Four months after a tense labor strike, the long-running dispute between Tufts Medical Center and its unionized nurses is dragging on, and recent comments from the hospital’s CEO appear to have made the situation worse.
Officials from the hospital and the Massachusetts Nurses Association have been negotiating a new contract for more than 18 months. The two sides have returned to the bargaining table several times since the walkout of 1,200 unionized nurses in July, but they remain unable to reach an agreement.
“We’re very, very frustrated,” said Mary Havlicek Cornacchia, an operating room nurse and cochairwoman of the nurses’ bargaining team. “There has been some incremental movement in the right direction, but we’re not there. There’s still major gaps to bridge.”
Union leaders organized a picket outside the hospital in Boston’s Chinatown neighborhood last week.
Tufts’ chief nursing officer, Terry Hudson-Jinks, agreed the process has been frustrating but said the two sides have made progress. “They’re listening, we’re listening, we’re trying to find common ground on complicated issues,” she said.
Dr. Michael Wagner, the Tufts chief executive, exacerbated the already tense relationship when he touched on a key issue for the union: nurse staffing.
In a CommonWealth magazine story published in October, Wagner said: “To say that quality of care is dependent on the number of nurses is so monochromatic, so incorrect. Patient care quality has nothing to do with the number of nurses. To connect the two is moronic.”
A growing body of research, however, shows a powerful link between nurse staffing and quality of care.
Patient mortality rises 7 percent for each additional patient added to a nurse’s workload, said Linda Aiken, a University of Pennsylvania researcher who published these results with colleagues in 2014 in the journal The Lancet.
Studies show “without a shadow of a doubt that the more nurses there are in the hospital — or the fewer patients each nurse is responsible to care for — is significantly related to lower mortality, readmission rates, and infection rates,’’ Aiken said.
She said this is because nurses act as the “surveillance system in hospitals. Patients are acutely ill and at any moment can show signs of deterioration. The more patients you are responsible for the less often you can lay eyes on patients.’’
At Tufts, union nurses took offense at Wagner’s comments, and Wagner apologized and said his words were taken out of context. He said the quote was in response to the idea of setting rigid nurse-patient staffing ratios into law — not about nurse staffing in general. (The nurses union supports staffing ratios, while hospital leaders oppose them.)
Wagner sent an e-mail to nurses in October, saying: “I wholeheartedly believe nurse staffing is critical to the Medical Center’s mission of providing high quality care. . . . I am passionate about getting health care right in a very complex environment; I didn’t do a good job of articulating that in the CommonWealth article. I apologize for that.”
The UPenn group conducts detailed surveys of thousands of nurses in Pennsylvania, New Jersey, Florida, and California and compares factors like workload, educational background, and work environment to patient outcomes. Because California is the only state with mandated minimum nurse-to-patient ratios, researchers also have been able to look at the impact of the law.
Aiken said mortality in California declined more rapidly than in other states after the law was implemented in 2004.
The Massachusetts Nurses Association has pushed a similar proposal for years, but it has failed to pass amid vigorous opposition from hospital leaders, who prefer flexibility in staffing.
Union leaders at Tufts said Wagner’s comments about nurse staffing demonstrated a lack of respect for nurses. “We were astounded, disheartened,” said Cornacchia, the union representative.
The union and the hospital have moved closer to resolving two big sticking points in their contract talks — wages and retirement benefits — but they remain far apart on staffing, according to union leaders.
Cornacchia said the union is asking Tufts to establish a team of nurses to specialize in inserting patients’ IV lines. Union leaders also want a team of nurses available to respond to emergencies, or “codes,” such as when a patient stops breathing.
“These are very small simple resources that benefit patients in the hospitals,” Cornacchia said.
But Hudson-Jinks, who oversees contract negotiations for Tufts, said hospital officials prefer not to write specific roles into the labor contract.
“We can’t create contract language that will tie our hands in the future in how we want to deliver . . . care to patients,” she said.
Tufts executives say they are limited in how much they can compensate nurses — and other workers — in part because the hospital is paid less than its competitors for providing similar care. Still, Tufts has been hiring additional nurses and has offered to boost nurses’ wages to make them more competitive with others in Boston, they say.
Hudson-Jinks said the hospital is trying to move on from the controversy around the CEO’s nurse staffing comments.
“Nursing care matters, and nurses’ time with patients matters,” she said.