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12.07.2006
Hundreds of St. Vincent Hospital Nurses Picket
Today
Call for Safe Nurse Staffing and a Fair Contract With Vanguard Health
Systems
The nurses are once again struggling with a for-profit
owner that is placing a concern for profits over a concern for the
safety of patients
WORCESTER—Carrying signs that read “safe
staffing now” and “nurses put patients before profits,”
hundreds of registered nurses from St. Vincent Hospital, along with
nurses from surrounding hospitals and other members of local labor
and community groups, conducted an informational picket for safer
nurse staffing levels and a fair contract today outside the main
entrance to the Worcester-based facility. For over a year the nurses,
who are represented by the Massachusetts Nurses Association, have
been attempting to negotiate their first contract with Vanguard
Health Systems, Inc., the newest for-profit owner of the hospital.
The nurses, who conducted an historic 49-day strike in 2000 against
Tenet Healthcare over the issues of staffing and mandatory overtime,
are once again locked in a protracted dispute with the new owners
over similar concerns.
“Every day in this hospital patients are being placed at
an increased risk for harm because nurses are being forced to care
for too many patients at once. In addition, we face increased pressure
to speed up the delivery of care and a lack of appropriate ancillary
staff to support nurses in delivering quality care,” said
Carolyn Moore, RN, a nurse at the hospital and chair of the nurses’
local bargaining unit. “Hospitals are not factories; our patients
trust us with their lives. Vanguard's practices are appalling and
dangerous and we are seeking the public’s support in convincing
management to place concern for patients ahead of profits.”
Specific issues in dispute include: the nurses’ desire to
set safer staffing levels in the hospital; to establish a prohibition
on routinely assigning nurses additional non-nursing tasks that
detract from their ability to provide safe patient care; protection
of health insurance benefits; pay parity with nurses at UMass Memorial;
and the nurses’ strong opposition to a number of management
proposals to strip nurses’ contract rights.
Poor Staffing and Working Conditions Jeopardize Patient
Safety
Maintaining appropriate staffing levels is a constant struggle
at the facility, which is causing nurses on a number of units to
take on excessive patient assignments. The nurses point to concrete
evidence of a rapid deterioration in staffing conditions that jeopardize
the safety of patients every day:
- In the last year, nurses have filed 385 (an average of one
per day) official reports of incidents when staffing levels jeopardized
the safety of their patients.
- Staffing is particularly dangerous on the surgical/telemetry
floor – a floor for patients recovering from cardiothoracic
procedures, such as cardiac bypass and lung surgeries. These are
acutely ill patients, requiring multiple nursing interventions
and constant electronic monitoring to identify potential complications.
These patients are transferred from the intensive care unit where
they share a nurse with only one other patient to the telemetry
floor where they now share their nurse with up to six other patients
– a staffing level that research shows places them at a
14 – 21 percent increased risk of death.
- Last January, Vanguard significantly increased the capacity
of the emergency department and doubled the nurses’ workload,
without adding a single nurse. Around the same time, Vanguard
laid off 25 nurses and closed a medical/surgical floor specifically
designed to accommodate admissions from the emergency department.
This has caused longer waits for patients, and in many of these
instances, jeopardized the safety of patients seeking emergency
care.
- In addition to cutting back on nursing staff, the hospital
has also cut back on non-nursing support staff such as unit secretaries,
patient transporters, nurses’ aides, etc. Patients have
not only lost access to the valuable services this staff provides,
but as a result, nurses have been routinely assigned a number
of these non-nursing duties, which detracts from the time they
have to provide clinical nursing care, such as monitoring a patient’s
condition and intervening to address problems and complications.
- While cutting back on patient care resources, the hospital
is attempting to reap higher profits by increasing the volume
of surgeries. Vanguard has instituted a speed up of the turnover
of patients entering and leaving surgical suites and the recovery
room, forcing nurses and support staff to move out one patient
and prepare the room for the next patient in just 15 minutes.
The process has placed an enormous strain on all staff in these
areas and has limited registered nurses’ ability to properly
monitor and administer pre and postoperative care.
The nurses have been complaining about the poor staffing and patient
care conditions for months and the hospital has taken little or
no action.
“We have had monthly meetings with management detailing serious
concerns where we have highlighted a number of specific instances
when patients were harmed or suffered preventable complications
due to these practices. In nearly every case, nothing was done,”
said Marie Ritacco, RN, a nurse in the recovery room and a leading
patient safety advocate on the nurses’ negotiating team.
