Judge Rules in MNA's Favor
Disaffiliation Mail Ballot Vote is Lawful
Rejects ANA Bid to Stop Final Tally
A federal Judge held a hearing today (April 23, 2001) on a motion filed by
ANA supporters to enjoin the MNA from completing mail balloting, as
requested by the Judge, for MNA members who couldn't attend a special
business meeting in March to allow the MNA to disaffiliate from the American
Nurses Association. The judge ruled today that the MNA has complied fully
with his order and that the process put in place by the MNA to allow those
who couldn't attend the meeting because of religious reasons or workplace
conflicts was lawful; and should be allowed to go forward. Today, April 23rd,
was the cutoff for votes to be allowed in the final tally, which will be
conducted on April 30th under the supervision of the American Arbitration
Association.
On March 24, 2001, 82 percent of the members attending a special business
meeting in Worcester voted in favor of disaffiliation from the American
Nurses Association. More than 2,400 nurses attended the meeting, which is the
largest gathering of nurses in Massachusetts history. The MNA is confident
that when the mail balloting is complete next week, the vote for
disaffiliation will increase in size. The MNA is anxious to have the issue
decided so that it can focus its resources on winning passage of safe
staffing legislation now before the state legislature.
Under the judge's ruling, the MNA must go before the court one more time on
May 10, 2001 for one last review of the process, at which time the judge will
allow the vote to be binding and final.
David Schildmeier
Director of Public Communications
Massachusetts Nurses Association
800-882-2056 x717 (Within Mass. only)
781-830-5717
781-821-4445 (fax)
781-249-0430 (cell phone)
508-426-1655 (pager)
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Brockton Hospital Nurses Vote Overwhelmingly to Authorize A Strike
Brockton Hospital Nurses voted last night by an overwhelming margin to
authorize a strike in their contract talks with Brockton Hospital
management. More than 83% of the nurses voted in favor of the strike
authorization, out of the 91% of the bargaining unit that voted.
The next step: The MNA will now contact the federal mediator involved in
negotiations to inform him of the vote and to schedule a negotiating session
as soon as possible. The Brockton Hospital nurses are hopeful management will
take this strike vote as a sign that they need to negotiation in good faith
over the key issues in the dispute specifically: mandatory overtime and
salary.
The nurses are seeking strict limits on mandatory overtime, similar to
provisions negotiated by the Massachusetts Nurses Association-represented
nurses at St. Vincent Hospital/Worcester Medical Center last year. The St.
Vincent nurses conducted a highly publicized 49-day strike over the issue in
2000, and have won national recognition for their stand over this public
health issue. Since that time, other MNA-represented hospitals have
negotiated similar provisions.
The nurses are also outraged by the hospital’s stance on the salary in the
negotiations. While the hospital CEO Norman Goodman has repeatedly boasted
of the hospital’s ability to make a profit for the last six consecutive
years, as it has dramatically increased its patient volume, Brockton
Management is offering the nurses a 2% raise each year for a three-year
contract. They are offering this while paying Goodman $500,000 per year, and
an additional $20,000 in benefits.
The nurses, whose contract expired on Oct. 19, 2000, have been negotiating
their new contract since September, 2000. A total of 15 negotiating sessions
have been held with the last five before a Federal Mediator.
"The nurses at this facility want the public and our patients to know that
the hospital has made a calculated decision to put the interest of profits
ahead of patients, and they are doing it on the backs of the nurses," said Ti
na Russell, chair of the MNA Bargaining Unit at Brockton Hospital, which
comprises more than 400 registered nurses at the facility. "Instead of
investing in their nurses, they are abusing them, forcing us to increase our
workloads regardless of the impact on our patients and ourselves. We have
asked them for the simple right to refuse mandatory overtime if and when we
feel working extra hours and shifts would jeopardize patient care. They have
refused to grant us that right. We have asked them to limit the amount of
times a nurse can be mandated to work overtime; again, they refuse to place
any limits on mandatory overtime."
