Psych center’s future in spotlight
The 20-bed psychiatric unit at Cape Cod Hospital, Whitcomb Pavilion, has seen recent scuffles between nurses and patients. Cape Cod Times/Christine Hochkeppel
By Cynthia Mccormick
cmccormick@capecodonline.com
May 23, 2011
HYANNIS — Contract negotiations between nurses and Cape Cod Healthcare are raising questions about the future direction of the Cape Psych Center. There isn’t enough nursing staff to handle the increased patient load at the psych center, located across the parking lot from Cape Cod Hospital, said Patricia Casey, a nurse and union representative.
She said the situation is getting dangerous, noting that two nurses are still out with injuries following scuffles with patients in January and March.
When she mentioned her concerns during a recent "town meeting" for hospital staff, Cape Cod Healthcare CEO Michael Lauf said "he talked to his team and they may have to close it," Casey said.
David Reilly, the spokesman for Cape Cod Healthcare, the parent company of Falmouth and Cape Cod hospitals, said there are no plans to close the psych center.
But he said continued cuts in mental health funding are putting the 20-bed psychiatric center in a precarious condition.
"We know cuts to reimbursement for inpatient psychiatric care are likely to continue, and this could put (Cape Cod Healthcare) in a difficult position with regard to future operation of the program," he said in an email.
Many community hospitals have closed their psychiatric beds, Reilly said in a phone interview. "We’re trying to stay open," he said. "We’re trying to make sure we provide this service for the community."
The 900 nurses at Cape Cod and Falmouth hospitals, including the psych center, are in negotiations for a three-year contract with Cape Cod Healthcare, but talks have stalled over issues such as a pay raise, mandatory overtime and staffing.
Nurses held an informational picket Thursday outside Cape Cod Hospital and Friday at Falmouth Hospital.
Staffing and overtime
Understaffing and mandatory overtime are issues throughout the hospitals but are particularly problematic at the psych center, where a nurse injured her shoulder and neck in an interaction with a patient in January, Casey said.
She said another nurse is still out after sustaining an elbow injury at the end of March while trying to protect one patient from another. Since February, she said, nurses have been asked to stay and work overtime 40 times at the center.
During the day there are typically four nurses and two mental health workers on staff, but management wants to cut a nurse and add a lower-paid mental health worker, Casey said. "What they’ll be asking these people to do you need a nursing license to do," she said.
Reilly said staffing levels are safe and appropriate and in line with state Department of Mental Health licensing standards as well as the Joint Commission accreditation guidelines.
He said he would not comment on the specifics of nurse injuries at the psych center, but said, "We have had injuries here … particularly as patient acuity increases."
Increased demand
Casey and Reilly agreed that recent cuts in mental health funding have combined with an increased demand for services to stress the psychiatric services offered by Cape Cod Hospital.
Gov. Deval Patrick and the House of Representatives plan to cut $16 million from the state Department of Mental Health budget this year and close state-funded beds off-Cape, possibly creating even more demand at the Cape Cod Hospital emergency room and the Cape Psych Center.
And state beds aren’t the only ones closing. Health Alliance, whose parent company is UMass Memorial Medical Center, closed a 15-bed psychiatric unit at its Burbank campus in Fitchburg in January.
As other beds close, patients who would have gone off-Cape end up in the local system, both Casey and Reilly said. The health care organization endured a firestorm of protest when it closed the adolescent wing of its psych center in 1997.
The hospital’s emergency department had a record 302 patients in April, many of whom were addicted to substances, Casey said. She said the hospital has also seen "an unbelievable increase in aggressive patients."
Hospitals strained
Low reimbursement rates for mental health treatment put a strain on hospitals, Reilly said.
"Our leadership is making every effort now to make thoughtful clinical and financial decisions today to allow us to operate in a sustainable way in the future, and give us the flexibility and resources necessary to continue to operate important community programs like the psych center," he said in an email.
Regarding the negotiations in general, Reilly criticized the nurses for "using inaccurate information to scare and mislead the public."
He said the hospitals can’t afford the 2 percent pay raise nurses are demanding because nurses already have step increases that give those at the top step an average salary of $102,000 by the third year.
Shannon Sherman, who is the MNA chapter head for nurses at Cape Cod Hospital, said the nurses’ biggest concerns are staffing and mandatory overtime, which she said the hospital has refused to address.
She said nurses are scheduled to meet this week with administrators to resume talks.
