MNA: As BID Plymouth RNs Seek to Negotiate Needed Improvements in Staffing Analysis of Hospital's Publicly Reported Staffing Plans Show Significant Decreases in Patients Access to Vital Nursing Care for 2025

Current conditions and excessive patient assignments for nurses mean patients receive up to two fewer hours of nursing care each day, exposing them to an increased risk for poor outcomes and preventable harm

PLYMOUTH, Mass., Feb. 27, 2025 /PRNewswire/ -- As the 420 registered nurses of Beth Israel Deaconess Hospital-Plymouth (BID Plymouth) engage in a months long effort to negotiate desperately needed improvements in staffing to ensure safer patient care, a recently completed analysis of the hospital's publicly reported staffing plans for 2025 shows a deliberate reduction in nurse staffing levels, resulting in patients receiving up two fewer hours of care from nurses each day, exposing them to an increased risk for poor outcomes and other complications. 

"We became nurses to serve our community-to advocate, care for and protect the most vulnerable individuals in their moment of need and ensure appropriate monitoring and care of these patients. Our hospital has implemented staffing plans that compromise our ability to provide the care we so desperately want and need to provide this community," said Liz Taylor, RN, a long-time medical surgical nurse at BID Plymouth and co-chair of the nurses MNA local bargaining unit for the hospital. "We simply don't have the staff or the time we need to monitor and care for the patients the way we know they need to be cared for, and when we took a look at the hospital's staffing plans we realized this was a conscious decision to by our administration to provide less nursing care as a budgetary decision at the expense our patients health and safety."

The nurses' claims are not based on conjecture or anecdote but are based on a recent analysis of the BID Plymouth's own publicly reported staffing plans, which are posted on the Massachusetts Health and Hospital Association "Patient Care Link" website. 

Every year, BID-Plymouth, along with other hospitals affiliated with the MHHA post their plans for staffing each patient care unit so that the public can see the level of nursing care they should expect to receive while in the hospital. The plans provide the number of registered nurses and aides expected for each shift, including the total number of hours of patient care patients should expect to receive during each day in the hospital. The recently completed analysis by the nurses provides a comparison of the staffing plans for 2024 and 2025, with most units showing reductions in RN positions and a reduction in the amount of nursing care patients are to receive each day. The full report with the actual staffing grids for each unit can be found here, or by contacting David Schildmeier at [email protected].

Key Findings: Decreased Staffing Across Critical Units

Reduced Direct Worked Hours Per Patient

One of the most concerning trends is the decrease in direct worked hours per patient across multiple units. This reduction means that nurses and support staff have less time to dedicate to each patient, increasing the risk of delayed care, medication errors, and overall diminished patient outcomes.

• 2 East (Medical-Surgical Unit): Hours per patient decreased from 9.0 to 7.2 (-1.8 hours per patient).
• 3 East (Medical-Surgical Unit): Hours per patient decreased from 9.38 to 8.26 (-1.12 hours per patient).
• 3 South (Medical-Surgical Unit): Hours per patient decreased from 9.83 to 7.72 (-2.11 hours per patient).
• Critical Care (CCC): Hours per patient decreased from 17.77 to 15.66 (-2.11 hours per patient).
  The reduction in staffing and patient care access in the ICU has resulted in multiple violations of a state law requiring one-to-one care for critically ill patients who need that care.
• Progressive Care (PCU): Hours per patient decreased from 15.96 to 10.7 (-5.26 hours per patient).

Increased Patient Load Without Matching Staff Increases

Several units are now handling more patients while receiving fewer nursing hours. This increased patient census without proportional staffing puts greater strain on nurses, reducing their ability to provide high-quality, attentive care.

• 2 East: Census increased from 41.77 to 48.92 (+7.15 patients), but direct worked hours per patient decreased.
• 3 East: Census increased from 28.15 to 31.00 (+2.85 patients), with reduced hours per patient.
• 3 South: Census increased from 26.04 to 33.16 (+7.12 patients), yet received fewer worked hours per patient.
• CCC: Minor census reduction from 10.8 to 10.73, but staffing reductions remain concerning.
• PCU: Minor census reduction from 4.51 to 4.48, but hours per patient sharply declined.

These changes indicate that staff are being asked to handle more patients with fewer resources, creating an unsustainable workload that could lead to burnout and increased turnover rates among RNs. It is also important to note that these staffing plans as presented are "budgeted staffing plans," which do not reflect the reality on any given day, as the staffing may be even worse than what the plans present as the best case. 

The real impact on patient care at BID-Plymouth has been reflected by the nurses with their filing in real time, official reports – known as "Objection to Unsafe Staffing Reports," which are official reports nurses file in real time on any shift where they confront staffing conditions that threaten the health and safety of their patients. Since the implementation of the 2025 staffing plans, there has been a four fold increase in the number of reports filed by nurses, with more than 90 such reports filed to date, one of which documented conditions in the emergency department that may have contributed to the death of a patient. 

Nurses in the emergency department also report being assigned too many patients to safely manage, with nurses often asked to take on 7, 8 or 9 patients a time, including ICU level patients who are waiting to be admitted to the intensive care unit. As the ED nurses struggle to meet the needs of the current influx of patients, they have raised serious concerns about BI's plan to renovate and expand the emergency department, doubling its size, when they don't have the nurses to provide safe care in the ED as it is configured now. 

To compensate for the cutbacks in staffing, the hospital has resorted to dangerous staffing alternatives, including the floating of nurses, which calls for moving nurses from one unit to another, often without regard for that nurses ability to provide the level of care required for patients on that unit, or utilizing mandatory overtime, forcing exhausted nurses to work extra hours to compensate for the lack of staff. 

In response to these changes, the nurses at BID Plymouth have filed a grievance against the hospital's implantation of these plans, and are utilizing their ongoing negotiations for a new union contract as a vehicle to require the hospital to provide contractually enforceable staffing improvements to ensure patients receive appropriate levels of nursing care, and which can help prevent the burnout of nurses and stem the exodus of nurses that these conditions have caused. The other key issue the nurses have on the table is a competitive wage increase, that will allow BI Plymouth to recruit the nurses to fill the vacancies and to add the staff needed to provide appropriate care. 

The nurses have been engaged in negotiations for a new contract since October 3, 2024, with 11 negotiating sessions held to date, and the next session scheduled for March 12th. The nurses' current contract was set to expire on December 31, 2024, and has since been extended to March 31, 2025. 

"For nurses, this is all about patient care. When you push that call button, we want and need to be there, and when you come to our emergency department, you need to be seen and evaluated in a timely manner, as in many cases, your life may depend on it," Taylor concluded.

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SOURCE Massachusetts Nurses Association