Editors note: This article has been clarified to include the fact that nurses at Fairview Hospital are not represented by MNA.
Pittsfield — An organized group of healthcare professionals with longstanding grievances against Berkshire Health Systems held a forum Tuesday night (September 19), airing in graphic detail what they say are chronic understaffing problems that have caused patient neglect at Berkshire Medical Center.
About 100 people attended the forum at the First United Methodist Church organized by the Massachusetts Nurses Association, which, at 23,000 members, is the largest union of registered nurses in the state and the one that represents BMC nurses.
BHS holdings also include Fairview Hospital in Great Barrington. However, Fairview nurses are represented by a different union, which reached an agreement with BHS on a new contract late last year, a BHS spokesman told the Edge.
With a potential strike looming, moderator Liz Recko-Morrison told the audience, “We think the community should be part of that discussion.” The union, she said, has been “bargaining in good faith for over a year,” while BHS management has dragged its feet.
Union members said hospital representatives had been invited but declined to attend the event, which was sponsored by a variety of labor-oriented groups including the Berkshire Democratic Brigades, the Berkshire Central Labor Council, Indivisible Pittsfield and Massachusetts Jobs with Justice.
A panel of five nurses told stories of understaffed and overwhelmed nurses and certified nursing assistants. Sarah Garson has been a nurse for about a year and works in orthopedics. It takes two people to lift nonambulatory patients out of bed, but there are usually only two nurses on duty in her unit during her overnight shifts. That results in unacceptable delays in moving patients.
“This is more and more frequent where we are pulled in so many different directions,” Garson said. “Surgeries are a big scary thing. Blood pressure can drop … We need to make sure these kinds of things are not happening. The patients are being cared for but it’s taking a lot out of us.”
Leilani Holver has been at BMC for three years and started out in the psych ward working nine-hour overnight shifts. Often she was the only nurse on the floor of that unit. If a patient needed to be moved, it would take her and her three nursing assistants, leaving no one to attend to the other psych ward patients.
“To have a single nurse on that floor is scary. Patients are lashing out at us, detoxing,” Holver said. “All hands need to be on deck to calm a patient.”
On several occasions, Holver has been called into work on her day off, a situation among many for which she said, “BMC needs to be held accountable.”
Sandra Vosburgh has worked at BMC for 32 years in the maternal health and critical care departments. Three nurses retired within two months and the hospital has yet to post the jobs. The situation is especially critical because of the volume of premature and opiate-addicted babies and mothers, she said.
Vosburgh said her unit has at least three withdrawing babies daily who receive morphine. The staff tries to work with the state to help keep the babies and their mothers together.
“How are we to help these mothers recover, learn to care for their babies, medicate their babies?” Vosburgh asked rhetorically. “We do everything we can to provide their bonding and nutrition … We often give them the shirts out of our lockers. We don’t have enough staff to support them without getting tired and overworked.”
“It’s hard to be a team player when you can’t help each other,” added audience member Melanie Robbins, who identified herself as a 10-year BMC employee.
Garson said the situation has deteriorated to the point that many Berkshire County pediatricians are sending patients to Baystate Medical Center in Springfield out of frustration.
A critical care nurse, Amber VanBramer, complained that BHS management “has refused to bargain with us over the staffing issues,” which, she said, is “very important to the hundreds of nurses” at BMC.
“They still have the final say on any issues that are brought up,” VanBramer said.
Mark Brodeur, a nurse in BMC’s post-anesthesia care unit who is also on the bargaining committee for the Massachusetts Nurses Association, spoke of the problems short staffing can cause in his unit and relates a story of what happened to his own mother at BMC. See video below:
The union says BMC nurses have raised patient safety concerns to hospital management using various means for years, including directly to supervisors, at labor-management meetings and during ongoing collective-bargaining negotiations.
When specific nurse-to-patient ratios were dismissed during negotiations for what the union calls “safe staffing,” management also rejected a request to staff shifts with “charge nurses” who would roam without specific patient assignments and fill in wherever needed.
Nurses have been documenting those concerns on unsafe staffing forms. In a 23-month period between 2015 and 2017, nurses completed more than 430 unsafe staffing reports, the union said in a new release announcing the forum.
“The reports tell the story time and again: Hospital units short multiple nurses and/or other staff members, patients waiting for hours in the emergency department, patient falls, and critically ill infants with too few nurses to care for them,” union spokesman Joe Markman said. “Hundreds of other incidents have gone undocumented as nurses are typically too busy caring for too many patients to write a report.”
Markman says BMC nurses have also filed three unfair labor practice charges with the National Labor Relations Board against BHS. Those alleged unfair practices on the part of management include “threatening to retaliate against nurses if they engage in protected activity and refusing to provide health insurance data necessary for bargaining.”
Negotiations began for a new contract began about a year ago and include a federal mediator. More than 25 bargaining sessions have been held. On May 31, 82 percent of the union nurses rejected the hospital’s “best and final” contract offer.
In July, 83 percent of the nurses voted to authorize a potential one-day strike. The 16-member bargaining committee has the authority to call for such a strike provided it issues a 10-day strike notice, as required under federal law.
No one from BHS management was present at the forum. The hospital has, however, created a website, bmcnurses.com, in which unidentified BHS officials attempt to answer the concerns of the union and dispute its allegations.
Among other things, the hospital contends that the collective bargaining process exists to ensure that “we are providing our nurses with fair and reasonable pay and benefits for the essential work that they do.” It did not include staffing levels or working conditions among items for bargaining.
