Nurses go public to expose what the nurses believe is an unrelenting and illegal attack on nurses and their patients by the hospital administration that has degraded care throughout the facility since the end of the nurses’ historic strike
“Once again our CEO and her administration has made an utterly senseless and profit-driven decision that only serves to cause our patients physical and emotional harm, denying them the highest standard of care and dignity they deserve. We cannot and will not remain silent about this or any decision by Tenet that threatens the safety of our patients and our community”
Marlena Pellegrino, RN.
WORCESTER, MA — In response to what the St. Vincent Hospital nurses characterize as a “callous and dangerous” decision to eliminate the hospital’s specially trained and highly skilled IV (Intravenous) Therapy Team, a delegation of nurses will deliver a petition to the hospital’s CEO Carolyn Jackson urging Jackson and highly profitable Tenet Healthcare to maintain this vital service for patients and caregivers. The delegation will gather outside the Summer St. entrance to the hospital on October 27 at 12 noon to meet with members of the media who wish to learn more about this issue, and several other deficiencies impacting the care of patients. The event will also be livestreamed on the Massachusetts Nurses Association Facebook page: www.facebook.com/massnurses.
The petition, which was signed by more than 80 percent of the hospital’s nurses, including signatures from more than 30 physicians, along with respiratory therapists, pharmacists and other hospital staff who rely on the IV Team states: “These professionals provide a valuable service to the hospital, our physicians and our patients and their elimination will only serve to degrade patient satisfaction, increase the risk of serious harm and unnecessary suffering for our patients, expose our staff to preventable needlestick injuries, and yes, result in the loss of revenue due to the complications resulting from this decision.”
The elimination of the IV Team is just the latest assault on the quality and safety of patient care that has further alarmed the nurses and precipitated a decision to alert the public about rapidly deteriorating patient care conditions impacting every aspect of care at St. Vincent Hospital. The nurses have documented a number of deficiencies in patient care and safety including:
- A chronic lack of needed staff, from nurses to aides to respiratory therapists to secretaries to housekeeping staff that is causing inadequate care and monitoring of patients;
- At least three “never events” have occurred in recent months, these events are serious errors that must be reported to DPH;
- Nurses report that numerous operations have concluded with incorrect sponge and instrument counts, with the prospect of these items being left inside a patient;
- A lack of supplies and faulty equipment, including IV tubing and IV fluid, not enough functioning computers for staff, lack of necessary medical, linen, nourishment and cleaning supplies;
- Chronic failures in maintaining essential environmental health and safety over many months, including serious malfunctioning of the air conditioning system and lack of hot water in many areas of the hospital, and even a period of time when the water was shut off throughout the hospital.
All of these deficiencies have contributed to dangerous delays in care, the exodus of more than 100 nurses and other staff, while increasing the risk of serious, potentially life-threatening infections, preventable patient falls and other forms of harm to patients. A full list of these issues is covered later in this release.
“Once again our CEO and her Administration has made an utterly senseless and profit driven decision that only serves to cause our patients physical and emotional harm, denying them the highest standard of care and dignity they so deserve,” said Marlena Pellegrino, RN, a 35-year medical surgical nurse and co-chair the MNA local bargaining unit at St. Vincent Hospital. “We cannot and will not remain silent about this or any decision by Tenet that threatens the safety of our patients and our community.”
Tenet Healthcare has been cutting back on the basics of patient care safety while raking in hundreds of millions of dollars in profits. Earlier this year, Tenet reported a doubling of its profits to $915 million. Meanwhile, the company paid its CEO Saum Sutaria $21 million in FY 2021. According to Becker’s Hospital Review, Tenet Executive Vice President and CFO Dan Cancelmi also took home $7.22 million.
IV Team Elimination
The IV Therapy Team operates 24/7 and is comprised of five long-term, expert RNs dedicated to the specialty of IV placement and care across all clinical settings both in-patient, and out-patient. The IV nurses provide an array of complex care and treatments in addition to initiating peripheral IVs. This team of IV specialists administers various therapies such as blood products, intravenous cathflo activase, a clot busting medication used to dissolve blood clots in central lines and other medications. They provide nurses and medical staff with the education needed to identify central lines along with their use and care. The IV team is also called upon to assess patients who need central line access. Between 80-90 percent of hospital patients require some form of IV therapy. Many of these patients are frail, elderly, or have other conditions that make accessing a site for IV insertion more difficult and require a highly skilled practitioner.
