By Rachel Zimmerman
February 15, 2011
Commonhealth

The nurses at Tufts Medical Center say recent staff cuts 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.”

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 cuts.

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:

–On one occasion a patient was transferred to an understaffed unit with no room available. The patient had just experienced a serious head injury and was actively withdrawing from alcohol. Since there was no room or nurse to take care of the patient, the nurses on that unit were told by their manager to “leave the patient in the hallway and make due with a bad situation.” Because of this placement in the hallway, there was no access to provide IV therapy to properly medicate the patient for his seizure or withdrawal so he was at a high risk for another fall. In fact, he repeatedly tried to climb out of his stretcher. The requests from the nurses for an aide to sit with the patient to keep him safe were denied. Again, they were told “there are no sitters available, just make do.” This difficult patient now required two nurses for safe care while at the same time two additional patients were sent to the floor and left in the hallway to be watched by an unlicensed technician. As a result, the 12 other very ill patients on the floor did not receive their needed care.

–On another occasion, nurses on a busy pediatric floor found themselves with every room full of sick kids, all of whom required attention from the nurses on duty. While the nurses were busy giving medications, a child on the other side of the unit began experiencing a seizure. When no one could respond to the call button and all RNs were in patient care areas, a person ran to the other side of the unit crying for help and found a nurse to attend to the seizing patient. This never would have occurred had there been an appropriate number of nurses on staff. Luckily, the outcome was not tragic, but it could have been.

–On a busy cardiac floor, nurses found themselves overwhelmed with a full unit of extremely acute patients, yet no attempt was made to adjust the staffing level to account for the intense needs of these patients. The ED kept sending up patients. Without time to prepare, clean rooms (which increases the risk of acquiring a serious and potentially deadly infection) nurses were again forced to place patients in the hallways (an equally dangerous situation). One of the patients on the floor had returned from cardiac surgery in acute distress and was experiencing dangerous heart rhythms that set off multiple cardiac alarms requiring an immediate response and required attention from two nurses to administer medications to prevent a serious complication. Again, while these nurses cared for this patient, many of the other seriously ill patients were neglected, resulting in multiple patient complaints, including numerous call lights left unanswered. At any moment, any one of these patients could have slipped into severe cardiac distress and died.

The nursing staff cuts 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 Massachusetts 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.”