Partners HealthCare has increased patient assignments for nurses in the hospital’s ICUs in direct violation of a new state law requiring one-on-one attention to ensure patient safety
In conjunction with the press conference, nurses launched an effort to leaflet patients and families entering the hospital to warn them about the impact on their care, and the need to contact the hospital CEO to demand BWH follow the law
BOSTON, Mass. — The Registered Nurses at Brigham & Women’s Hospital, who are represented by the Massachusetts Nurses Association/National Nurses United, held a press conference today to alert the public about deteriorating patient care conditions and illegal practices by hospital management that are compromising the nurses’ ability to provide safe care and close monitoring for the most critically ill patients at this Level One trauma and transplant center. The press conference coincides with the launch of an effort by nurses to leaflet patients and families entering the hospital to warn them about the conditions and the impact on their care.
“The public needs to know that the health and safety of their loved ones is being placed in jeopardy here at Brigham & Women’s Hospital, and it is being done in direct violation of a state law that is designed to ensure their safety,” said Patricia Powers, RN, an operating room nurse at the facility and chair of the nurses MNA/NNU local bargaining unit of more than 3,200 RNs at the facility. “We want patients and families to know that they have a legal right to a safe standard of care at this hospital, and that they should not accept substandard care.”
The patient safety crisis at the Brigham comes at a time when Brigham & Women’s Hospital takes care of the state’s most critically ill patients, as evidenced by the high number of specialized intensive care units in the facility designed to provide minute-by-minute monitoring and cutting edge treatments for unstable, critically ill patients who are recovering from serious traumatic injuries, cardiac and thoracic surgery, acute medical conditions, premature and vulnerable infants, and patients recovering from heart, lung and kidney transplants. These patients demand one-one-one attention from BWH’s highly skilled nurses to help them recover.
To ensure the safety of critically ill patients, a new state law went into effect this month that mandates intensive care unit nurses can only be assigned one patient at a time. A nurse may care for a second patient only if the nurses on the unit have assessed that it is safe for both patients.
Unfortunately, in the wake of the law’s passage and its call for closer monitoring of ICU patients, the administration at BWH decided in August to cut the number of ICU beds and staff at the facility, eliminating five beds from the burn/trauma surgical intensive care unit and three beds from the thoracic intensive care unit. In addition, nurses in many of the hospital’s intensive care units have seen managers force them to take a second and even a third patient in direct violation of the law and the hospital’s own past practices.
“When nurses have too many patients, medical errors, complications, and even patient deaths are more likely, particularly for the highly vulnerable patients our ICU nurses take care of,” Powers said. “Now critically ill patients, who should have one-on-one attention, are being forced to share their nurse with another unstable critically ill patient, despite the strong objections by the nurses responsible for their care and safety.”
Since the hospital has implemented the cuts to ICU beds and increased nurses’ patient assignments, nurses have filed a number of official reports where their patient care assignments jeopardized the safety of their patients.
“To understand how serious this issue is for our patients, you need to understand how sick these patients are and what it takes to keep them safe,” Powers explained. “We are talking about patients who may have just come out of major surgery, they may be intubated and connected to a ventilator to help them breathe, they may have numerous intravenous lines delivering highly sensitive medications into their bodies, they may be on dialysis, and connected to several monitoring devices to track their heart rate, blood pressure, oxygen levels, brain function, etc. And nurses are there to monitor and manage all of it, to interpret what the monitors are showing, to adjust the dosage of medications, to observe the patients skin coloring, pupil dilation, urine flow, all manner of signs and symptoms that show how well the patient is recovering; and depending on what the nurses see, they are there to take immediate action that could prevent a patient from going into crisis, and in many cases, it can mean the difference between life and death. For years, our hospital has recognized the need for one nurse to be totally devoted to the care of these patients. Now they want to divert nurses’ attention away from these patients, and hold them responsible for dividing their time among two of these very sick patients. It’s a recipe for disaster.”
Recently, nurses on the thoracic intensive care unit, which cares for patients undergoing lung transplants, reported being forced to care for two patients, including highly vulnerable lung transplant patients, who should never share their nurse with another patient. One nurse reported a potentially dangerous delay in responding to an alarm connected to a ventilator to breath for the patient because the nurse was in another room caring for another critically ill patient.
At a recent meeting with management where nurses reviewed these reports and informed the hospital of their obligation to follow the new law, management flatly refused to heed the nurses’ concerns or to follow the dictates of the new law. Because the regulations regarding compliance with the law are still in development, the nurses have decided to go public with their concerns to pressure management to provide the care patients deserve.
ICU Care Cuts Part of Broader Effort by Partners to Cut Costs at the Expense of Patient Safety
The reduction of ICU beds and the increase in patient assignments in the ICU is having a ripple effect throughout the institution impacting the care and safety for patients in a number of other areas. With fewer ICU beds and staff to care for them, critically ill patients who should be in an ICU bed cared for by a single nurse are now being held for hours in the Post Anesthesia Care Unit (PACU) waiting for an ICU bed to open. Other ICU-ready patients are being held in the emergency department, where their nurse has two or three other patients under their care. Last week, the hospital was so busy, administration called a “Code Amber” which meant there were no beds available and patients had to be diverted to other hospitals. In the past, a Code Amber was called only when there was an external or internal disaster, such as when Hurricane Sandy hit, or the Marathon Bombing. This Code Amber was called because there weren’t enough ICU beds and staff to care for the patients entering the hospital that day.
In addition to cutting care in the ICU the hospital has also decreased staff on its “code” team, eliminating a nurse from a group of specially trained staff who are on hand to respond to patient care emergencies. With the cuts in ICU staffing, it is more likely there will be situations where the code team is needed to revive a patient in crisis, yet with fewer code nurses, it will take longer to respond to those emergencies. When the nurses questioned the decision, management stated that cuts to the code team could save the hospital up to half a million dollars. Coincidently, B&W CEO Betsy Nabel has recently received a 26 percent raise of just that amount – $500,000.
“As nurses, we provide 90 percent of the clinical care our patients receive. We have always been proud to be Brigham nurses because we could provide the high quality nursing care our patients needed,” Powers concluded. “But now we are appalled that the leadership of Partners HealthCare, an organization that posted more than $600 million in profits last year and is spending millions of dollars in legal fees to win approval to expand their empire, has chosen to cut care to our patients and violate the law at the expense of our patients’ safety. We cannot and will not stand for these dangerous practices and we will be out here to educate the public that depends on this hospital to work with us to ensure they receive the care they deserve.”