PITTSFIELD, Mass. — After hitting a stalemate in negotiations, the nursing union has released 437 "unsafe staffing forms" that it says document specific instances when nurses felt they needed more help.
The local chapter of the Massachusetts Nursing Association, representing registered nurses at Berkshire Medical Center, have been negotiations with Berkshire Health Systems on a new contract. Particularly, the nurses say they hope to a contractual agreement to bolster staffing.
But, months ago the hospital had already put forth its "best and final offer," which the nurses rejected.
Since then, there have been multiple bargaining sessions but both sides remain apart. The MNA says it is concerned with patient safety and has been pushing "safe staffing" as a major talking point. Recently, the nurses have sought out members of the health systems' board of trustees to join their side and are looking for public support.
Over the last 22 months, the nurses documented instances when they felt staffing was subpar and those instances were made public on Wednesday as the MNA continues to seek support. Those specific incidents are detailed below after the union released the paperwork to the media on Wednesday.
"We are concerned by our administration's continued disregard for the negotiating process, and more importantly, for our documented patient safety incidents by their continued refusal to work with us to improve staffing to ensure the highest quality care," Alex Neary, a registered nurse and co-chair of MNA's bargaining committee.
Citing a number of patient safety awards the hospital has received, BHS administrators said the release of those reports is a one-sided attempt to "disparage" the hospital. Chief Operating Office Diane Kelly, also a registered nurse, said the documents lack follow up information and fail to show that the instances truly put patients in danger.
"We're deeply troubled at the union's continued campaign to disparage the hospital," Kelly said. "The forms released are not Berkshire Medical Center forms."
She said the supervisors, on some of the occasions, responded to the change in patent numbers or needs and got help, but that part wasn't documented. She said there were occasions on the list in which a supervisor heard the complaint and investigated it, only to find out that the situation wasn't as dire as the complaint made it seem. She called the forms a "scorekeeping card" showing only one perspective.
"If there is a need to respond, [supervisors] respond," Kelly said.
Kelly said the hospital has an internal quality assurance process to handle any such situation. The forms released by the union were not part of that process; the forms the MNA released were union documents.
"They can write whatever they choose," Kelly said.
The union says the nurses wouldn't have taken the time out of their day to write the report if the situation wasn't serious. The reports are made when the nurses feel patient safety is in jeopardy. The documentation includes the date, the unit, the shift, how many patients were on the unit at the time, the staffing level, how much staff should be needed according to staffing grids, the supervisor's response, and a brief summary of the incident.
"For years, we have been raising concerns and attempting to convince management to address what is a clear pattern of unsafe patient care incidents that we continue to document in real time with these unsafe staffing reports," Neary said.
"We have brought these forms to nearly every meeting we have had with management at the hospital prior to negotiations and repeatedly during contract negotiations, yet management continues to dismiss our concerns and reject our proposals to address this problem. Since management refuses to acknowledge these situations, we are sharing them with the public so they can understand what we are dealing with, and hopefully, understand that they have the most to lose if management continues to ignore our call for staffing improvements. The nurses just want to be able to provide the safe and effective care their patients deserve."
The nurses say the documentation is "tangible evidence of a chronic lack of staffing needed to keep patients safe."
The union said address staffing deficiencies has been the main point of its negotiations and at first pushed to include specific staffing ratios, based on the number of patients and levels of sickness into the contract. That would have held management accountable for breaking the contract if and when these type of instances occur.
The hospital, however, said specific ratio would take away too much of management's control over how to staff the hospital. The hospital wants flexibility when it comes to making those decisions and says it uses a team approach, by not just counting the number of nurses but including staff from all disciplines.
The hospital put forth the concept of a new staffing committee. That committee would meet regularly and include nurses, union officials, and management to discuss the data and make recommendations as to how to best staff a unit.
"We agree that we should have a format of face to face conversation [about staffing]," Kelly said. "That is why it is in our best and final proposal."
The nurses, however, says there is already a staffing committee that is clearly not working. The union moved off from its position of a specific matrix but still pushes for language that includes having charge nurses unassigned to patients, freeing them up to manage the unit.
Chief Nursing Officer Brenda Cadorette, a registered nurse, responded by saying the new committee would be different because it would focus more on the individual units and because it is contractual, both sides will be forced to participate in the meetings and process.
"The new proposal is about the nursing manager and their staff," she said. "It is much more specific than it had been before."
In May, the hospital had presented its best and final offer. At the end of that month, the nurses rejected it by a vote. Both sides returned to the table, with the union putting forth the charge nurse proposal. The hospital hasn't countered and instead continues to support its final offer. The nurses have accused the hospital of rejecting any path toward coming to an agreement.
The hospital, however, says for the first year of negotiations management had revised its proposal multiple times based on union feedback, while the union hadn't budged nearly as much.
"For the first 14 months, Berkshire Medical Center made many, many changes," Kelly said. "We believe in our best and final offer."
The union's bargaining committee has the authorization to call a one-day strike, which requires a 10-day notice. And the hospital has already made plans to bring in replacement nurses for an entire week should that happen. The nurses have not yet called a strike, but the possibility looms.
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