The nurses are once again struggling with a for-profit owner that is placing a concern for profits over a concern for the safety of patients
WORCESTER — Carrying signs that read “safe staffing now” and “nurses put patients before profits,” hundreds of registered nurses from St. Vincent Hospital, along with nurses from surrounding hospitals and other members of local labor and community groups, conducted an informational picket for safer nurse staffing levels and a fair contract today outside the main entrance to the Worcester-based facility. For over a year the nurses, who are represented by the Massachusetts Nurses Association, have been attempting to negotiate their first contract with Vanguard Health Systems, Inc., the newest for-profit owner of the hospital.
The nurses, who conducted an historic 49-day strike in 2000 against Tenet Healthcare over the issues of staffing and mandatory overtime, are once again locked in a protracted dispute with the new owners over similar concerns.
“Every day in this hospital patients are being placed at an increased risk for harm because nurses are being forced to care for too many patients at once. In addition, we face increased pressure to speed up the delivery of care and a lack of appropriate ancillary staff to support nurses in delivering quality care,” said Carolyn Moore, RN, a nurse at the hospital and chair of the nurses’ local bargaining unit. “Hospitals are not factories; our patients trust us with their lives. Vanguard’s practices are appalling and dangerous and we are seeking the public’s support in convincing management to place concern for patients ahead of profits.”
Specific issues in dispute include: the nurses’ desire to set safer staffing levels in the hospital; to establish a prohibition on routinely assigning nurses additional non-nursing tasks that detract from their ability to provide safe patient care; protection of health insurance benefits; pay parity with nurses at UMass Memorial; and the nurses’ strong opposition to a number of management proposals to strip nurses’ contract rights.
Poor Staffing and Working Conditions Jeopardize Patient Safety
Maintaining appropriate staffing levels is a constant struggle at the facility, which is causing nurses on a number of units to take on excessive patient assignments. The nurses point to concrete evidence of a rapid deterioration in staffing conditions that jeopardize the safety of patients every day:
- In the last year, nurses have filed 385 (an average of one per day) official reports of incidents when staffing levels jeopardized the safety of their patients.
- Staffing is particularly dangerous on the surgical/telemetry floor – a floor for patients recovering from cardiothoracic procedures, such as cardiac bypass and lung surgeries. These are acutely ill patients, requiring multiple nursing interventions and constant electronic monitoring to identify potential complications. These patients are transferred from the intensive care unit where they share a nurse with only one other patient to the telemetry floor where they now share their nurse with up to six other patients – a staffing level that research shows places them at a 14 – 21 percent increased risk of death.
- Last January, Vanguard significantly increased the capacity of the emergency department and doubled the nurses’ workload, without adding a single nurse. Around the same time, Vanguard laid off 25 nurses and closed a medical/surgical floor specifically designed to accommodate admissions from the emergency department. This has caused longer waits for patients, and in many of these instances, jeopardized the safety of patients seeking emergency care.
- In addition to cutting back on nursing staff, the hospital has also cut back on non-nursing support staff such as unit secretaries, patient transporters, nurses’ aides, etc. Patients have not only lost access to the valuable services this staff provides, but as a result, nurses have been routinely assigned a number of these non-nursing duties, which detracts from the time they have to provide clinical nursing care, such as monitoring a patient’s condition and intervening to address problems and complications.
- While cutting back on patient care resources, the hospital is attempting to reap higher profits by increasing the volume of surgeries. Vanguard has instituted a speed up of the turnover of patients entering and leaving surgical suites and the recovery room, forcing nurses and support staff to move out one patient and prepare the room for the next patient in just 15 minutes. The process has placed an enormous strain on all staff in these areas and has limited registered nurses’ ability to properly monitor and administer pre and postoperative care.
The nurses have been complaining about the poor staffing and patient care conditions for months and the hospital has taken little or no action.
“We have had monthly meetings with management detailing serious concerns where we have highlighted a number of specific instances when patients were harmed or suffered preventable complications due to these practices. In nearly every case, nothing was done,” said Marie Ritacco, RN, a nurse in the recovery room and a leading patient safety advocate on the nurses’ negotiating team.
