ANA Urges Massachusetts Voters to Vote "No' on Ballot Initiative on Nurse Staffing

Posted 10 months ago


November 1, 2018




Shannon McClendon, 301-628-5391


Joan Hurwitz, 301-628-5020



Silver Spring, MD-The American Nurses Association (ANA) stands with American Nurses Association Massachusetts and the Coalition to Protect Patient Safety in urging voters to reject Question 1, which would mandate specific, numeric nurse-to-patient ratios in all Massachusetts hospitals.

"ANA is a strong advocate for appropriate nurse staffing in all health care settings.  We know that nurse staffing makes a critical difference for patients and the quality of their care," says ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.

"However, ANA does not believe a one-size-fits-all, strict numeric ratio approach to nurse staffing is the answer. Nurses know as patient needs change, so must their staffing. Many factors affect the number of patients for whom each nurse may safely care for-it's not just math.  ANA believes that direct care registered nurses, who are closest to the bedside and who understand the complex factors that impact staffing, must be empowered to determine the unique and variable needs of their unit to ensure safe, quality care for their patients.

The mandate called for in Question 1 is a blunt and wrong-headed solution that would have significant, unintended consequences for patients, nurses, hospitals, and communities, and that is why I urge voters to reject it." 

Given the complexities of nurse staffing, ANA has developed Principles for Nurse Staffing and a bipartisan federal legislative proposal that emphasize the role of nurses' professional input and decision-making in determining nurse-patient staffing.  

ANA's Principles underscores that:

  • nurse staffing is more than numbers

  • one size does not fit all

  • nurses' experience, as well as other components of the staffing mix, along with patient acuity, workflow such as volume of admissions, transfers, and discharges, and available resources in the delivery of care, all impact the determination of what is appropriate staffing at any given time

  • patient care needs are fluid – and vary between hospitals, among units in a hospital and across shifts

  • nurses work as a team; flexibility and teamwork are essential to effectively meet the ever-changing needs of patients.


Founded in 1896, the American Nurses Association is a professional association that represents the interests of the nation's 4 million registered nurses. All registered nurses are eligible to join ANA. ANA has affiliations with 50 state and constituent nurses' associations, including ANA Massachusetts. Reflective of the profession, ANA's membership is inclusive of many roles, including: direct care nurses, advanced practice registered nurses, nurse educators, and nurse managers, who work in a wide range of settings such as acute care hospitals, clinics, long-term care, schools and other settings.  Approximately 50 percent of ANA's members who hold membership at the state and national level are direct care, staff nurses. 


The American Nurses Association (ANA) is the premier organization representing the interests of the nation's 4 million registered nurses. ANA advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all. For more information, visit


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