WORCESTER, Mass.—Nurses at a Massachusetts hospital have been on strike for more than four months in a battle over safe staffing with Tenet Healthcare, one of the nation’s largest and most aggressively expanding hospital chains.
About 700 nurses at Saint Vincent Hospital in Worcester walked out of March 8, after management rejected the Massachusetts Nurses Association’s demand for contract language specifying that they should generally not have to take care of more than four patients at a time on medical-surgical units. The strike is the longest one by nurses in the United States in at least 10 years, says MNA spokesperson David Schildmeier.
After 15 months of contract negotiations, the union had presented a “very comprehensive proposal” detailing “what we needed at the bedside to do our jobs,” says veteran post-surgical nurse Dominique Muldoon, a cochair of the MNA’s negotiating committee. “Management did not seem to want to talk about it. It was so unsafe in the hospital that we needed to take to the streets.”
Nurses rarely go on strike for longer than a 72-hour period, but “the bottom line is that patients were suffering,” says MNA vice president Marie Ritacco, a nurse at Saint Vincent since 1983. Tenet could “certainly afford to do the right thing,” she adds, but “it’s not about money for them. It’s about control and power.”
In May, management, which has been running the hospital with a mix of about 100 staff nurses and temporarily hired strikebreakers, threatened to replace strikers permanently. Talks halted for several weeks, but resumed July 9. That first meeting came two days after Saint Vincent nurses traveled to Dallas to protest outside Tenet’s corporate headquarters there.
Hospital CEO Carolyn Jackson dismissed the protests as “a publicity event” in a statement released July 6, but management said that its latest contract offer would accept union staffing proposals for four units.
The Dallas trip “did exactly what it was intended to do—force them back to the table,” Ritacco told LaborPress.
Tenet’s latest proposal, she says, would give nurses a mix of assignments with either four or five patients, with a resource nurse for backup and ancillary staff such as secretaries, cleaners, and nurses’ aides. Before the strike, the resource nurse often had five patients of her own, and units often had no ancillary staff on some shifts.
“You cannot run a medical-surgical floor like that,” Ritacco says. “Patients do not get the care they need.”
The union is willing to accept some assignments with five patients, she says, but “there have to be very real and enforceable limits on how many patients each nurse is assigned,” as well as adequate support staff.
Four patients per nurse is considered the optimum standard on medical-surgical units. The previous contract, allowed four or five, Ritacco explains, but Tenet interpreted that as “five.” “If they’d just followed the intention and the spirit of the contract,” she adds, “we wouldn’t be out here.”
Still, she says “we’re optimistic” that management seems to be willing to talk about staffing, when it was previously intransigent. In April, Jackson, speaking to the Worcester Telegram & Gazette, accused the MNA of “using nurses as pawns” to push for the mandatory staffing ratios contained in a state ballot initiative that was defeated last November.
Jackson did not respond to questions emailed by LaborPress.
“There is no valid research that concludes that staffing ratios improve patient outcomes,” Saint Vincent management posted on the “Strike News” section of its Website, on a page titled “MNA Myth Vs. Fact.” “Numerous professional medical groups, including other nursing organizations, agree that healthcare decisions are best made by healthcare professionals and nurses at the bedside, not by a union contract.”
That’s ludicrous, nurses respond, the outrage palpable in the flow of their voices. Five patients might not sound like a lot, says Muldoon, but “their condition can change in a minute.”
Patients need to be turned over to prevent bedsores. Fed. Bathed. Taken to the toilet, especially those at risk for falls. And be observed to see if their surgical wounds are healing properly, their oxygen intake is working, that they’re getting the painkillers they need.
“A patient needs better than a nurse who can pop in for five minutes,” says Muldoon. “When you’re that rushed, you can’t deal with anything unexpected. Corners are cut.”
“Patients are not widgets. They have a face and a name,” says Marlena Pellegrino, also a cochair of the MNA’s negotiating team, who started nursing school at Saint Vincent when she was 18 and has worked there since 1986. “When a nurse can’t see a subtle change in a patient, it’s life and death.”
Time spent talking to patients and their visitors might not be counted as useful by productivity metrics. But, says Muldoon, it not only makes them feel like someone cares about them, “very often things come out that you need to know,” such as how sharply they’ve deteriorated, or whether they’re isolated at home or have a support network.
“It’s all about caring,” she says. “That caring leads to better outcomes for the patient.”
