According to Recent JAMA Study, University Campus Staffing Ratios Place Some Patients at 31 – 49% Greater Risk of Death
Nurses Regularly Report Having a Lack of Supplies Needed to Provide Safe Patient Care
WORCESTER, Mass. — After more than 10 months of negotiations with hospital management over their union contract, the registered nurses of UMass/Memorial – University Campus have decided to go public with their concerns about the status of contract talks, which involve a number of issues that impact the safety and quality of patient care at the city’s major tertiary care facility. While the nurses have been requesting an opportunity to discuss their concerns privately with CEO John O’Brien, he has refused to come to the negotiating table, allowing his negotiating teams to block proposals the nurses believe are central to the delivery of quality patient care.
The key issues stalling a settlement include the hospital’s refusal to accept language creating a union-management staffing tribunal to develop safer staffing levels, the hospital’s refusal to accept language committing them to provide necessary supplies for the delivery of appropriate nursing care, and the hospital’s refusal to pay nurses a salary that reflects the complex nature of nursing care required at the University Campus, the most sophisticated and demanding health care environment for nurses in all of Central Mass. The hospital is also insisting upon authority to select RNs who may remain after lay-off. Given the current nursing shortage, it is unbelievable that these negotiations even involve such discussions.
More than 700 registered nurses are represented by the Massachusetts Nurses Association on the University Campus. The nurses’ contract expired on April 1, 2002 and talks began on April 16. To date, 26 negotiating sessions have been held, with the last five sessions facilitated by a federal mediator.
Earlier in the negotiating process, CEO John O’Brien inserted himself into the negotiations by explaining his position that he seeks a standard wage scale across all UMass/Memorial campuses. This means that RNs at the University Campus are being offered a lower wage increase in the first year than RNs in the rest of the system. Despite that fact that the RNs respectfully listened to Mr. O’Brien’s proposal, he refuses to respectfully listen to the RNs response to his position.
At the center of the nurses’ complaints is the lack of management’s recognition of the complexity of the services provided on the University Campus and its impact on the RNs workload, the level of skill and experience required to deliver care and the lack of recognition of the value they bring to the organization.
"We are the major trauma center, a regional transplant center and a leading research/teaching facility for all of Central Mass," said Kate Maker, chair of the nurses’ bargaining unit. "Our nurses work with the most complex cases, with experimental, cutting edge drugs and procedures. We have the most sophisticated and demanding practice in the region and we deserve to be paid on a par with nurses in the state who provide the same level of care. Why? Because we are losing nurses every day to major teaching hospitals in Boston who pay their nurses a fair salary for their experience."
If you compare the University Campus nurses’ salaries to those in facilities of comparable complexity, the nurses are dramatically underpaid when compared to Brigham & Women’s Hospital and New England Medical Center. The hospital’s proposal would place the University Campus nurses 10% below the salaries of nurses in comparable facilities.
The salary issue takes on added significance when nurses compare their working conditions with those of better staffed facilities. University Campus staffing levels are among the worst in the area, and are well below those of teaching hospitals in Boston.
"We are in the midst of a nursing shortage, driven by low salaries and poor staffing conditions. We will never provide the level of care our patients expect unless and until we guarantee their nurses to conditions they need to want to work in this high stress environment," Maker said.
Below is summary of the each of the key issues in dispute:
Unsafe Staffing Conditions
"Our staffing ratios are not just inadequate, they are patently dangerous in some cases," said Maker
"Nurses on some floors are regularly assigned 6 and 7 patients per nurse, and sometime as many as 11 patients, this on a floor with severely ill trauma, neurological and surgical patients requiring constant monitoring and oversight from their nurses," said Sally Charest, RN. According to a recent study published in the Journal of the American Medical Association, these ratios are life threatening. The study found that for every patient over 4 that is assigned to a nurse there is a 7% increase in mortality of those patients. The risk of death and complications for a patient being cared for a nurse with 7 patients is 21% higher, for a patient whose nurse has 11 patients, it’s 49%.
While staffing conditions have been a problem at the facility for a number of years, they have worsened following changes made by the Hunter Group to consolidate floors and to cut resources and staff that provided support to the nurses.
These staffing levels are untenable for a typical community hospital, never mind a trauma center. "We have newly recruited RNs who leave within the first six (6) months of hire because they can’t believe the level of patient acuity and the patient load. These RNs opted to leave, rather than practice in these circumstances," Maker explained.
To address the problem, the MNA has proposed contract language that has been successful at other facilities with similar problems, including Boston Medical Center and Cambridge Health Alliance, where John O’Brien had served as CEO before coming to UMass/Memorial.
The language calls for the creation of a staffing tribunal, made up of equal numbers of union members and nurse managers. The group would have 90 days to review the staffing on all floors and to come up new staffing patterns to ensure safe patient care. These recommendations would be presented to management and could not be unreasonably denied.
The hospital has instead only proposed that the RNs discuss issues with a staffing advisory committee that would have no binding authority to establish staff guidelines for each floor or unit based upon the number of patients and their acuity.
"We have been talking to management about these issues for months and nothing changes. It’s time they made a commitment to work with us to ensure that staffing at this facility is safe and appropriate. This process has worked in other places and it can work here," Kathie Logan, RN, bargaining unit Vice-Chair.
Lack of Appropriate Supplies
Nurses are also concerned about a chronic lack of appropriate basic equipment and supplies needed to take care of patients. Nurses in the Intensive Care Unit report that oftentimes there is insufficient equipment and supplies on a unit, requiring RNs to spend precious time tracking down and borrowing the necessary items. Other departments report a chronic lack of oxygen tanks for patients with respiratory problems.
"Nurses are forced to scramble and literally grovel for supplies from other departments to ensure their patients get what they need," Maker said. "It’s absurd that a hospital operates in this way and that patients suffer because nurses don’t have the most basic items at their disposal. Again, we have complained about these problems for years and nothing is done to address them, we only get promises of change."
To address the problem, the union has proposed simple language that obligates the hospital provides necessary resources and supplies to provide care. Once in the contract, the nurses would have the right to use the grievance and arbitration process to force the hospital to provide adequate supplies.
"It’s sad that we have to push for language to obligate a hospital to do what it should do automatically, but we can’t allow the current neglect of patients to continue. We need some leverage to make them act responsibly," said Maker.