Labor Action News
The power of a picket
03.15.2010
From the Massachusetts Nurse Newsletter
March 2010 Edition
RNs at BMC and Tufts show solidarity in their dedication to safe patient care
The MNA nurses at both Boston Medical Center’s East Newton Campus and Tufts Medical Center took the unprecedented step last month of conducting joint informational picketing outside their facilities to protest dangerous changes in RN staffing levels at both hospitals. The changes will result in nurses caring for too many patients at one time and could compromise the quality and safety of patient care.
The pickets had nothing to do with any contract negotiations (both groups have contracts in place) and the protest had nothing to do with the nurses’ wages or benefits. It was about nurses’ concern for the health and well-being of the patients under their care.
“We protested because we are concerned for our patients’ safety,” said Barbara Tiller, an RN at Tufts and co-chair of the local bargaining unit. “Nurses go to work every day with the fear that an unnecessary patient death or injury will take place under the current staffing conditions.”
“Nurses at Boston Medical Center, like our colleagues at Tufts Medical Center, decided they couldn’t remain silent while our respective administrations attempt to cut costs at the expense of the safety of patients,” said Ann Driscoll, RN, a long-time nurse at BMC and chair of the local bargaining unit. “The public has a right to know about decisions that are being made at these hospitals that jeopardize their safety.”
The nurses at these facilities have been facing what is becoming a growing trend as the hospital industry attempts to exploit a challenging economic climate to reduce costs and to boost their profit margins by cutting nursing staff. In the 1990s, hospital management employed the same tactics. At that time, this response to the advent of managed care resulted in a dramatic deterioration in the quality and safety of care in hospitals and led to thousands of preventable patient deaths across the country.
Nurses, who have been through this failed strategy before, are not going to allow hospitals to make the same dangerous mistakes again without a fight. The Feb. 11 picket was the beginning of that effort.
Boston Medical Center: The issues
The hospital is seeking to increase the number of patients assigned to nurses in the critical care areas. On one unit, where nurses have traditionally cared for no more than two patients at a time, the hospital is now demanding that nurses take a third patient, which, given the condition of the patients on this floor, would put these patients at a much greater risk for serious complications.
Nurses on other floors have also seen their patient assignments increase. In addition, the hospital is staffing at a bare bones level and is making up for the shortage of staff by the use of widespread “floating” of nurses. In the ICUs, some units are staffed so that more than half the nurses are floats who are not familiar with the unit.
In the last several months, the nurses have filed dozens of official reports of inadequate staffing conditions at the facility, and some have reported that these conditions compromised the care of their patients.
In a letter opposing the staffing changes sent to the board of trustees, which the majority of the nurses working in BMC’s ICUs signed, the nurses wrote, “We implore hospital management to address the situation and to turn away from these dangerous conditions and the tragic patient outcomes that may result.”
Driscoll pointed out that the hospital’s vice president of nursing, Lisa O’Connor, has refused to work with the nurses through a legally binding process at the hospital to set appropriate staffing levels. For more than a decade, the union and management worked together, under contract language negotiated during the last staffing crisis in the late 1990s, which established a staffing tribunal made up of union nurses and management with the expressed purpose of setting safe and appropriate staffing levels. O’Connor, however, has failed to work through the tribunal, and instead is pushing for unilateral changes over the objections of those providing the care.
In addition to failing to provide a safe working environment, O’Connor has employed a number of oppressive management practices, creating a punitive environment that has caused unrest within the nursing community at the hospital, one that the nurses say needs to change if BMC is to maintain its reputation as a first rate medical center.
“Nurses are the backbone of any hospital, but our nursing management seems intent on breaking the backs of nurses,” said Driscoll. “Our members have made it clear that we can’t take this anymore, and we will do whatever is necessary to protect our patients.”
The nurses are further outraged that the hospital has made these cuts while providing the outgoing CEO with a $3.5 million bonus. The nurses are hopeful that the needed changes will be easier to implement under the direction of Kate Walsh, the hospital’s new CEO.
Tufts Medical Center: The issues
At Tufts Medical Center, even at current staffing levels, nurses have reported difficulty providing the level of care patients deserve. However, in the last six months the hospital has engaged a high-priced consulting firm to develop a “new model” of care with a principal economic goal of cutting the amount of money ($34 per patient day or $3 million) spent on patient care.
The planned cuts involve limiting the amount of care provided by RNs while simultaneously caring for more patients on almost every unit. In fact, according to the Massachusetts Hospital Association’s “Patients First” Web site, many units at Tufts will have the lowest nurse staffing levels of any similar-sized hospital in the city.
The consultants used by Tufts are typical of consultants used during the 1990s when “redesigning” the delivery of nursing care was all the rage. At that time, there was not a shred of research to support such changes in staffing. Today more than 40 studies contain overwhelming scientific evidence proving that implementing changes such as those proposed at Tufts dramatically increases the risk of patient injury, complications, lengths of hospital stays, and could even lead to otherwise preventable patient deaths.
In a letter to management signed by nearly all the nurses on a busy cardiac floor, the nurses wrote: “With both the current and newly proposed staffing models … opportunities for critical observation and patient advocacy will effectively disappear … higher nurse-patient ratios will lead to increased mortality and poor patient outcomes.”
In creating the new staffing model the hospital violated the nurses union contract, which includes a process for the union and management to work together to address staffing concerns. Tufts management ignored that process and utilized the consultant to engage in a process, common for these redesign schemes, where committees are formed and elaborate processes are implemented to give staff the illusion that they have helped develop the new model of care.
“This process is a sham,” said Julie Pinkham, RN, executive director of the MNA, who was involved in efforts during the 1990s to combat the redesign initiatives. “Management knows from the beginning what cuts are going to be made and what model they will end up with. The committees are used to co-opt the employees and to make them believe they are responsible for creating the changes, the very changes that will undermine their ability to deliver safe patient care.”
The process did not fool the nurses at Tufts. More than 30 nurses who participated in the planning committee for the new model signed a letter stating their opposition to the changes and to the fact that their actual suggestions to improve care at the hospital were ignored.
Last year, Tufts CEO Ellen Zane engaged in a highly public battle with a major insurer demanding higher payments for the care of Tufts patients, citing the fact that Tufts nurses and physicians care for the most acutely ill patients in the state. Now, instead of investing those resources in better patient care, Tufts is cutting the level of care provided to them.
According to the Agency for Health Care Research and Quality, every additional patient assigned to an RN is associated with a 7 percent increase in the risk of hospital-acquired pneumonia, a 53 percent increase in respiratory failure, and a 17 percent increase in medical complications. Better RN staffing results in improved patient outcomes, fewer deaths and shorter hospital stays.
“The nurses who work at these hospitals understand the limitations of the current economic climate,” Driscoll added. “But we believe the hospitals should not exploit this situation to boost their bottom line and patients should not pay the price for misguided decisions to cut costs at the expense of quality patient care.”
