Question 1 on nursing vote redux: A column about column writing

By Roy Lincoln Karp
Special to the Reporter

I hope you don’t mind if I turn a bit meta-cognitive. This is a column about the process of writing a column, in particular the one I wrote two weeks ago about Question 1. After much equivocation, I came down in favor of the ballot measure, which seeks to limit the number of patients hospital nurses can care for at one time.

The day after it went to print, I heard through the grapevine that a highly respected member of the Dorchester community had read my piece. My heart rate quickened as his assessment was relayed to me. “He says you don’t know what you’re talking about.” It felt like a punch in the gut. For the next few hours (okay, days) these words kept rolling around in my head. Had I come down on the wrong side of this contentious public policy issue?

I retraced my steps. Reflecting on my thinking process, I recalled being deeply conflicted. Both sides claimed to be speaking on behalf of nurses, so I thought I would drill down on this aspect of the issue. I talked to many of the nurses I have gotten to know over the last few years as the parent of a medically complex child who has spent a lot of time in the hospital.

Most of them were in favor of setting patient limits. They expressed frustration about having too many patients to provide quality bedside care. On the other hand, one of my daughter’s NICU nurses, who has become a close personal friend, articulated her strong opposition. “It’s too restrictive,” she complained. She was also concerned that smaller community hospitals would struggle to satisfy the new mandate.

I was torn. My ambivalence persisted even as my 5 p.m. deadline approached and then whooshed by. I found it impossible to finish the piece until I came down on one side or the other, thinking being the requisite precursor to writing. That night, I attended a meeting of the Columbia-Savin Hill Civic Association, which had invited nurses from both sides to speak. I was desperate to hear something that would tip the scale.
Standing outside the meeting, a conversation with a group of nurses voting yes resonated with me. Looking back now, I have to admit my response was more emotional than rationale. Perhaps this was inevitable. When I was 14, my father died in a hospital room after suffering unnecessarily for days. This was a deeply formative experience, to say the least, one that led to a life-long antipathy toward hospitals.

I am deeply skeptical of hospital administrators who say they cannot afford to hire more nurses, especially when they are being paid in the millions and spend lavishly on new corporate headquarters. I am also sympathetic to nurses who say they are persistently overworked and have advocated for years for legislative reforms.

I recently spoke with Bill Walczak, the esteemed resident who was unimpressed with my column. Walczak, currently the president of the South End Community Health Center, has over 40 years of experience in community health. He also believes the law is too rigid and fears it will draw nurses away from the state’s fifty community health centers, all of which oppose Question 1.

Walczak would like to see greater emphasis placed on preventative medicine and the social indicators of health. “I would love to hire more Community Health Workers who go into people’s homes to address root causes of illness.”

These are important and complex issues. The latest polls show support for Question 1 is flagging. Whether it passes or not, a great deal of work remains to be done if we want to improve health outcomes, especially for our most vulnerable populations. At the end of the day, the greatest way to improve nurse-patient ratios is to reduce the number of people requiring hospital-level care in the first place.