When staff nurse Mary Havlicek Cornacchia reported to Tufts Medical Center at 7 a.m. on July 12, it was not for the early morning shift. Rather, Cornacchia, along with nearly 1,200 of the Tufts Medical Center nursing staff, was joined by community members in what would be the first nurses’ strike in the city of Boston in over 30 years, and the largest nurses’ strike to ever occur in the state, according to the Massachusetts Nurses Association (MNA), the union representing the Tufts nurses.
The strike came after the nurses attempted to parse out the details of their contract with Tufts Medical Center and make addendums to the existing agreement.
“Staffing, wages and our retirement plans are the three big sticking points,” Cornacchia, who is also the co-chair of the MNA bargaining unit at Tufts Medical Center, explained.
According to David Schildmeier, the director of public communications at MNA, the amount of participation from the nurses was unprecedented.
“Twelve hundred nurses were eligible to strike and I think by their account, only 13 did not participate, which is astounding,” he said. “That is a tremendous show of support.”
Schildmeier went on to explain that though the strike was only a day-long affair, the nurses were unable to resume ‘work as usual’ for an additional four days.
Tufts Medical Center hired replacement nurses from an agency with hiring requirements that necessitated the five-day lockout.
“Nurses who do choose to strike would not be able to return to work for five days,” Tufts Medical Center wrote in an online fact sheet, “the minimum guarantee we must provide the replacement nurses who will be here to care for their patients.”
For Schildmeier and some of the nurses at Tufts Medical Center, this was an alarming prospect, as many of these contract nurses had never set foot in the Tufts medical facility or worked in the specific positions to which they were assigned.
He said striking was a final recourse, noting that many of these issues mirror those that drove the Tufts Medical Center nurses to announce an earlier strike in 2011. However in 2011, nurses and administrators reached an agreement hours before the strike time, according to WBUR.
According to Schildmeier, both parties will go back to the bargaining table on Aug. 31, with two more talks tentatively scheduled for Sept. 12 and Sept. 18.
In attempts to contact officials at Tufts Medical Center, Director of Communications Rhonda Mann said that the hospital would not comment.
“We are not talking about this topic right now, especially for a print issue,” Mann wrote in an email to the Daily.
Chief Nursing Officer Therese Hudson-Jinks wrote in an open statement that open dialogue with nurses is an important step moving forward for the medical center.
“I hope we can soon stop looking back and begin moving forward as one team, providing the absolute best care to patients and families in the best environment,” she wrote in the Aug. 1 statement.
Senior Teddy Cahill, who attended the strike as an intern for Massachusetts Jobs with Justice, a labor activism group, explained that he supports the nurses’ cause for its potential to improve labor rights.
“Supporting labor and strikes is important,” Cahill wrote in an electronic message to the Daily. “They are the only way workers can fight back against unfair treatment by bosses, who have substantially more resources and power at their disposal than workers.” There were several other Tufts students who attended the strike rally on the nurses’ behalf.
The strike also drew support from several Massachusetts politicians. Congressman Stephen Lynch (D-MA) and Mayor of Boston Marty Walsh were among attendees.
Cornacchia said there was a months-long effort to draw up a suitable contract that addressed the nurses’ desired changes. Unlike the past two negotiation sessions, which Cornacchia described as primarily extensions of existing contracts with minor edits, the nurses from Tufts came to the negotiating table last April to solidify the contractual language with more heavy, structural changes.
Safe Staffing Ratios
Cornacchia said a key demand was requesting compliance with a law signed by then-Governor Deval Patrick in 2014 that establishes a nurse-patient staffing ratio of 1:1 or 1:2 depending on patient stability. She said that the hospital ignores the legally imposed ratio “daily.”
“Initially, we asked for [a] specific nurse to patient ratio at every floor,” Cornacchia said.
“The hospital backed down at that,” she said.“It would be a huge expense for the hospital — it would be a lot to meet the staffing need we were asking for … so we backed off.”
Cornacchia laments the lack of consistency in the ratio of nursing staff in the Intensive Care Unit, as well as the patina of accountability the law provides, without any real mechanisms for enforcement.
“The [Intensive Care Unit] staffing law doesn’t have teeth … there is no way to hold [the hospital] accountable,” Cornacchia said.
Cornacchia believes that the hospital administration may have misconceptions about the nurses’ motives in seeking a codified shift in staffing ratio.
“[The hospital is] looking at nurses as whiney … or lazy, but in reality, that isn’t true,” she said.