Mandatory Overtime/Staffing is Top Priority
Nurses at Brockton Hospital have a long history of problems with management
over the issue of mandatory overtime, i.e. forcing a nurse against her/his
will to work extra hours or shifts to compensate for a lack of appropriate
staffing. It was the principle issue of concern in their last contract
negotiation of 1998. While the hospital had promised to eliminate the
problem, the practice continued at an even higher rate. With the hospital’s
negotiation of an exclusive contract with the Goddard Park Medical Group in
1999, patient volume has increased dramatically, creating increased workload
for the nurses and unrelenting staffing problems and stresses on the nurses.
In 1999, the nurses took the unusual step of sending a letter to the new
physician group and the Board of Trustees, sharing with them numerous
documented reports of unsafe staffing that threatened patient care and
warning them of dire consequences for the facility and their patients if
improvements were not made in the nurses staffing conditions.
While the hospital claims mandatory overtime shifts represent only 1 percent
of its total nursing hours, they have refused to provide any data or proof of
this claim to the nurses’ bargaining unit. To the contrary, the nurses report
that mandatory overtime on certain units occurs every single week, and during
peak periods, such as the winter flu season, it is a daily occurrence. "They
won’t produce the data because it doesn’t exit," Russell stated. "We have
documented hundreds of occurrences of mandatory overtime and poor staffing,
any instance of which, could have had dire consequences for the patients on
that floor. The bottom line is mandatory overtime should never be accepted or
condoned."
The nurses are not alone in their concerns about poor staffing/mandatory
overtime and the impact on the safety of patients. The Chicago Tribune
reported in a three-day series last September that a majority of hospitals
nationally have significantly reduced registered nurse staffs. Since 1995, at
least 1,720 patients have died and 9,584 others were injured in cases linked
to overwhelmed nurses, poor staffing, excessive overtime and inadequate
training.
Lucien Leape, MD, MPH, Professor of Health Policy at the Harvard School of
Public Health and the nation's leading expert on hospital deaths and adverse
drug events caused by medical errors told an audience of nurses at the MNA’s
Annual Convention last November, "Health care is the only industry in America
that doesn't believe fatigue degrades performance." On the specific issue of
mandatory overtime, Dr. Leape said, "It ought to be illegal."
"I have been mandated on a number of occasions and I can tell you it places
enormous stress on you both mentally and physically," said Barbara Cook, RN.
"Patients on my unit are being carefully monitored for changes in their
condition. They are very sick and often on complex medications. When I’m
working and exhausted, I have to double and triple check my work to make sure
I am doing it correctly. Many times I have caught myself before making an
error, but I, along with countless other nurses, live in fear of that one
error we don’t catch."
"It comes down to this," nurse Linda McMahon explained. "Do you want your
mother, brother or daughter being cared for by someone who has been forced to
work 16 hours straight? We are not factory workers making widgets here; we’re
skilled professionals caring for extremely vulnerable patients. This hospital
has an obligation to provide enough staff to cover all its shifts."
Salary Is Key To Recruiting Nurses To Ensure Safe Care
The issue of salary is directly linked to the staffing and mandatory overtime
issue, because the state, as well as the nation, is in the midst of a major
nursing shortage, where the competition for nurses, especially experienced
nurses, is tremendous.
According to Russell, "We are losing nurses all the time to surrounding
hospitals, and to hospitals in Boston because of our working conditions. The
hospital claims to have hired more than 125 nurses recently to improve
conditions, but the Brockton nurses claim the new recruits aren’t staying,
and that the hiring has not had an impact on the amount of mandatory overtime
at the facility."
A number of hospitals in the Bay State are offering significant salary
increases, bonuses and other incentives to recruit staff, while at the same
time negotiating limits on Mandatory Overtime. Just last week, nurses at
UMass Medical Center ratified a two-year contract granting their nurses
between a raise of between 12 and 25% based on nurses’ experience. The UMass
nurses also negotiated the St. Vincent Hospital mandatory overtime provisions
into their pact.
The Brockton Hospital Nurses are asking for a three-year contract with a 6.5%
pay hike in the first year, and 7% in the last two years. The nurses have not
had an increase since October, 1999 and they claim the hospital can well
afford to meet their demands given its recent financial performance.
In fact, the hospital’s web site recently featured a story celebrating the
hospital’s unprecedented growth and financial stability, as announced at its
recent annual meeting. Goodman pointed to the hospital’s continued investment
in growth and development in services, including a $5 million expansion of
its radiology department, a $6 million expansion of the emergency department
and a $1 million investment in a physician practice facility. He also cited
the nurses for having one of the highest patient satisfaction ratings in the
country.