The hospital says it “has long recognized the value of the staffing guidelines developed by” the American Nurses Association. The hospital insists it sets and adjusts its nurse staffing levels by taking into consideration several factors “identified by the ANA as important to achieving safe and effective nurse staffing.”
Interestingly, a 2014 survey of over 10,000 nurses conducted by the same American Nurses Association found that 25 percent had been physically assaulted by either a patient or a patient’s family member.
On its website, the ANA says it is “the nation’s only full-service professional organization that represents the interests of the nation’s 3.6 million registered nurses.”
According to its publicly available IRS 990 return filed for 2015, the nonprofit ANA derives the bulk of its funding from program service revenue, which includes membership dues, service fees, publications and conference fees. The ANA’s total revenues that year were almost $36.4 million.
There were a number of questions from the audience, which included retired healthcare professionals and activists from the region. Ellen Mary D’Agostino, a retired certified nursing assistant from Lee, said she was upset by the reports coming from the hospital.
“I am shocked this is even … I don’t know what to say,” D’Agostino said, her voice cracking with emotion.
Leonard Yost, a psychologist from Lee, wondered why BHS was so concerned about staffing levels when it was “ninth in the state for profits.”
“Doesn’t the board of trustees have this information?” Yost asked. “They’re out to win at all costs regardless of what it does to the community. They’re paying for billboards ads and supporting the [Berkshire] Eagle with advertising.”
Jim Lipa of North Adams, a member of the North County Cares Coalition, asked about the effect of the closure of North Adams Regional Hospital might have on BMC staffing. See video below:
Others emphasized that, even though BHS is a privately owned nonprofit, it really is a community asset.
“Your needs are our needs because eventually we will all be patients,” Frank Farkas, former chairman of the Berkshire Democratic Brigades, told the nurses.
Mary Anne Hicks of Richmond, a retired healthcare professional, said the last nurses’ strike at the hospital was in 1981.
“It’s not easy when we do this,” Hicks said. “I would ask the community to support us.”
The next round of negotiations is set for Sept. 27.
At deadline, BHS spokesman Michael Leary responded to the Edge’s questions. The queries (in bold) and his responses (in italics) are below:
Hi Terry, here are the answers to your questions.
1) I know it’s been an ongoing complaint for years, but what is management’s response to the claims by the nurses of chronic understaffing endangering patient welfare? There were numerous anecdotes of patients’ health being compromised because of a lack of staff on certain shifts. Employees complaining that they are so busy that they don’t even have to time to break for lunch, or any other meal, during their shifts.
I want to start by saying we look forward to going back to the bargaining table on September 27th, the date of our next scheduled session, and hope that the session will result in an agreement. In our view, the MNA rally here was part of several events across the state to promote the union’s ballot initiative to mandate patient care ratios. Many of those who attended were not BMC employees, and several came from other parts of the state.
On your question, we do not agree with the MNA’s characterization of our staffing, which we regularly monitor and adjust as necessary during each and over the course of each shift. The union raises this as an issue during every contract negotiations, both here and at nearly every other hospital in Massachusetts where the MNA represents nurses.
We staff based on the guidelines established by the American Nurses Association, a model in which nurses are empowered to create staffing plans specific to each unit. This approach helps establish staffing levels that are flexible and account for changes over the course a day; including patient needs, the number of admissions, discharges and transfers during a shift, the specific complement of nurses, and the layout of the unit. Our staffing model also takes into account all of the resources we devote to patient care, including other direct care providers, patient care aides and assistants.
Unlike the American Nurses Association, which is a professional organization, the MNA is a labor union that would directly benefit from arbitrary ratios that would add to its number of dues-paying members. The MNA’s proposed mandatory ratios, would actually limit a hospital’s ability to care for patients in a safe and sensible way and add significant costs to our state’s health care budget and consumers’ healthcare costs.
BMC is proud to provide high quality care as validated by national organizations that rigorously study patient care and safety. Among them are Healthgrades, the Leapfrog Group and the Centers for Medicare and Medicaid Services which rank BMC among the best in the nation for patient care and safety.
2) The nurses also say management refuses to include staffing levels as a subject for discussion in the current collective bargaining action. Why not?
Staffing has been and continues to be discussed at the bargaining table. Our best and final contract offer would establish unit-based and hospital-wide staffing committees made up of nurses and and nursing leaders. This committee would give MNA-represented nurses a strong voice staffing decision-making tailored to the needs of each of the 17 patient care units and is considered a “best practice” by the American Nurses Association.
3) There were numerous complaints that BMC is top-heavy with administration and that the organization has a virtual monopoly on critical care in the Berkshires. There were also claims that BHS spends $4 million annually on advertising. Is that true? If so, why is it necessary when BHS has so few competitors?
Our quality and patient satisfaction ratings tell our story best. We have a strong team of experienced, committed leaders who have run this organization with a focus on delivering superior patient care, contributing to this community and providing excellent jobs. We also believe that it is important that the community we serve understands both the array of services available right here in Berkshire County and the dedicated care teams available to provide them. We have a modest budget to advertise our services and clinical personnel, but nothing near $4 million.
4) As a result of the low staffing levels, turnover is high. And when nurses and CNAs leave, they are rarely replaced. True or no?
Absolutely false. BMC has a significantly lower turnover rate than the nationwide average. According to a national study conducted by Nursing Solutions, Inc., in 2016 the average RN turnover rate at hospitals was 17%, while BMC’s turnover rate is 7%. In addition, we continually recruit to replace nurses as they move or retire. We have hired and oriented more than 130 new nurses in the past two years alone, enhancing staffing in several areas.