Executive Director's Column: Everything old is new again (and we’re not talking fashion)


From the Massachusetts Nurse Newsletter
April/May 2012 Edition

Julie PinkhamExecutive Director's Column
By Julie Pinkham

Question: What do platform shoes, bell bottoms and big hoop earrings have in common with hospital mergers/acquisitions, the privatization of public services and the substitution of RNs with unlicensed personnel?

Answer: They are proof that, if you live long enough, everything will come around again.

In the 1990s:

  • 30 hospitals in Massachusetts closed
  • An entire county health care system was eliminated
  • One-third of the state’s health care system was either privatized or closed
  • Most public-sector hospitals, with the exception of Cambridge Health Alliance, were either closed or privatized
  • And two-thirds of all remaining hospitals were merged into several large, integrated delivery systems (i.e., Partners, Caritas, UMass/Memorial, Baystate)

Well, we are there again. Except this time, we have ratcheted up the merger-mania with the sale of the Caritas hospitals to private equity firm Cerberus. As a result, Cerberus now has a health division product line with an impressive equity portfolio—which in turn allows them to buy any other “low hanging fruit” throughout Massachusetts. Cerberus has now grown to a 10-hospital system and there is no end in sight.

Likewise, Partners has been building new facilities while affiliating with others. And, it may acquire more hospitals, including—if the rumors are true—South Shore Hospital in Weymouth.

Cost cutting circa 1992 vs. 2012

Cost cutting efforts in the 1990s included decreasing the number of RNs on staff and substituting them with unlicensed assistive personnel (UAPs). In fact, the effort was so expansive that the Board of Registration in Nursing created regulations to address the issue (now known as CMR 3.05).

Fast forward 20 years: The BORN is considering revamping 3.05 in the name of “cost containment,” although history shows that cost containment ultimately leads to the erosion of the scope of our nursing practice. To be more precise, the use of UAPs in the 90s was an abysmal failure and it created one of the worst nursing shortages the state ever experienced. No cost savings were realized and patient outcomes deteriorated. But consultants are expert revisionist historians, and the words “cost savings” are once again being bandied about. I have no doubt that we will be fighting this battle again, particularly since many of our contracts—as well as our licenses and livelihoods—are tied to the regulatory language itself.

We have fought hard for the rights and benefits contained within our contracts, and we need to fight just as hard for legislative initiatives that will protect our practice, such as language banning mandatory overtime and language on safe staffing. We also need to protect existing legislation and regulations in order to ensure that our practice does not erode further.

Back in the 90s, the MNA organized many new facilities, and we negotiated better standards in our contracts. We also fought to protect patients by successfully advocating for the creation of the UAP delegation language.

If you were an MNA RN during those campaigns, you know what’s at stake. It is time to step up again, and it is also time to share your knowledge and experiences with colleagues who weren’t practicing back in the 90s. Because, as merger mania and cost cutting efforts swell again, we’ll only get through this latest storm together.