Registered nurses with the Visiting Nurse Association (VNA) of Cape Cod, represented by the Massachusetts Nurses Association (MNA), have voted overwhelmingly to reject Cape Cod Healthcare’s (CCH) so-called “last, best, and final” contract offer, calling the proposal inadequate to address unsafe staffing, unfair wages, and urgent recruitment and retention needs.
The VNA nurses, who provide essential home health and hospice care to patients across Cape Cod and the Islands, previously voted 96% in favor of authorizing a potential three-day strike if progress is not made at the bargaining table.
“Clearly progress has not been made at the table, given that management forced this last, best, and final contract on us,” said Mike Barry, RN, and bargaining unit co-chair, along with Pam Anderson, RN. “That offer is completely unacceptable, because it does nothing to resolve the problems plaguing the VNA: Challenges in recruiting and retaining nurses, and the resulting unsafe staffing.”
At the heart of the contract dispute is management’s refusal to offer VNA nurses the same percentage wage increases that hospital nurses, also employed by Cape Cod Healthcare, recently secured. In July, nurses at Cape Cod Hospital and Falmouth Hospital ratified a contract providing a 19% wage increase over three years. Hospital nurses were already earning, on average, 20% more than VNA nurses. Under management’s last proposal of only a 10% wage increase over three years, that disparity will widen to nearly 29%.
“VNA nurses are not asking for the same pay as hospital nurses,” said Diane Munsell, RN, case manager and bargaining unit secretary. “We are asking for the same fair percentage wage increases, just to keep up with inflation and the high cost of living on Cape Cod and the Islands. Without that, we will fall even further behind — and so will our patients.”
A federal mediator joined negotiations in July; the next negotiation session has not been scheduled.
Background: The Vital Role of VNA Nurses
Cape Cod VNA nurses are essential to the region’s healthcare system, ensuring patients can safely return home from the hospital sooner and with greater medical needs than ever before. In Fiscal Year 2025 alone, the VNA cared for 11,165 home health admissions, 861 hospice admissions, and hundreds more patients through public health services.
These patients often require highly technical care, including complex IV therapies, nephrostomies, ostomies, Pleurex drains, and wound vacs. But unlike in hospital settings, VNA nurses deliver this care independently in patients’ homes, without immediate backup, relying solely on their expertise and judgment.
In every patient case, VNA nurses assess, treat, coordinate with providers in real time, adjust care plans, and provide comfort and education to families — all while holding the same professional licenses and responsibilities as hospital-based nurses.
Crisis In Staffing
Nearly one-third of the VNA staff are traveling nurses — an expensive, unstable practice that disrupts patient care. CCHC spends hundreds of thousands of dollars monthly on travel staff yet refuses to strengthen the permanent workforce by improving wages, improving patient assignments, and addressing issues such as travel distances, seasonal surges, and added responsibilities outside of patients’ homes.
“Fair wages, manageable patient assignments, and contract language that reflects the realities of home care on the Cape and Islands are what will truly strengthen this workforce and protect our patients,” added Alison Young, BSN, RN, CRRN. “The money spent on travel nurses drains resources and disrupts patient care. Cape Cod Healthcare has the means to fix this; they just need the will.”
