Anna Jaques Hospital RNs Go Public with Concerns for Patient Safety Resulting from Lack of Needed Staff & Closure of Essential Services

Nurses cite the closure of the Pediatric Unit, the periodic closure of CT Scanning Service and the lack of staff in other departments as cause for excessive ED wait times, delays in care and the unwarranted transfer of patient to other facilities at a time when medical transport services in Newburyport are already strained

Efforts by the nurses to convince hospital administration to address these concerns and to recruit and retain needed staff (AJH nurses are the lowest paid nurses in the region) to ensure quality patient care have fallen on deaf ears

NEWBURYPORT, Mass., Nov. 22, 2022 /PRNewswire/ -- Registered nurses at Beth Israel Lahey Anna Jaques Hospital (AJH) are sounding the alarm about the safety of patient care at the facility due to the lack of needed staff in a number of departments and the recent decisions by the hospital administration to close essential services, including the decision last year to close the hospital's pediatric unit and the periodic closure of the hospital's Computer Tomography (CT) scanning service. 

These conditions have resulted in excessive wait times for patients in the hospital's busy emergency department, delays in patient care as overburdened nurses and other staff struggle with excessive patient loads, and the unnecessary need to transfer patients to other facilities at a time when the medical transport services in the region are already strained. It has also caused an exodus of many types of staff who are burnt out from the conditions and those seeking positions in better staffed, higher paying facilities. 

"As nurses we have a professional and legal obligation to advocate for our patients to ensure they receive the care they need when they need it and since our administration refuses to listen to us, we feel the public has a right to know about these conditions," explained Colleen Carbone, RN, a nurse in the hospital's emergency department and co-chair of the nurses local bargaining unit with the Massachusetts Nurses Association (MNA).

The problems for staff and patients at AJH are not new or recent. In fact, in January the nurses presented to hospital management a petition, signed by the majority of nurses, calling on the administration "to take immediate steps to address the ongoing unsafe acuity of daily assignments….that is jeopardizing the safety of patients, staff and the community." In response, nurses report that hospital management has done nothing to address the conditions, which have only gotten worse.

"As nurses, we are professionals, we are the eyes and ears of everything that is happening with our patients, we are the front line of care for our patients in the hospital, but we are not being heard, we are not being respected. In fact, we are being outright ignored, it's like talking into an abyss," said Elizabeth, Goullaud, RN, a nurse on the hospital's behavioral health unit.

The lack of 24/7 access to CT scanning services is of critical concern for the staff and patients, as this scanning is key to diagnosing a variety of critical medical conditions, including evaluation of patients presenting with head or other internal injuries and those suffering from a potential stroke, where rapid identification and treatment are essential to protecting vital brain function.  Since September, due to the loss of technicians and management staff in this service and the hospital's failure to replace them, CT scanning has been unavailable between 30 – 50 percent of the time – a particularly galling development for a facility that on its web site states, "Anna Jaques is an accredited stroke facility and provides evaluation of potential stroke patients in our Emergency Department 24 hours a day."

"We were also concerned that while the CT service was closed, the public and our patients were not informed of that fact," Carbone said.  "They have a right to know when such a vital service is not available so they can make appropriate life-saving choices about their care." 

In response, the MNA, which represents the 350 registered nurses at the hospital, has appealed to the hospital administration for action to preserve full access to the service and has filed official complaints with the Massachusetts Department of Public Health and the Joint Commission, the agency that provides accreditation of acute care hospitals.  

As stated in the complaint: "The hospital is a busy one providing emergency care to 27,000 patients annually, critical care and medical surgical care at the crossroads of busy interstate highways and the popular beach communities in the area. The unavailability of the CT scan has contributed to seriously worsened ED wait times, wait times for diagnostics, and has also pushed the region's EMS transport system beyond its capabilities as AJH has had to transport out patients to facilities with working CT scans. In cases that do not get transported out of the hospital those patients are boarding in the ED for eight hours or more to wait for the CT scan."

Adding to the nurses' concerns is the closure last year of the hospital's pediatric unit.  After a public hearing on the closure, the state's Department of Public Health, deemed the service "essential" for the health of the community.  Despite the finding and given the fact that DPH lacks the authority to mandate continuation of the service, AJH administrators moved ahead and closed the service, resulting in very sick children being boarded in the hospital's emergency department waiting for a transfer to a facility that can provide needed care. This is occurring when there is a statewide shortage of acute care pediatric hospital beds and services due to an early seasonal surge of respiratory diseases such as respiratory syncytial virus, enterovirus, and rhinovirus.

"AJH has forgotten that their nurses are there when the first breath of life is taken and when the last breath of life is taken. The AJH nurses are there to fight with you for every breath in between. They have to be supported in their practice with appropriate staffing and equipment," said Walter Keenan, RN, and emergency department nurse and member of the nurses negotiating committee. "Nurses should be a priority at AJH and not taken for granted."

Nurses also cite significant staffing shortages, including RNs, nursing assistants, unit coordinators, technicians and other frontline staff in nearly every department, which for nurses means being required to take on excessively large patient assignments that studies show jeopardize the safety of their patients, results in less time for nurses to monitor their patients, as well as excessive delays in their ability to administer medications and other treatments. The lack of adequate staff also results in significant delays in a nurses' ability to move patients out of the ED and onto the medical/surgical floors, or the psychiatric unit, forcing ED patients to be placed on stretchers in hallways waiting for needed care.  