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HHS Study Finds Strong Link Between Patient
Outcomes and Nurse Staffing in Hospitals
MNA Applauds Study For Demonstrating
Positive Impact Nurses Have on Patient Care
Study Underscores Need for Legislation
Pending to Mandate Safe Staffing Levels
Washington, D.C. The number and mix of nurses in a hospital makes a
difference in the quality of care patients receive, according to a Department
of Health and Human Services study released on Friday, April 20, 2001. For
nurses in Massachusetts, the study's findings provide a strong scientific
underpinning for legislation pending on Beacon Hill that would mandate
improvements in nurse staffing levels in Massachusetts health care
facilities.
"This study validates what the Massachusetts Nurses Association and thousands
of nurses across the Commonwealth have been saying for more than seven years
- nurses are the key to quality care in our hospitals and efforts to
decreases nurses staffing levels are harming patients," said Denise Garlick,
President of the MNA, the Canton-based professional association and the
state's largest union of registered nurses.
The study, Nurse Staffing and Patient Outcomes in Hospitals, is based on 1997
data from more than 5 million patient discharges from 799 hospitals in 11 sta
tes (including Massachusetts). It found a strong and consistent relationship
between nurse staffing and five outcomes in medical patients -- urinary tract
infection, pneumonia, shock, upper gastrointestinal bleeding, and
length-of-stay. A higher number of registered nurses was associated with a 3
percent to 12 percent reduction in the rates of adverse outcomes, while
higher staffing levels for all types of nurses was associated with a decrease
in adverse outcomes from 2 percent to 25 percent.
According to the study, the costs associated with patient complications can
be substantial. Reductions in the rates of adverse outcomes reduce hospital
costs as well as significant financial and psychological costs to patients
and their families.
"The study findings show that nurse staffing matters considerably to the well
being of the hospital patients," said Peter Buerhaus, co-project director for
the study. "Perhaps the study results will move health policy forward, making
it possible to provide hospitals and nurses with the resources that will
enrich staffing levels to the point where the adverse patient outcomes we
found can be reduced."
For years, the MNA has been raising concerns about the negative impact of
dramatic cutbacks in nurse staffing levels at Massachusetts health care
facilities. Nurses have claimed these staffing reductions have resulted in a
rapid deterioration in nurses' working conditions, contributed to a dramatic
shortage of nurses, and placed patients in jeopardy.
In response, the MNA has already provided the industry and policymakers with
the mechanism to improve care for Massachusetts Hospitals, and reap the cost
benefits identified in the HHS study, with its filing of HB 1186, An Act
Relative to Sufficient Nurse Staffing to Ensure Safe Patient Care. Sponsored
by State Rep. Christine Canavan and State Sen. Robert Creedon, both Democrats
from Brockton, this legislation would put in place a process that would
result in mandated staffing standards for all health care providers based on
the needs of the patients. A similar bill was passed by the California
legislature in 1999.
In addition to this study, recent nursing research, as well as a number of
media exposes, have made a clear link between all of these issues and
decreases in nursing staffing levels and unsafe nurse-to-patient ratios. It
is not uncommon for medical/surgical nurses at a Massachusetts hospital to be
assigned between 9 - 12 patients on a shift, or nurses working in long term
care to be assigned 30 - 40 patients. Home care nurses, who a few years ago
were seeing 5-6 patients in a day, are now being asked to see between 7-9
patients. And in all of these settings, patients are more acutely ill and in
need of more nursing care. None of these ratios are considered safe, and all
contribute to the types of outcomes identified by this study, according to
the MNA.
HHS funded this study as a result of a series of activities stemming from a
1993 congressional hearing that focused national attention on the delivery of
nursing care in hospitals and its effect on patient care. Subsequently, the
Institute of Medicine examined the same issues and concluded that more
research was needed on the relationship between quality of patient care in
hospitals and the level and mix of nurse staffing. Four HHS agencies - the
Health Resources and Services Administration, Health Care Financing
Administration, Agency for Healthcare Research and Quality, and the National
Institute of Nursing Research of the National Institutes of Health -
sponsored the study. It was conducted by the Harvard University School of
Public Health.
Copies of the study are available on HRSA's web site at
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