“Yes” vote empowers union leaders to call a strike at any point, but does not send nurses immediately to the picket line; nurses back at the table tomorrow, Aug. 21
On Monday evening, Aug. 19, the 62 registered nurses working for the Visiting Nurse Association of Cape Cod Healthcare (the VNA), and who are unionized with the Massachusetts Nurses Association (MNA), unanimously voted in favor of allowing union leadership to call a strike should one be needed in their ongoing contract struggles with Cape Cod Healthcare (CCHC) management.
Since February 28 of this year, VNA nurses have been at the contract table across from CCHC management trying to win important contract language that will improve nurses’ ability to work safely, effectively, and efficiently while providing the best and safest care possible to Cape Cod residents.
The nurses’ key concerns include CCHC’s inability to retain and recruit nurses to the VNA due to low wages; the need for improved patient assignments; and the need for contract language that adjusts for the unique circumstances affecting care delivery to at-home patients on the Cape, such as distance between assignments, seasonal population increases, traffic, and the additional job responsibilities that happen outside of patients’ homes.
But after 14 arduous negotiation sessions, and the arrival of a federal mediator to the process, little headway has been made at the table.
“We know what our patients need, and we know how to get there,” said Mike Berry, RN and co-chairperson of the VNA’s MNA bargaining unit. “We are 100 percent committed to being the strong advocates our patients deserve, but CCHC is fighting us at every turn.”
Lack of Competitive Wages Breaking the Cape’s VNA System
Only 61 permanent MNA RNs currently work for the VNA. The following list details the exodus of nurses — an exodus that union leadership has been pointing out to management for months:
Count of Permanent MNA RNs at CCHC/VNA Since January of 2022:
- January of 2022: 91
- January of 2023: 79
- August of 2023: 76
- January of 2024: 70
- August 20, 2024: 61
Although seasonal travel nurses are always part of the VNA’s nursing mix on the Cape, travelers now work year-round and during the off-season. A total of 30 travel RNs currently work at the VNA. They make up a shocking 33 percent of the workplace.
Meanwhile, employing so many travel RNs comes at a tremendous cost to CCHC, and the money should instead be invested in rebuilding a permanent VNA workforce. There are more than 25 open positions at the VNA, and no union nurses have been hired since September of 2023.
“Our wages are not competitive, and they haven’t been competitive in a very long time,” said Barry. “With such uncompetitive wages in place, recruiting new permanent nurses to the VNA is almost impossible, and keeping our highly-skilled permanent nurses is no easier. Meanwhile, CCHC spends hundreds of thousands of dollars each month desperately trying to hold the VNA system together with temporary RNs.”
The salary issue was compounded when, in early January of this year, CCHC president Mike Lauf took “a pro-active approach to wages” and recognized that “the market [had] changed for nursing pay.” He then implemented a “significant interim wage adjustment” for RNs and LPNs at CCHC’s Hyannis and Falmouth hospitals. Those wage improvements remain in place today but have yet to be extended to the VNA nurses.
Patient Assignments Out of Step with Realities of VNA Care on the Cape
The CCHC VNA nurses care for patients across 1,000 square miles — an area accessible via one primary highway — and whose needs run along a long, complex spectrum. However, how patients are currently assigned to CCHC VNA nurses does not consider the acuity of patients as it relates to the realities of nurses’ workdays.
The agency stated that the average home visit is 42 minutes, but this does not account for travel, patient acuity, and documentation completion. Nor does it account for all the ancillary things nurses do around each visit. “We do prep work and documentation. And we draw labs and deliver these labs to various locations for assessment,” said Diane Munsell, RN and MNA union co-chair. “All of this happens outside patients’ homes, but it is still part of the patient assignment. Add to this the differences in patients’ acuity, the everyday SNAFUs that occur, and traffic and it becomes clear the patient assignments need to be reduced.”
The nurses have offered proposals to improve the situation, including reducing patient visits by two per week per nurse, and taking one patient less per day for every 30 miles a nurse travels from one assignment to the next.
“With the wage improvements we’ve proposed we will easily attract more VNA nurses to CCHC,” added Munsell, “and that in turn will allow for patient assignments in line with the realities of our jobs.”
About Visiting Nurses
In recent years, many hospital-based services have shifted to in-home services, making visiting nurses an essential and ever-expanding part of the American healthcare system. Hospitals now move patients back home faster than before, as doing so reduces costs and opens in-hospital beds. This has led to a dramatic increase in the size of the region’s at-home patient population, as well as in the complexity of those patients. However, the working conditions for the VNA nurses who care for at-home patients have not kept pace with environmental changes or the market.
“Our ability to provide high-quality care to our at-home patients directly contributes to CCHC’s success in meeting Medicare’s value-based compensation criteria,” said Lisa Schultz, a VNA nurse. “We have also successfully minimized the likelihood of readmissions after the 30-day window. CCHC management needs to acknowledge these contributions, rather than viewing us as a separate entity. And if it takes going on strike to get management there, we are ready to go.”
The nurses’ next negotiation session is scheduled for tomorrow, Aug. 21.
