The Vigil Will Be Held on the Third Anniversary of Nurses’ Historic 49-Day Strike
WORCESTER, Mass. —The registered nurses of St. Vincent Hospital/Worcester Medical Center will hold a candlelight "solidarity" vigil for safe nurse staffing and a fair contract with Tenet Health Care on Monday, March 31, 2003, beginning at 6:30 p.m. outside the Summer St. entrance to the facility. The vigil is being held on the third anniversary of the nurses’ historic 49-day strike for their first contract with Tenet Health Care, with the dispute once again focused mainly on staffing issues and the nurses’ concerns for contract language that will allow them to provide quality nursing care.
Specifically, the nurses are hoping to prevent the hospital from eroding contractually agreed upon registered nurse staffing guidelines, which guarantee patients a minimum level of safety; language to protect nurses from being floated, i.e. forced to practice in areas or units for which they are not competent to practice; language limiting the hospital’s use of flexible positions, whereby nurses can be sent home with limited notice and forced to use their benefit time; and a competitive salary scale with other hospitals in Worcester to allow for the recruitment and retention of nurses to provide quality patient care.
The contract talks which began in November 2002 had been proceeding relatively smoothly, according to the nurses, but took a negative turn during the last eight weeks as Tenet Health Care, one of the largest for-profit health care corporations in the world, became embroiled in a series of financial scandals, including federal investigations for improper billing of Medicare. As Tenet has embarked on a corporation-wide cost cutting plan, nurses have witnessed a deterioration in Tenet’s commitment to meet safe and agreed upon staffing guidelines and a hardening of their positions at the negotiating table.
"We are disappointed that Tenet has chosen once again to take a hard line in negotiations with its nurses, especially after all we have been through in the past and after the strides we had made to foster a better working relationship," said Debra Rigiero, RN, a nurse in the hospital’s intensive care unit and chair of the MNA bargaining unit. "We have called the vigil to register our concern for the impact Tenet’s positions are having and will continue to have on the quality of patient care, and to once again enlist the public’s support in convincing Tenet to treat its nurses and patients with dignity and respect."
Staffing is Number One Issue
In 2000, the St. Vincent nurses went out on strike because of the hospital’s refusal to commit to providing safe RN staffing conditions and to prevent the hospital from using mandatory overtime to staff the hospital.
"We won that strike, negotiating landmark language prohibiting mandatory overtime and, shortly after the strike, we further improved patient care by negotiating with Tenet to establish minimum staffing guidelines that obligated Tenet to provide adequate RN-to-patient ratios to ensure a basic level of safe care for our patients," Rigiero explained.
For over a year, the nurses and management worked together to meet the guidelines and maintain an acceptable level of nursing care to patients. "While our staffing wasn’t up to the highest nursing standards, they did provide a basic safety net," Rigiero said.
However, over the last eight weeks, the hospital has repeatedly violated the guidelines, forcing nurses to care for seven, eight and even nine patients at a time. According to the Journal of the American Medical Association, the Tenet guidelines as established pose a 14 percent increase in patient mortality. When these guidelines are violated and nurses are assigned seven to nine patients at a time, research shows these levels increase a patient’s risk of death by as much as 38 percent.
In response, more than 500 nurses (more than 70 percent of the bargaining unit) signed an "Unsafe Staffing Petition" that was delivered to management on March 18, 2003.
The petition read in part: "Nurses are outraged over the issue of unsafe staffing at St. Vincent Hospital. In recent weeks, we have not only been forced to accept assignments in excess of our contractual guidelines, but the hospital’s move to speed up admissions, discharges and transfers has jeopardized patient care and our professional standards. This practice is unacceptable. We are unable to safely care for our patients. Tenet Health Care is violating its own standard to provide patients with the very best care and placing its patients and nurses at risk."
Unfortunately, Tenet has come to the table looking to erode the existing guidelines, while proposing to severely cut expert nurses who provide important and specialized services to patients. This includes a plan to severely cut the hospital’s specialized intravenous (IV) nursing team. These nurses are experts in safely and painlessly inserting intravenous lines, a practice that dramatically reduces hospital infections while limiting repeated painful needlesticks.