Nurses picket Cape Cod Health Care
Susan Vaughn
A large number of nurses from Cape Cod Hospital picket Thursday afternoon along Lewis Bay Boulevard in Hyannis to make known their grievances in their stalled negotiations with Cape Cod Health Care.
By Susan Vaughn
THE REGISTER
Posted May 20, 2011 @ 02:39 PM
Barnstable — Several dozen nurses in bright blue smocks formed an enthusiastic picket line along Lewis Bay Boulevard at Main Street in Hyannis Thursday afternoon enthusiastically waving placards stating their grievances with Cape Cod Health Care in their stalled negotiations for a new union contract.
More than 900 nurses from Cape Cod and Falmouth hospitals, represented by the Massachusetts Nurses Association, have been without a contract since October. The nurses’ three core grievances are insufficient staffing levels, excessive use of mandatory overtime and fair and equitable raises. They say their primary concern is not pay, although they have not had a general wage increase for five years. They are asking for an average increase of 70 cents an hour.
“Unsafe staffing, unsafe patient care,” said Debby Merrifield, RN, summarizing her grievances at the picket.
Jane Feinstein, RN, said mandatory overtime is the biggest issue for her. “It’s just not right,” she said. “I don’t want to be taken care of by a tired nurse.”
Shannon Sherman, a Cape Cod Hospital nurse and chairwoman of the association’s local bargaining unit, addressed the nurses at the end of their three-hour picket. She thanked them for turning out and encouraged them to “stand up and not take the rhetoric from the hospital,” to take their energy back to their co-workers and show up for the next round of negotiations next Friday.
“As nurses, we shouldn’t have to be fighting for safe patients’ care,” she told the group. Part of the reason for the demonstration, Sherman said, was to get the hospital’s attention. “We’re really hoping the hospital will take us seriously,” she said.
A recent communication from Cape Cod Health Care cited charts showing step increases over the proposed three-year contract offered by the hospital of 11.8 percent at Sept 2 to 22.8 percent at Step 12. Hospital spokesman David Reilly said the union is asking for an additional 2 percent across the board.
Reilly also said the nurses will earn wage increases that are more than double the federal government’s rate of inflation with the step advancements.
Copyright 2011 Wicked Local Barnstable. Some rights reserved
Read more: Nurses picket Cape Cod Health Care – Barnstable, MA – Wicked Local Barnstable
Cape Cod, Falmouth Hospitals nurses picketed today
05/19/11
Local Registered Nurses conduct informational picketing today and Friday
The nurses had information picketing signs Thursday at the Cape Cod Hospital in Hyannis. Tracey Thorpe photo.
Even Cape Cod dogs support the local nurses demands.
Call for a Fair Contract with Safe Staffing and Limits on Mandatory Overtime
Holding signs that read "Safe Staffing Now, Protect Our Patients, and Mandatory Overtime is Unhealthy for Nurses and Patients," registered nurses from Cape Cod and Falmouth Hospitals held an informational picket and rally outside the main entrance of Cape Hospital today to protest Cape Cod Health Care (CCHC) administration’s refusal to provide adequate RN staffing, safe working conditions and the resources needed to ensure patients receive quality patient care at these two facilities serving all of Cape Cod.
A second picketing outside Falmouth Hospital is scheduled for Friday, May 20 from 2-5 p.m.
The 900 nurses, who are currently involved in negotiations for a new union contract, have been meeting for months with administration to reach an agreement, and the last several sessions were held with the assistance of a federal mediator.
"Nurses are appalled that a health care system that is posting multimillion dollar profits refuses to invest those resources to improve care delivered to their patients."
– Shannon Sherman, RN.
The nurses say they are outraged that despite posting a record $30 million in profits over the last two years, the hospital continues to object to needed improvements in RN staffing levels, continues to force nurses to work extra hours and double shifts to cover for staffing shortages, and refuses to grant nurses a modest pay increase in light of the sacrifices they have made to promote the hospitals’ strong financial performance.
Nurses Call for Safer Staffing and an End to Mandatory Overtime as Staffing Tool
A press release from the Massachusetts Nurses Association stated, "Every day nurses are working under strenuous and sometimes dangerous conditions to ensure our patients receive the care they deserve at this hospital," said Shannon Sherman, RN, a nurse at Cape Cod Hospital and chair of the Massachusetts Nurses Association local bargaining unit. "The nurses are appalled that a health care system that is posting multimillion dollar profits is refusing to invest those resources to improve care delivered to their patients."