“Every patient that comes into a hospital whether it is an elective surgery, having a baby, or because they are ill and need our services, is anxious, and have the fear of the unknown, including when they have IV lines placed,“ said Deb Berberian, RN, one of the impacted IV Team nurses with more than 30 years’ experience on the team. “We understand their anxiety and we are there to reassure them. The first thing I say to all of the patients I encounter is, 'Trust me. I know what I am doing. I have years of experience because this hospital values an IV team.' I am just so upset now by all of this because our administration seems to have no idea how we can impact the lives and satisfaction of our patients during their stay with us."
The nurses’ petition points out that no other hospital in the city, and very few in the state have made this decision, and when they have, most have reversed the decision due to the negative impacts. In fact, several years ago, a previous administration at SVH attempted to eliminate the team but reversed the decision after a senior physician leader intervened and urged against its elimination.
“Our IV team performs a whole range of specialized skills along with the insertion of IV catheters that will have to be reassigned to staff nurses who lack those skills and experience,” according to Dominique Muldoon, RN, a frontline medical surgical nurse and co-chair of the nurses local bargaining unit with the MNA, who relies on the IV team in the care of her patients. “The loss of this team will result in our patients not only enduring multiple needle sticks, increased infections, complications such as phlebitis and tissue injuries, but also extensive delays in care as our staff nurses scramble to try to fit in the time for these added, complex responsibilities. The reason other hospitals maintain this service is that in the short term, expert IV teams prevent complications that are too costly to ignore and we can’t understand why in a competitive healthcare market our administration is seeking to put our patients at risk.”
The nurses state that numerous studies have documented the importance of IV Therapy Teams. In fact, the Joint Commission, the organization that oversees accreditation of the nation’s hospitals, has reported that "Studies have shown that the use of specialized vascular access teams (or lV teams), consisting of trained nurses or technicians who use strict aseptic technique during catheter insertion and follow-up care can reduce the risk of phlebitis, blood stream infections and costs.”
"We spend our days supporting physicians and nurses by responding to their calls to handle complex IV insertions, and when there is a code {patient experiencing cardiac arrest in need of resuscitation and immediate attention} we have the skill, confidence and experience to calmly place a line that is needed to deliver life-saving medication," Berberian said.
With the elimination of the Team, the hospital plans to require all of its bedside nurses to attend training to learn this highly technical skill, which has distressed the nurses. Forcing nurses who are struggling to maintain safe nursing practice in an already understaffed environment, to take on this new care, along with the high number of novice nurses on staff, will place an additional undue burden on already overwhelmed staff that can compromise the care they deliver and may result in unnecessary pain, while increasing the risk of complications and harm to patients.
“We are the second line of defense for our nurses, who are already overwhelmed caring for acutely ill patients. With our skill and experience, we can insert a line in minutes, without multiple sticks, which may take nurses, even experienced nurses much longer. Our expert support frees them up to focus on other aspects of patient care. This is even more important for novice nurses, who are just getting their feet under them and don’t know what they don’t know,” said Berberian. “Our services are also essential for the care of our inpatient oncology patients, so much so that the policy now is that only our team members are allowed to manage the IV ports that are used to administer life-saving chemo therapy and other cancer treatments.”
In addition to signing the petition, the majority of nurses have registered their opposition to this change by wearing buttons that read “Save Our TV Team: Don’t Stick It to Our Patients” Pellegrino and Muldoon, on behalf of the nurses wrote a letter, a “nurse-to-nurse appeal letter” to the hospital’s Chief Nursing Officer Jay Prosser asking for a meeting to discuss their concerns.
That letter reads in part: “This decision is inconceivable with the current staffing situation, including, the more than 100 RN position vacancies, the continual weekly trickle of resignations of experienced nurses, together with the high number of recently graduated, novice nurses who are already struggling to acclimate themselves to a challenging acute care environment. Nurses approach us daily concerned for the safety of their patients, their practice and the stability of their units. Our patients deserve the highest standard of care and dignity. This is the foundation and obligation of St. Vincent nurses. We respectfully request to meet with you as soon as possible to discuss our urgent call for the administration to rescind this plan. We await your response.”
