Panel of Voters Met in Watertown, Created Guide for 2018 Nursing Ballot Question

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Charlie Breitrose

A group of 20 voters from around the state gathered at the Watertown Library for the Citizens Initiative Review.

Charlie Breitrose

A group of 20 voters from around the state gathered at the Watertown Library for the Citizens Initiative Review.

This November, Massachusetts voters will be asked to vote on a ballot initiative about nurse staffing at hospitals in the Bay State. The information about Question 1 can be confusing, with both sides making similar claims. However, a group of voters from around the state studies the issue intensely and came up with a statement to help voters make up their mind. 

Twenty Massachusetts voters gathered at the Watertown Free Public Library a couple weeks ago and got the the chance to hear from the campaigns for and against Question 1.

The effort, known as the Citizens Initiative Review, was a organized by Watertown State Rep. Jonathan Hecht in partnership with Tufts University’s Jonathan M. Tisch College of Civic Life and Healthy Democracy, the organization that pioneered CIR in Oregon and others states.

The nurse staffing ballot question seemed to be one that would benefit from a deeper examination, Hecht said.

“This one is especially well suited to this type of process,” Hecht said. “Most people get their information from commercials and sound bites, and it is hard to sift through the information.”

While complicated, the main aim of Question 1 is to set up required nurse to patient ratios in Massachusetts hospitals. The Citizen Initiative Review panel came up with a statement in favor, a statement against the ballot question, and presented a set of findings, or facts, that voters could find useful. See the CIR panel’s statement by clicking here. The text of the ballot question is available on the Secretary of State’s website (click here).

The Process

The 20 voters, known as the citizen panel, gathered for four days packed with activities. Their days went from 8 a.m. to as late as 5:30 p.m. On the first day, after learning about the process, they heard opening statements from the pro and con sides. The second day the group got to come up with questions for the two sides, each of which got 60 seconds to respond.

The answers given by the pro and con groups claimed that patient care and waits at hospitals, particularly in emergency rooms, would improve if their side wins. And, on the flip side, would get much worse if their side loses.

The pro Question 1 side compared the initiative to the rules used in California, which also has required nurse/patient ratios for many years. They said the ratios have led to shorter wait times in California.

Those against the question said ratios are too rigid. They say the requirement would lead to longer wait times if there is a sudden influx of patients at a time when there are not enough nurses working at the time. They prefer to staff based on average number of patients for the day and even time of day.

Later on the second day, the panelists got to speak to two independent panels of experts.

On the third day the panelists wrote up the claims from both sides and ranked them, and on the final day the group wrote up the panel’s statement that is available for voters to review (see it below).

2018 MA CIR Final Citizens Statement by Charlie Breitrose on Scribd

The Panel

The panelists were selected from people who responded to a mailer sent to 15,000 randomly-selected voters in the Commonwealth.

“It went very well. Once again the panelists were great,” Hecht said. “They worked incredibly hard for four straight days. They were really so committed to the task, and think about this complex questions.”

Organizers tried to make a panel that reflects the demographics of Massachusetts, and included women and men from diverse racial and ethnic backgrounds. There were Democrats, Republicans and unenrolled voters in similar proportions to the state as a whole. The panelists came from every congressional district in the state; they came from urban areas and small towns; their educational background ranged from high school to graduate degrees; and they ranged in age from 20 to 73.

Interest in CIR

This is the second time the CIR has been run in Massachusetts, Hecht said, after the legalization of recreational marijuana was examined in 2016. Hecht has sponsored legislation on Beacon Hill that would make the CIR a state law.

“A bill on Citizen Initiative Reviews got favorable response from the Joint Committee on Election Laws,” said Hecht.

Charlie Breitrose

The panel of voters got a chance to question representatives on both sides of Question 1, the ballot initiative focusing on nurse staffing.

CIR has been used in a number of states, including Oregon, where it has been an official part of the election process since 2011. The 2016 and 2018 Citizen Initiative Reviews are part of a pilot program in Massachusetts.

The bill had been submitted in previous sessions, and Hecht said he will continue to advocate for it. He noted that bills often take several legislative sessions until they are approved.

The interest in the Citizen Initiative Review goes far beyond Massachusetts. This year’s panel was observed by two documentary film crews, including one from Brazil.

There were also observers from other countries.

“They wanted to see how the process works, and see if it would help address political issues in their country,” Hecht said.

Where to View It

The result of the panel’s work will not be sent to every voter. For now, they will just get the full text in the voter guide mailed out by the Secretary of State’s office.

You can read the Citizen Initiative Review’s statement here:, and find more more about the process at

Hecht said he and his colleagues will also be sharing it on social media.

3 thoughts on “Panel of Voters Met in Watertown, Created Guide for 2018 Nursing Ballot Question

  1. I guess the only thing I would say is that the CIR kind of fumbled the ball on one important part of the ballot question — when ratios can be waived. The CIR wrote:
    “Unit specific ratios would legally apply to all Massachusetts hospitals, except during a state or nationally declared emergency.” That’s just false. The law states the only thing that can waive them is a “declared PUBLIC HEALTH emergency.” So when Gov. Baker declares a “state of emergency” — as he did for the recent gas explosions — that would not lift the ratios, even as people flood into emergency rooms. There have been only 4 “PUBLIC HEALTH emergencies” since around 1970 — the last being in 2014 when Gov. Patrick declared a public health emergency for the opioid crisis. Before that, there was a swine flu one. State of emergency/public health emergency — big difference. The union doesn’t want ratios lifted EVER, even after mass transit accidents, mass shootings, hurricanes. Shocking. Vote No on Question 1.

  2. To those of you who have not read the “The 2018 Citizens’ Statement” on question 1 don’t bother. It will not help you and will only waist your time like it did mine.
    I am angry you would put out something which has “may” used through out.
    It mentions that the bill “could cost between $46 million & 1.5 Billion but doesn’t offer any rational for it so I can only assume it might also save $1.5 billion since we are just pulling figures out of a hat.
    While there are some facts presented in favor of the measure they are generalizations and seem contradictory in some places. On one hand it is implied that the measure saved money and hospitals did not have to close. On the other hand it says that nurses won’t have to work so hard because there will be more nurses per patient. But that would no doubt cost ore money so how would that save hospitals from closing?
    None of it makes much sense.
    Shame on you people for wasting your time and everyone else’s by not presenting something with basic, investigated facts to help us make a decision.

    The ‘citizen’s initiative review’ is a great idea,
    just wish you have someone with an eye on details who can get you to a useful final document.
    Anything with “may” or “maybe” or ‘might” should investigated further or thrown out.

  3. Vote Yes on question2 !!!
    We have to get our power back as citizens in a free society.
    The power of the individual, of a single voting person, has to be honored and respected above that of corporations which can and do use there great sums of money strip us of our freedom, healthcare and dignity.
    Corporations are not people and do not deserve the rights of people.
    Unless of course you want to be like Russia, Hungary, Poland etc. where democracy has been replaced by totalitarianism disguised as democracy.

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