The parties began negotiations in Oct. 2006 and to date, 15 sessions have been held. Talks on April 24 failed to yield significant movement on the key issues, at which point both parties agreed to call in a mediator. The first negotiating session involving a federal mediator has not been scheduled. The contract expired on Oct. 31, but has been extended until late May.
“In any hospital, nurses provide most of the clinical care patients receive; we are the key to patient safety and the quality of patient care,” said Diane Lee, chair of the MNA local bargaining unit at Lawrence General Hospital. “Inadequate and sometimes dangerous understaffing, combined with poor working conditions and lack of respect for nurses by management at this hospital are threatening to cause a mass exodus of qualified staff. On a daily basis, the safety of patients is being placed in jeopardy. We are attempting to negotiate a fair and competitive contract that will help to retain and recruit the staff needed to provide the care our patients expect and deserve.”
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 intensive care units, the hospital has just informed the nurses that they will be assigned up to three patients at a time, a practice that is patently dangerous and unacceptable by any standard of nursing practice. This has never been the practice at LGH. Historically, LGH has adhered to national standards of care assigning no more than two patients per nurse in its intensive care units. In fact, in 2003, the Institute of Medicine, the nation’s leading medical research body, issued a report on patient safety that stated no intensive care unit nurse should ever be assigned more than two patients.
- Staffing is particularly dangerous on the hospital’s two telemetry floors, where patients with cardiac problems are connected to special heart monitoring machines. Nurses on these floors are often assigned five and six patients – a dangerous patient load for patients with these conditions. In January the Hospital expanded its telemetry capacity opening a new 12-bed telemetry unit and hired additional registered nurses to staff the unit. Many of the new nurses are newly licensed recent graduates and others are nurses new to telemetry, with most lacking the necessary training and experience in reading the heart monitoring equipment. In the last two months, nurses have filed more than 20 official reports of staffing conditions on these floors that the nurses reported jeopardized the safety of their patients.
- Registered nurses on the medical surgical floors are often assigned 6, 7, 8 and even 9 patients at a time. According to recent nursing research, these staffing levels place patients at LGH at a 14 – 35% increased risk of injury or death.
- Last year, the hospital spent millions of dollars to double the size of the emergency department without adding the nursing staff needed to safely care for the increase in patient volume. As a result, nurses’ patient assignments in the emergency department have nearly doubled, which has led to increased boarding of patients, caused longer waits for patients, and in many instances, jeopardized the safety of patients seeking emergency care. A new study published this month in the journal Medical Care found that when hospitals increase admissions without adding staff the rate of medical errors increases dramatically.
- Staffing is also a major problem on the hospital’s maternity unit, where the hospital is routinely forcing nurses to be on call to cover for longstanding vacancies. A number of positions have been open and gone unfilled for months, and schedules are posted regularly with multiple holes, forcing an exhausted staff to provide care to more patients.
- In addition to insufficient nursing staff, the hospital does not employ adequate non-nursing support staff, such as unit secretaries, patient transporters, nurses’ aides, housekeeping staff, etc. As a result, patients wait longer for the valuable services this staff provides, the flow of patients through the Hospital is impeded, and nurses are expected to assume many of these non nursing duties to compensate. This detracts from the time nurses have to provide clinical nursing care, such as monitoring a patient’s condition and intervening to address problems and complications.
The nurses have been complaining about the poor staffing and patient care conditions for months and the hospital has taken little or no action.
Last month, nurses from the telemetry floor met with management in an urgent appeal to increase staffing to improve care. The hospital refused to add any staff.
“This hospital is understaffed and nurses are often forced to work in unsafe conditions constantly worried about being mandated to work overtime. Instead of hiring the nurses it takes to provide appropriate care, they are choosing to staff this hospital with overtime, sometimes forced overtime or requiring nurses to be on call – it’s totally unacceptable”, said Doreen Pacheco, a nurse in the outpatient surgery department and co-chair of the nurses union. “I, like most of the nurses who have worked at this hospital for years, have always been proud to be a Lawrence General nurse, but I can’t say that anymore. That’s why we are fighting so hard to change things. It’s not only our license that is on the line here, but for many of us, this is our community hospital too.”
