More than 2,500 nurses at four Philadelphia area hospitals are preparing to go on strike in the coming days. Represented by the Pennsylvania Association for Nurses and Allied Professionals, or PASNAP, the nurses have found themselves deadlocked with health system operators over one central issue: safe staffing on the hospital floor. It’s a concern nurses nationwide have fought for with increasing success in recent years, and which has been exacerbated by the COVID-19 crisis.
The 800 nurses at St. Mary Medical Center in Bucks County and the 260 plus at Mercy Fitzgerald in Delaware County have already voted to authorize a strike and each gave a 10-day notice to their employer, Michigan-based Trinity Health. In Philadelphia, nurses at St. Christopher’s Hospital for Children and Einstein Medical Center have voted to authorize a strike but have not yet given their notice to management.
“This is not something that we want to do,” said Maria Plano, an ICU nurse who has worked at St. Christopher’s for 16 years. “This is not something we take lightly.”
Safe staffing ratios, or “grids,” as they’re known within the nursing profession, mandate the maximum number of patients that one nurse should care for at a given time. The ratios ebb and flow depending on how acutely ill the patients are, which unit they’re in, what season it is, and a number of other variables, but the standard in places like California, which passed legislation mandating ratios, is about one nurse to every four patients.
While staffing grids exist at some of the hospitals, nurses say they aren’t always honored. So, they are pushing for the ratios to be included in their contracts, making them enforceable.
Staffing issues predated the pandemic, but pressures created by the coronavirus crisis have exacerbated the issue. The 800 nurses at St. Mary in Bucks County formed a union in 2019 specifically to address staffing ratios there, and are now negotiating their first contract with Trinity Health.
When the coronavirus hit, nurses weren’t laid off, said Lynn McCarthy, a labor and delivery nurse, but administrative staff were. That led to more secretarial duties for nurses, eating into their time for patient care.
“We’re not there to answer the phones all day, we’re not there to schedule cases in our schedule book,” said McCarthy. “It really does impede what we’re there to do, and that’s to be at the bedside.”
Nurses at Mercy Fitz are also negotiating their first contract since Trinity took over the hospital in 2018. Registered nurse Annemarie Dellago said tensions in the hospital are running high — her colleagues have found their membership fliers ripped up in the break room.
Dellago, too, said staffing issues were made worse by the pandemic. As people retired, called out sick, or went on FMLA to care for family members or watch children attending virtual school at home, they weren’t replaced.
“They made a lot of promises, but they never filled the spots,” said Dellago, who has worked as a nurse for 39 years. “In situations where they may have needed three nurses, they’re only hiring one.”
Dellago said she was concerned that the ratios were only going to get worse as the hospital fills back up with COVID-19 patients, landing nurses who should be caring for four patients with six, eight, or even ten each.
“That’s a risk for the patient and the nurses’ health,” she said.
In a statement, Trinity Health officials said they were disappointed to hear of the strike announcement, and still hoped to reach an agreement.
“Our teams remain fully committed to negotiating in good faith with union representatives in the spirit of obtaining fair, consistent and sustainable agreements,” they wrote. “We have always been and continue to be committed to patient safety and ensuring appropriate staffing in line with national guidelines.”
Trinity noted it is preparing contingency plans for the strike, and does not plan to interrupt any care at the hospital.
The 470 nurses at St. Christopher’s Hospital for children got off to a rocky start with the hospital’s new owners, Tower Health and Drexel. The two entities bought the hospital after its previous owner, Philadelphia Academic Health System, declared bankruptcy and closed Hahnemann Hospital. Tower and Drexel told St. Christopher’s nurses that the paid time off they had accumulated under the hospital’s previous ownership would not roll over, even for pregnant employees who had been saving the time to go on maternity leave.
“When they came in, they wanted to break our union,” said Plano. “They still do.”
She said she didn’t think the resistance to the staffing grid was a financial issue, but rather a statement of who is in charge.
“The cost to replace us is probably more than the contract is even worth,” said Plano, noting that Tower has also said it would hire temporary nurses if its employees do walk out. “Why not just honor the contract?”
In a statement, Tower Health said that determining staffing levels is a fluid process, and grids alone aren’t an effective tool.
“The union wants to create the perception that mandated staffing grids are the solution, when in fact they have yielded mixed results nationally,” wrote spokesperson Richard Wells.
Research has shown that for every individual increase to a nurse’s patient load, mortality rates increase by 7%. Too few nurses with too many patients leads to faster employee burnout, more turnover, and higher risk of patient infection, studies show.
Einstein Medical center, whose bargaining unit consists of 1,100 nurses, negotiated its first four-year contract in 2016. The union has been bargaining with the hospital for almost a year over a new contract, including over language that would keep their union and its contract in place in the likely event that the hospital is sold.
Einstein and Jefferson have proposed a merger, which was challenged in court by the Federal Trade Commission, and which a federal judge is expected to rule on shortly.
Julia Kirstan, an ER nurse at Einstein, said that even if the merger is blocked, she and her colleagues expect an ownership change in the coming year or so, making the successorship language vital. She said management has indicated they might agree to successorship language as it became clear a strike was a real possibility.
Einstein did not respond to a request for comment.
Nurses at Jefferson are not unionized, but Kristan said they’d be more than happy to have the nurses there join with them if there is indeed a merger.
She added that competitive wages are another priority.
“We see a lot of nurses come in, get their experience, and go to the higher paying hospitals and the Penn system, and it’s hard to compete with that,” said Kristan.
Nurses at Mercy and St. Mary gave their 10-day notice last Friday, November 6. Since then, management has reached back out to schedule further bargaining sessions. If no agreement is reached by the end of the day on Monday November 16, the nurses are set to stop work for two days beginning Tuesday.
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