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MASSACHUSETTS NURSE NEWSLETTER ::
July/August 2007
NEMC nurses protest unsafe staffing, declining conditions
Hundreds walk picket line at Boston hospital
In the wake of chronic understaffing and unsafe patient care conditions,
more than 300 of the unionized RNs at New England Medical Center
(NEMC) participated in a lively demonstration outside the entrance
to the facility on June 27. Carrying signs that read “NEMC Patients
Deserve Safe Care” and “Safe Staffing Now,” the RNs marched for
two hours to protest the hospital’s failure to respond to repeated
requests for additional staff and equipment that nurses need to
keep patients safe.
 “We
are reaching out at this time because we are concerned for our patients.
Nurses go to work with the fear that an unnecessary patient death
or injury will take place under the current staffing conditions.
We hope to spur the hospital into making improvements. We do not
want a tragedy to be the event that gets their attention,” said
Nancy Gilman, RN, co-chair of the nurses bargaining unit and an
intensive care unit nurse at the hospital. The protest by the nurses,
who are represented by the Massachusetts Nurses Association, came
at time when the hospital has been engaged in a concerted effort
to boost its profit margin by admitting patients despite the lack
of staff and resources to adequately care for them. At the same
time an aggressive campaign by the hospital to expand into suburban
communities has drawn resources away from patient care.
In communications with hospital staff, the management of NEMC has
emphasized the need to create a culture of saying “yes” where all
patients, be they transfers from other hospitals or admissions from
physicians, must be accepted.
“When management demands that we say ‘yes’ to admissions and transfers
without regard to adequate staffing, they are saying ‘no’ to safe
patient care,” said Cathy Proctor, a nurse in the emergency department
and co-chair of the nurses’ union. “Our emergency department is
frequently overcrowded and our nurses are often assigned too many
patients to care for. This means patients are waiting longer to
be seen, with delays in treatment, and extended periods with no
nursing attention. When the backlog of patients awaiting available
inpatient beds overwhelms the ED, management institutes a policy
of forcing patients on to inpatient units where nurses already have
full assignments. It simply moves the unsafe assignment from one
unit to another without solving the underlying staffing problem.”
Maintaining appropriate staffing levels is a constant struggle at
the facility, which is requiring nurses to work overtime to fill
gaps in the schedule and is also causing nurses on a number of units
to take on excessive patient assignments. This is not a result of
the current “nursing shortage,” but is the direct result of management’s
periodic layoff of nurses and the reduction of nursing positions.
A number of nurses from a variety of areas of the hospital have
provided concrete evidence along with written letters to management
highlighting serious patient care issues that have gone unresolved.
This includes:
- In the last few months alone, nurses have filed more than 90
official reports of unsafe staffing conditions at the facility,
conditions nurses say compromise their ability to deliver the
care their patients deserved.
- Nurses from the hospital’s emergency department have sent CEO
Ellen Zane a letter highlighting a number of concerns including
the introduction of a new Level 2 trauma service and a pediatric
emergency service without providing the staff, equipment and training
needed to safely care for these patients. “We believe that the
financial needs of suburban expansion have taken priority over
safe patient care,” the letter states.
- Nurses on the hospital’s surgical floor echo the concerns of
the emergency department nurses on the impact of the “just say
yes” admissions policy along with the new trauma services. In
a letter to Zane, the nurses stated: “The trauma program has created
additional problems. The need to rapidly transfer SICU (surgical
intensive care unit) level patients who may or may not be ready
for transfer has created not only chaos but also an unsafe environment
that diverts attention from the patients already on the unit.
Some of these patients wind up back in the ICU within hours. A
post-op kidney transplant patient used to be included in a ratio
of two or three patients to one nurse. Now, the ratio is four
to one. The amount of care these patients need has not decreased.”
- Nurses from the hospital’s post anesthesia care unit, where
patients recover immediately after surgery, have also drafted
a letter to Zane highlighting the ripple effect hospital cutbacks
and poor staffing have on their patients. “Patients are brought
here to recover from surgery and then transferred to a hospital
room for further care. However, for at least two years now, floor
beds are not readily available for patients, requiring long stays
in the PACU, sometimes for as long as three or four days.” One
letter states, “There is a desperate need for the hospital to
provide quality patient care for patients having surgery.”
- Nurses from the hospital’s medical floors report being assigned
higher numbers of patients, which places those patients at increased
risk for injury or death. In their own letter to Zane, these nurses
also highlight the impact of dramatic cuts in ancillary and support
staff on the ability of nurses to deliver quality care. “The lack
of ancillary staff requires that nurses spend much of their shifts
on non-nursing duties. Our patients are increasingly acutely ill.
Every minute that a nurse spends performing secretarial duties,
emptying trash, removing food trays, is another minute that she/he
is not assessing, medicating or alerting a physician to a change
in patient status. Do we not state in our mission statement that
we are providing ‘the highest standard of patient care and service
to all’? Due to insufficient staffing we have not been able to
provide this level of care in quite some time.”
The nurses have been complaining about poor staffing and patient
care conditions for months and the union has been meeting with hospital
management in repeated attempts to convince them to address the
crisis. The nurses have asked for a number of steps to be taken
to improve the quality and safety of patient care including:
- Increase the staffing in the emergency department and on the
medical surgical floors to allow the safe care of patients.
- Capping admissions when there are not enough staff to properly
care for the patients.
- Going on ambulance diversion when there are no beds or staff
to properly care for the patients; and/or stabilizing and transferring
emergency care patients to a facility that can properly care for
them.
- Create a staffing plan that accommodates ill calls and surges
in patient census.
- Ban the practice of forced overtime at the hospital.
Although the hospital has been open to discussion with the nurses
and some minor improvements have been made, safe patient care has
yet to become a priority in management decision making. In fact,
the hospital recently announced a layoff including registered nurses
that deliver direct bedside care.
Gilman said: “Many of us have been at this hospital for 20 plus
years and we deeply care about its growth and success. We understand
and support efforts for financial stability, but we can’t allow
those efforts to override this hospital’s primary mission to provide
quality medical and nursing care. As nurses we are legally and ethically
accountable for the safe care of our patients.”
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