As Contract Talks Stall Over Staffing, Mandatory Overtime, Pension and Pay Nurses Dispute Highlights Growing Health Care Crisis, as Poor Staffing, Working Conditions and Inadequate Benefits Threaten Patients’ Access to Safe Nursing Care
BRIGHTON, Mass. – Registered nurses at St. Elizabeth’s Medical Center (SEMC) in Brighton will hold a candlelight vigil outside the facility (at the corner of Cambridge and Washington Sts.) on Monday, Dec. 8, 2003 from 4:30 – 6 p.m. The nurses planned the vigil to draw public attention to key issues in dispute in stalled contract talks with management that the nurses believe impact their ability to deliver safe care to patients at the facility.
More than 650 registered nurses are represented by the Massachusetts Nurses Association at SEMC. They have been negotiating their contract since June, with 16 negotiating sessions held to date. Key issues in dispute include the nurses’ demand for contractually mandated RN-to-patient ratios, an end to the use of mandatory overtime to cover for the inadequate staffing at the facility and the need for an increase in their salaries to remain competitive with other Boston teaching hospitals. The nurses are paid between 21 – 30 percent less than their counterparts at other Boston teaching hospitals, which is causing many nurses to leave the hospital and preventing the recruitment of others to help address the growing staffing problems at the hospital.
The nurses were further outraged by a recent demand by the management of Caritas Christi Health Systems, the owner of SEMC, to dismantle the nurses’ long-time defined benefit pension plan as of January 1, a move that could result in the loss of up to 30 percent of the value of the nurses’ retirement benefit.
“The nurses have decided that in light of the seriousness of the issues on the table, it was time to communicate directly to the public and let them know the true impact of these negotiations,” said CeCe Buckley, RN, a nurse at SEMC and co-chair of the Massachusetts Nurses Association bargaining team at the facility. “We don’t have the staff to provide the safe care patients expect and deserve. Nurses are being forced to work long hours against their will, which is hampering their ability to deliver safe care, and management’s refusal to pay a competitive wage, along with their assault on our pension and other benefits, is preventing this facility from keeping nurses and from recruiting nurses to ensure safe patient care. We want the public to know that there’s more than a contract on the line here, the very safety of patients is at stake.”
Unsafe Staffing is at Center of Dispute
The nurses’ dispute comes at a time when the issue of poor RN staffing and poor working conditions for nurses has gained statewide as well as national prominence, as numerous research studies and official government reports document a dramatic deterioration in the quality and safety of patient care in our nation’s hospitals. Here in Massachusetts, the Department of Public Health reported last month that medical errors and patient complaints for the commonwealth’s hospitals jumped 32 percent in the last three years; 76 percent over the last seven, with the majority of these incidents related to nursing care. At nearly the same time, the prestigious Institute of Medicine of the National Academies joined the chorus of medical researchers who have found that “there is a clear relationship between staffing levels and patient safety.”
The nurses at St. Elizabeth’s have been struggling for years to convince management to improve RN-to- patient ratios in the hospital to better protect patients. Nurses at SEMC who work on a medical/surgical floor are regularly assigned more than the safe standard of four patients and on many occasions, up to eight patients at a time.
The staffing ratios at SEMC and the danger they present to patients were brought into sharp focus with the release of a study on RN staffing and patient outcomes published in the prestigious Journal of the American Medical Association. The study was the first to tie hospital death rates directly to nurses’ caseloads. “We found that for every additional patient added to a nurse’s caseload after they have four patients already, there is a 7 percent increase in the risk of death,” according to Linda Aiken, Ph.D., RN and the study’s author.
To better protect patients, nurses are asking the hospital to establish contractually guaranteed RN-to-patient ratios, specific to every floor and specialty unit in the hospital. The ratios are based on the results of the JAMA study, and mirror the ratios contained in legislation passed in California and those currently contained in legislation before the Massachusetts legislature. The bill, H. 1282 An Act Ensuring Quality Patient Care and Safe RN Staffing, was recently approved by the Joint Committee on Health Care and has been endorsed by more than 60 of the state’s leading health care and citizen advocacy organizations.
“The nurses have looked at the current staffing levels, compared them to the best scientific research, to pending legislation and they have concluded that we need these ratios to be part of our contract to ensure that no patient at our hospital has his or her life placed at risk simply because a nurse has too many patients to care for. While we have joined thousands other nurses and citizens in pushing for safe staffing legislation on Beacon Hill, we can’t afford to wait for the legislature to act on this measure because every day we wait, the well being of our patients is placed at unnecessary risk,” said Mary Rogers, co-chair of the nurses’ union.
