Failures to support frontline nurses and other healthcare workers, along with communication breakdowns at Steward Healthcare-owned facilities throughout Massachusetts, has prompted nurses represented by the Massachusetts Nurses Association to sound the alarm about the health system’s response to the COVID-19 pandemic.
The Massachusetts Nurses Association represents more than 2,750 nurses and health professionals working in eight Steward owned hospitals in Massachusetts including Carney Hospital (Steward’s designated COVID-19 Hospital), Carney’s satellite ER in Quincy, Good Samaritan Medical Center in Brockton, Holy Family Hospital in Methuen and Haverhill, Morton Hospital in Taunton, Nashoba Valley Medical Center in Ayer, Norwood Hospital and St. Elizabeth’s Medical Center in Brighton
Since the onset of the COVID-19 pandemic, nurses and MNA staff asked to postpone for several months all contract negotiations and similar meetings and disputes to instead focus 100% on engaging in crisis management collaboratively with Steward, similar to efforts MNA nurses have been making with hospital networks throughout the Commonwealth. But very serious issues remain unaddressed pointing to systemic breakdowns in communication, and delays in providing nurses and patients with what is needed to respond to the pandemic.
Systemwide Lack of Proper PP
While assuring staff and the public that Steward has a “robust supply” and a stockpile of PPE and there is no shortage in the system, Steward is inconsistently providing PPE including N95 masks, gowns and other equipment to staff when needed. If the stockpile exists, there is a disconnect because the supplies are not generally accessible to staff when needed.
According to Peg Conlon, RN, a nurse at Carney Hospital, which has been designated by Steward as the COVID-19 hospital in the system, nurses are not being provided access to N95 masks at all times, and are forced to reuse soiled masks for days.
“Yesterday there were not enough N95 masks available in the ICU, in the special COVID-19 units or anywhere in the hospital.” said Conlon. “What we do see is a dangerous rationing of PPE at Carney, which is a guarantee for more spread, and of a loss of staff as more of us become sick.”
At St. Elizabeth’s Medical Center, physical access to PPE is controlled not by a doctor or a nurse manager but by the Director of Finance, who has instituted a process that leads to lengthy delays in nurses accessing the protective equipment. Similar reports abound in hospitals throughout the system.
Issues in Designated COVID Units in addition to PPE
MNA representatives continue to urge the management at each facility to adequately staff the special COVID-19 units by providing needed nurses and other staff to assist in the safe donning and doffing of PPE to prevent exposure and spread, and to serve as helping hands in emergencies. Extra staff is also needed because of the unusually high level of care required for hospitalized COVID-19 patients.
At St. Elizabeth’s Medical Center and at Morton Hospital, the lack of appropriate RN and support staff was a major concern before the COVID-19 crisis and now it has only gotten worse. According to SEMC RN and MNA Board member Ellen MacInnis, “We started out approximately 43 RN positions short here at St. E’s before the crisis hit. We want to be there for our patients, we only ask for the tools we need to do that job.”
Carney Hospital
Steward publicly announced on March 17 that Carney Hospital in Dorchester had become its dedicated facility for the care of COVID-19 patients but gave no notice to the nurses and physicians prior to the announcement, who learned about it from reporters. While nurses have not criticized the plan in its concept, there was no advanced planning or discussions that involved frontline staff before the plan was announced. Following the announcement, Steward Carney management did not cancel elective surgeries or stop admitting non-COVID-19 patients for some weeks, adding to the generalized confusion and undermining preparedness. Carney staff have been struggling since the announcement to put proper protocols in place, including establishing a safe ER screening process, as well as ensuring access to PPE and other supplies.
Protection of Staff Who Are Exposed
There are not clear protocols known by staff who have been exposed or who suspect they may be positive. “It seems as if they don’t want to know if we are feeling symptomatic, or if we are concerned about a possible exposure, which again, is another way to guarantee unnecessary spread,” said the Carney’s Conlon.
Unlike many other Massachusetts hospitals, Steward is requiring staff who are out of work because they are sick with COVID-19 or in quarantine for two weeks for exposure, to pay out of their own accrued time. At the Carney, for example, vacation and sick leave is in a combined bank, and so an RN out for weeks with COVID-19 may have no vacation time left when she recovers.
To date, Steward has held back on agreeing to a written set of conditions that would enable a nurse or healthcare professional to seek reassignment away from a COVID-19 unit. The MNA has proposed: pregnancy, compromised immune system, heart disease, pulmonary disease, diabetes, etc. and/or that they cohabitate with someone with one or more of these risk factors.
Management has insisted that this agreement must be part of a document in which the MNA would agree that management can order, on threat of discipline, RNs to leave their own hospitals where they are caring for patients and be sent to any other Steward hospital where the RN has never practiced.
Mandatory Policies to Move Nurses Between Facilities Without Proper Safeguards
On March 31 Steward implemented, over the strong objection of MNA nurses, that they can order, on threat of discipline, RNs to leave their own hospitals where they are caring for patients and be sent to any other Steward hospital where the RN likely has never practiced
The MNA strongly supports creating a voluntary COVID-19 crisis float pool among the hospitals and has been urging management to engage with us on that for four weeks. Without working out with the nurses how the voluntary float pool would work and systematically recruiting for it, management cut off discussions and announced that as of March 31 they would enact the policy where they could send nurses to any hospital with 90 minutes notice, “effective immediately”.
During these discussions, the MNA nurses proposed the following protection as part of the process, that “Personal Protective Equipment will be provided to staff.”
Management rejected that proviso and instead substituted it with the following meaningless wording, that only “Available proper Personal Protective Equipment will be provided to staff.”
This policy also fails to acknowledge, and Steward executives have failed to understand that every hospital in the Steward system now has COVID-19 patients, and nurses fear that they will be forced to leave patients in need at their hospital without enough RN staff.
Fears Become Reality Today at Nashoba Valley Medical Center
Yesterday Steward management ordered the RNs who were on the schedule to work at the Nashoba Valley Medical Center ICU to report to work instead at Carney Hospital where they had never practiced. There are three COVID-19 patients and COVID-19 suspected patients daily at NVMC. Some of the cases have been very serious and there have been two reported patient deaths despite the excellent and heroic efforts of the staff. There is a well-publicized COVID-19 outbreak at a nursing home close to the hospital.
The ICU RNs said they could not go to Carney if it would result in there being no RNs in the Nashoba ICU. This morning Steward management shut down the Nashoba ICU and sent the RNs home without pay.
“Because they have shortchanged all our facilities with staffing, their plan to shuffle staff will only weaken care for everyone,” said Jacqui Fitts, an RN and co-chair of the nurses MNA local bargaining unit at Morton Hospital.
The Steward plan to force nurses to move from facility to facility as opposed to a system of accepting volunteers is causing fear of loss of critically needed staff, as it may force nurses to resign and immediately go to work for other hospitals that need them where they will be treating COVID-19 patients under more favorable conditions.
The MNA has been calling upon Steward daily to engage in emergency discussions to resolve these issues. MNA members are raising these concerns now publicly because they need urgent help.
