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Crisis in health care stems from work conditions, not a shortage of workers

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It’s all about working conditions. At least that’s what Massachusetts nurses are saying about their colleagues’ decisions to leave bedside care positions in the state’s hospitals to find other work environments.

Massachusetts Nurses Association President Katie Murphy voices her concerns about the growing crisis in health care;  she was a moderator at a virtual hearing on several legislative measures that would increase compensation, limit patient loads and address workplace violence held virtually on Monday, May 8, 2023.

Massachusetts Nurses Association President Katie Murphy voices her concerns about the growing crisis in health care; she was a moderator at a virtual hearing on several legislative measures that would increase compensation, limit patient loads and address workplace violence held virtually on Monday, May 8, 2023.

“The nursing shortage is not real,” said Katie Murphy, who is assigned to the intensive care unit at Brigham and Women’s Hospital in Boston and is president of the Massachusetts Nurses Association, an umbrella organization that represents some 25,000 nurses throughout the state. She said Massachusetts has an adequate number of professional nurses and is graduating more every year.

The issue, the lack of bedside nurses staffing hospitals, is all about worker burnout, Murphy said during a legislative hearing on three separate measures that address issues in health care, from staffing problems to workplace violence and the effect of service interruptions and closures on the communities where they occur.

The online hearing on Monday, timed to coincide with National Nurses Week, was sponsored by Sen. Joan Lovely, D-Salem, and Rep. Denise Garlick, D-Needham.

Claims that work conditions are the drivers behind the lack of health care workers are not just hearsay.

Almost 1,000 bedside nurses responded to a survey conducted by Beacon Research that crystalized the state of nursing and patient care in Massachusetts. Of those who responded, 85% thought the state of health care in Massachusetts was worse than it was pre-pandemic, and 52% qualified it as “much worse.”

Stretchers, chairs set up in hallways to accommodate the overflow

Kimberly Vazquez, a nurse at Good Samaritan Hospital in Brockton, said the national standard limits the number of patients assigned to emergency room nurses at four; in her hospital, she said, she had up to 31 on one shift.

“We have stretchers, chairs in the hallways,” Vazquez said.

Maureen Healey, no relation to the governor, who is assigned to the cardiac care floor of her hospital, said she works in “chaos.”

“I start my workday running, going as fast as I can, but patients are not getting the care they need; this causes problems with medication, causes mistakes,” Healey said. “Morale is low, nurses are leaving in droves.”

Major challenges cited by respondents: no time to care adequately for patients (72%), too many patients assigned to one nurse (72%), inadequate pay (67%), and the use of “travel nurses,” or contract workers to fill vacancies in schedules (51%).

Many nurses said the conditions were present pre-pandemic and exacerbated by the COVID-19 crisis.

Almost all of those questioned, 88%, favored setting limits to the number of patients assigned to each nurse. The proposal was posed as a ballot question in 2018 but voters rejected it. However it has since been taken up by legislators in this new session with the filing of legislation by Sen. Lydia Edwards, D-Boston, and Rep. Natalie Higgins, D-Leominster.

The bills would require the state Department of Public Health take the question of whether limits should be set, and at what level, directly to the public in a series of hearings around the state. Once the department has collected the necessary data and heard public comments, it will be responsible for setting and enforcing limits.

“By law, we couldn’t go back to the voters once the ballot question was defeated,” Murphy said. Massachusetts nurses had to find a new way to address the overriding issue of ensuring patient safety by limiting patient loads, and to ensure safe working conditions for the nursing staff.

In 2022, said Healey, hospitals spent $1.5 billion on travel nurses. She believed that if the state had addressed the conditions that were driving nurses from the work force, those funds could have been used to hire and compensate staff.

One assault every 38 minutes

Workplace safety is also a significant consideration for bedside staff – at least 63% of those surveyed said it was a serious problem.

John Palmgren, an emergency room nurse at UMass Memorial Health Marlborough Hospital, said the level of violence in the workplace has escalated in the last two years. The increase in assaults on nurses is partially due, he believes, to the lack of psychiatric beds in Massachusetts and the warehousing or boarding of patients in the state’s emergency rooms.

Addressing care deserts in Massachusetts

Addressing care deserts in Massachusetts

“And it’s not a case of an elderly patient inadvertently scratching a nurse,” Palmgren said, citing incidents that resulted in concussions and other major injuries. He was told of a 30-year-old colleague who was randomly punched in the head by a patient they were not assigned to treat. The assaulted resulted in a two-week recovery time.

That patient, Palmgren said, had been brought to the facility by the police for assaulting strangers and, due to a lack of psychiatric beds, was boarding in the ER. The patient assaulted six other people in the hospital, he said.

Colleague Amy Baker, a nurse for more than 22 years, said the situation “is bad.”

According to statistics compiled by the Massachusetts Health and Hospital Association, in 2020, there was an incident every 57 minutes on average; now, there’s an assault every 38 minutes.

“This is unacceptable; the risk is not worth it,” Baker said. One of her colleagues, a new graduate, left the position as a bedside worker just four months after starting because she could not deal with the violence. Another, a travel nurse signed a 12-week contract with maximum pay, left within days after being punched in the stomach by a patient when she was eight weeks pregnant, Baker said.

“It happens day-in, day-out, and we have no protection apart from our scrubs,” Baker said.

It’s not just the staff members who are affected by violence: patients suffer as well.

“Hospitals are not a healing environment,” Baker said.

The chart indicates communities in Massachusetts lacking maternal care facilities

The chart indicates communities in Massachusetts lacking maternal care facilities

The nurses also discussed the effect of service closures on the state’s health care environment, describing maternal care, pediatric and mental health facility closures as a problem that needs oversight by the state.

Everybody, said Janet DeMoranville, a maternity nurse in Plymouth, loves the feel-good story about the cop delivering the baby in the back seat of the patrol car. It’s all well and good if the baby is healthy and born without complications.

“But what happens when the baby isn’t fine,” DeMoranville said. “A community hospital should serve the whole community, not just the departments that bring in the highest revenue.”

Lovely urged legislators to work “shoulder-to-shoulder” to get the legislation passed in this session. Legislators noted that it costs between $40,000 to $60,000 to train a nurse, depending on their field.

This article originally appeared on Telegram & Gazette: Nurses say dearth of hospital workers due to burnout, work conditions