BOSTON – In the wake of chronic understaffing and oftentimes unsafe patient care conditions, more than 300 of the registered nurses of New England Medical Center 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, comes 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 an available inpatient bed 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 have 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,” the 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.”