According to Ritacco, Vanguard management has refused to restore or add staff to ensure the appropriate expert nursing care patients deserve. For example, Vanguard has increased the practice of closing floors and transferring patients to areas of the hospital where the nurses do not specialize in the care the patients’ require. They have reduced patients’ access to nurses who are experts in inserting and monitoring intravenous lines. Vanguard’s reduction in staffing has also caused an increase in patient falls because nurses and support staff can’t be on hand to prevent at-risk patients from falling. Management’s only response to the problem was to state they might consider purchasing beds lower to the floor.
To address the staffing crisis, the nurses are asking management to improve staffing guidelines that were negotiated with the nurses following the strike in 2000. The nurses want to improve RN staffing ratios on the medical/surgical, cardiac telemetry, and maternity units, as well as add addition staff to the emergency department. The nurses also want to add a resource nurse to each floor and each shift, who would be responsible for overseeing the safe and appropriate flow of patients throughout the hospital and to be on hand to assume patients’ assignments when census increases unexpectedly.
The nurses are also seeking contract language that prohibits the hospital from routinely assigning non-nursing duties to nursing staff to ensure nurses can focus on providing the nursing care patients deserve.
Nurses Seek to Limit Controversial "Flex" Staffing Plan
Like Tenet before it, Vanguard has continued to hire and staff the hospital utilizing predominantly “flex staff”. Flex staffing is a system that allows the hospital to send staff home when the hospital determines they are not needed, forcing the employee to either opt to go without pay or use vacation time to ensure a full paycheck. The process is based on the application of factory models of “just in time” production to the delivery of nursing care. The problem is the demand on hospital units vary and flex staffing actually exacerbates the staffing crisis. A nurse may be sent home in the beginning of what appears to be a low census day, only to find that the unit has a sudden influx of unexpected patients. Once the nurses are sent home they are not brought back, and the nurses on the unit are left with an unacceptable patient assignment.
“This is another example of Vanguard’s attempt to run this hospital like a factory, forgetting that it is a place where we need to have resources at a moment’s notice to respond to emergencies of every kind,” Moore explained. “The only way to safely care for patients is to have a full complement of nurses on the floor who are ready to meet all the needs of patients.”
Lack of Competitive Pay and Benefits Contributes to High Turnover of Staff
In addition to poor staffing and working conditions, the patient safety crisis at St. Vincent Hospital has been further compromised by significantly lower wages and less attractive benefits for the nurses at St. Vincent Hospital in comparison with the facility’s cross-town rival – UMass Memorial Medical Center. The St. Vincent nurses are paid between 15 and 28 percent less than nurses at UMass, depending on years of experience.
Nurses at St. Vincent also have significantly inferior pension and health insurance benefits. One of the key issues currently in dispute is the nurses’ efforts to protect the existing health insurance benefit.
The St. Vincent nurses are proposing a salary increase that will place them at parity with the UMass nurses, while the hospital’s wage proposal would continue to leave senior experienced nurses at least $5 per hour below their counterparts at UMass.
“As long as St Vincent Hospital continues to pay its nurses below market wages, St V’s will continue to be the training ground for nurses looking to gain some experience and then move on to some other better paying facilities such as UMass Memorial,” Moore said.
The St. Vincent nurses are outraged by the hospital’s lack of effort to negotiate a fair settlement with the nurses in light of the fact that Vanguard Health Systems has turned a significant profit since assuming ownership of the hospital in 2005. The hospital made more than $4.3 million in 2005, and has already quadrupled its profits this year, posting a $17.3 million profit through the first three quarters of 2006. The hospital’s profit margin of 6.6 percent is among the highest in the state.
“We are angered by hospital management, which every day expects us to do more with less while they reap millions in profits at the expense of the health and safety of the patients we care for,” said Moore. “Nurses deserve better and so do our patients.”
The St. Vincent Hospital nurses and management have been negotiating their contract since November 2005. To date, more than 30 sessions have been held, with the last three sessions involving a federal mediator. The contract expired on December 31, 2005 and has been extended until January 11, 2007. The two parties are scheduled to meet again on Dec. 13.
“
