Conditions Threaten Patients’ Access to Safe Nursing Care, and Force Many
Nurses to Consider Leaving the Facility BRIGHTON, Mass. – As contracts talks between nurses and management at St. Elizabeth’s Medical Center (SEMC) enter their 10th month, a survey of the nurses reveals a health care environment characterized by often inadequate staffing patterns, substandard working conditions and lack of management support causing many of the nurses to consider leaving the facility and/or hospital nursing altogether.
The nurses presented the results of the survey to management at a recent negotiating session. More than 650 registered nurses are represented by the Massachusetts Nurses Association at SEMC. They have been negotiating their contract since last June, and working without a contract since January 1st. 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, protection of their pension benefit and the need for an increase in their salaries to remain competitive with other Boston teaching hospitals.
To help draw attention to these issues, the nurses conducted informational picketing outside the facility (on the corner of Cambridge and Washington Sts.) from 4 – 6 pm.
The survey was conducted early this year and includes response from 83% of the nurses on staff. Key findings include:
- 74% of those surveyed reported being given an unsafe patient assignment at least once in the last month, with 26% reporting four or more occurrences every month;
- Over 30% report being forced to work overtime since September, while 66% report feeling pressured to work overtime because of understaffing at the facility;
- 72% of nurses rated SEMC as fair or poor in meeting their needs for ancillary support staff;
- 60% of nurses believe senior nursing management is not effectively advocating for RNs at SEMC;
- 76% of nurses at SEMC report having been contacted by other hospitals or recruiters about nursing positions while 46% of the nurses have seriously considered leaving SEMC; and
- And most alarming, 56% of SEMC nurses have considered leaving hospital nursing altogether, with nearly 70% of those nurses citing unsafe staffing conditions as the primary reason.
“These results are shocking,” said Cece Buckley, RN, co-chair of the nurses’ bargaining unit at SEMC. “It is unconscionable and unacceptable that three quarters of our nurses are regularly placed in a situation that compromises their patients’ safety.”
These results, along with petitions calling for a fair contract, were delivered to Deb Finch, RN, PhD, Vice President of Patient Services at SEMC. In addition, the nurses’ negotiating committee brought more than a dozen front-line nurses from a variety of inpatient units to share their personal experiences, providing compelling testimony regarding unsafe staffing and unsafe working conditions at SEMC.
One recent newly graduated nurse who works on a medical/surgical floor testified to working a recent shift where she was assigned nine patients to care for. This nurse’s assignment exceeded the hospital’s own staffing guidelines. When she brought her concerns to her supervisor, she was told that “the guidelines were just guidelines and they (the hospital) did not have to go by those.”
A nurse from the interim cardiac care unit, where patients go who require specialized monitoring and observation, reported an incident where she and another RN were alone with seven patients and no ancillary support. Each nurse had a patient experiencing serious problems and a third patient experienced a serious complication. Fortunately for this patient, the attending physician happened to be there at the time of the incident averting what could have been a life threatening situation.
A number of nurses testified to experiences of working mandatory overtime, some being forced to work 16 hours straight, and then having to return for their regular 12-hour shift only hours later. The nurses reported feeling exhausted and overwhelmed from the fatigue of working such long hours while still being responsible for excess patient assignments that compromised their ability to deliver safe care.
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 nine patients at a time.
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 prominent scientific studies, 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 of other nurses and citizens in pushing for safe staffing legislation on Beacon Hill, we can’t afford to wait for the legislature,” 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.
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.”
As recommended in the IOM report, the nurses of SEMC are proposing language be added to their contract that would prohibit any nurse from being forced to work 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.
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. 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 nurses’ survey found that 70% of the nurses oppose management’s plan to change their pension.
“As our survey showed, 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.”
“As the surveys indicate, we have lost valuable talented RNs to other facilities with better wages, benefits and RN staffing,” Rogers explained. “If we cannot recruit new nurses, and more importantly retain our existing staff, we will not be able to staff this hospital appropriately, and then it will be the patients who suffer.”
While talks continue, pressure within the rank and file membership is building for more dramatic steps to move the process along. Before the holidays nurses held a candlelight vigil to alert the public of their concerns. The event has garnered significant interest. In fact, the nurses made a presentation before the Brighton Allston Improvement Association, a local community advocacy organization, on March 4th.
“We are reaching out to the public to alert them that they have the most to lose if nurses’ concerns are not met in these negotiations,” Buckley explained. “While we are a long way from a strike, we may need to consider this action if we cannot reach agreement on our key issues. The safety of our patients and our nurses continues to be our top priority.”
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