Sherman pointed out that on many floors, and on many days, the hospital is failing to meet contractually mandated staffing standards and/or they refuse to adjust RN staffing to meet the needs of the patients. "When this happens, nurses are forced to care for too many patients at one time, resulting in subpar care. In many cases the patients wait longer for the nurse to complete important physical assessments and to administer necessary medications. And because of this, these patients are placed at an unnecessary risk for serious complications."
"The hospital has cut staffing levels so low that they plan mandatory overtime as a way to complete their staffing."
– Nicky Powderly, RN.
"The hospital has cut staffing levels so low that they plan mandatory overtime as a way to complete their staffing," said Nicky Powderly, a nurse at Falmouth Hospital and chair of the MNA bargaining unit. "Nurses should not be forced to work extra hours and double shifts at the expense of their patients. Exhausted nurses cannot provide safe patient care. Do you want a nurse who has been awake for 24 hours caring for you?"
Sherman added that because there aren’t enough nurses on staff, on some days patients wait hours in the hallways of the emergency room or holding areas waiting for a bed. Recently 10 patients were placed in a holding area with no one to take care of them. The hospital finally had to resort to mandatory overtime, forcing two nurses to work a double shift to care for the patients.
"Of course the nurses did what was needed, but this never would have happened if the hospital was properly staffed," Sherman explained. "Those patients should not have had to wait for care, and when they received care, it should not be by a nurse who is exhausted and, according to the research, is three times more likely to make a medical error. This happens many times every summer and it is even more troubling when it has already occurred and the summer hasn’t even begun. I cannot imagine what conditions will be like in a few months."
Psychiatric unit staffing is dangerous both for patients and nurses
On some floors, such as in the psychiatric unit at Cape Cod Hospital, staffing is often dangerous both for patients and nurses. A number of nurses have been injured due to patient assaults precipitated in part by poor staffing conditions, and patients are often placed in a chaotic environment that places their safety in serious jeopardy. Repeated attempts to convince management to address these situations, including communications to the board of trustees, has failed to result in needed improvements.
"The hospital boasts about its ‘quality care’ but continues to ignore the nurses’ plea for improved staffing. How can the hospital say that it puts patients first when it refuses to staff the hospital with the nurses the patients need," said Sherman.
To improve patient care, the nurses are seeking safer limits on nurses’ patient assignments, safe limits on the use of mandatory overtime and a modest pay raise increase in recognition of the contributions nurses have made to the successful turnaround of the hospital in recent years.
Two years ago, when this hospital was in dire financial straits, the nurses stepped up and agreed to major changes to their health insurance benefit to save the hospital millions, while agreeing to minor pay increases.
"Now that the hospital has recovered, and nurses are working under sometimes deplorable conditions, they tell us we, and our patients, need to sacrifice more," said Powderly. "It’s time to invest in our patients and to be fair to the nurses who care for them."
The nurses began negotiations with the hospital in August of 2010
The nurses began negotiations with the hospital in August of 2010. For the first time, CCHC management has agreed to joint negotiations with the nurses’ bargaining units Cape Cod and Falmouth Hospitals. The last negotiating session was held on May 3, 2011. The next negotiating session will be scheduled by the federal mediator.
The nurses hope their efforts to educate the public will move management to work in good faith to a rapid settlement. Nurses are also concerned by the CCHC administration’s false claims that they are planning or threatening to go out on strike at this time.
"There has been no discussion of strike by the nurses," Sherman stated. "We are simply taking the time to educate the public so they can understand how our concerns impact the quality and safety of their care."
Founded in 1903, the Massachusetts Nurses Association is the largest professional health care organization and the largest union of registered nurses in the Commonwealth of Massachusetts with 23,000 members.
SOURCE: Massachusetts Nurses Association.
The Time our Nurses did strike
They did it before, will they do it again?
On August 10, 1981 the Registered Nurses at Cape Cod Hospital went on strike after rejecting a last-minute contract offer by the hospital. The hospital evacuated 240 patients in anticipation of the walkout.
The only hospital units to remain open were the radiation therapy center and the emergency room, for life-threatening situations. Nurses began picketing the hospital when the strike started this morning at 7 o’clock. The 300-member bargaining unit of the Massachusetts Nurses Association rejected the hospital’s latest contract proposal by a vote of 231 to 2. They had originally asked for a one year package with a 20 percent salary increase but had agreed to settle for 15 percent. Under the contract that expired Friday, a nurse’s starting salary was $288.48 a week; the maximum was $336.91.
The hospital’s final offer, which came after a 13-hour negotiating session, was a 9 percent increase for each year of a two-year contract.
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