Feb. 11, 2010
BOSTON, MA - The registered nurses of Boston Medical Center's East Newton Campus and Tufts Medical Center, who are represented by the Massachusetts Nurses Association, are taking the unprecedented step today of conducting joint informational picketing outside their respective facilities to protest what they believe are dangerous changes in RN staffing levels, which will result in nurses caring for too many patients at one time and could compromise the quality and safety of patient care.
This job action is not related to an ongoing contract negotiation (both groups have contracts in place) and this protest has nothing to do with the nurses' wages or benefits. It is about nurses' concern for the health and well being of the patients under their care.
"We are protesting today because we are concerned for our patients' safety." said Barbara Tiller, RN, a nurse at Tufts Medical Center and co-chair of the nurses' local bargaining unit. "Nurses go to work every day with the fear that an unnecessary patient death or injury will take place under the current staffing conditions."
"Nurses at Boston Medical Center, like our colleagues at Tufts Medical Center, can no longer remain silent while our respective administrations attempt to cut costs at the expense of the safety of our patients," said Ann Driscoll, RN, a long-time nurse at BMC and chair of the local bargaining unit. "The public has a right to know about decisions that are being made at these hospitals that jeopardize their safety."
The nurses at these facilities are facing what is becoming a growing trend as the hospital industry attempts to exploit a challenging economic climate to cut costs and to boost their profit margins by cutting nursing staff. The same tactics were employed during the 1990s. At that time this response to the advent of managed care, resulted in a dramatic deterioration in the quality and safety of care in hospitals and also resulted in thousands of preventable patient deaths across the country. Nurses, who have been through this failed strategy before, are not going to allow hospitals to make the same dangerous mistakes again without a fight. This picket is the beginning of that effort.
Boston Medical Center, which is a level one trauma center, and Tufts Medical Center, which has a level one pediatric trauma and level two adult trauma center, care for some of the sickest patients in the Commonwealth, requiring a more intense level of nursing care to keep patients safe. At current staffing levels, nurses contend it has been a struggle to provide the level of care patients deserve. Now, both hospitals are proposing and implementing staffing changes that increase the number of patients assigned to many of their nurses, and neither facility is adequately adjusting their level of nursing care based on "patient acuity," which is the actual needs or illness level of the patients. At both facilities, nurses believe management is pushing staff to move patients through the hospital faster and faster without providing the resources to support this speed up in care delivery.
Issues Specific to Boston Medical Center
The hospital is seeking to increase the number of patients assigned to nurses in the critical care areas. On one unit, where traditionally nurses have cared for no more than two patients at a time, the hospital is now demanding that nurses take a third patient, which, given the condition of the patients on this floor, would put these patients at a much greater risk for serious complications.
Nurses on other floors have seen their patient assignments increase. In addition, the hospital is staffing at a bare bones level and is making up for the shortage of staff by the use of widespread "floating" of nurses, a process that involves moving nurses from unit to unit. In the intensive care units, where the patients require the most attention and observation, some units are staffed so that more than half the nurses are floats who are not as familiar with the unit.
In the last several months, the nurses have filed dozens of official reports of inadequate staffing conditions at the facility, and some have reported that these conditions compromised the care of their patients.
In a letter opposing the staffing changes sent to the Board of Trustees, which was signed by the majority of the nurses working in BMC's ICUs, the nurses wrote, "We implore hospital management to address the situation and avert dangerous conditions and tragic patient outcomes we fear may occur."
Driscoll pointed out that the hospital's Vice President of Nursing, Lisa O'Connor, has refused to work with the nurses through a legally binding process at the hospital to set appropriate staffing levels. For more than a decade, the union and management worked together, under contract language negotiated during the last staffing crisis in the late 1990s, which established a staffing tribunal made up of union nurses and management with the expressed purpose of setting safe and appropriate staffing levels. However, O'Connor has failed to work through the tribunal, and is instead pushing for unilateral changes over the objections of those providing the care.
