Mass. Health Cost Law Bans Mandatory Overtime For Nurses


At 350 pages, the state’s new health cost control law contains multitudes. (Readers, can you name the poet? “I am large. I contain multitudes.” True, not actually written in reference to health reform.)

We’ll surely be focusing on a wide range of the law’s elements, but here’s one called to our attention today by the Massachusetts Nurses Association: The bill that Gov. Patrick signed into law today bans mandatory overtime for nurses. (Here’s the full relevant text.) Some background from the nurses association:

Under this law, a hospital could not, except in the case of a declared emergency, require a nurse to work beyond their scheduled shift, and no nurse would be required to work more than 12 hours in a 24 hour period. Hospitals who assign a mandatory overtime shift are required to report those incidents to the Department of Public Health, along with the justification for its use. Any nurse can refuse overtime without fear of retribution or discipline of any kind from their employer.

The dangers and costs of mandatory overtime have been well documented in a number of scientific studies published in the last decade, which included findings that nurses working mandatory overtime are three times more likely to make costly medical errors; and that overtime for nurses was associated with an increased risk of catheter-related urinary tract infections and bedsores, both preventable medical complications. In 2002, the Institute of Medicine issued a report linking mandatory overtime and the understaffing of nurses to thousands of patient deaths each year, and called for an all out prohibition of the practice.

In short, mandatory overtime is out as a means of dealing with a nursing crunch. But those crunches are expected to grow. Word also arrived today from the Massachusetts Hospital Association that the nurse vacancy rate has been rising, and in the coming years, a shortage is predicted. From the MHA: Continue reading

Breaking: Tufts, Nurses Reach Tentative Pact; Strike Averted

The Massachusetts Nurses Association sent out an email a little before 3 a.m. this morning saying that the looming nurses’ strike at Tufts Medical Center has been averted. The union is scheduled to vote on the agreement May 19. The pact follows a similar one at St. Vincent’s on Wednesday.

From the MNA release:

Pact Provides Nurses with Staffing Improvements, Limits on Patient Assignments in Key Areas, and Strict Limits on the Use of Mandatory Overtime as a Staffing Tool

BOSTON, MA — After a 15 -hour negotiating session, the registered nurses of Tufts Medical Center have reached a tentative agreement with management, averting a strike that was set to begin today. The 18-month pact includes a number of staffing improvements sought by the nurses to improve patient care at the facility.

The 18-month agreement runs from May 18, 2011 to Nov.19, 2012. The pact includes the following key provisions:

Increased staffing with limits on nurses’ patient assignments in a number of areas – the hospital has agreed to limit patient assignments for nurses working on the medical-surgical floors to six patients on the night shift, and to no more than two patients in the intensive care units. The hospital has also agreed to language in the contract that assures they will not move to a six patient assignment for medical-surgical nurses on the day and evening shifts for the life of the agreement. The hospital has also agreed to convert a number of temporary travel nurses positions to core staff, which will further improve care on a number of units and has increased positions in its float pool, which will provide nursing support to overburdened units.

-The addition of charge nurses with limited assignments to a number of the hospital’s busiest medical surgical floors on day and evening shifts.

-Strict limits on mandatory overtime… No nurses will be required to work more than 16 hours in a single shift, and cannot be assigned more than 12 hours of mandatory overtime in a calendar quarter. The hospital has also agreed to post full schedules to minimize the need for mandatory overtime.

-Protection from inappropriate floating

-Wage increase – the pact includes a 2% across the board wage increase for all nurses upon ratification.

Here’s what management had to say this morning:

Tufts Medical Center announced this morning it has reached a tentative 18-month contract extension agreement with the Massachusetts Nurses Association/National Nurses United, averting a 5-day strike the union had planned beginning at 6 a.m. today.

“For the past six months Tufts Medical Center has negotiated in good faith with the MNA/NNU, and we are pleased that we have been able to reach a tentative agreement and avoid a strike,” said Ellen Zane, President and CEO of Tufts Medical Center. “This has been a long and difficult process, but throughout we have listened to our nurses and responded to their needs. We value the hard work and dedication of our nursing professionals, who are some of the most skilled in the nation. Now is the time for us all to move forward together.”

The final agreement contains additional resources for nurses, including a charge nurse program and a more robust float pool. Nurses will receive a 2-percent salary increase.

Both organizations acknowledged their joint commitment to safe, high quality patient care and agreed that the decision to increase a nurse’s patient assignment above normal staffing patterns would be worked out by the nurse manager or supervisor in collaboration with the RNs involved and the nurse executive as needed. There are no mandatory ratios in the contract.