To date, Prosser has refused to respond to the nurses offer to meet.
“At this tenuous time in health care when other hospitals are doing all they can to retain valuable nursing staff, and when our staff are struggling every shift to meet even the most basic needs of our patients, this decision will only serve to harm our patients and drive still more nurses from the hospital,” Pellegrino explained. “There is no justification for this shameful decision.”
Pellegrino’s warning of the loss of staff due the decision was immediately validated with the loss of Karen Soper, a 26-year, highly respected nurse on one of the hospital’s cardiac telemetry floors, who resigned her position in direct response to the IV Team elimination and Tenet’s failure to provide adequate resources for nurses and patients.
“I am resigning because the working conditions make me afraid for my patients and my license. Administration has made it crystal clear they will always put profits before patients. Every shift is met with unsafe staffing, lack of basic supplies, and patient care needs that are barely being met. The deliberate downsizing of critical team members like secretaries and respiratory therapists and most recently the plan to eliminate our IV team, is no longer something I choose to tolerate,” Soper explained.
Nurses Report Deficiencies in All Areas and All Aspects of Care Delivery
It has been more than 10 months since the nurses ended their historic 301 days strike, which they had hoped would bring an end to the rancor in the hospital and the punitive management culture that had led to the strike in the first place. While the hospital’s CEO Carolyn Jackson had publicly touted her commitment for a more positive relationship, she instead has engaged in a concerted and unrelenting assault on the nurses’ rights, failed to honor key provisions of the nurses contract regarding staffing levels, pursued discriminatory practices against the nurses, appealed to support a failed attempt to decertify the union and unilaterally implemented a plan to force all nurses to work 12-hour shifts, regardless of the impact on their family life and clinical practice.
“For our part, our overriding concern has been and continues to be our commitment to provide the best, most compassionate care to our patients, yet that has become nearly impossible under the conditions and the culture promoted and sustained by our CEO,” said Muldoon. “Since returning from the strike our nurses have been under constant attack from this administration, and even worse, we have witnessed how Ms. Jackson’s policies have degraded every aspect of care for patients throughout this hospital.”
Safety issues nurses have documented include:
- A chronic and deliberate failure by the hospital to provide contractually required RN and other staffing levels, including the assignment of unsafe patient loads resulting in delays in care, including delays in pain relief and other necessary medications, increased risk of falls and other forms of patient harm (i.e., since January, the nurses have filed more than 250 official reports of unsafe staffing conditions that jeopardized the health and safety of their patients);
- With the loss of more than 100 nurses at the hospital largely due to these conditions, Tenet has overly relied on travel nurses and other temporary staff who lack the experience and training on proper hospital policies and procedures, resulting in serious lapses in safety procedures, including patients being admitted to floors without needed documentation and physician orders;
- Nurses report that numerous operations have concluded with incorrect sponge and instrument counts, with the prospect of these items being left inside a patient; and worst of all, at least three “never events” in the last three months. This included a wrong site surgery for one patient, and two wrong site procedures;
- There are currently no chemo certified staff RNs for providing inpatient chemotherapy, jeopardizing patients who require urgent inpatient chemo treatment, exposing them to potential errors in care by inexperienced staff;
- A lack of patient care assistants (PCAs), which means patients are not fed and bathed in a timely manner, and patients are not repositioned and walked routinely, which results in poor patient outcomes, including infections, bedsores and other preventable complications;
- Not enough staff “safety sitters” to provide 1:1 monitoring of patients identified as at high risk for falls, elopement or suicide, while the administration has urged staff to physically restrain patients in lieu of providing the required sitters;
- Not enough secretaries to provide clerical support to the unit, leaving nurses to manage the important functions secretaries provide including coordinating aspects of patient needs such as transportation, labs, tests, and consults. This means nurses are pulled away from providing needed direct patient care to perform these functions, resulting in further delays in care.
- Not enough cleaning staff resulting in dirty floors, “filthy” toilets that can’t flush, mold in the showers on one of the medical floors, overflowing trash barrels on many units as well as unproperly cleaned beds, chairs and tables — with dried blood and other bodily fluids and debris visible. Such poor sanitization contributes to an increased risk for infection for patients and staff, particularly when we are still dealing with COVID-19 and the other contagious diseases.
