Harborview Medical Center staff, locked into fraught contract negotiations with management, are protesting what they say are difficult working conditions for them and unsafe conditions for patients. Some 1,900 nurses and other healthcare workers, represented by SEIU Healthcare 1199NW, have been operating without a contract since October 31. On Thursday, several hundred of them donned picket signs and marched in front of the hospital for the second time in the last six months.
“We’re here. We’re strong. We’ll fight for patients all day long!” they chanted.
Although salaries of some workers are at issue, nurses say the biggest concern for them is staffing. Currently, when nurses take a break, they hand over their patient load to another nurse, who must therefore handle twice as many patients during their colleague’s break-time. During the night-shift, this can mean caring for as many as 10 patients at a time.
“It’s unsafe for patients,” says night-shift nurse Vanessa Patricelli, pointing out that nurses dispense medication and that an error can therefore have dangerous consequences.
When people think of medical error, they tend to focus on doctors, thanks in part to some high-profile articles and books in recent years, including The Checklist Manifesto: How to Get Things Right , by Harvard Medical School surgeon and New Yorker writer Atul Gawande. But researchers are increasingly looking at the mistakes made by tired and overburdened nurses as well. One 2011 study published in the New England Journal of Medicine found a “significant association” between nurse under-staffing and increased mortality.
In the mid-aughts, California enacted legislation that requires a certain level of nurse staffing, even during break times. Harborview nurses want to write a similar measure into their contract. “We’re trying to change the culture,” Patricelli says.
Others add that even if no outright error occurs, there can be problems with having nurses double up on patients. Joseph Hufford, another Harborview night-shift nurse, says that patients may end up waiting 20 minutes or so to get pain medication or to have their bed changed after they’ve soiled it “People have had to lay in their feces with their wounds exposed,” he says.
Or, he adds, nurses are so uncomfortable with the situation that they end up not taking any breaks at all during a 12-hour shift.
A few days before the picketing, Harborview announced that it was willing to conduct a six-month “project” that would assign nurses “to dedicated nurse relief,” according to a statement. The hospital was short on details, however. “I’m not sure what it will look like,” spokesperson Tina Mankowski says of the project, adding that the idea is not yet “fully fleshed out.”
Picketing nurses were skeptical. “It is very much of a last-minute offer,” said nurse Kristie Dimak, who, like others, was waiting to see what language the hospital is willing to put in the contract.
More nurses would, of course, mean more money and, like many hospitals these days, Harborview has been cutting costs. Mankowski says the public hospital, which falls under the umbrella of University of Washington Medicine, trimmed its budget by $26 million last year.
Yet, some staffers say that Harborview has been wasting millions of dollars on a consulting group that the hospital, along with other facilities within UW Medicine, has used for the last three years. Mankowski says that the Florida-based Studer Group is a “highly-regarded, evidence based” organization that is helping to improve “patient satisfaction.”
Critics say the consultants are focused more on “messaging than substance,” as Hufford puts it. For instance, the Studer Group has introduced a standardized way of talking with patients that includes having nurses introduce themselves, explain what they’re doing and tell patients how long it will take.
It’s nothing Harborview’s nurses don’t already know, contends Dimak, adding that all the time and money spent on consultants could instead “be spent on patient care.”