Hospital staffing forum precursor to possible 2018 ballot vote
PITTSFIELD — A forum Tuesday took up a health care issue that may soon confront all state voters:
How many registered nurses are needed on a hospital shift to ensure proper patient care?
Organizers of the event say they invited representatives of Berkshire Medical Center to a downtown Pittsfield church to discuss what constitutes proper staffing — a central issue in nearly a year of contract negotiations between the hospital and its registered nurses.
No speaker represented the hospital. In the absence of that perspective, the floor at a First Methodist Church "town hall" belonged to five union nurses, who shared their experiences at work with a receptive audience that at times resembled a pep rally.
A year from now, the Safe Patient Limits ballot measure sponsored by the Massachusetts Nurses Association may put this complicated and controversial issue before voters.
"It's going to be a battle royal," said Carla Skidmore, one of about 150 people who came to listen in the church sanctuary.
The night's moderator, Liz Recko-Morrison of the Berkshire Central Labor Council, agreed the event offered a sort of trial run on a 2018 ballot question, though not all arguments were voiced.
"We think the community should be part of the discussion," she said.
Recko-Morrison expressed regret that the hospital wasn't represented, saying the occasion was not meant to be "clandestine" or one-sided.
Tuesday's forum was sponsored by four labor and economic justice groups — the labor council, Berkshire Brigades, Indivisible Pittsfield and Massachusetts Jobs with Justice.
While exchanges over two hours focused on staffing within BMC, the night offered a peek at debates to come across Massachusetts.
The nurses union is working to collect 70,000 signatures in support of the referendum to move the measure to the ballot. The MNA faces other hurdles next year, when the Legislature will have the opportunity to take up the issue.
"The patient care concerns put forward by nurses at Berkshire Medical Center and elsewhere are local, concrete examples of the overall problem," the MNA said in a statement provided Wednesday to The Eagle. "Too many patients being assigned to nurses at one time."
In short presentations Tuesday, members of the MNA described occasions when they believe the quality of patient care was compromised by a lack of staffing. The nurses were Sarah Garson Roberts, Leilani Hover, Sandra Vosburgh, Amber VanBramer and Mark Brodeur.
After nurses spoke, members of the audience rose with questions about nursing care, including a man who asked: How do you determine what is adequate staffing?
Stephen Radin, a retired teacher, asked whether a shortage of nurses is complicating the hospital's staffing.
Frank Farkas, chairman of the Ward 5 Democratic Town Committee in Pittsfield, brought the issue back to the legislative front when he stood to note that California law sets minimum staffing standards for nurses.
"Do you agree with that?" he asked.
Brodeur, the Pittsfield nurse on the panel, was quick with his reply.
"It will help our hospitals across the state," Brodeur said, referring to the possibility of the 2018 ballot question in Massachusetts. "You'll probably be hearing a lot of different voices as that comes out."
A different message may come from the Massachusetts Health & Hospital Association.
Pat Noga, vice president for clinical affairs with the association, said that to her knowledge, no academic study has
identified the "right" number for nurse staffing ratios in any setting.
She said any attempt to impose fixed staffing numbers obstructs the ability of nursing leaders to reach their quality-of-care goals.
Noga, who is a registered nurse, said she doesn't believe the proposed ballot question would improve care.
"MNA's misguided attempt to impose assembly-line-like staffing quotas takes decision-making away from nurse leaders in each hospital, where it belongs," she said.
Michael Leary, director of media relations for Berkshire Health Systems, said set staffing ratios don't allow hospitals to adapt to changing needs of their patients, in a setting in which a hospital like Berkshire Medical Center must deploy staff to nearly 20,000 shifts each year.
"If enacted, mandated ratios could limit hospitals' flexibility and ability to meet patient needs, ultimately undermining patient access to quality care," Leary said in a statement provided in response to questions from The Eagle.
He went on to challenge the union's motives in pursuing a new state law.
"In fact, as a labor union with dues-paying members, the MNA would directly benefit from legislation that would inflate the number of nurses Massachusetts hospitals must employ, potentially at the expense of other caregiver jobs and certainly adding significant cost for healthcare
consumers," he said.
Strike issue raised
Through the evening, other nurses in the audience rose to echo what panelists said about short staffing.
Ellenmary Dagostino, a retired nurse who moved to the area 12 years ago, was the first to raise her hand when the moderator asked for questions.
"I think you need to go on strike for the sake of the patients," she told the panel.
While registered nurses at the hospital voted in July to authorize a one-day strike, that action, which requires 10-day notice, has not been called. The hospital says it stands ready to keep the facility open with the help of replacement RNs.
Later, pausing in an aisle on her way out, Dagostino said she was persuaded by what she had heard — and thinks nurses are being asked at times to care for too many patients.
"I believe these people," Dagostino said of the nurses who spoke. "The compassion can't be done if they don't have adequate staffing."
Others, like Farkas, also urged the MNA members to strike, though another in the audience offered a note of caution.
Mary Anne Hicks, of Richmond, a 43-year BMC nurse who now works on a per-diem basis and is not a member of the MNA, asked people to remember the 69-day strike that took place in 1981.
Striking isn't easy, she said. "We're going to need a lot of support."
In a follow-up phone interview Wednesday, Hicks said she believes a strike like the one she experienced 36 years ago would "reverberate for years, if it actually happens."
She said of the hospital, "I'm very committed to the organization and feel we [nurses] do good work."
Robert Skidmore, a retired General Electric employee who served as a pastor at First Methodist from 1994 to 2000, rose during the forum to say he'd resist making a sermon. But he expressed support for BMC nurses.
In an interview later, Skidmore said that he, like his wife, Carla, anticipates a knock-down debate over the ballot measure.
"I think it's going to be a real battle because hospitals will fight it tooth and nail," he said. "Whether the truth can get out, we don't know. I don't profess to think that it's simple."
Reach staff writer Larry Parnass at 413-496-6214 or @larryparnass.
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