The nurses also point out that earlier this year the hospital relinquished its status as a regional trauma center, downgrading the level of services available in the emergency department and further signaling its commitment to a lower standard of care for the community. If there was any consultation with the state or the local community about this decision and its impact, it was not readily apparent. 

"I have had patients waiting in our ED for over 17 hours waiting for a transfer to a Boston hospital to provide the care they need," Carbone explained.

Staffing shortages are also resulting in the unavailability of key services, particularly on nights and weekends -- services such as cardiac catheterizations, echocardiograms, nuclear medicine – tools particularly important for evaluating cardiac emergencies. This could mean patients must be transferred to another facility, or to wait for these procedures, placing them at undue risk. 

Michelle Eaton, RN, another emergency department nurse explains how the culture at AJH has changed under the current administration. "I started my nursing career at AJH over 20 years ago. I've had the opportunity to work in several departments having started as a CNA with the majority of my career being spent as an ER nurse," said explained. "The culture here had always been one of respect, teamwork, and pride. It was difficult to get a job here as we had excellent staff retention. It wasn't uncommon to be working alongside highly skilled and experienced people who had worked here for 20, 30, or 40 years. We were listed as being a "Top 150 Places to Work in Healthcare" several years in a row. We were a family, had comradery. We had a CEO who made rounds in each department almost daily. Over the past several years there's been a shift. We've gone from a proud community hospital to a corporate environment where the general feeling is that we're replaceable, and that there is no concern for improving our quality of work life or patient care. Nurses are burnt out from working double shifts, in some cases, to fill holes due to lack of staffing. We're flying by the seat of our pants most days; long wait times, boarding in the ER, lack of supplies, failing equipment, and upper management has done nothing to even give the impression that they are concerned or even open to discussion."

"Nurses are also leaving because they worry that their nursing license could be in jeopardy, and they don't want to risk their professional future, their livelihood and the safety of their patients working under such conditions," Carbone added.

There are currently over 30 unfilled RN positions listed on the hospital's web site, and these postings do not represent the actual need for safe RN staffing at the facility. The problem is compounded by the fact that AJH nurses are the lowest paid nurses in the region, paid between 15- 40 % less than their counterparts at other facilities, including nearby North Shore Medical Center or Beth Israel Lahey's Northeast Hospital Corp facilities – Beverly Hospital and Addison Gilbert Hospital. Those facilities just negotiated new contracts granting significant wage hikes to help recruit and retain their nursing staff. 

In lieu of recruiting and retaining local nurses, AJH is relying on the hiring of more expensive travel nurses to fill the void, which the AJH nurses see as a costly and unsustainable alternative. Studies show that the best care is delivered when hospitals have an adequate supply of nurses on staff who are familiar with the community and the patient population served by the hospital.

"The culture at AJH always used to be one of neighbors taking care of neighbors," said Margaret Mirecki, RN, a nurse on the hospital's telemetry floor and a member of the nurses negotiating team. "It doesn't feel like that now. We have already lost so many strong nurses that if retention is not addressed, it will become a place where local nurses will not want to work here anymore."

While the AJH nurses are working under an existing contract through Dec. 31, 2023, the MNA has made clear its willingness to work with AJH to explore opportunities to address this staffing crisis.  To date, AJH's administration has turned a deaf ear to the nurses' concerns and their efforts to address the nurses' concerns. Adding insult to injury the hospital recently switched to a new payroll system that failed to properly pay several nurses, sometimes for multiple hours and shifts. When nurses complained, the hospital was slow to respond and continues to refuse to complete an audit of the nurses' payroll to ensure all nurses have been properly paid. 

"When I started working at AJH, there was so much support and encouragement from my co-workers, you could feel that everyone was happy to be making a difference within the community," said Amy Chaisson, a nurse on the hospital's medical/surgical floor. "But lately, with the lack of resources, communication and continued lack of management presence or interaction with any of the staff, the morale has severely suffered. Nurses are moving on, taking jobs just a few miles up the road and receiving better pay, more resources and more support from managers to make a difference, while we continue to ask for these things from our administration and continue to get nowhere and see no improvement in our conditions." 

The AJH nurses see no reason why their hospital, which is owned by Beth Israel Lahey Health, one of the states' largest and most profitable healthcare providers, can't provide nurses and the community with the resources needed to ensure the highest quality patient care. The nurses also take issue with BI Lahey's efforts to close needed services, both at AJH and also at Northeast Hospital Corp., where they recently made the controversial decision to close the North Shore Birth Center affiliated with Beverly Hospital. When the hospital's parent corporation was allowed to form through a merger creating the Beth Israel Lahey System (BILH), they made a commitment to the Attorney General that they would "maintain access for the communities served by BILH Hospitals substantially similar clinical services as before the Closing Date" of the merger.

"Anna Jaques has a long and proud history of serving Newburyport and surrounding communities, and nurses and all of our fellow staff members have played a vital role in that effort," said Polly McDowell, RN, a longtime nurse at AJH and co-chair of the nurses local bargaining unit with the MNA. "We hope by educating the public about these issues, our administration will finally be convinced to work with us to better protect our patients and the communities we all are here to serve."

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Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

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