After filing more than 150 reports of what RNs consider to be unsafe patient care and greater patient risk with the hope that hospital administrators would rectify the situation and negotiate with RNs, which they did not, 94% of the nurses voted in favor of the strike

Editor’s Note: Follow this link to view a detailed report on the patient safety crisis at Quincy Medical Center.

QUINCY, MA — To protest dangerous staffing conditions at their hospital, today registered nurses at Cerberus-Steward- owned Quincy Medical Center issued a required 10-day notice of their intent to conduct a one-day strike on Thursday, April 11. The strike will be the first nurses’ strike at a Greater Boston hospital in more than 25 years and it has been sanctioned by the most overwhelming nurses strike vote in Massachusetts history.

After filing more than 150 reports of what RNs consider to be unsafe patient care and greater patient risk with the hope that hospital administrators would negotiate a safe staffing plan to rectify the situation, which they did not, 94% of the nurses voted in favor of the strike, with 90% of the Mass Nurses Association members at the Hospital participating in the one day secret ballot vote.

The long-standing patient safety concerns at the hospital turned into full blown crisis on February 17 when Cerberus-Steward, the for-profit owner of the hospital, shut down a 40-bed nursing unit. As a result, nurses report that as many as a dozen patients per day are being “boarded” in the hospital’s emergency department (ED), sometimes for 24 hours or more under conditions the nurses consider to be unsafe.

“The public needs to know how worried we are, that we’ve been telling management we don’t consider this situation to be safe, and they have been refusing to discuss the staffing plan with us,” said Stacey McEachern, RN, a nurse in the emergency department. “The patients who are being boarded in our ED have been admitted to the hospital, but are not receiving an appropriate level of care because they are being placed on stretchers in an emergency room, waiting for a bed on a medical floor that no longer is available to them. The bottom line is patients are being deprived of the services they need. Management has told us that the hospital is trying to cut costs, and that their parent company Cerberus won’t invest more money, and that it’s their right to make these decisions”

The nurses issued the formal 10-day strike notice, which is required by federal labor law, as hospital management continues to refuse to agree to negotiate solutions for desperately needed improvements to ensure that patients do not continue to be at risk. Numerous studies over the last decade have shown a direct and immediate link between excess patient assignments for nurses and the serious complications, medical errors, and readmissions caused by a lack of access to timely nursing care. The one-day strike will begin at 6 a.m. on Thursday, April 11 and will end on Friday, April 12 at 6:00 a.m.

“Our members have had enough,” said Paula Ryan, RN, a nurse at the hospital and chair of the MNA local bargaining unit. “We have attempted to negotiate for months with management. We have presented written reports; we have told them we are worried that there are immanent risks of negative patient outcomes. They have refused to respond except to say that this is a financial decision. We feel that we have a duty to our patients and our practice and to each other to take action. We also consider it to be our duty to the future of this hospital that we love. I have been a nurse here for 45 years. I received my RN training here, and had my children here. This is our hospital and we want it to succeed. But when you find yourself to be in a hole, the first step is to stop digging. We are at the point where we have to say ‘stop.”

Since the closing of the medical-surgical unit, ED nurses report being put in the position of providing types of care for which they are not equipped for patients who have been “admitted” to the hospital as ICU, Medical Surgical or Telemetry patients, but who, in reality, are physically being housed in the ED. They also report that they are caring for admitted patients without bolstering the number of staff in the ED. When not boarded in the emergency department, patients are being sent to other areas of the hospital, such as the intensive care unit, which means that there are now fewer beds available for more critically ill patients. MNA/NNU nurses have been complaining urgently to Steward management for four weeks that patients are not receiving the level of nursing care they should expect and deserve, and that they are greatly concerned about immanent potentially negative outcomes.

The nurses have been attempting for months, well before the closing of the unit, to convince the hospital to negotiate with them to improve patient safety and care, as fewer nurses have been expected to care for too many patients at one time. In the past 12 months, nurses have filed more than 150 written reports of unsafe conditions at the hospital where they felt the safety of their patients was placed in jeopardy as direct result of excessive patient assignments. In early January, dozens of nurses from the hospital, including nurses from the unit that was just closed, were out in the community, handing out leaflets at T stations and shopping centers detailing their serious concerns about potentially unsafe staffing conditions at the hospital. Nurses have also informed the Department of Public Health that they consider conditions to be unsafe for patients.

There have been several episodes in the past month in which there have only been two nurses on the schedule in the Emergency Department instead of the five nurses that are supposed to be on duty to care for patients under normal circumstances. McEachern and the MNA/NNU confronted management and asked how they expected the nurses to care for patients in the event of a “code” -- a critical case that demands at least two RNs, leaving no one else to care for other emergencies. Management has been non-responsive, saying they aren’t obligated to have that conversation.

“At a time when we already lacked the staff needed to provide the care our patients deserve, Steward has inflamed the situation by closing a unit that we desperately need,” said Paula Ryan, RN, a nurse at the hospital and chair of the MNA local bargaining unit. “What is worse, they made this decision without fulfilling their obligation to meet with us and to ensure we had a staffing plan in place to ensure the safety of our patients.” The MNA/NNU has filed an Unfair Labor Practice charge against the hospital with the National Labor Relations Board over management’s refusal to negotiate over these and related issues.

According to retired QMC RN and MNA Board of Directors member Sandy Eaton, “Among us are people who were born at QMC, whose children were born at QMC, whose families have been cared for at QMC, and who have provided care here for up to 45 years. We are deeply committed to the mission of this institution that we have helped to build and which we urgently want to see succeed. Recent facts paint a disturbing portrait of the effects of recent decisions of the hospital’s owners. This is our hospital, and we are speaking out for the quality of patient care and defending the hospital from harm so that it can thrive for decades into the future are, in our view, one in the same.”

The 236 nurses at Quincy Medical Center have been in negotiations for their first contract with Cerberus Steward, which purchased the hospital in October of 2011. Countless negotiations sessions have been held since December 2011.

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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.