Bad blood at St. Vincent
By Suzanne Gordon and Steve Early, Boston Globe, 4/12/2000

Score another hit for mismanaged care. In the midst of the biggest nursing shortage in recent years, Tenet Health Care Corp.'s St. Vincent Hospital in Worcester has forced its nurses to strike over conditions that discourage people from entering the nursing profession and prevent them from caring for patients safely. The March 31 walkout by 535 members of the Massachusetts Nurses Association raises critical questions. Is the corporate drive for profit really compatible with the delivery of quality health care? Does the never-ending cost-cutting imposed on hospitals by HMOs and other insurers make it impossible for nurses to do their job?

It is no coincidence that the first nursing strike since 1986 in an acutecare facility in Massachusetts is taking place at St. Vincent. While many nurses have voiced similar complaints about short-staffed units, huge patient loads, and mandatory overtime, union members at not-for-profit hospitals have managed to resolve their differences with management without a major walkout.

Thanks to a for-profit conversion in 1997, St. Vincent's is now one of only two investor-owned hospitals in the state. Prior to arriving in Massachusetts, Tenet had a long and sordid history of attempting to boost its bottom line by fleecing the federal government and private insurers. In its previous incarnation - as National Medical Enterprises - the company was forced to pay $379 million in criminal fines, civil damages, and penalties because of its fraudulent transactions. More recent fraud claims by six insurers were settled for $125 million. Meanwhile, patients have collected more than $120 million in damage settlements involving Tenet and its physicians.

Testimony in some of these cases revealed that National Medical Enterprises paid head-hunting bounties for referrals of people with good mental health coverage to its psychiatric hospitals. Hundreds of patients - often children and teenagers who had minor behavioral problems - were held against their will , given unnecessary medication, subjected to questionable and potentially abusive therapies - until their insurance ran out. Then, no matter what new problems had been created for them, they were discharged. When nurses opposed such practices, managers called them rebellious, falsely accused them of negligence, and fired those who continued to complain.

Tenet's attitude toward nurses at St. Vincent's has unsettling echoes of this earlier scandal. RNs have seen their patient loads double over the past few years. They've already filed 475 reports of staffing assignments that they believe put patients in jeopardy. Yet the hospital insists that they must be available to work unlimited amounts of mandatory overtime - up to 16 hours a day if necessary.

For a largely female work force (with day care providers who don't work double shifts), such long hours and the lack of fixed schedules make it very difficult to juggle job and family responsibilities. For patients, it increases the risk that a mistake made by an exhausted and overworked RN will worsen their condition or kill them.

The hospital argues that forced overtime is necessary not to fill in for unforeseen emergencies but because of a shortage of staff. At the same time, management claims that there are sometimes too many RNs on duty in units without enough patients. To remedy that, St. Vincent's wants to send nurses home without pay, forcing them to use up vacation days. If they exhaust their vacation time, they would go without pay.

Tenet's intransigence on staffing and scheduling issues creates a no-win situation for nurses, patients, and the community. RNs are indisputably in short supply in hospitals throughout the country. Yet as the American Hospital Association itself admits, their dissatisfaction may be driving the current shortage. In a job market that offers women greater choices than ever before, more qualified women - and men - will enter nursing only if caregiving work gets the recognition and respect it deserves.

When hospitals impose conditions on RNs that would be unacceptable to any other group of professionals is hardly an advertisement for a career in nursing - at St. Vincent's or anywhere else.

Suzanne Gordon is the author "Life Support: Three Nurses on the Front Lines."  Steve Early works for the Communications Workers of America.

This story ran on page A19 of the Boston Globe on 4/12/2000.  © Copyright 2000 Globe Newspaper Company.
 

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