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Nurse Staffing Initiative Petition Survives Court Challenge

The SJC rejected a challenge brought by a hospital-backed group, which argued that Attorney General Maura Healey should not have certified the ballot initiative supported by a major nurses union because it contained two provisions that did not relate closely enough to each other.

Supporters of the ballot initiative, which is backed by the Massachusetts Nurses Association, say it is necessary because nurses often are overburdened. Opponents say the rigid staffing mandates will further contribute to rising health care costs without actually improving patient safety.

After hearing arguments on April 3, the court determined the two elements of the initiative form a unified statement of public policy … and therefore are related.

Nurses for years have pushed staffing requirement legislation on Beacon Hill, but their proposals have failed to gain traction in the Legislature.

This staffing reduction restriction represents a permissible choice of the laws drafters as to how the patient assignment limits may be implemented. As long as all parts of the proposed law are related, as they are here, such policy choices are committed to the drafters discretion and will not be disturbed, Justice Barbara Lenk wrote in the courts ruling.

In asking the court to keep the question off the November ballot, the hospital-backed Coalition to Protect Patient Safety argued that the attorney general should not have certified the question because it contains multiple subjects which are not related or mutually dependent.

The Supreme Judicial Court ruled Monday that the initiative petition seeking to impose limits on the number of patients a nurse can be assigned to care for at a time can go to voters on the November ballot.

In the states response to the court, Healeys office wrote that the proposed ballot question was determined to be acceptable for the ballot because all of its parts are operationally related to its common purpose of implementing patient-to-nurse assignment limits in hospitals and because the workforce reduction ban relates to the remainder of the law.

The ostensible purpose of the entire petition is patient safety. The Patient Assignment Limits for registered nurses may, arguably, advance that purpose. But the Workforce Reduction Ban is not limited to nurses, bedside caregivers, or any similarly tailored category, the coalition wrote in its argument to the court. Instead, the Ban dictates the retention of virtually everybody who works for or at a subject facility, including many workers (e.g., lawyers and marketers) whose job functions could not possibly have an impact on the quality of nursing care in particular, or on patient safety in general.

Specifically, the coalition argued the ballot initiatives two main provisions the patient limits and a prohibition on any reduction in the staffing levels of the health care workforce due to the implementation of the patient limits are not linked closely enough to be part of one ballot question.

The ballot has been the preferred route for easing the states marijuana laws culminating in the legalization of adult use marijuana in 2016 and the nurses union threatened to go to the ballot in 2014 with a similar nurse staffing question before agreeing to a compromise that mandates certain staffing levels in intensive care units.

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