AYER, Mass — The 124 registered nurses at Steward Nashoba Valley Medical Center (NVMC) in Ayer, who are represented by the Massachusetts Nurses Association (MNA) and who are currently in contract talks with management, cast an overwhelming vote this week (on April 30 and May 1) authorizing their local union leaders to call a one-day strike should hospital management fail to address several issues that currently affect RNs’ ability to deliver the best possible care to their patients.
The RNs have been in contract talks with management since December of 2018, with the previous contract expiring exactly five months and one day from this week’s authorization vote. 13 negotiation sessions have been held so far. Throughout these sessions, the nurses have been committed to improving nurse staffing levels and making NVMC financially competitive for the benefit of nurse recruitment and retention.
Only once in those 13 sessions has management actively engaged in discussions about economics, and it has completely rejected the nurses’ proposals aimed at improving nurses’ patient assignments.
“Our hospital has an excellent reputation in the community, and it is staffed with great, dedicated caregivers,” said Fran Karaska, co-chair of the MNA bargaining unit at NVMC. “But the hospital’s inability to recruit and retain RNs, due to a lack of competitive wages, will harm both the hospital and community in the long term.”
Related Statistics on NVMC’s Nurse Staffing Levels; ICU is Particularly Affected
- Overall turnover of the nursing staff at NVMC is more than 200 percent of the northeast hospital average of 16.5 percent annually. The current RN vacancy rate is likewise more than 200 percent of the national average.
- In 2018, 12 percent of the time (84 shifts out of 730) the Intensive Care Unit (ICU) was staffed with only one RN. In the first three months of 2019, 35 percent of the time (52 shifts out of 148) there was only one ICU RN.
- Apart from approximately three nurses, the RN staff in the geriatric psychiatric unit has turned over entirely three times in the past three years.
- Schedules, which are posted three weeks in advance, almost always have “holes,” meaning that management cannot say what RNs will be assigned to what shifts because there are not enough RNs on staff for proper scheduling. During a six-week period in February and April, there were 93 open shifts in the ER alone.
- Patients are frequently transferred from the ER to other hospitals because there is not enough staff to care for them. ICU patients are routinely transferred from NVMC to other Steward hospitals due to a lack of appropriate nurse staffing.
- ICU beds have been closed due to the shortage of ICU RNs. In response, the hospital depends on unsafe stopgaps: boarding ICU patients in the ER and transferring ICU patients to non-ICU floors where the nursing care is not specialized. During some shifts, management closes the ICU entirely due to a lack of RN staff.
“Management often closes the ICU entirely for portions of days, which means that any patients coming in through the ER who need ICU care have to be transported away,” said Audra Sprague, RN and bargaining unit co-chairperson. “They also regularly limit the number of open beds in the ICU to just two, because they cannot find nurses to staff the unit. All these closures and transfers put patients at risk unnecessarily, as what patients really need when they arrive at our hospital is care now — not simply an assessment and a transfer elsewhere for care that we are completely qualified to deliver here.”
“We have tried addressing these issues at the bargaining table,” added Sprague. “But after countless hours of sitting with management, it has become apparent our concerns are not being taken seriously. For the health and safety of our patients, and for the future of our hospital, we needed to take this strike authorization vote.”
A recent analysis that compared the wages of Nashoba RNs to those of RNs at 22 competing hospitals showed that NVMC nurses earn up to 25 percent less than some of their local counterparts. Over the course of 20 years with these wages in place, a Nashoba RN would lose out on nearly $217,000 in wages alone, before adding in loss of comparative benefits.
Adding insult to injury, Steward NVMC recently successfully applied with the Centers for Medicare & Medicaid Services (CMS) to have its reimbursement-rate designation changed from “Central Massachusetts” to “Boston.” Steward’s rationale for this request was that its costs are like those of Boston hospitals, including labor costs. Since receiving this reclassification in 2018, RNs have not seen an increase in compensation, nor has its rate of new nurse-hires flourished.
“Whatever financial benefit the executives of this for-profit hospital have seen from reclassification, it has evidently gone into their pockets,” said Karaska, “because it has not trickled down to the people providing the care, and it has not resulted in an increase in hiring. We continue to lose staff to other hospitals, including Boston, Lawrence, and Worcester hospitals where wages are 15 to 25 percent higher.”
The secret-ballot vote took place inside of the medical center from 6 a.m. to 8 p.m. on both Tuesday, April 30 and Wednesday, May 1, the latter of which was International Workers Day. While the vote does not mean the nurses will strike immediately, it gives the nurses’ negotiating committee authorization to call a one-day strike when they feel it is necessary.
Should the committee issue an official notice to strike, the hospital will then have 10 days before the nurses go out on strike.