A protracted dispute between the Tufts Medical Center and the union representing its nurses continues amid talk of an impending nurses strike.
Following changes to the hospital's staffing pattern undertaken in early 2010, which strained tensions between Tufts Medical and its nursing staff, the hospital has offered a one-year contract extension to members of the Massachusetts Nurses Association (MNA), the professional association and union supporting Tufts' 1,200 nurses.
Negotiations, which began in November of last year, are still ongoing, and public statements from both sides indicate the two sides are still at odds in advance of the current contract's expiration date of April 11. Negotiators will meet again tomorrow and then again next Monday, but the future of negotiations beyond that point is unclear.
Tufts Medical has proposed a one-year extension of the current contract that also includes changes such as a 3-percent raise for all nurses and has offered to maintain current health and pension benefits. The offer also includes proposals to hire additional nurses who would be available on a moment's notice to fill short-term staffing needs, add charge nurses that serve solely as a clinical resource and limit the use of overtime and temporary reassignments of nurses.
"We have received very good feedback on the offer from our nurses and we understand that many of them would like the opportunity to accept this proposal," Julie Jette, director of media relations and publications at Tufts Medical, told the Daily in an email.
The hospital's proposal, however, does not set a concrete limit to the number of patients assigned per nurse, which an MNA representative called the main issue at stake in the negotiations.
"[Tufts Medical Center has] said they can not consider our proposal because they can never set a firm limit that would have to be held to on how many patients a nurse takes care of," David Schildmeier, director of public communications for the MNA, said.
The hospital changed its staffing pattern in January 2010, resulting in a savings of $34 per patient per day, which Schildmeier said put economic concerns over those of patients.
"They're cutting millions of dollars of care," Schildmeier said. "It's totally an economic interest. ‘Let's cut the cost of care to patients, the money we spend taking care of them, so that we can profit more money for ourselves.'"
Jette said the hospital, a nonprofit institution, insisted that the changes were undertaken in order to improve the institution's financial standing, not for profit's sake.
"We do not have shareholders who derive earnings from our revenue," Jette said. "Whatever margin we generate — if any — is invested back into the hospital. In order to invest in the vital equipment we need to save lives and to improve quality, we must generate some margin to reinvest."
Jette said the MNA's proposed nurse-to-patient ratios would cost the hospital an additional $33 million a year, which would not be financially sustainable.
The 2010 changes enabled the hospital to initiate more specialization among its nursing staff, benefiting a blood phlebotomy program and the process by which they conduct X-rays, according to Jette.
"The work we have done to reduce costs per patient day is part of a much larger effort involved in redesigning the way we care for patients to improve safety, quality and the patient experience," Jette said.
The new model of care assigns more patients to one nurse, according to the MNA. Prior to the change, each nurse usually had no more than four patients at a time, Schildmeier said. Now, he furthered, it is common for a nurse to have up to seven patients at one time, which the union says poses a danger to patients.
"[The studies] say that when you cut staffing, you increase the risk of infection, medical errors and patient death," Schildmeier said. "There's a direct correlation. … No nurse should ever have more than four patients on a typical hospital floor and no more than two in an ICU. This hospital regularly assigns nurses five, six, seven and even eight patients on a medical surgery floor, and regularly assigns three in the ICU — an unheard practice that is unsafe by any measure."
Jette calls into question the credibility of these statistics.
"There is absolutely no proof or evidence in the research that the staffing ratios called for by the NNU/MNA … would enhance the quality or safety of care delivered at Tufts Medical Center," she said, referring to National Nurses United, the parent union of the MNA.
An additional area of concern raised by the MNA involves "floating," a practice under which nurses are assigned to areas of the hospital where they have no prior experience. Longer shifts and mandatory overtime work are also at issue.
While Jette said instances of floating are rare and carefully considered, MNA representatives were not so positive.
"There are cases where patients were harmed because we weren't able to respond to what they needed," Barbara Tiller, a Tufts Medical nurse of 21 years and the chair of the MNA bargaining unit, told the Daily. "That occurred because the hospital set us up with not enough staff."
In a March 16 press release, Tiller said staffing changes "transformed [Tufts Medical] from being one of the best-staffed hospitals in Boston to the worst-staffed in the city."
Jette said there has been no change in quality and said the use of staffing ratios was a poor indicator.
"The NNU/MNA would like to use nurse-staffing ratios as a stand-in for quality," Jette said. "It is absolutely false to do so. Tufts' quality ratings in key quality measures reviewed by third-party health care rating organizations demonstrate that we have better quality than a number of hospitals who have higher nurse-to-patient ratios."
Nurses on March 16 held an informational picket and rally outside the main entrance of the center and have staged flash mobs inside. If an agreement is not reached, a strike is possible, Schildmeier said.
"The nurses are prepared to take whatever steps are necessary, including a strike, if that's the only thing that will work to convince them," he said.
The hospital is preparing for a potential strike by contracting with a firm that provides temporary nurse staffing, according to Jette.
"Nobody wins in a strike," Jette said. "Tufts MC estimates that a strike will cost the Medical Center a minimum $4.2 million. However, the NNU/MNA has left Tufts MC with no choice but to prepare for a walkout. … After a walkout, it will take time to rebuild our census and many nurses will not be able to return to their jobs immediately."
Tiller said the NNU/MNA is prepared for a strike.
"We need something that holds them accountable for the staffing at the hospital," Tiller said. "It can't be on the nurses. Do we want a strike? No. Is there room for a conversation? Yes. We need to come up with something in the middle that we can both agree with. Unless they're willing to agree to something that we can all be accountable to, we can't accept it."
