By Liz Kowalczyk
Boston Globe
March 16, 2011 

Tufts Medical Center nurses are ratcheting up their heated contract dispute with the Boston teaching hospital. Nurses planned to follow a flash mob at South Shore Plaza yesterday with picketing from 4 to 6 p.m. today outside the hospital in Chinatown.

Nurses say that recent cuts in staff and other changes in how they deliver care mean that nurses are caring for more patients at one time on nearly every unit. These changes, they say, have transformed the hospital from one of the best staffed in Boston to the worst.

For example, according to figures derived from a public database posted by the Massachusetts Hospital Association, each Tufts nurse in pediatrics cares for at least 1.4 critical care patients, compared with 1.03 patients at Massachusetts General Hospital, the nurses union says.

To compensate for chronic understaffing, Tufts is forcing nurses to work overtime and to "float" from one area of the hospital to another where they might not be competent, according to the Massachusetts Nurses Association. The group represents 1,200 nurses at the hospital and is trying to prohibit these practices in a new contract.

Even so, nurses said, there are delays in assessing patients, giving them medications and tests, and in changing bed linens, as well as more falls because nurses cannot get to the bedside as quickly to help patients walk.

Hospital spokeswoman Julie Jette said in an e-mailed statement: "Delivering high-quality and cost-effective care is critical for our patients and the health care system. Understanding this is not as simple as reviewing a particular number of patients per nurse. We are developing a new model of care at Tufts Medical Center that utilizes the skills of many clinical team members, including nurses, to deliver the best care possible. We are confident that our new model is working because we are seeing excellent results in our quality metrics."

For example, Jette cited the hospital's low infection rate for patients receiving nutrition, hydration, and medication through tubes called central lines. 

A study published this afternoon in the New England Journal of Medicine from researchers at several US teaching hospitals supports the idea that low numbers of nurses can hurt patients. In a review of 197,961 admissions between 2003 and 2006 at one unnamed academic medical center, researchers found that the risk of a patient dying increased 2 percent for each nursing shift that had a below optimal number of nurses.