Issues of Salary, Benefits, a Variable Hours Program, Use of Temporary Personnel and Duration of the Contract are at the Center of the Dispute
BOSTON, Mass. — The registered nurses represented by the Massachusetts Nurses Association (MNA) at Brigham & Women’s Hospital will hold an informational picket outside the entrance to the facility on Sept. 23, 2002 from 2 – 4 p.m. to protest the hospital’s failure to bargain in good faith for a contract settlement. Key issues in dispute include the nurses’ call for a salary increase, improvements in benefits, an end to a controversial "Variable Hours" program (where nurses can be sent home at the hospital’s discretion), and the duration of the contract.
The hospital is demanding that the nurses accept a two year contract with a modest 3% pay increase each year. The nurses are seeking a significant increase for a one year contract to help them to keep pace in a fiercely competitive market for nurses, and to allow them to monitor and respond to changes in nurse staffing conditions, including the outcome of efforts to pass desperately needed legislation to regulate RN-to-patient ratios – a measure the nurses across Massachusetts are promoting to address the shortage and improve patient care.
The Brigham & Women’s Hospital nurses and management have been negotiating their contract since July 9, 2002. To date, five sessions have been held. Both sides contend they wish to reach a settlement on the contract before its expiration date on Sept. 30, 2002. There are more than 2,400 nurses represented by the MNA at the facility.
"We are extremely disappointed with how management has approached these negotiations," said Barbara Norton, RN, chair of the nurses’ bargaining unit and a nurse in the neonatal intensive care unit. "They came to the table demanding that we accept a two year contract, and they have presented an economic proposal that is an outrage to every nurse in this bargaining unit who has been working harder than ever to maintain this hospital’s stellar reputation for quality care."
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, requiring the most sophisticated nursing care. 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.
"Our nurses are working longer, harder and faster, and they are getting nothing for it," Norton said. "Our salaries will soon be behind those of competing hospitals in the city, including Boston Medical Center and New England Medical Center. We are already losing nurses to other facilities with better staffing conditions and better pay, which is further compromising our staffing conditions."
To address the situation, the Brigham nurses are pursuing a two-fold strategy. To address staffing concerns, they are working in coalition with nurses and citizens across the state to promote and pass legislation to regulate RN-to-patient ratios in all hospitals. The MNA came close to moving the legislation in the last legislative session and is hoping to win passage of the bill next year.
"We proposed a one year contract to allow this process to play itself out and see where it leaves us," Norton said. "If the legislature fails to adopt the legislation, we can then come back to the negotiating table to address these serious workload issues. In the meantime, we want to negotiate a salary increase that will allow us to recruit the nurses we need to maintain safe care.
She added, "In this volatile environment, we don’t want to accept a two year contract and lock ourselves into a long term situation where we don’t have the power to influence conditions that may get worse and endanger our patients. With a one year contract, the hospital will be more accountable to us, because they will know we will be back at the table to discuss how they are honoring this agreement."
Other Issues in Dispute: Retiree Health Insurance, Variable Hours Program
In addition to these issues, the nurses want the hospital to provide retiree health insurance benefits, which they see as a major enticement to recruit and retain experienced staff at the facility.
They also want the hospital to eliminate a "variable hours" program, which allows management to cut nurses’ hours during the week. The problem is the hospital has been cutting the hours of staff nurses, and giving those hours to temporary nurses.
"This program hurts the morale of staff, who see preferential treatment given to nurses outside the facility, while those who work here every day are penalized," Norton said. "In addition, it impacts quality patient care, as permanently staffed nurses are more familiar with the facility and can provide a higher quality of care. Studies have shown that patients suffer more complications at hospitals that use temporary nurses in place of regular staff."
Dispute is Manifestation of Broader Crisis
The contract dispute at Brigham & Women’s Hospital is one being played out at a number of facilities across the state in the wake of a growing nursing shortage in the Commonwealth. Similar job actions have been called for by nurses at MNA local bargaining units at Cape Cod Hospital and Carney Hospital.
These disputes comes at time when the health care industry is in the midst of a growing national shortage of nurses, which was driven by a decade where nurses saw a dramatic increase in their patient assignments, a deterioration of their working conditions, and pay rates that have remained virtually flat.
Here in Massachusetts, hospitals are now scrambling to recruit sufficient numbers of registered nurses from a very small pool of nurses still willing to work under current conditions. Nurses, frustrated with their pay and working conditions, are moving from facility to facility in search of the best environment.
While Massachusetts has the highest population of nurses in the nation (over 82,000 RNs licensed by the state), we are experiencing a serious shortage of nurses willing to work at the hospital bedside. A recent survey of Massachusetts nurses found that while 81% were working in nursing, only 46% (an estimated 37,000) are working at the hospital bedside, and more than half of those nurses are working part time.
According to Julie Pinkham, Executive Director of the MNA, "The current shortage of nurses was created by the bad policies of the health care industry and made worse by consistent mistreatment of its nursing staff over last 15 years. Nurses are just plain tired of being taken advantage of."
Throughout the 1990s, hospitals laid off thousands of nurses and/or replaced them with unlicensed personnel in an attempt to cut costs under managed care. Such a plan proposed by Brigham & Women’s Hospital drove the nurses to authorize a strike back in 1996.
Also, under managed care, only the sickest patients made it into the hospital. Nurses at the bedside saw their patient assignments increase while their patients were sicker, requiring more intensive nursing care. At many hospitals, managers compensated for inadequate staffing levels by using mandatory overtime as a mechanism for staffing their facilities.
Not only did these conditions impact nurses, those who suffer most under current conditions are patients. A number of recent studies, including one published this May in the New England Journal of Medicine and a more recent report by the Joint Commission on the Accreditation of Hospitals, shows that inadequate RN staffing is causing serious harm to patients, including increases in complications, an increase in medical errors and thousands of patient deaths each year.
A recent national survey of nurses by the federal government found that nurses have the lowest job satisfaction of any employee group surveyed by the government. Staff nurses in hospitals and in nursing homes have the lowest job satisfaction of all, which is due to poor working conditions and low pay.
Nursing is also one of the most dangerous professions. Nurses and nurses aides have the highest claims’ rate for back injuries of any profession. The injury and illness rate for nurses and other health care personnel surpasses that of mining. Nurses and other health care personnel are three times more likely than the general public to contract Hepatitis C, and nurses suffer assaults and workplace violence on a par with police officers and prison guards.
To address the issue of poor working conditions and dangerous staffing levels, nurses are turning to the legislature and fighting for passage of legislation similar to what was recently passed in California, which would regulate RN-to-patient ratios. The regulation of nurse staffing is essential to retaining the current workforce and to enticing those that have left the bedside to return.
"Unless and until the RN-to-patient ratio legislation is passed and working conditions throughout the state’s hospitals are improved, the wages for the nurse willing to work in this environment (which have been stagnant for more than a decade) must be addressed immediately."