- The lack of needed supplies and equipment essential for patient care and comfort, including IV tubing and IV fluid and colostomy supplies; lack of clean linens, slip resistant socks, bed pans and urinals; as well as materials for fighting the spread of COVID such as antiseptic cleaning supplies and N-95 masks.
- Broken or malfunctioning equipment including computers used to document patient care, scanners to ensure patients are receiving the correct medications, and other equipment needed for the monitoring and treatment of patients, including a broken laser in the operating room that posed a risk for a fire or injury to a patient or staff.
- Chronic lack of hot water on some inpatient units, which is needed for bathing patients, proper hand washing and other activities essential for preventing infections.
- Lack of functioning air conditioning at the height of the summer heat, with air temps exceeding 82 degrees on inpatient units, specifically on the maternity unit, as well as the Cancer Center, where treatments had to be delayed and rescheduled due to the health risks these conditions posed.
“None of these issues are acceptable on any level and any administrator responsible for these conditions is committing managerial, if not medical malpractice,” said Muldoon. “Our nurses have always taken such pride in being a St. Vincent nurse and we are disgusted to see what this administration is doing to our community hospital and the patients we serve every day.”
Nurses/MNA Seek Every Legal Means to Hold Tenet Accountable
In response to the oppressive and chaotic environment created by Tenet and Carolyn Jackson, the MNA has explored every available legal avenue to hold the corporation accountable.
“We have always acted in good faith to convince our administration to work with us to provide the best care possible,” Pellegrino explained. “For years, we were able to work with local leadership without the need for the filing of charges of unfair labor practices and very few, if any. arbitrations. That has changed since Tenet hired Carolyn Jackson as the CEO. We have tried to meet with them and engage in a rational discussion of all these issues and at every turn we have been met with disdain and disrespect, always dealing with Texas-based Tenet corporate labor relations representatives who have no connection to this hospital or our community.”
Since returning from the strike the nurses have taken multiple legal steps to force Tenet to follow the contract they negotiated with the nurses and to comply with federal labor law including:
- The nurses have filed more than 100 grievances against the hospital for serious and egregious contract violations including violations of required staffing levels, the unilateral hospital wide change to 12-hour shifts, discrimination and retaliation against union nurses to name a few.
- The nurses have filed more than 50 of these grievances for arbitration.
- The nurses have filed a total of 13 charges encompassing 29 counts of unfair labor practices by Tenet with the National Labor Relations Board. Those counts include charges that Tenet:
- Unlawfully targeted MNA leadership for discipline;
- Engaged in unlawful repudiation of the contractual labor management/staffing process;
- Twelve counts for unlawful failure to provide information needed by MNA to process grievances.
- Unlawfully refused to return striking nurses pursuant to the contract’s Return to Work Agreement;
- Engaged in discriminatory floating and flexing of nurses returning from the strike;
- Failure to bargain over the conversion of nursing shifts from 8 hours to 12 hours;
- Failed to provide information needed by MNA regarding compliance with the Stike Settlement Agreement;
- Unlawful refusal to bargain and direct dealing with bargaining unit nurses over mandatory subjects for bargaining;
- Failed to provide information to MNA regarding health insurance plans.
- Discriminated against union nurses and staff by failing to provide access to the Hospital property to conduct legally protected union activity.
In addition to pursuing these legal and contractual remedies, the nurses continue to communicate with local, state and federal elected representatives, policy makers, labor and community-based organizations about the conditions they and their constituents are facing as a result of Tenet’s unseemly behavior.
While the nurses were prevented from speaking out publicly about these issues for the first six months following the contract settlement as part of that agreement, they now feel compelled to take their concerns directly to the public through this press event and subsequent activities as they believe it is the patients and the community served by St. Vincent Hospital that have the most to lose if Tenet behavior continues unchecked.
“As nurses we have legal and moral responsibility to serve as advocates for our patients and to do whatever is in our power to keep them safe,” Muldoon explained. “For our patients, this is truly a matter of life and death and we will not let them down without a fight.”
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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.
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