Getting the Facts Right on Nurse Staffing

Saint Vincent Hospital Provides Transparency on Staffing

Worcester, MA – March 10, 2021 – Saint Vincent Hospital offered its nurses a very generous proposal well before a strike notice was issued by the Mass Nurses Association (MNA), because we recognize our team members who contribute so much, especially during 2020. The comprehensive offer included significant wage increases, benefits improvements, enhanced ER security measures and staffing. The MNA, instead of responding constructively, went on strike and made claims about safety and staffing that are not true.

Saint Vincent Hospital took the MNA’s claims on safety and staffing seriously. Rather than dismissing them, we chose to conduct a thorough review of our performance in these areas.

First, the hospital is not only safe, but has performed well and continued to improve. Since 2019, hospital mortality rates decreased 9%, hospital-acquired infection rates decreased over 30% and the number of serious patient safety events decreased to 0. Additionally, the rate of patient falls and hospital-acquired pressure ulcers has remained relatively flat. Despite claims from the MNA of hundreds of complaints from nurses, the Massachusetts Department of Public Health (DPH) has issued only 2 citations to the hospital since 2019. Both citations were cleared quickly. Saint Vincent is the excellent hospital you know it to be, and it is why multiple external agencies including US News and World Report have rated it among the best hospitals in the state.

Second, the hospital has consistently staffed a mixture of 1:4 to 1:5 nurse to patient ratio across med-surg units and followed staffing guidelines in the current contract. Our contract has had staffing guidelines since 2000. They are already restrictive with 1:4 to 1:5 staffing dependent on patient census, limited ability to float nurses and a requirement to have a resource nurse on every unit. The resource nurse supports the nurses providing direct patient care but only directly cares for patients under select conditions.

We took the accusations that the hospital was staffing outside its established guidelines seriously. We performed a detailed evaluation of staffing on each med-surg unit for every month over the last two years. We used a conservative approach to evaluate actual nurse worked hours and patient census data.

The approach and findings from our evaluation were validated by an independent third party. We are sharing these to set the record straight.

• Pre-COVID from Jan 2019 to Feb 2020, the hospital staffed med-surg units at an average of 1 nurse to 4.4 patients. If the resource nurse is included in the calculation, the ratio is 1 nurse to 3.8 patients
• Throughout COVID, the hospital staffed those same units at an average of 1 nurse to 4.7 patients. If the resource nurse is included in the calculation, the ratio is 1 nurse to 4.0 patients
• While the number of patients per nurse rose slightly during COVID, each med-surg unit remained within the contractual guidelines throughout the pandemic despite a national nursing shortage.
• For context, California, the only state with mandated ratios, requires 1 nurse to 5 patients with no resource nurse on med-surg units. The state also waived staffing ratios for select hospitals during its COVID surge.

“The staffing guidelines in our contract provide for coverage that is well within industry standards and are comparable to major Boston-area hospitals that also have outstanding reputations for quality and safety. While COVID-19 posed an additional challenge, we have worked within the guidelines without compromising care,” said Lisa Beaudry, Chief Nursing Officer of the hospital.

“It’s important to provide the community transparency into the numbers given the inaccurate statements from the MNA,” Jackson said. “The facts discredit the MNA’s claims. We have consistently staffed within the guidelines of our contract and maintained a high quality of care, even during the pandemic. We are sensitive to the fact that our nurses worked even harder last year and took this into account in our generous wage and benefit proposal which will not only respect the work done last year, but also help us be competitive to hire more nurses to help combat the national nursing shortage.”

Saint Vincent Hospital carefully considered the MNA’s staffing proposal, reviewed the needs of the hospital’s patients and proposed several additional improvements in staffing, including:

• Addition of COVID staffing guidelines during the declared COVID State of Emergency, so that no nurse on a med-surg floor will be assigned more than four COVID patients and no nurse in the Progressive Care Unit will be assigned more than two COVID patients.
• Classification of two additional nursing units to 1:4 nurse to patient staffing guideline, in recognition of increased patient acuity. In doing so, 3 out of 8 med-surg units would have 1:4 staffing.
• Maintained the addition of a dedicated Critical Care float position within the existing float pool 24 hours a day, seven days a week, to address additional patient loads as needed.

Unfortunately, the hospital could not accept the aggressive staffing levels in the MNA proposal. For example, it included increasing the staff in a well-functioning ER from 71 full-time employees to 157 without an increase in patients. The MNA staffing proposal echoed the failed 2018 statewide ballot question calling for mandatory ratios in all Massachusetts hospitals. Those ratios were opposed by hospitals and many medical professional organizations, including two nursing organizations, and it was defeated by a 70-30 margin.

“The MNA’s overreaching agenda of mandated ratios should be addressed in the proper legislative forum, not in individual hospital contracts and with irresponsible actions like a strike during a pandemic,” Jackson said. “We have met our obligations to our nurses and patients in our proposal. We respectfully request a reasonable negotiation that takes these facts on our safety and staffing into account so we can work towards an appropriate solution.”