Adjust Font Size

Communication Regarding Ballot Question 1: Hospital Nurse Staffing Ratios

On November 6, 2018 (Election Day), Massachusetts voters will consider Question 1 that would institute government-mandated nurse staffing levels at all hospitals across the Commonwealth. If approved by voters, the law would require every hospital to adopt by January 1, 2019 the fixed, Registered Nurse-to-Patient ratios defined in the statute for each type of hospital unit at all times – regardless of a hospital’s size, location, or the needs of patients. Question 1 would also not permit hospitals to reduce the staffing levels of their health care workforce to offset the costs of implementing these ratios.

Atrius Health encourages every registered voter to become well-informed about the issue and to research both sides. However, we wanted to let you know that Atrius Health strongly opposes Question 1 and is encouraging our patients and their family members to Vote No on Question 1.  Even though Question 1 does not apply directly to us as we are not a hospital, we believe Question 1 would negatively affect Atrius Health patients and all Massachusetts healthcare consumers.

Why does Atrius Health Oppose Question 1?

  • Increases Nursing Shortages: Nurses are needed in all healthcare settings, including ambulatory settings, home health, and hospice settings. There is already a nursing shortage in the U.S. that is projected to grow substantially.  Question 1 is only focused on shifting more nurses to hospital settings, which will make it challenging for Atrius Health and VNA Care to employ enough nurses to provide the highest quality care for our patients.
  • Ratios are Arbitrary:  There is no scientific basis for the ratios that have been established, no scientific study that has determined a “correct” nurse-to-patient ratio, and no evidence that mandated staffing ratios improve the quality of care.
  • Creates Barriers to Improving Patient Care:  Atrius Health supports innovation to improve care for patients which requires flexibility in the delivery of care. Mandatory fixed staffing will make it more difficult to develop and test new (and possibly better) ways to deliver care.
  • Increases Healthcare Costs for Patients:  Cost increases due to the fixed ratios set forth in Question 1 will be passed on to Massachusetts residents and employers through increased premiums, copays, deductibles and taxes. Question 1 has been estimated to cost $1.3 billion in the first year and $900 million annually (1), jeopardizing the cost of health care and health insurance for many citizens in the Commonwealth.
  • Threatens Access to Care in the Community:  Atrius Health and our patients rely on services in our communities for high quality care close to home. Community hospitals are particularly vulnerable to the high cost implications of Question 1, and they may be forced to cut services like behavioral health or turn away patients to adhere to increased staffing requirements.

We strongly encourage you to cast your vote against Question 1 on Election Day - November 6th.  If you are unsure where to vote or need additional information including on-line registration and an absentee ballot application, please visit and select the red box “Elections and Voting.” More information about Vote No on Question 1 is available at

Steve Strongwater, MD, President and CEO
Guy Spinelli, MD, Chair, Board of Trustees
Atrius Health

(1)  2018 study conducted by Mass Insight Global Partnerships and BW Research Partnership and paid for by the Massachusetts Health and Hospital Association.