Schildmeier emphasized the importance of these ratios, noting that studies consistently reveal that patients have better health outcomes when there is a lower nurse-to-patient ratio. A 2014 survey conducted by State Representative Denise Garlick (D-Needham) found that nearly eight in 10 registered nurses in Massachusetts reported quality of patient care is suffering due to nurse understaffing.
Cornacchia continued to detail the nurses’ demands, highlighting their desire to have two nurses on the IV therapy team from 7 a.m. to 11 p.m. Cornacchia explained that currently, staff nurses without expertise in inserting IVs are occasionally taken away from the regular patients. She noted it can take between 30 and 45 minutes to effectively insert the IV when some of these staff nurses without specialized training are assigned to the job.
However, on the online fact sheet, Tufts Medical Center maintained that patient care was a high priority.
“We continually assess our patient needs to ensure the right complement of staff – and make adjustments within the Tufts MC Clinical Care Team as necessary, as often as every four hours,” the online fact sheet read. The webpage noted Tufts Medical Center has received several awards for medical care.
A Fair Pension Plan
The nurses also hope to refine the contractual language surrounding retirement benefits. Cornacchia pointed to the hospital’s motion to freeze the pensions of those on the defined benefit pension plan, over 300 nurses. These nurses would be put on the higher risk 403(b) matching program, which would result in losses in retirement funding for most nurses, according to the MNA.
Cornacchia and Schildmeier both emphasized that the Tufts Medical Center nurses have the lowest pension benefits of all the hospitals in the city.
Tufts Medical Center countered in its fact sheet that freezing the current plan would amount to significant savings for the hospital. This money can instead be reinvested into nurses’ wages. Additionally, the hospital noted over half of the cost of the current pension plan does not go to nurses, but toward administrative costs.
Tufts Medical Center also rejected the union’s proposed pension plan.
“We’ve offered [Tufts] a proposal that would actually give [the nurses] a competitive pension, and the way it is structured would save the hospital 85 million [dollars] over four of five years … it boggles the mind why they won’t work for this with us,” Schildmeier said. “It’s a great proposal, it’s a fair proposal and gives all the nurses a secure retirement — we just can’t understand why they won’t budge on that issue. It makes no sense.”
In its fact sheet, Tufts Medical Center argues that the union’s plan provides fewer benefits and creates greater risks for nurses, while costing the hospital more.
Schildmeier highlighted that Tufts nurses receive some of the lowest wages in Boston, averaging between nine and 11 fewer dollars hourly than their counterparts at peer institutions such as Brigham and Women’s Hospital and Boston Medical Center.
Tufts Medical Center explained in its fact sheet that Brigham and Women’s Hospital and other Boston hospitals have a far greater operating margin than Tufts Medical Center. The website also noted that with the wage increases administrators proposed in contract negotiations, Tufts Medical Center would only be four percent below the hourly rates of nurses at Brigham and Women’s by 2020.
Cornacchia said that the hospital could have the funds to hire more nurses and pay nurses more, but are instead prioritizing construction and renovations.
“They are not having a financial crisis. They are having a priority crisis,” Cornacchia said. “[Modernizing] is all fine and good, but you need to pay your nurses. We have the most direct interaction with [patients], we are there 24/7. You need to compensate the people who are running the hospital.”
Cornacchia noted that new nurses are hired under flex hours, meaning that the number of hours worked per week can vary and may be less than 40 hours. Cornacchia believes this policy, combined with less-than-competitive wages, impacts retention rates of new nurses and turns the hospital into more of a revolving door.
Tufts Medical Center said in its fact sheet that it had a 94 percent nurse retention rate.
For Cornacchia, who has nearly 30 years of experience at Tufts Medical Center, striking is a last stand to protect the patients she serves and the medical center she respects.
“Tufts is special,” she said. “It is a small community hospital in the big city. We do big things. It’s the largest heart transplant program in New England. We do a little bit of everything.”
Cornacchia went on to reprove some of the cultural shifts that have happened throughout her time at Tufts Medical Center.
“There [was] a lot of longevity here, and it is because of the sense of community [that was] among us … 10 years ago,” she said. “Nurses were well-respected and staff was [too] … but we’ve lost that, that respect and collaboration.”
Schildmeier added that nurses decided to strike not only to improve their working conditions but also to deliver the best care possible for patients.
“[Striking] is the method of last resort to try to convince the management to change things,” he said. “It’s an ethical problem, because the people who are suffering from [the hospital’s] corporate greed … are the people who go to the hospital with their lives on the line.”