Safe Staffing Ratios for Patients in Critical Care Units a Key Area of Concern
Worcester — Registered nurses (RNs) on the UMass Memorial Medical Center-Memorial Campus will conduct informational picketing outside the entrance to the facility today from 2-6 p.m. in an effort to draw public attention to key issues disputed in their stalled contract talks with management. The nurses believe the issues impact their ability to continue to provide safe care for their patients and the hospital’s ability to retain and recruit experienced staff.
The 900 nurses at Memorial Campus who are represented by the Massachusetts Nurses Association have been negotiating a new contract since September 2004, with 28 all-day sessions held to date.
Specific issues in dispute include the nurses’ desire to set safe staffing levels in the hospital’s critical care units; pay parity for the Home Health and Hospice staff; showing experienced nurses respect in terms of shift rotation and not moving them to another shift and then replacing them with an agency or per diem nurse; and limiting the patient assignment for charge nurses.
Nurses Seek Safe Ratios for Patients in Critical Care Units
A key issue for the nurses and the patients they care for is the inadequate RN-to-patient ratios, particularly for nurses caring for the most critically ill patients. Staffing ratios in the critical care units at Memorial are among the worst in the state, with nurses sometimes assigned up to four patients at a time, and this includes extremely ill infants in the neonatal intensive care unit. The nurses are seeking a limit of two patients per nurse.
"As always the nursing staff is putting the safety of our patients as our primary concern. We have a proposal that will ensure safe staffing in the critical areas including the medical critical care unit and the neonatal intensive care unit," said Jackie Brosnihan, RN and chair of the bargaining unit. "It is impossible for the registered nurses in these areas to provide quality care to their critically ill patients if their assignments are not limited."
The nurses’ position on the issue is supported by all the latest research, including a groundbreaking report by the prestigious Institute of Medicine of the National Academies of Science, which recommends that critical care nurses never be assigned more than two patients. For the care of infants, a recent study published by the journal Pediatric Critical Care Medicine found a direct link between RN-to-patient ratios and serious complications in pediatric intensive care units.
The study concluded that pediatric patients are more likely to experience complications when the nurse had two patients instead of one. Other recent studies have cited different problems related to the RN-to-patient ratio. One study found that newborns die more often at night in hospitals, which the authors partially attributed to poor RN staffing on the night shift.
Charge Nurse Assignment
The RNs have put forth a proposal that would further guarantee patient safety by limiting the patient assignment for a nurse who is acting as charge nurse. The charge nurse on any unit has the responsibility for everything that happens on that unit. They make patient assignments; oversee the care; handle all emergencies; and make sure all the orders are carried out. The nurses are proposing that the charge nurse have a 50 percent patient assignment.
Pay Parity for the Home Health and Hospice Staff
The RNs that work in Home Health and Hospice are caring for patients in the home who, today, are much sicker and require more sophisticated care. While hospital stays have been shortened, the care that was delivered in the hospital is now being performed in the patients’ home. These nurses work in very stressful and sometimes dangerous situations. These nurses are an important part of the continuity of care provided by UMMMC and they should be placed on the hospital pay scale.
Setting Guidelines for Reasonable Rotation
The RNs feel this is a simple issue of respect. Over the years the nurses have accepted that they will do some rotation off their regular shift. Now the administration is proposing much more widespread rotations. The nurses feel this would adversely affect not only patient safety but the health of the nurses.
According to Brosnihan, many of the RNs at Memorial need two incomes to manage their households—and several are required to work a second job as a result. "These nurses feel the immediate effects of a last minute rotation," added Brosnihan. "They struggle to manage everything from second jobs to day care arrangements when this happens." Older nurses also struggle in this situation, and many of them find it difficult to rebound after an unexpected rotation to an off shift. "We want a guarantee that if we’re rotated to another shift, the hospital will not then turn around and replace us with a per diem nurse or a nurse working extra hours," said Brosnihan.
According to Lynne Starbard, vice chair of the bargaining unit, the RNs are looking forward to getting back to what is important to them, "We’re looking toward a successful conclusion to these negotiations. The issues are very important to our patients and we want to get back to what we do best, providing quality nursing care to our patients."
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