In addition to failing to provide a safe working environment, O'Connor has employed a number of oppressive management practices, creating a punitive environment that has caused unrest within the nursing community at the hospital, one that the nurses say needs to change if BMC is to maintain its reputation as a first rate medical center.
"Nurses are the backbone of any hospital, but our nursing management seems intent on breaking the backs of nurses," said Driscoll. "Our members have made it clear that we can't take this anymore, and we will do whatever is necessary to protect our patients."
The nurses are further outraged that he hospital has made these cuts while providing the outgoing CEO with a $3.5 million bonus. The nurses are hopeful that with the recent introduction of a new CEO, Kate Walsh, much needed changes will be made.
Issues Specific to Tufts Medical Center
At Tufts Medical Center, even at current staffing levels, nurses have reported difficulty providing the level of care patients deserve. However, in the last six months the hospital has engaged a high priced consulting firm to develop a "new model" of care with a principal economic goal of cutting the amount of money ($34 per patient day or $3 million) spent on patient care.
The planned cuts involve limiting the amount of care provided by registered nurses, with RNs forced to care for more patients on almost every unit. In fact, according to the Mass. Hospital Association's "Patients First" web site, many units at Tufts will have the lowest nurse staffing levels of any similar-sized hospital in the city.
The consultants used by Tufts are typical of consultants used during the 1990s to redesign how nursing care was delivered with disastrous results. At that time, there wasn't a shred of research to support such changes in staffing. Now there are more than 40 studies that provide overwhelming scientific evidence demonstrating that implementing changes such as those proposed at Tufts would dramatically increase the risk of patient injury, complications, the length of hospital stays, and could even lead to preventable deaths.
In a letter to management signed by nearly all the nurses on a busy cardiac floor, the nurses wrote: "With both the current and newly proposed staffing models ... opportunities for critical observation and patient advocacy will effectively disappear ... higher nurse-patient ratios will lead to increased mortality and poor patient outcomes."
In creating the new staffing model, the hospital violated the nurses union contract, which includes a process for the union and management to work together to address staffing concerns. Tufts management ignored that process and utilized the consultant to engage in a process, common for these redesign schemes, where committees are formed and elaborate processes are implemented to give staff the illusion that they have helped develop the new model of care.
"This process is a sham," said Julie Pinkham, RN, executive director of the MNA, who was involved in efforts during the 1990s to combat the redesign initiatives. "Management knows from the beginning what cuts are going to be made and what model they will end up with. The committees are used to co-opt the employees and to make them believe they are responsible for creating the changes, the very changes that will undermine their ability to deliver safe patient care."
The nurses at Tufts were not fooled by the process. More than 30 nurses who participated in the planning committee for the new model have signed a letter stating their opposition to the changes and to the fact that their actual suggestions to improve care at the hospital were ignored.
Last year, Tufts CEO Ellen Zane engaged in a highly public battle with a major insurer demanding higher payments for the care of Tufts patients, citing the fact that Tufts nurses and physicians care for the most acutely ill patients in the state. Now, instead of investing those resources in better patient care, Tufts is cutting the level of care provided to them.
"The primary reason you are admitted to a hospital is because your condition is so severe, you require around-the-clock attention by a registered nurse," Tiller explained. "Nurses are specially trained to monitor your condition from minute-to-minute and to take immediate action to prevent complications or to save your life. There's a lot at stake for patients in this struggle, for them, it's truly a matter of life and death."
According to the Agency for Health Care Research and Quality, every additional patient assigned to an RN is associated with a 7 percent increase in the risk of hospital-acquired pneumonia, a 53 percent increase in respiratory failure, and a 17 percent increase in medical complications. Better RN staffing is linked to better patient outcomes, fewer deaths and shorter hospital stays.
"The nurses who work at these hospitals understand the strictures of the current economic climate," Driscoll added. "But we believe the hospitals should not exploit this situation to boost their bottom line and patients should not pay the price for misguided decisions to cut costs at the expense of quality patient care."