Crisis and Cash
“COVID made everything ten times worse,” says Muldoon. “Nurses were going home crying. Instead of feeling like we were taking care of people, we were running around putting out fires.”
Patient loads increased to five or six per nurse, says Ritacco, and patients with COVID shared the same nurse as those who weren’t infected, greatly increasing the risks of contagion. And for the first time in her career, staff had to reuse personal protective equipment such as masks and gowns.
The hospital was also furloughing nurses, says Pellegrino. “We were begging for help,” she says. “They sent nurses home in the middle of a shift.” And COVID, she adds, weakened patients so much that even younger ones had to be escorted to the toilet.
Hospital management says all the furloughs were voluntary. But as the pandemic was nearing its Northeastern peak in April 2020, the Dallas Morning News reported, Tenet CEO Ronald A. Rittenmeyer told shareholders that the company was using federal COVID-relief funds and furloughs to “maximize our cash position.”
“The pandemic exposed how the system failed and Tenet used it for profiteering,” Schildmeier says.
Where Did the Aid Go?
Tenet Healthcare, founded in California in 1969 and now based in Dallas, is ranked as one of the ten largest U.S. hospital chains. It owns 65 hospitals and more than 450 outpatient-surgery and other facilities.
It first acquired Saint Vincent, a 381-bed hospital opened in 1893, in the late 1990s. In 2000, nurses went on strike for seven weeks to win their first union contract, with mandatory overtime their biggest complaint.
Saint Vincent was acquired by Vanguard Health Systems in 2005, but returned to Tenet when the company bought out Vanguard and its 30 hospitals in 2013.
Pellegrino says the hospital became increasingly corporatized, especially after Jackson became CEO in 2019. For example, its payroll department was outsourced to the Philippines.
“We’re a community hospital. This corporation has done everything to strip us of our identity,” she says. “We have a standard. This is a place that means something to us. These patients are our community.”
Tenet is facing increasing criticism about its use of the $2.6 billion in COVID-relief funds it received. In May, Reps. Katie Porter (D-Calif.) and Rosa DeLauro (D-Conn.) sent a letter to the Federal Trade Commission expressing concerns about hospital chains using that aid to finance mergers and acquisitions. Tenet, they said, spent $1.1 billion acquiring 45 surgery centers from SurgCenter Development in December 2020, and plans to spend $150 million to acquire between 25 to 40 ambulatory surgery centers this year.
Meanwhile, they charged, “Tenet understaffed the emergency room and intensive care unit at Detroit Medical Center’s Sinai Grace Hospital so severely that single nurses were charged with treating as many as 20 COVID-19 patients at a time,” “the emergency room ran out of oxygen and beds and was forced to prop dead bodies upright in chairs,” and staffers who organized to ask for reinforcements were fired.
Tenet reported $3.1 billion in profits for 2020 to the Securities and Exchange Commission. In the first quarter of 2021, its hospital division reported $3.947 billion in net operating revenues, 2.9% more than during the same period in 2020. Rittenmeyer was paid almost $16.7 million in 2020, 306 times the median employee salary of $54,501, according to the AFL-CIO’s Executive Paywatch figures.
Saint Vincent has a 14% profit margin, by far the highest of any for-profit hospital in Massachuusetts, says Ritacco. That’s a sign it’s “doing something very different,” she believes — rationing care through insufficient supplies and staffing.
In late June, four members of Massachusetts congressional delegation — Senators Elizabeth Warren and Edward Markey, and Reps. James McGovern and Lori Trahan — wrote to Rittenmeyer asking him to explain how Tenet used federal aid “to enrich its executives and shareholders rather than meet the needs of its health care providers and patients during the COVID-19 pandemic.”
The MNA estimates that Tenet has spent close to $100 million trying to break the strike, with $5 million a week going to hire strikebreaker nurses and $200,000 for off-duty police officers for security, says Schildmeier.
“With the amount they’re spending, they could have settled the strike on day one with the staffing we need,” says Pellegrino. “They chose not to.”
She suspects that the corporation saw the nurses’ strong bargaining unit as an obstacle to be taken down, and thought they could get away with it because they perceived the profession’s compassion as a sign of feminine weakness.
“I think they underestimated us,” she opines.
“Our goal is to get a settlement that provides safe patient care and gets us back to the bedside where we belong,” she concludes. “The path is there. We just need them to understand how important patient safety is.”