In addition, Tenet wants to completely eliminate a team of psychiatric nurses who work in the emergency room evaluating acutely mentally ill patients and dealing with patients who might be in crisis. These nurses help the facility provide efficient and effective psychiatric care to the most volatile and vulnerable patients, protecting both the patients and others who might be in the emergency room. They also are the professionals who are qualified to make accurate physical assessments which are necessary in finding appropriate placements for this population.
"They are proposing to cut these services at a time when the mental health system across the state is in crisis and mental health services are already overburdened. These cuts will be even more devastating should the state make the mistake of closing Worcester State Hospital and those acutely mentally ill patients come to us," said Sandy Ellis, RN, a psychiatric nurse at the facility and a member of the negotiating team.
Floating of Nurses
While staffing levels are in jeopardy of being eroded, the hospital has also come to the table with a proposal to change current contract language to expand the practice of "floating" nurses from one area of the hospital to another. It is analogous to asking a math teacher to also teach French. In the hospital setting, such practices can be dangerous.
While the current contract language only allows nurses with like skills and competencies to float among pre-determined floors where it is reasonable for them to practice, Tenet wants the right to float nurses to a variety of areas where they lack the competency and experiences to properly care for those patients.
"Their approach is that a nurse is a nurse is a nurse," Ellis explained. "The fact is nursing is highly specialized, just like medicine. Just as you wouldn’t want a primary care physician performing your surgery, you also wouldn’t want a medical nurse treating you in the intensive care unit."
Flexible Positions
Back in 2000, one of the other issues leading to the strike vote was Tenet’s excessive use of "flexing." Flexing refers to the practice of requiring a nurse to leave work when the hospital deems there are too many nurses on staff that day. Nurses sent home are forced to use their own benefit time to compensate for their loss of pay. If they run out of their benefit time, they would go without pay.
This practice has been roundly rejected and/or limited by nearly all unionized nurses and hospitals across the state as ineffective, detrimental to patient care and oppressive to nurses.
The hospital is seeking language in the contract to allow for 80 percent of the nursing positions to be flex positions. Nurses in those positions would be subject to being flexed down (sent home) or flexed up (required to work extra).
According to Pat Mayo, co-chair of the nurses’ bargaining unit, "this proposal is an insult to working men and women and dangerous to patients. First of all, there is rarely if ever a time when we need to or should send nurses home. Also, on many occasions nurses have been sent home only to have their units see an influx of patients, with no effort by the hospital to call the nurse who was sent home back to work, thus forcing the remaining nurses to work with dangerously high patient ratios."
"We have had nurses in the intensive care unit and other units sent home, resulting in the hospital closing ICU and other beds, which has resulted in patients being boarded for up to 24 hours in the emergency room, because they now lack the staff to move the patients out of the ER. These patients are going without necessary treatments and nursing care simply because the hospital is more concerned with cutting costs," Mayo said.
Competitive Salaries
Finally, the nurses are seeking a salary increase that will allow them to retain the most experienced nurses. Unfortunately, Tenet’s current financial offer would result in St. Vincent’s most experienced nurses being paid between $5 and $8 per hour below their counterparts at the other two hospitals in Worcester.
According to Mayo, "In the last six months, we have lost nine experienced, highly qualified operating room nurses to other hospitals in Worcester, simply because they were better paid and didn’t have to deal with the "flex" issue."
In crafting their salary proposal, the nurses of St. Vincent are only asking for a salary that is close to that of competing hospitals.
"We have forgone asking for parity with these other hospitals because we are more concerned with convincing Tenet to work with us to ensure better staffing conditions. All we are asking for is a salary level that is competitive and that will allow us to retain our most experienced staff. This will ensure we provide optimum care," Mayo said.
While the nurses are holding the vigil to educate and mobilize support for its positions, they are hoping that talks can resume on a better footing, with a commitment to reach a settlement to avoid an unnecessary escalation of tension in these talks. In fact, while the hospital was urging to move to mediation for the dispute, the nurses urged Tenet to put off this measure to allow for good faith negotiations to reach a settlement without the intervention of a mediator.
According to Ellis, "The nurses of St. Vincent Hospital first and foremost are concerned about providing the care we have been educated and dedicated to providing to our patients. We have been through a strike and we know what that entails. It is our fervent hope and desire that after this vigil Tenet Health Care will put aside its current hard-line agenda and see the wisdom of working with us for the good of our patients, this hospital and this community. "
The parties head back to the bargaining table on April 2.
