure on the ballot, as did other prominent Democrats, including Boston Mayor Martin J. Walsh and Senator Elizabeth Warren.

Hospital officials say they need flexibility to staff their units because it is difficult to predict when the number of patients will increase or decrease, especially in the emergency room. But union leaders say that nurses routinely carry too many patients, which increases the likelihood of delays and errors.

California is the only state that requires patient limits, also known as nurse-to-patient ratio. California law, implemented in 2004, is less strict than the issue of voting in Mbadachusetts, and studies on the effect of the law are varied. Some studies found improvements in the results after the patient limits went into effect, while others did not.

Question 1 would have required hospitals to adhere to patient boundaries at all times of day and night, even when nurses take breaks to eat.

See the live results of the 2018 interim election here.

See the full results of the elections here.

Correspondent Morgan Hughes contributed to this report. You can contact Priyanka Dayal McCluskey at [email protected] Follow her on Twitter @priyanka_dayal.

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