Contract Talks Stall Over Issues of Poor Staffing Levels, Overburdening of New Nurses and a Wage Offer that Leaves Brigham Nurses 10 percent Below Like-sized Hospitals
BOSTON — In what promises to be the largest informational picket of a hospital in Massachusetts history, more than 1,000 registered nurses represented by the Massachusetts Nurses Association (MNA) at Brigham & Women’s Hospital plan to demonstrate outside the entrance to the facility on Oct. 12, 2006 from 2 – 4 p.m. The 2,700 RNs at Brigham & Women’s Hospital, who are attempting to negotiate a new union contract, are protesting the hospital’s failure to recruit and retain the staff needed to safely care for patients.
The Brigham nurses are outraged by the hospital’s lack of effort to negotiate a fair settlement with the nurses in light of the fact that Brigham & Women’s Hospital is one the busiest and most profitable hospitals in the state, with state-of-the-art services catering to a patient population with complex needs and who require the most sophisticated nursing care. Brigham & Women’s profits increased by more than 75 percent in 2005 to more than $74 million, and the facility posted another $42 million in profits through the second quarter of this year. In the wake of this success, the hospital is offering its nurses a 1.5 percent pay hike and is asking them to pay for that increase by cutting their sick time benefits. The hospital’s salary offer will leave the Brigham nurses pay scale as much as 10 percent below nurses at like-sized facilities?including Boston Medical Center and the Dana Farber Cancer Center.
“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 Barbara Norton, RN and chairperson of the MNA bargaining unit at the hospital. “Nurses deserve better and so do our patients.”
Maintaining appropriate staffing levels is a constant struggle at the facility, which is causing nurses to work overtime hours to fill gaps in the schedule and for 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 three weeks alone, nurses have filed more than 65 official reports of unsafe staffing conditions at the facility, conditions nurses say compromised their ability to deliver the care their patients deserved. Hundreds of these reports have been filed in the last year.
- Nurses on a floor that specializes in providing post-operative care to critical patients recovering from brain surgery and other neurological conditions recently signed a letter to management and physicians pleading for more staff. The letter stated, “We struggle everyday to keep these patients safe. We are tired of learning that our patients?no matter how hard we try?are still at risk. We fear something catastrophic is going to happen.”
- On one recent occasion, two newly licensed nurses were left alone on a floor with 15 patients?a patient assignment that the medical research shows placed those patients at a 21 to 31percent increased risk of death.
The nurses have been complaining about poor staffing and patient care conditions for months and the hospital has taken little or nor action. As a result, the nurses report a high turnover rate and the posting of schedules every four weeks that are filled with staffing holes.
Union Looks to Protect Newly Licensed Nurses
“The bottom line is that this hospital is devaluing its nursing staff,” Norton said. “We are losing nurses to other hospitals with better working conditions and higher pay because these nurses can’t keep up with the hectic pace and untenable conditions at the Brigham.”
The union is particularly concerned about protecting the newly hired nurses and newly licensed nurses at the facility, who are a key to solving the growing staffing crisis. This includes proposals that the union has made to prevent hospital management from forcing new nurses to assume responsibility for overseeing the flow of patients on a floor (called the charge nurse role) or to be charged with teaching other nurses on the floor (serving as a preceptor) unless and until they have a specific level of orientation and experience.
“Right now this hospital expects newly licensed nurses to take charge of an entire floor with only three months experience. It’s unreasonable and it’s unconscionable,” Norton explained. “This hospital works with a very complex patient population, utilizing the latest technology, cutting-edge medicines and surgical procedures. It takes experienced nurses with a keen understanding of this environment to make this operation run smoothly. We can’t believe our administration is refusing to guarantee our patients and our nurses the most common sense protections.”
Variable Hours Program Drives Crisis
In recent years, the hospital has adopted a practice known as “variable hours” staffing that has helped exacerbate the staffing crisis. Under the program, the hospital has hired as much as 25 percent of its nursing staff with the understanding that hospital management can and will cancel the nurse’s shift if and when the hospital deems it necessary. 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 demands on hospital units vary. 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.
The hospital has come to the table seeking to increase the number of nurses hired under the “variable hours” program, specifically in the hospital’s float pool, which is a cadre of nurses that are supposed to be on hand to compensate for staffing shortages throughout the hospital.
“They continue 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,” Norton explained. “The only way to safely care for patients is to have a full compliment of nurses on the floor who are ready to meet all the needs of patients.”
The Brigham & Women’s Hospital nurses and management have been negotiating their contract since July 13, 2006. To date, seven sessions have been held. The contract expired on Sept. 30 and has been extended until the next negotiating session on Oct. 23. If talks continue to stall, the nurses are considering taking a vote to authorize a strike.