“Tufts Medical Center is known for exceptional clinical care and great compassionate, and our nurses are a vital part of our medical care team,” said Michael Wagner, MD, Chief Medical Officer at Tufts Medical Center. “We are thrilled that our nurses will continue to be with our patients Friday morning.”

Tufts Medical Center provides outstanding care that has been recognized by independent, third-party organizations including the Joint Commission, University HealthSystem Consortium and the Massachusetts Department of Public Health.

“I am extremely grateful to all our employees who worked tirelessly to prepare our organization to carry forward with excellent patient care no matter what the result of our negotiations,” Zane said. “We all look forward to continuing our work for our patients, side by side with our nursing colleagues.”

CommonHealth Analysis: Nursing Staff Levels At Tufts Medical Center Trail Competitors, Data Suggest

There’s a heated dispute currently underway between the Massachusetts Nurses Association — specifically the 1,200 RN’s at Tufts Medical Center — and management at the hospital. They are engaged in contract negotiations that haven’t been pretty. The nurses accuse the hospital of allowing staffing levels to fall so low over the past year that patient care has slipped and conditions have become dangerous; the nurses have complained to the hospital’s board citing numerous examples of egregious care. The hospital, in response, says its care has in no way faltered, and that the complaints are part of a national union strategy to boost the nurses’ bargaining power.

So what’s the truth?

We decided to look at the numbers, and came up with a simple analysis of nursing staff levels based on publicly available 2011 data from a statewide hospital-sponsored website called Patient Care Link. According to these numbers, it appears that registered nurses at Tufts Medical Center do spend less time caring for patients in key medical units such as the emergency department and adult critical care unit compared to nurses at the other Boston teaching hospitals. Tufts also has a more meager nurse-to-patient ratio in its combined medical-surgical unit compared to other hospitals with similar units, according to the data from Patient Care Link.

Nurses: Less Time With Patients

Our analysis basically calculated the number of hours nurses are scheduled to work, and divided that by the average number of patients seen in the particular unit. This measure is called “nurse hours per patient visit.” So, for instance, in its emergency department, Tufts provides 1.98 nurse hours per patient visit (again, the average number of hours a nurse cares for a patient during that patient’s visit to the ER), according to the website numbers. That’s fewer nurse hours compared to the other teaching hospitals: we calculated 3.2 nurse hours per patient visit at Massachusetts General Hospital; 2.36 hours at the Brigham & Women’s Hospital and 2.31 hours at Beth Israel Deaconess Medical Center.

Let me say here that Patient Care Link is far from a precise measurement of staffing levels. It’s a site sponsored by the Massachusetts Hospital Association. It’s voluntary and non-binding. And all it asks is that hospitals submit their staffing plans. Still, these are the numbers that are available. And short of sneaking into the hospital undercover and doing headcounts, this is all the public has to work with. If anyone out there has a better way to figure this out, please let us know.

A spokesperson for Tufts Medical Center doesn’t dispute our numbers, per se, but says such comparisons don’t offer the full picture and that patient care at the hospital remains top-notch. “The numbers don’t truly tell the whole story,” says Tufts’ Julie Jette.

Nevertheless, here are the numbers:

Boston Teaching Hospitals
Unit Type Tufts MGH BWH BIDMC
Emergency Department
RN Hours Per Patient Visit
1.98 3.2 2.36 2.31
Adult Critical Care-Surgical
RN Hours Per Patient Day (24 Hours)
15.2 20.49 19.79 17.54
Hospitals with ACC Med/Surg Combined
Tufts Newton-Wellesley Good Sam Winchester
Adult Critical Care- Medical / Surgical Combined
RN Hours Per Patient Day (24 Hours)
13.33 15.48 15.45 15.04

Longer Wait Times

Nurses say this dip in staffing — with fewer nurses available for more patients — has a detrimental effect on patient care. Barbara Tiller, an RN at Tufts for 21 years, says patients now wait a lot longer for a nurse. “These are patients in pain, ringing the bell, and waiting 20, 40 minutes,” she says, “or patients who can’t get out of the bed to toilet themselves, and then they end up waiting there in a wet, soiled bed.” Continue reading

Nurses Say Staff Reductions Put Tufts Medical Center Patients At Risk; Hospital Denies Charges

The Massachusetts Nurses Association says recent staff reductions and reorganizations at Tufts Medical Center are putting patients at risk, and they cite more than 520 reports of “incidents that jeopardized patient care in the last year.”

Care is being dangerously compromised, they say, due to: “delays in nursing assessment, delays in the administration of medications and tests, nurses missing significant changes in patients’ health status…patients falling due to lack of assistance with getting up and moving around and patients being left in soiled beds for hours at a time.”

Officials at the medical center deny the charges and say the statements are a “union tactic” for contract negotiations.

