Staffing Levels At Root Of Dispute Between Nurses, Hospitals
PHOTO/EMILY MICUCCI
Vanguard Health Systems employees and supporters picket outside MetroWest Medical Center in Natick last week. Nurses held the informational picket to call for increased staffing at the hospital. The nurses, represented by the Massachusetts Nurses Association, have been in negotiations for a new contract with Worcester-based Vanguard for 11 months.
Ongoing labor negotiations between area hospitals and their nurses this fall have unleashed opposing points of view of safe staffing levels and how they might affect patient care.
Recently, nurses staged informational pickets outside Vanguard Health Systems-owned MetroWest Medical Center in Natick, and UMass Memorial Medical Center in Worcester. Each group tried to draw attention to what they say are unsafe nurse-to-patient ratios at UMass and MetroWest Medical Center hospitals.
The nurses want the hospitals to establish ratios that reduce the average patient load a nurse is assigned at a given time.
Currently, hospitals establish their own policies and staffing ratios, which are not mandated by state law. The Massachusetts Nurses Association (MNA), which represents both nurses' groups, claims reducing ratios will improve patient outcomes, as well as working conditions.
“There are nurses who haven't had a lunch off the unit in two years,” said David Schildmeier, a spokesman for the MNA.
Hospital budgets are under new financial strain brought on by reduced Medicare and Medicaid reimbursements under federal health care reform, plus state-mandated cost-control measures. But Schildmeier said nurses and hospitals have tussled over staffing levels for a decade, and now hospital administrators are using reform as an excuse to cut staffing.
“Hospitals have glommed on to those two elements to say 'The sky is falling … let's cut patient care',” Schildmeier said.
The MNA cites studies conducted by organizations such as the American Medical Associations that suggest a connection between reduced staffing levels and poor patient outcomes, But officials from area hospitals dispute those claims, saying they design staffing plans to safely meet the needs of individual hospital units, like the emergency department and intensive care.
MetroWest Management Says Assignments 'Very Safe'
Donna Gemme, chief nursing officer at MetroWest Medical Center, which has campuses in Framingham and Natick, said each MetroWest nurse works a “very safe assignment” of four or five patients at a time.
MetroWest staffing plans, along with those from all members of the Massachusetts Hospital Association (MHA) are posted on the MHA website. Gemme said staffing levels often exceed the ratios outlined in the staffing plan, and they're tailored to fit the needs of each hospital unit at a given time. Staffing ratios proposed by the MNA in recent months would set a maximum patient load of four per nurse, with smaller loads for nurses working in more demanding departments, such as intensive care.
Though the difference in numbers isn't large, Gemme said she doesn't anticipate the staffing policy will change as hospitals switch to a care model that includes shorter hospital stays in favor of allowing patients to recover at home.
Gemme also said it's valuable for a hospital to be able to schedule staff based on the needs of a department on a given day, rather than to set strict ratios.
MetroWest nurses have been negotiating a new contract with Vanguard for 11 months. Gemme said she believes the hospital and nurses are close to a resolution, but was surprised they decided to picket Nov. 19 over staffing, saying it was not part of the MNA's proposal at the most recent meeting Nov. 14. But according to Schildmeier, the proposal is still on the table.
In Worcester, nurses at UMass Memorial Medical Center and the UMass Memorial and Hahnemann campuses have been negotiating new contracts (one for the medical center, the second for the other two sites) for almost a year, and cited deteriorating staffing levels behind their Nov. 7 picket.
UMass Memorial Health Care, the medical center's parent, maintains a website, www.umassmemorialchange.org, which is designed to provide information on the hospital's changing policies as it tries to trim costs. Hospital spokesman Robert Brogna referred the Worcester Business Journal to the website when asked about ongoing negotiations with the MNA.
According to the website, the UMass operating budget has decreased since 2008 due to economic conditions and a new “financial reality” in the health care industry. As a result, the hospital has reduced staffing levels across the system, and proposed pension changes for nurses to save money. The website also states that implementing mandatory staffing ratios, as proposed by the MNA, would cost UMass about $50 million in annualized costs (based on 2012 figures) and reduce hospital flexibility.
The MNA has supported legislation to implement state-mandated staffing ratios under The Patient Safety Act, a bill that has been referred to committee. Schildmeier said two pieces of similar legislation filed in the last 10 years were stalled in the state Senate. n
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