“At Tufts Medical Center, our goal is to treat each patient and family as we would want our own families to be treated.”
Tufts Medical Center nurses should be commended for their commitment to the safety of their patients and for taking seriously the legal duties placed upon them by the Massachusetts Nurse Practice Act and their professional ethics to advocate for their patients. This patient care report is a representative summary of written unsafe staffing reports submitted by Tufts nurses over the last 18 months, as well as evidence of unsafe working conditions as identified by OSHA (Occupational Safety and Health Administration). The unsafe staffing report form is a tool for nurses to identify and track professional practice issues within the hospital where a nurse objects to an unsafe, or potentially unsafe, patient care assignment. These reports are signed by the nurse or nurses who file them and shared with the supervisor on duty. The forms are also shared with management on a regular basis in the hopes of using this evidence to address systemic problems that compromise the quality and safety of patient care.
Tufts nurses have been struggling to get resolution of unsafe working conditions, in particular dangerous staffing levels, which have resulted in the filing of more than 626 reports from September 2009 to February 2011 — reports of unsafe situations where patient care was compromised. However, not every incident of short staffing or unsafe patient care is documented. Nurses fear retaliation and reprisal by supervisors or administrators for complaining about unsafe conditions; and the limitation on their time make the completion of reports difficult. Therefore, the number of actual unsafe situations is significantly higher. Nevertheless the numbers of unsafe staffing reports continues to grow, and as a result, the quality and safety of patient care at Tufts Medical Center continues to decline.
Tufts has become a “poster child” for deplorable nurse staffing practices. This growing national hospital industry problem has also become increasingly prevalent in the Commonwealth of Massachusetts. RN understaffing practices are dangerous and unacceptable. They contribute to the widely recognized failure to stem hospital morbidity, mortality and medical errors. They are outrageous from a patient safety standpoint and foolish from a cost-benefit business perspective. Extensive research studies exist which have documented for several years now that poor staffing and mandatory overtime contribute to millions of preventable complications for patients and causes thousands of preventable deaths each year.
Due to the Massachusetts legislature’s failure to address the issue of safe staffing in hospitals, nurses at Tufts are being forced to take new steps to protect their patients. Tufts Medical Center nurses are attempting to achieve safe patient limits through the collective bargaining process. Because there is no current Massachusetts legal requirement or state law requiring hospitals to provide safe patient assignments for nurses, the only option for nurses may be to strike for patient safety. To ignore the situation is to fail our patients.
For well over a decade, the Massachusetts hospital industry has fought furiously to defeat any regulatory measure that would limit their ability to engage in unsafe staffing practices. Different versions of safe staffing legislation have reached both the Massachusetts House and Senate floors over the past 15 years. In 2006 the Massachusetts House passed legislation which would have protected patients. The legislation has never successfully passed through both chambers and so has never reached the Governor’s desk.
The nurses of Massachusetts, along with more than 125 leading health care and consumer groups who are part of the Coalition to Protect Massachusetts Patients, firmly believe that safe limits on nurses’ patient assignments, along with limits on forced overtime, will dramatically improve patient care and significantly reduce the turnover of nursing staff while at the same time improving the financial performance of hospitals. This is an issue of professionalism for nurses, who cannot continue to work in a setting where their own professional assessment is that they cannot provide proper care to all of the patients assigned to them. The analogy in aviation circles is that working with inadequate staffing is akin to flying a plane known to pilots to be dangerous. Just as we all hope our pilots would speak out, now is the time for our nurses to be heard.
The following pages explain the nature of Tufts Medical Center, the exceptional quality of nursing care at Tufts, the purposeful reduction in nurse staffing from their new staffing model and the resulting deterioration in Tufts’ patient care environment. The regulations in support of nurses’ objections to the current environment are included, as well as a partial listing of the extensive scientific research in support of the nurses’ demands. Our recommendations – indeed, our demands – for addressing this intolerable and unacceptable unsafe environment conclude this report.
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