RNs, others say the problem puts patients, staff and the local community in jeopardy
TAUNTON, Mass.— A recent survey of nurses and health professionals at Taunton State Hospital (TSH) found that a shocking 97 percent report staffing conditions that are dangerous, risking the safety of patients and staff as a result; nearly 90 percent report working conditions that prevent them from providing care up to their professional standards; and nearly 80 percent report that they have/are considering leaving the facility because of the unsafe conditions.
After more than a year’s worth of meetings with nursing administration and management at TSH regarding the issue of understaffing and its impact on patient safety, nurses and health professionals represented by the Massachusetts Nurses Association (MNA) recently announced the results of an in-hospital survey that aimed to better gauge exactly how pervasive the issue of understaffing has become, and how it is impacting the safety of TSH patients, staff and the larger Taunton community as a result. In addition, they recently completed a petition drive that yielded hundreds of signatures from TSH employees. The petition—which called for the administration at Taunton to provide safe and consistent RN-to-patient ratios, as well as appropriate numbers of LPNs and mental-health workers in order to end the dangerous conditions that patients, nurses and professionals face on a daily basis—was delivered to TSH administrators early last week.
Michael McCarthy, RN and chairperson for the MNA at Taunton stated that, "If TSH management maintains its current staffing practices, they run the risk of leaving room for a major mistake to be made. The potential for disaster is there. For example, understaffing contributes to the inability of RNs to adequately assess patients for changes in mental status, or behaviors that indicate what safety interventions are needed."
More than 75 percent of those RNs who received the anonymous survey responded. Key results included:
- 97 percent of respondents believe that management is dangerously understaffing the hospital, risking the safety of patients and staff as a result.
- 95 percent believe that staffing levels have been chronically inadequate for the last two years.
- 89 percent felt as though their working conditions force them to provide a level of care that is below their professional standards.
- 100 percent said that they do not feel that they have sufficient time to provide the level of care that their patients require.
- 92 percent said that they do not feel supported by the nursing department at TSH.
- 78 percent said that they have seriously considered leaving TSH.
- 54 percent had been the victim of physical abuse at TSH.
- And a shocking 97 percent of respondents know of a co-worker who has been the victim of on-the-job violence.
According to the most recent medical research, this chronic understaffing is guaranteed to have an overwhelmingly negative impact on patient safety. In fact, survey results alluded to this happening at TSH already—with most respondents reporting that they have seen a marked increase in the number of patient assaults on staff; patient self-injuries; re-admissions; and medication errors in the last two years.
Concern for the Patients, Concern for the Community
"Taunton State Hospital is meant to provide services and care to a population of patients that has acute mental health needs and require a high level of attention and care," said Jesse Hill, an RN and vice chairperson for the MNA unit at Taunton, as well as a recent recipient of a 2004 Employee Performance Recognition Award from the Department of Mental Health. "In addition, we know that any mental health facility is best able to provide these types of services when it has appropriate RN-staffing levels along with appropriate levels of support staff. If things were done right, there would be consistency in staffing levels on a day-to-day basis. But this is not what is happening at Taunton. Staffing is unpredictable at best, and it is often unsafe."
According to Hill, this also puts another population at risk: the greater Taunton community as a whole. "One of the unique things about TSH is that there are a significant number of forensic (court-involved) patients being treated here. In these situations, the issue of understaffing takes on even more importance."
"We’ve discussed all of these issues with key TSH administrators numerous times over the last year", said Bill Fyfe, an RN at Taunton State and president of the executive board representing health care professionals employed by the commonwealth, "and we hoped to have made more progress on them by now. But, to some extent, administration says that they are bound by the budgetary constraints placed upon them by the Department of Mental Health. If that’s the case, then TSH is part of something even bigger that is in need of urgent repair. And until that happens some of our state’s most at-risk citizens will continue to suffer the consequences."
"Unless something is done and done quickly to improve conditions at this facility, we are very fearful that something could go seriously wrong at this facility—a facility that cares for some of the region’s most severely mentally ill patients, including forensic patients," added Fyfe. "We have been trying to work with management to convince them to fix these conditions, but they have failed to address our concerns."
Nurses at TSH say that the survey results are compounded by the fact that TSH has seen a dramatic and disturbing turnover rate in its nursing staff since the issue of understaffing became so pervasive. In fact, one informal evaluation showed that approximately 50 MNA-represented registered nurses have left TSH in the last four years—with about 30 of these nurses leaving in the last 12 months.
"What we have is the equivalent of a mass exodus of nurses from Taunton State," said Ellen Farley, an RN and the membership chairperson for the MNA at Taunton.
"Because conditions are so unbearable, nurses are leaving the hospital in droves" added Karen Coughlin, an RN and the bargaining unit’s secretary. "And we’re to consider as many options as possible in order to make it known to administration and DMH that the conditions that have led to this exodus cannot continue.