The 1,200 RNs at Tufts are currently negotiating a new contract, and seeking “safe staffing levels, and prohibitions against forced overtime and the inappropriate floating of nurses.” Today they are holding a candlelight vigil to protest the staffing levels.

Barbara Tiller, a nurse at Tufts Medical Center for 21 years, said that due to several factors — including the center’s new care delivery model and cost-savings plan, and the fact that the nursing ranks have dwindled — patient care has suffered. “The upshot is fewer nurses caring for more patients,” Tiller said in an interview. “Patients are laying in their beds hoping someone will care for them and there are fewer and fewer of us to do that. Medications are late, tubes don’t get changed, people are laying in wet beds.”

In a letter last May to the medical center’s Board of Trustees, nurses cited several examples of unsafe practices that led to bad patient care. The medical center says these allegations have been investigated and are all “baseless.”

The reduced nursing staff and other changes means that providers are caring for more patients and that the hospital has gone from “being one of the best staffed hospitals in Boston to the worst staffed hospital in the city,” according to a press release put out by the state nurses association. “To compensate for chronic understaffing, TMC is using mandatory overtime, and is forcing nurses to “float” from one area of the hospital to another where they might not be competent to provide appropriate care.”

Workplace Bullies As Health Threats, Especially In Health Care

Normally, we do our best to ignore artificial news events like “disease-awareness” days. But when it crossed my screen that this is “Freedom From Workplace Bullies Week,” I jumped at the chance to write about the devastating mental and physical harm that a bad boss — or co-worker — can wreak.

Over the last couple of years, I’ve watched three friends suffer through jobs turned bad by bully bosses. It was horrifying and infuriating, to see three virtuous, diligent, intelligent people laid low in ways that struck not just the wallet but the deepest sense of self. Said one:

“It was a feeling that never left, that didn’t lift when I went home for the night or weekend. It was starting to color all of my experiences. And I had real suicidal thoughts for the first time since my junior year in college, 22 years earlier.”

Another started to lose sleep and even hair: “It was awful and threw my entire system out of whack.”

The third entered a state of prolonged panic and anxiety-induced exhaustion. I fantasized about writing a letter to her boss: “Do you understand the pain you are causing, not just to her but to her entire family?”

This was not just a flukish statistical cluster. A Zogby International poll commissioned this year by the nonprofit Workplace Bullying Institute — slogan: “Work Shouldn’t Hurt” — found that 35 percent of the American workforce had been bullied at work, and another 15 percent had witnessed it.

Now for the health aspects: The research found that among those being bullied, 45 percent reported related health problems. They are so common that on the Workplace Bullying Institute’s FAQ, the fourth question is: “Is it normal for my health to be falling apart?” (The answer begins, “It is not good, but it is typical.”)

Law professor David Yamada of Suffolk University

David Yamada, a professor of law and director of The New Workplace Institute at Suffolk University, is a leading legal scholar on workplace bullying, and has been helping to lead a new push to pass a law against it in Massachusetts. (His blog is here.)

His “Healthy Workplace” bill died in the latest legislative session, but plans are afoot to re-launch it next year, he said. Organizers are meeting at Suffolk later this week to strategize.

So what is known about the health effects of workplace bullies?

Summing up dozens of studies, Prof. Yamada said that “At a minimum, we’re talking about all sorts of stress-related disorders; clinical depression; in more serious cases, hypertension; at least increased risk of cardiovascular disease; evidence of impaired immune systems. We are seeing symptoms very consistent with Post Traumatic Stress Disorder.” Continue reading

‘Contentious’ Year Ahead For Mass. Nurses — MNA

Several hundred nurses are expected to picket outside the UMass Memorial hospital campus in Worcester on Wednesday — and this, says Massachusetts Nurses Association spokesman David Schildmeier, is only the opening salvo in what promises to be a “very contentious environment between nurses and health-care administrators over the coming year.”

During the 1990s, he said, the last time the health care system was in a state of major upheaval, there were eleven strike votes and two nurses’ strikes in the state, and “we anticipate that kind of activity, because they’re really making dangerous decisions.”

The MNA says the picket is protesting “poor staffing conditions, the recent decision to close a much-needed medical surgical floor, as well as demands for wage and benefit cuts; all of which the nurses believe compromise their ability to deliver the quality of care patients deserve.” Their announcement is here.

The last Massachusetts nurses’ strike was a five-hour stoppage in 2007, Schildmeier said. But as hospitals in the current economic climate try to cut staffs and services, “we expect a lot of contentious demonstrations, because nurses aren’t going to stand by and let their patients die.” Having been through the cutbacks of the 1990s and their effects, he said, “We’re not going to do it again.”