Nurses Seek End to Mandatory Overtime
In addition to being assigned too many patients to care for on a regular basis, mandatory overtime is a regular occurrence at the facility, and the dangerous practice is being used as an alternative means of staffing the facility.
The practice of using forced overtime to staff hospitals has been widely condemned in recent years and has led to an increase in errors and injuries, and it has also led to a number of high profile nurses’ strikes in Massachusetts and throughout the country. Last month, the prestigious Institute of Medicine issued a report that also condemned the practice stating that unlike other safety-sensitive industries, such as nuclear energy, public and commercial transportation, the military, police and fire – that have responded to overwhelming scientific evidence and placed limits on overtime, “the health care industry is notable in that, with few exceptions, it places no such limit on work hours. The IOM report concluded that, “Health care and labor organizations representing nursing staff should establish policies and practices designed to prevent nurses who provide direct patient care from working longer than 12 hours in a 24 hour period..”
Buckley is well aware of the dangers of the practice of mandatory overtime. She tells a story of being forced to work extra hours against her will and against her doctor’s orders when she was eight months pregnant.
“I got through the shift, and nothing bad happened, but it could have. I had to make a choice between leaving a very ill and vulnerable patient or potentially harming my child or myself. I should have never been placed in that position. No nurse should be forced to make those choices. It’s up to a hospital to have staff to operate. But nearly every day they are forcing a nurse in this hospital to make similar choices.”
As recommended in the IOM report, the nurses of SEMC are proposing language be added to their contract that would prohibit any nurse from working more than 12 hours, and would provide the nurse with the right to refuse overtime anytime he or she felt too ill or too tired to provide safe patient care. Similar language has been included in a number of contracts negotiated by the MNA. Caritas management has refused to accept the language, demanding the right to assign nurses to work up to 16 hours.
Protecting Pension Benefit
Caritas management has also come to the negotiating table demanding the right to dismantle the nurses’ pension benefit, unilaterally changing it from a defined benefit to a defined contribution plan as of Jan. 1, 2004. Under a defined benefit pension plan, the employer is obligated to provide a guaranteed contribution to the employees’ pension and is obligated to provide a guaranteed level of retirement benefit to the employee regardless of the investment returns of the plan. Under the defined contribution plan proposed by Caritas Christi, both the employer and the employee would make contributions to a 401K type retirement investment plan, with the investment risk borne entirely by the nurses. For many nurses at SEMC, a change to a defined contribution pension plans could cut their retirement benefits by as much as 30 percent.
“The competition for nurses in the current labor market is fierce. One of the strongest benefits offered by the Caritas system, and one of the most important tools for retaining our most seasoned and experienced nurses, is our defined benefit,” Buckley explained. “This benefit may be the single item in our contract that is causing nurses to hang in with SEMC. And now they want to take that away.”
Competitive Pay to Recruit and Retain Staff
One of the most important issues contributing to the staffing problems at SEMC is the below-market wages paid to nurses at the facility compared to other hospitals in the city, particularly teaching hospitals. The disparity is most acute for the more experienced nurses, where St. Elizabeth’s nurses at the top of the salary scale are paid between 21 – 30 percent below nurses at Brigham & Women’s Hospital, New England Medical Center and Boston Medical Center. St. Elizabeth’s salary scale barely exceeds that of many smaller community hospitals.
“We are losing nurses every week to other facilities in this city, valuable, talented nurses who don’t see why they should do the same work for inferior pay and unacceptable staffing conditions when they can just cross the city and work for New England Medical Center or Brigham & Women’s,” Rogers explained. “If we can’t recruit new nurses, and more importantly retain our existing staff, we will not be able to staff this hospital appropriately.”
In addition to the candlelight vigil, the nurses have hand delivered a written appeal to the office of Archbishop Sean P. O’Malley, citing their concerns and seeking a personal meeting with the Archbishop on the issues.
“We understand that the Archbishop has a personal history of labor activism and has publicly stated that the archdiocese has a commitment to the rights of workers,” Buckley said. “We want him to understand how this arm of the church, which has a mission of caring for the sick, is implementing labor policies that violate that mission and strip the rights of workers.”
The nurses’ contract, which expired on Nov. 14, 2003, has been extended through December 8, with the next negotiating session following the candlelight vigil scheduled for Dec. 15.