To address these concerns, the nurses are seeking contract language to prevent the hospital from routinely assigning non-nursing duties to nursing staff to ensure nurses can focus on providing the nursing care patients deserve. The nurses are also seeking contract language to prevent the hospital from using mandatory on call as an alternative to fully staffing the hospital.
In addition to meeting with the hospital to try and convince them to improve the nurses’ staff levels voluntarily, the nurses are committed to alerting the public of the current dangerous conditions to put pressure on management to provide safer staffing.
The nurses are also working on the state level to support passage of H. 2059, The Patient Safety Act, which is pending legislation that would require all hospitals to adhere to safe staffing standards, and guarantee nurses a safe limit on the number of patients they are assigned.
Improvements in Workplace Safety
When nurse staffing levels are low, the potential for injuries to nurses and workplace violence against nurses increases dramatically. Nursing is one of the most dangerous professions. Nurses are injured on the job more than construction workers and they are assaulted on the job more than police officers and prison guards.
The nurses at LGH report that their members are concerned about suffering injuries and assaults and other forms of workplace violence, particularly in the emergency department.
To address these concerns, the nurses have proposed contract language to require the hospital to work with the nurses to ensure a safer work environment, including the creation of enforceable policies and procedures to assist nurses with the safe handling of patients to prevent muscular skeletal injuries, along with procedures to decrease nurses’ exposure to workplace violence. This language is common in many nurses’ union contracts, including at Anna Jacques Hospital and the facilities affiliated with Northeast Health Corporation, yet the management of Lawrence General Hospital is refusing to adopt the language.
Competitive Wages
The nurses at LGH are seeking a salary level that is competitive with hospitals in surrounding regions: hospitals on the North Shore, Greater Boston and Worcester pay their nurses between 20 – 30% more than the nurses at LGH. The need for nurses is particularly acute in specialty units – the emergency department, maternity unit, critical care units and telemetry floors — where there is a need for experienced, skilled nurses.
In response, the nurses have asked for a salary increase that would make them competitive so that they can keep the skilled nurses they have and to allow LGH to recruit new nurses. While the hospital has made some movement on the issue of salary, their last offer still leaves the majority of LGH nurses far below nurses in other markets.
Hospital Seeks Benefit Cuts
While failing to provide nurses with a fair salary and a safe work environment, management has come to the table seeking to take away a number of longstanding benefits of the current contract. The most far-reaching is a proposal to take away a prorated holiday benefit for part time nurses. This benefit is a standard benefit offered to nurses at area hospitals. More importantly, taking away the benefit serves as yet another disincentive for nurses working at LGH to stay at LGH.
“Because nursing is still a field dominated by women, many of whom are parents with school-age children, many nurses require a part-time schedule,” said Lee. “In fact, when the hospital posts nursing jobs, very often they are posting part-time positions. We couldn’t run this hospital, nor could any hospital in Massachusetts operate without the valuable contributions of part-time nurses. At a time when we are struggling to hold onto our nurses and to attract nurses to this hospital, it is not only wrong, but it is shortsighted to take away this benefit.”
In anticipation of the scheduling of the first negotiating session with a mediator, the nurses are mobilizing to take their case directly to the public for support. An open meeting has been scheduled for May 8, where a vote will be taken on the need for an informational picket, as well as other job actions.
“Yes, this is struggle is about a union contract, but it is also about much more than that,” said Pacheco. “The public has the most to lose as a result of these negotiations and the hospital’s response to our appeals for staffing improvements. For many nurses, the outcome of these negotiations will decide their future at this hospital. For patients, this is truly a matter of their health and safety.”
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