The nurses paced back and forth along North and Wahconah Streets.
PITTSFIELD, Mass. — Nurses and supporters paced back and forth along North and Wahconah streets on Tuesday afternoon, holding signs and chanting "if we're out here, something is wrong in there."
On the other side of the hospital walls, the administration is reviewing data showing Berkshire Medical Center ranking in the top when it comes to patient safety and preparing a forum to celebrate those numbers with employees.
Outside, the nurses chant that the staffing levels are unsafe. Inside, a staffing office is reviewing the personnel on hand to make sure everything is covered.
What separates the two is more than a wall.
The Massachusetts Nursing Association and Berkshire Medical Center are now in collective bargaining for a new contract and little progress has been made. The nurses want language outlining specific staffing ratios in the contract. The hospital, however, says putting in specific ratios takes away the administration's flexibility when it comes to providing a "team" approach to care.
"As nurses, we see day to day what is going on, how unsafe it is, how short staffed we are," said nurse Jody Stefanik said.
"That's what brought it about. It didn't have anything to do with the MNA's agenda. It didn't have anything to do with being angry with management. It had to do with what we need right now to be a better hospital and to make it safe to work here and to be a patient here."
The issue took hold in the Berkshires a little over two years ago when Berkshire Medical Center saw an increase in patients following the closure of North Adams Regional Hospital. Nurses started to feel they were constantly short staffed and patient care was being compromised. In December 2014, they held an informational picket protesting the staffing numbers.
"A way to address problems going on at the hospital is for the nurses meet with management on a regular basis and talk about those issues. The nurses brought forth the unsafe staffing at every single labor management meeting between that picket and this contract negotiation. The hospital did not address the problem," said Joe Markman, a MNA spokesman.
"Coming into this negotiation, the nurses said this is our No. 1 priority and we have to address it in the negotiation process."
Hospital officials, however, say there isn't an issue with staffing and patient safety ratings support that.
BMC Chief Operating Officer Diane Kelly says the staffing guidelines are taken directly from the best practices as laid out by the American Nurses Association. Kelly says there is an entire staffing office reviewing the numbers of patients, levels of sickness, and other factors on an hourly basis and making adjustments as needed.
"It's looked at every hour. How many patients are coming out of OR, how many coming out of the ICU, how many medical patients are going home," Kelly said.
"Someone is looking at this every single hour, making judgments and sending people and moving people. For me to have a contract that restricts that, I don't believe is for the best care of patients."
Kelly says one difference in viewpoints between the administration and the nurses is that the MNA is looking solely at the number of nurses while the hospital is taking all staff, including doctors and therapists and others, into account.
Kelly said there are many other employees from various disciplines who are available and moved around as additional resources to ensure there is safe staffing.
"The American Nurses Association and our staffing plan builds them into our plan because we know that is the best quality. Quality care delivered is a team concept. The Mass Nurses Association is completely silent on anyone but a registered nurse. They don't take them into account and you can't not include those people," Kelly said.
Later she added, "This is well founded, well developed, and it honors all of the disciplines. Every single person in health care will tell you there is no one discipline that can carry the ball on their own ... You are only as good as your team and we believe building your staffing on that team concept is critical."
The MNA, however, says it had nurses document every time there was unsafe staffing level. That threshold was based on the hospital's staffing plan and when patients got sicker or there was an influx, adequate resources were not brought in 280 times in the last year.
"When I write one of those out, it is serious. I don't write them out just for fun. It's a pain to do and so when I write it out, I would hope they would notice and take it seriously," Stefanik said.
After failing to see things eye to eye, the MNA is now asking for nursing staffing levels to be written into the contract.
That would make the staffing ratios immovable by hospital administrators during the length of the contract and force accountability. If a violation of those minimum levels is made, the nurses would then have grounds for a grievance. That could ultimately lead to an arbitrator becoming involved and the hospital being required to address any issue.
"The mix could be anything. There could be more full-time or part-time nurses as long as there are enough nurses at the moment in time ... You set a minimum threshold. The hospital can go above that threshold but they can't go below it," Markman said.
