Nurses Delivered Petition Signed by More than 80% of Tufts' RNs to CEO Ellen Zane Protesting Dangerous Staffing Conditions at the Medical Center

As Nurses Picket, New England Journal of Medicine Study Released Today

Shows Direct Link to Cuts in RN Staffing and Patient Mortality

BOSTON, March 16, 2011 /PRNewswire-USNewswire/ -- Holding signs that read "Safe Staffing Now," "Protect Our Patients," and "Mandatory Overtime is Unhealthy for Nurse and Patients," hundreds of nurses joined by their supporters from the greater Boston community held an informational picket and rally outside the main entrance of Tufts Medical Center today as part of their effort to pressure management to agree to desperately needed improvements in patient care conditions at this major Boston teaching hospital.

"The public needs to know that the nurses are out in front of this hospital today because we cannot provide the care our patients deserve under current conditions," said Barbara Tiller, RN, a nurse at the hospital and chair of the Massachusetts Nurses Association local bargaining unit of 1,200 nurses at the hospital.

The nurses have serious concerns about recent cuts in RN staffing levels and other changes in how they deliver care that has resulted in nurses being forced to care for more patients at one time on nearly every unit. 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.

"Those changes transformed this hospital from being one of the best staffed hospitals in Boston to the worst staffed hospital in the city," Tiller explained. "No other institution in the city is operating ICUs where their nurses are expected to care for three patients, nor are they expecting their medical surgical nurses to carry assignments of up to seven patients on a regular basis."

Tiller added that staffing changes have caused a dramatic deterioration in both the quality of care nurses are delivering and, in some cases, has resulted in serious lapses in care.  In the past 14 months alone, nurses have filed more than 600 reports of incidents that jeopardized patient care.

"I see nurses all over the hospital going home late and in tears over how bad their shift was, and hear that they spend sleepless nights wondering what they missed, or feeling horrible about not being able to provide the level of care they know their patients deserve.  Even one of these occurrences is unacceptable, but to have it happening nearly every day is disgraceful, and it is patently dangerous," Tiller added.  "Issues that are occurring from larger patient assignments include delays in nursing assessment, delayed administration of medications and tests, nurses missing significant changes in patients' health status, poor patient outcomes, patients falling due to lack of assistance in getting up and moving and patients being left in soiled beds for hours at a time."

The MNA pointed to a significant body of research demonstrating the link between poor staffing and the use of forced overtime to a variety of poor patient outcomes and an increase in preventable patient deaths in the nation's hospitals.

New Study in New England Journal of Medicine Supports Nurses Call for Safer Staffing

In fact, as the nurses picketed yet another study, this one in the New England Journal of Medicine, was released today and shows that when hospital floors or units are understaffed and where there is a high turnover of patients on a unit each day (as is the case on every unit at Tufts), the risk of patient death increases significantly.  According to the study's authors, "Our finding that below-target nurse staffing and high patient turnover are independently associated with the risk of death among patients suggests that hospitals, and those concerned with the quality of care, should pay increased attention to assessing the frequency with which actual staffing matches patients' needs for nursing care."

An earlier study in the Journal of the American Medical Association found that every patient above four assigned to a registered nurse resulted in a 7 percent increase in the risk of death for all patients under that nurses care.  So when a Tufts nurse complains about having seven patients at one time, the science demonstrates that all of those patients are at a 21% greater risk of death.  Additionally these same studies demonstrate that when nurses have fewer patients, there are significantly fewer complications, patient satisfaction increases, and nurse retention improves, with no negative impact on hospitals' financial performance.

Other studies have found that nurses working mandatory overtime are three times more likely to make a medication error, and a brand new study released this month found that nurses working more than 12 hours results in an increase in patient deaths in hospitals.  The Institute of Medicine has recommended that no nurse ever be required to work more than 12 hours, which is a regular occurrence at Tufts Medical Center.

The 1,200 RNs at TMC, who are currently in negotiations for a new contract, are seeking contractually guaranteed, safe staffing levels, which would be adjusted to meet patients' needs.  At Tufts, management has not only increased nurses' workload, but they have also refused to adjust staffing based on the acuity of patients (acuity is a term referring to the patient's level of illness).  In addition to calling for improved staffing levels, the nurses are also seeking a provision that would create a process to measure the acuity of patients on each unit and each shift, so that staffing could be further adjusted to meet the actual needs of patients.  These changes would accomplish what has been recommended in the New England Journal of Medicine study and other prominent research studies.  

The nurses are also calling for prohibitions against forced overtime and the inappropriate floating of nurses — all of which are needed to ensure that patients at Tufts Medical Center receive the safe care they deserve.

The nurses began negotiating a new contract with Tufts Medical Center management in September of 2010 and a total of 11 negotiating sessions have been held to date.  The current contract expired on Dec. 31, 2010, and it has been extended by agreement of both parties through the end of March.

"We sincerely hope the hospital will finally come to the table determined to resolve these issues," Tiller explained. "For our part, we are determined to do whatever it takes to protect our patients because they are the ones who have the most to lose if conditions don't improve.  For our patients, this is truly a matter of life and death."

Founded in 1903, the Massachusetts Nurses Association is the largest professional health care organization and the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 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. The MNA is also a founding member of National Nurses United, the largest national nurses union in the United States with more than 150,000 members from coast to coast.

SOURCE Massachusetts Nurses Association