According to Ritacco, Vanguard management has refused to restore
or add staff to ensure the appropriate expert nursing care patients
deserve. For example, Vanguard has increased the practice of closing
floors and transferring patients to areas of the hospital where
the nurses do not specialize in the care the patients’ require.
They have reduced patients’ access to nurses who are experts
in inserting and monitoring intravenous lines. Vanguard’s
reduction in staffing has also caused an increase in patient falls
because nurses and support staff can’t be on hand to prevent
at-risk patients from falling. Management’s only response
to the problem was to state they might consider purchasing beds
lower to the floor.
To address the staffing crisis, the nurses are asking management
to improve staffing guidelines that were negotiated with the nurses
following the strike in 2000. The nurses want to improve RN staffing
ratios on the medical/surgical, cardiac telemetry, and maternity
units, as well as add addition staff to the emergency department.
The nurses also want to add a resource nurse to each floor and each
shift, who would be responsible for overseeing the safe and appropriate
flow of patients throughout the hospital and to be on hand to assume
patients’ assignments when census increases unexpectedly.
The nurses are also seeking contract language that prohibits the
hospital from routinely assigning non-nursing duties to nursing
staff to ensure nurses can focus on providing the nursing care patients
deserve.
Nurses Seek to Limit Controversial "Flex" Staffing
Plan
Like Tenet before it, Vanguard has continued to hire and staff
the hospital utilizing predominantly “flex staff”. Flex
staffing is a system that allows the hospital to send staff home
when the hospital determines they are not needed, forcing the employee
to either opt to go without pay or use vacation time to ensure a
full paycheck. The process is based on the application of factory
models of “just in time” production to the delivery
of nursing care. The problem is the demand on hospital units vary
and flex staffing actually exacerbates the staffing crisis. A nurse
may be sent home in the beginning of what appears to be a low census
day, only to find that the unit has a sudden influx of unexpected
patients. Once the nurses are sent home they are not brought back,
and the nurses on the unit are left with an unacceptable patient
assignment.
“This is another example of Vanguard’s attempt to run
this hospital like a factory, forgetting that it is a place where
we need to have resources at a moment’s notice to respond
to emergencies of every kind,” Moore explained. “The
only way to safely care for patients is to have a full complement
of nurses on the floor who are ready to meet all the needs of patients.”
Lack of Competitive Pay and Benefits Contributes to High
Turnover of Staff
In addition to poor staffing and working conditions, the patient
safety crisis at St. Vincent Hospital has been further compromised
by significantly lower wages and less attractive benefits for the
nurses at St. Vincent Hospital in comparison with the facility’s
cross-town rival – UMass Memorial Medical Center. The St.
Vincent nurses are paid between 15 and 28 percent less than nurses
at UMass, depending on years of experience.
Nurses at St. Vincent also have significantly inferior pension
and health insurance benefits. One of the key issues currently in
dispute is the nurses’ efforts to protect the existing health
insurance benefit.
The St. Vincent nurses are proposing a salary increase that will
place them at parity with the UMass nurses, while the hospital’s
wage proposal would continue to leave senior experienced nurses
at least $5 per hour below their counterparts at UMass.
“As long as St Vincent Hospital continues to pay its nurses
below market wages, St V’s will continue to be the training
ground for nurses looking to gain some experience and then move
on to some other better paying facilities such as UMass Memorial,”
Moore said.
The St. Vincent nurses are outraged by the hospital’s lack
of effort to negotiate a fair settlement with the nurses in light
of the fact that Vanguard Health Systems has turned a significant
profit since assuming ownership of the hospital in 2005. The hospital
made more than $4.3 million in 2005, and has already quadrupled
its profits this year, posting a $17.3 million profit through the
first three quarters of 2006. The hospital’s profit margin
of 6.6 percent is among the highest in the state.
“We are angered by hospital management, which every day expects
us to do more with less while they reap millions in profits at the
expense of the health and safety of the patients we care for,”
said Moore. “Nurses deserve better and so do our patients.”
The St. Vincent Hospital nurses and management have been negotiating
their contract since November 2005. To date, more than 30 sessions
have been held, with the last three sessions involving a federal
mediator. The contract expired on December 31, 2005 and has been
extended until January 11, 2007. The two parties are scheduled to
meet again on Dec. 13.
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