"If nurses are able to get this staffing language into the contract, the hospital can be held accountable. If it isn't in the contract, the hospital can say we don't agree with you and that's it. If it is in the contract and the nurses say you are violating the safe patient limits, they can file a grievance."
Kelly said she had never received any of those 280 complaints. She said all of those were directly sent to the MNA headquarters and not to hospital management.
"If you believe those tools are to help you improve your processes, we have to see them. We have not seen them. So when I heard 280, how did that happen? They were sending them directly to Canton," Kelly said. "Did they want them for documentation or did they want them for improvement?"
Kelly's evidence that the management of staffing levels are working in the best interest of the patients comes from independent, third-party rating systems. She cited ratings from Centers for Medicare and Medicaid Services, Carechex, and LeapFrog as all ranking BMC high in patient safety. She said each of those independent assessments are made through analysis of hospital data.
"We are recognizing our patient safety scores for being No. 1 in Massachusetts with Carechex and being No. 1 ranked for CMS Patient Safety Index. [The picket] is very ironic because we would be celebrating, and congratulating, and thanking all of our employees including our registered nurses for a job well done. We are a safe hospital with high quality. It is something our community should be proud of, not picketing," Kelly said.
She called the picket "disappointing" because she believes in the staffing management of the hospital. What she doesn't want is to give into placing specific ratios on the numbers of nurses because it would take flexibility away from the decisions the staffing office has to make.
"They have a very specific ratio of nurse to patient and they don't care about anybody else in the equation. That is just a shortsighted approach," Kelly said.
Stefanik says the MNA has been very flexible when it comes to bargaining. She said the union has made multiple offers from specific nursing numbers in each unit at times to having the number of nurses set based on the level of care needed for individual patients.
"We have been very, very flexible and we've given them far more than anything. Quite frankly, they've been disrespectful to us. They are saying one thing and doing another. We've requested better security because we've had multiple occasions where weapons have been brought onto a unit, people have been injured. We asked for seven security guards on every shift — one at Hillcrest, two at North Adams, and the rest at Berkshire Medical Center — and they cut our security staff," Stefanik said.
"I think they are being very punitive with our requests."
Kelly said the administration has been willing to negotiate and had offered a proposal to form a labor board consisting of three nurses from the MNA and three members of management to address staffing issues on an ongoing basis. But, Kelly said that was rejected despite it, too, being a recommendation of the American Nurses Association.
Now, accusations are flowing from each side. Both sides say the other is not negotiating in good faith. Markman suggested that the hospital's safety ratings are from organizations that accept money to promote hospitals — which Kelly denies — and Kelly believes the nurses' picketing isn't focused on BMC but rather a statewide push by the MNA to get those ratios into contracts.
"This was a demonstration we've seen the MNA do across the commonwealth, basically carrying the exact same signs, the exact same bus pulls up from the MNA headquarters. And they have some people we've noticed are not Berkshire Medical Center nurses — quite a few actually," Kelly said.
Stefanik said the issue was brought forth after canvassing the nurses at Berkshire Medical Center, who cited the staffing as a top priority entering negotiations.
"It wasn't money. It wasn't better benefits. It was safe staffing. That was the No. 1 goal of the MNA bargaining unit here, who work at Berkshire Medical Center. They wanted safer patient ratios and safer staffing," Stefanik said.
Nurse Mark Brodeur says it is a top priority for him, especially working nights. He said it can often be difficult in the middle of the night to find additional resources to help when a patient takes a turn for the worse and there is an influx.
"I think situations change throughout the day, nursing is very inconsistent work, and people are unpredictable," Brodeur said.
He said if staffing levels are at unsafe level "once and something bad happens to somebody, that's often enough."
But how to ensure patients safety when it comes to staffing is right now putting a halt to the negotiations. The nurses' contract expired in September and the staff is currently working on that contract while a new one is being negotiated. The staffing issue has put a halt to much progress.
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