Request from nurses comes after 10 contract sessions, with little headway made on patient assignments, complexities of delivering care to at-home patients on the Cape, poor staffing, and pay inequity
The 66 registered nurses working for the Visiting Nurse Association of Cape Cod (the VNA), and who are unionized with the Massachusetts Nurses Association (MNA), recently invited a federal mediator to join their contract negotiations with Cape Cod Healthcare (CCHC) management. The mediator’s first session with the nurses and management was yesterday, May 15, and it comes after 10 previous sessions where little headway was made on key issues affecting the nurses’ ability to work safely, effectively, and efficiently while providing safe patient care to Cape Cod residents.
The nurses’ key concerns include CCHC’s inability to retain and recruit nurses to the VNA due to low wages; the need for improved patient assignments; and the need for contract language that adjusts for the unique circumstances affecting care delivery to at-home patients on the Cape, such as distance between assignments, seasonal population increases, traffic, and the additional job responsibilities that happen outside of patients’ homes.
Lack of Competitive Wages Stand to Break the Cape’s VNA System
The VNA currently employs approximately 66 MNA nurses, down from about 78. As recently as this month, 22 travel nurses were working for the VNA. Although travel nurses have always been part of the VNA’s nursing mix on the Cape, these 22 travelers have been working during the off-season, making up a quarter of the VNA’s nursing staff and to the tune of hundreds of thousands of dollars monthly.
“Our wages are not competitive, and they haven’t been competitive in a very long time,” said Michael Barry, RN, and chairperson of the VNA’s MNA union. “With such uncompetitive wages in place, recruiting new permanent nurses to the VNA is almost impossible, and keeping our highly-skilled permanent nurses is no easier. Meanwhile, CCHC spends hundreds of thousands of dollars each month desperately trying to hold the VNA system together with temporary RNs.”
The salary issue was compounded when, in early January of this year, CCHC president Mike Lauf took “a pro-active approach to wages” and recognized that “the market [had] changed for nursing pay.” He then implemented a “significant interim wage adjustment” for RNs and LPNs at CCHC’s Hyannis and Falmouth hospitals. Those wage improvements remain in place today but have yet to be extended to the VNA nurses.
Patient Assignments Out of Step with Realities of VNA Care on the Cape
The CCHC VNA nurses care for patients across 1,000 square miles — an area accessible via one primary highway — and whose needs run along a long, complex spectrum. But how patients are assigned to VNA nurses does not involve the acuities of patients as it relates to the realities of nurses’ workdays.
“The agency stated that the average visit is 42 minutes in the home, but this does not account for travel, patient acuity, and documentation completion,” added Barry. “But that does not account for all the ancillary things we do around each visit. For example, we do prep work and documentation. We draw labs and deliver these labs to various locations for assessment. All of this happens outside patients’ homes, but it is still part of the patient assignment. Add to this the differences in patients’ acuity, the everyday SNAFUs that occur, and traffic and it becomes clear the patient assignments need to be reduced.”
The nurses have put forth a configuration of proposals that would improve the situation, including reducing patient visits by two per week per nurse, and taking one patient less per day for every 30 miles a nurse travels from one assignment to the next.
“With the wage improvements we’ve proposed we will easily attract more VNA nurses to CCHC,” said Diane Munsell, RN and co-chair of the nurses’ union bargaining unit, “and that in turn will allow for patient assignments that are in line with the realities of our jobs. We hope that bringing a mediator to the table for the rest of the negotiations will help us achieve these goals.”
About Visiting Nurses
In recent years, many hospital-based services for patients have shifted to in-home services, making visiting nurses an essential and ever-expanding part of the American healthcare system. Hospitals now move patients back home faster than before, as doing so reduces costs and opens in-hospital beds. This has led to a dramatic increase in the size of the region’s at-home patient population, as well as in the complexity of those patients. However, the working conditions for the VNA nurses who care for at-home patients have not kept pace with environmental changes or the market.
“Unlike CCHC management, we see the pivotal role we play in maximizing Medicare value-based compensation. Through our dedication and expertise, we consistently deliver exceptional care to patients, resulting in improved health outcomes and reduced healthcare costs,” said Lisa Schultz, a CCHC VNA RN. “Our ability to provide high-quality care directly contributes to CCHC’s success in meeting Medicare’s value-based compensation criteria. We have also successfully minimized the likelihood of readmissions after the 30-day window. CCHC management needs to acknowledge these contributions, rather than viewing us as a separate entity.”
