Nursing Notes

February 14, 2010

Costs on rise, nurses protest staffing changes

I am a staunch supporter of some type of national nurse-to-patient ratio to be enacted.  I feel this way because I know what it is like to work a shift with too many patients and not leave at the end of your shift.  I know what it is like to wake up from a dead sleep to call the unit to make sure I did (or did not) do some task because I was so busy during my shift.

That said, I have to now say that the following article does not surprise me in the least.  I read articles each and every day that describe the effects on health care of all the budget cutting going on.  I know that hospitals really are a business and are always looking for ways to save money (read increase profits).  I knew it would not be long before “nursing costs” were under scrutiny and new and novel means developed to decrease those costs.

Granted, these nurses have been working with fewer patients than the norm.  Granted, these nurses are well paid.  However, it sets a really dangerous precedent for this hospital to increase nurse-to-patient ratios as a cost-cutting tactic.  What do you suppose will happen to that same hospital when it cannot find or keep nurses at the bedside?  Hospitals cannot operate without nurses, period.

Is there no other way to save money and increase profits besides increasing patient loads?  Surely there are some intelligent and creative people out there with better solutions to this problem.


Nerrissa Shurtluff and others gathered outside Tufts Medical Center in Boston. Nurses from Tufts and Boston Medical Center protested what they say are dangerous changes to staffing.
Nerrissa Shurtluff and others gathered outside Tufts Medical Center in Boston. Nurses from Tufts and Boston Medical Center protested what they say are dangerous changes to staffing. (Wendy Maeda/Globe Staff)

By Liz Kowalczyk Globe Staff / February 12, 2010
Tufts Medical Center says it has found a way to trim the high cost of nursing while improving care, but the plan prompted a protest yesterday outside the Boston hospital by nurses, who say it is an example of the intense cost-cutting pressure on hospitals statewide.

But they said cost was not the primary reason for the change, adding that they want to improve care and working conditions for nurses. The hospital is bringing on 35 technicians to free up nurses from unskilled jobs like transporting patients to imaging tests and tracking down missing meals, so they can focus on monitoring vital signs, giving medications, and providing essential patient care.

“Our nurses will be working smarter,’’ said Nancy Shendell-Falik, Tufts’ chief nursing officer, who said she believes patients could get more, not less, attention from their nurses. She said a consultant hired by the hospital found that nurses at Tufts – and, by extension, other Boston teaching hospitals – care for fewer patients than is typical for similar hospitals elsewhere in the country.

But many nurses are upset by the changes. They say that requiring nurses on the hospital’s medical and surgical floors to each care for five patients, most of whom are extremely ill, is dangerous. Tufts nurses have traditionally cared for three or four patients on regular floors. In intensive care units, Tufts is assigning two patients to each nurse in most cases, up from one, but can increase the number of nurses if patients are especially ill.

“Nurses are overwhelmed,’’ said Barbara Tiller, a nurse at Tufts for more than 20 years. “They are behind their entire shift. Patients slowly deteriorate now, and no one picks it up until they’re in a crisis mode.’’

The Massachusetts Nurses Association, a large union, also organized a protest at Boston Medical Center yesterday, which plans to increase the number of patients assigned to some nurses from two to three. Hospital administrators said that they are assigning patients who are not as ill to those nurses and that they hired the same consultants as Tufts, who said nurses in intermediate care units nationally usually care for three patients.

“Of course, cost is included in our decision, but we have to be responsible about patient safety first,’’ said Lisa O’Connor, vice president of nursing at BMC.

The union also bought newspaper advertisements yesterday criticizing the changes at the hospitals.

“We understand that everyone is in a budget crisis,’’ said Lisa Sawtelle, a nurse at Boston Medical center. “We will not complain about the money we bring home. But they’re making it more and more difficult for us to do our job at the bedside.’’

Soaring hospital costs statewide are under increasing scrutiny. Medical costs in Massachusetts are growing more than 7 percent annually, driving up insurance premiums and threatening to bankrupt businesses. Last month, the attorney general’s office found that the increases are largely driven by higher prices charged by hospitals and doctors, and Governor Deval Patrick proposed legislation Wednesday that would allow the administration to review and reject medical provider rates.

At the same time, some hospitals, including Tufts, have been at a financial disadvantage because they get lower reimbursement rates than their larger competitors with more market clout. Boston Medical Center, too, is struggling with cutbacks in state funding and has sued the state over the issue.

Nursing always has been a huge expense for hospitals. Administrators who testified at hearings held by the Division of Insurance last month said labor accounts for up to 70 percent of their costs, of which nurses are the largest component.

Massachusetts nurses have enjoyed some of the highest salaries in the United States, which is typical of states with strong nurses unions. The average salary for a nurse in Massachusetts was $79,000 in 2008, up from $57,000 in 2003, and second only to California, said Judith Shindul-Rothschild, a nurse and professor at Boston College. Massachusetts nurses also enjoy some of the best working conditions in the country and are among the most highly educated, she said.

The Advisory Board Co., the Washington, D.C.based consultants hired by Tufts, found that Tufts nurses have lighter workloads than average. Tufts nurses typically have cared for 3.7 patients each on regular medical and surgical floors, while the national average is 4.5 for teaching hospitals and 5.7 for all hospitals. The company, however, also found the hospital had lower than average numbers of support staff.

It is unclear whether the new Tufts plan or the consultant’s findings will lead other hospitals to assign more patients to their nurses.

Karen Nelson, a nurse and senior vice president of clinical affairs for the Massachusetts Hospital Association, said the deciding factor will be whether the hospital is able to maintain good results for patients.

Shindul-Rothschild cautioned against comparing nurse-to-patient ratios in Massachusetts with national averages, because they may not account for differences in patients and because they do not indicate if the state’s higher concentration of nurses leads to better care.

“Yes, maybe we have higher ratios,’’ she said. “But you can’t look at those in isolation of patient outcomes.’’

Here’s the link to the original article.

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