BOSTON -- The nearly 1,200 registered nurses who work at Tufts Medical Center in downtown Boston, and who are represented by the Massachusetts Nurses Association (MNA), cast an overwhelming vote tonight (March 29) authorizing union leadership to call a one-day strike should hospital management continue to refuse to address several urgent contract issues that stand to affect RNs’ ability to deliver quality patient care.
The Tufts RNs have been in talks with management for a new contract since April of 2016. 23 sessions have been held in total, but little headway has been made on the key issues RNs identify as being the most urgent, including: constant understaffing throughout the hospital; an end to the hospital’s use of reassignment as a staffing mechanism; high turnover of new nurses due to uncompetitive wages and benefits; and efforts by management to cut senior nurses’ pensions.
“None of us want to go on strike,” said Barbara Tiller, co-chair of the MNA bargaining unit at Tufts and an IV/PICC/CRN nurse. “But after hundreds upon hundreds of hours sitting with management trying to discuss these urgent issues, it has become apparent that our concerns are not being heard. For the health and safety of our patients, for the futures of our newest nurses, and for the security of Tufts RNs, overall we needed to take this next step.”
The strike authorization vote took place from 6:30 a.m. to 8 p.m. on Wednesday, March 29, at the DoubleTree Hotel on Washington Street across from the medical center. Nurses cast their vote by secret ballot, with 95 percent voting in favor of the strike authorization. While the vote does not mean the nurses will strike immediately, it gives the nurses’ negotiating committee authorization to call a one-day strike if and when they feel it is necessary. Should the committee issue an official notice to strike, the hospital will then have 10 days before the nurses go out on strike.
Long-Standing Concerns over Staffing, Safe Patient Care, and Fair Benefits Lead to Vote
At the heart of these contract negotiations is the issue of patient safety. In the current environment at Tufts, nurses across all units and floors are contending with unsafe staffing situations on a daily basis, with many units reporting constant holes in shifts and with management regularly trying to fill those holes last minute by offering a costly and ineffective “OT incentive program.” The result is too many RNs are regularly carrying patient assignments that are too large and unsafe. JAMA has long reported that for every patient in addition to four assigned to a nurse, the risk of death and failure to rescue increases by 7 percent. Many Tufts nurses are regularly carrying patient assignments beyond four.
Simultaneously, hospital management insists on using a fragmented and broken system of temporary reassignment as a way of trying to deal with its chronic staffing challenges. This results is RNs being directed to work on units and floors where they are unfamiliar and/or untrained on any number of items, from essential medical equipment and medication dispensary machines, to patient-care practices and protocols.
“Management insists on wanting the ability to reassign nurses as they see fit.” explained Mary Cornacchia, bargaining unit co-chair and OR nurse. “They believe a ‘nurse-is-a-nurse-is-a-nurse.’ But we know that nursing is a highly skilled profession that requires a deep understanding of not just specific patient populations, but also of all the tools, protocols and practices that go along with caring for those populations. All of that is lost when RNs are inappropriately reassigned.”
Challenges for the Newest of Nurses
The other challenge Tufts faces when it comes to staffing is the fact that it cannot recruit and retain new nurses, due in large part to the lack of competitive wages and benefits that Tufts offers. “Tufts RNs have the lowest wages of all the city’s major teaching hospitals,” explained Tiller. “We are a major trauma center in a city know globally for its healthcare expertise, but if a new grad can go three T stops further and get the same experience at a similar facility for more money, why wouldn’t they? ”
For new grads who opt to join Tufts, they often stay just long enough to get the necessary experience and then quickly move on. While they are working at Tufts, many find that their on-site training [precepting] is inconsistent and haphazard. “Traditionally, new nursing grads are hired in to a specific unit. They then train with a specific, experienced nurse who acts as their preceptor,” Tiller explained. “It is a long-term collaborative relationship that has the best interests of the patients, the new grad, and the institution in mind. This, however, is not how Tufts approaches new hires and preceptors.”
Preceptors at Tufts are not compensated for their work, which is markedly different from what happens at other hospitals. In addition, preceptors at Tufts regularly carry a full patient assignment. The result is precepting nurses are doing two jobs simultaneously and without fair compensation. “Not surprisingly, people aren’t rushing to volunteer as preceptors,” explained Cornacchia. “So instead, these new grads come in to work day after day and float from one overwhelmed temporary preceptor to another. There is no consistency. It’s no surprise they leave as quickly as they do.”
As part of the contract talks, the RN’s bargaining committee has proposed to management that trained preceptors receive a mere $5 per hour extra while precepting. Management rejected that proposal.
Senior Nurses Losing Out Too
New hires at Tufts aren’t the only group suffering under management. The hospital’s most senior nurses, and the defined benefit (DB) pension plans they have long been promised, are also under assault. Management wants to freeze nurses’ DB plans and instead institute a divisive, inequitable, and complex catchup/matching mechanism as part of a proposed higher-risk 403(b) matching program.
“Nurses on the cusp of retirement are now being told they’re going to lose retirement dollars, will have to bear the risk of their retirement dollars in a higher-risk plan, or both,” explained Cornacchia. “This proposal has sent a strong message to every nurse in the hospital, whether they have a DB plan or not: Tufts management has no loyalty to its nurses, even nurses who have invested 40-plus years in the hospital.”
In addition, management has said at the table that discussions about wages and other monetary-based contract improvements will not be discussed until the nurses accept their language on taking away the existing DB plans.
“Management is burning the candle at both ends, so to speak,” added Tiller. “At one end, they don’t want to invest in younger nurses by offering competitive wages and benefits, and quality on-the-job training. At the other end, management is comfortable with seeing senior RNs lose out on long-promised retirement benefits. And in the midst of it all, nurses are given dangerous patient assignments daily due to the chronic understaffing in the hospital, while other RNs are reassigned to units they’re not trained for. It’s a broken system; one where everyone loses out. And it is on the verge of collapse.”
Leapfrog Results Support Nurses’ Concerns
Leapfrog, a nationwide nonprofit watchdog group that assesses the quality and safety of care in U.S. hospitals, gave Tufts Medical Center an overall grade of “C” in 2016. That score is based on Leapfrog’s review of data that Tufts voluntarily submitted, and it covers multiple categories of data, including data on infections; problems with surgeries; practices to prevent errors; safety problems; and doctors, nurses, and hospital staff. In the last category, Tufts scored lowest in the subcategories of “having enough qualified nurses” and “training to improve safety.”
The 1,200 unionized MNA nurses at Tufts saw their contract expire on July, 30 of 2016. They return to the bargaining table with management on April 3 and again on April 13.