From the Massachusetts Nurse Newsletter
April 2011 Edition
Taking a strong stand for quality patient care, nurses in Worcester and Boston authorized a strike—if necessary—as their efforts for new contracts with safe staffing language were rebuffed by hospital management.
The nurses at St. Vincent Hospital and Tufts Medical Center, in separate votes that centered on the same issue of unsafe staffing, overwhelmingly approved the strike authorizations.
The 740 St. Vincent nurses are locked in a protracted dispute with Vanguard Health Care, the for-profit owner of the hospital. Working under the worst RN staffing levels in Worcester, they have filed more than 1,000 official reports of unsafe conditions at the facility (an average of more than two a day) in the last 16 months. To address the crisis, the nurses are seeking contract language to guarantee safer staffing levels in the hospital.
The Tufts nurses, meanwhile, have serious concerns about recent changes in RN staffing levels and other changes in how they deliver care that has resulted in nurses being forced to care for more patients at one time on nearly every unit. To compensate for chronic understaffing, Tufts is using mandatory overtime, and is forcing nurses to “float” from one area of the hospital to another where they might not be competent to provide appropriate care.
The votes do not mean the nurses will strike immediately. It gives their negotiating committees the authorization to call a one-day strike if and when they feel it is necessary. Once the committee issues its official notice to strike, the hospitals will have 10 days before the nurses will go out on strike.
St. Vincent: 16 months of negotiations
“With this vote, our membership is sending a clear message to management that we are ready to do whatever is necessary to protect our patients and to ensure that nurses are able to provide the care our patients deserve,” said Marlena Pellegrino, RN, a St. Vincent nurse and chair of the nurses local bargaining unit. “No nurse wants to strike, but we are prepared to do so if Vanguard continues to refuse to make improvements in staffing levels—improvements that are needed to prevent a continued deterioration in the quality and safety of care at this hospital.”
At one April negotiating session, talks ended without the hospital making any movement to respond to the nurses’ staffing proposal. Vanguard management’s initial response more than two months ago was a proposal that would add more nurses to a few floors, while also calling for the closure of nine beds in the intensive care unit, increase patient assignments for nurses on a floor caring for patients recovering from open-heart surgery and eliminate a team of patient support nurses who assist other nurses with complex cases. The hospital’s plan will actually make the conditions for nurses and patients more dangerous. The nurses have been waiting for a concrete reply on the issue of staffing from hospital negotiators for more than a month, but the hospital has yet to make any improvements to its original staffing proposal. At one session last month, they left the nurses’ negotiating team waiting all day, until finally sending the federal mediator into the room at the end of the session with an unspecified “statement of intent” to hire more nurses.
“It is clear that management continues to posture in these negotiations and has no real intent at this time to work with us to address our very serious concerns,” Pellegrino explained. “We hope this helps to change that as we cannot afford to allow these talks to drag on while our patients continue to suffer every day.”
Tufts: management draws line in sand
“Nurses are united in their belief that the current staffing plan at the hospital is unsafe for patients and it needs to change,” said Barbara Tiller, RN, chair of the MNA local bargaining unit at Tufts Medical Center, which represents more than 1,100 nurses at the hospital. “We can only hope that the hospital is listening and will finally work with us to address this patient safety crisis.”
While the nurses are hoping to reach an agreement to protect patients at the hospital, management has drawn a line in the sand, stating repeatedly that it has no interest in agreeing to enforceable limits on nurses’ patient assignments.
“Those changes transformed this hospital from being one of the best staffed hospitals in Boston to the worst staffed hospital in the city,” Tiller explained. “As a result, our nurses spend less time with patients than nurses at other hospitals in the city. No other institution in Boston is operating ICUs, including neonatal intensive care units, where their nurses are expected to care for three patients, nor are they expecting their medical surgical nurses to carry assignments of up to seven patients on a regular basis.” Tiller added that staffing changes have caused a dramatic deterioration in both the quality of care nurses are delivering and, in some cases, has resulted in serious lapses in care. In the past 15 months alone, nurses have filed more than 600 reports of incidents that jeopardized patient care. In addition, more than 80 percent of the nurses have signed petitions calling for safe staffing levels.
“I see nurses all over the hospital going home late and in tears over how bad their shift was, and hear that they spend sleepless nights wondering what they missed, or feeling horrible about not being able to provide the level of care they know their patients deserve. Even one of these occurrences is unacceptable, but to have it happening nearly every day is disgraceful, and it is patently dangerous,” Tiller added. “Issues that are occurring from larger patient assignments include delays in nursing assessment, delayed administration of medications and tests, nurses missing significant changes in patients’ health status, poor patient outcomes, patients falling due to lack of assistance in getting up and moving and patients being left in soiled beds for hours at a time.”
Research supports staffing levels
The nurses’ concerns about the staffing conditions at the hospital are supported by a significant body of research demonstrating the link between poor staffing and a variety of poor patient outcomes and an increase in preventable patient deaths in the nation’s hospitals. In fact, a study in the New England Journal of Medicine published last month shows that when hospital floors or units are understaffed, and where there is a high turnover of patients on a unit each day (as is the case on every unit at St. Vincent Hospital), the risk of patient death increases significantly.
An earlier study in the Journal of the American Medical Association found that every patient above four assigned to a registered nurse resulted in a 7 percent increase in the risk of death for all patients under that nurses care.
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