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Lynn Nicholas

Strike won’t cure what ails hospitals

By Lynn Nicholas
March 31, 2011

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MASSACHUSETTS HOSPITALS are working continuously to innovate, slow the growth of health care costs, and improve patient care. In addition, they are implementing new care delivery strategies to make sure the care they provide is better coordinated and more efficient.

But hospitals are also encountering obstacles as they work to do their part to change the health care delivery system for the better. As some of the state’s largest employers in this fragile economy, hospitals face the double pressures of escalating wage and benefit requirements on one extreme and continued government underpayment for the care they provide on the other. Hospitals are trying to balance the many demands on their limited resources — both human and economic — in ways that are both creative and allow for the effective continuation of their life-saving missions.

In light of these challenges, it is disappointing and disturbing to learn that the Massachusetts Nurses Association was reportedly planning a multi-hospital strike for Good Friday, April 22.

Such an action would be disruptive to providing optimal care to patients. While the nurses association now denies making a concerted effort to conduct same-day strikes at four Massachusetts hospitals and a facility in Maine, documents left by one of its members in a meeting room at St. Vincent Hospital in Worcester have been turned over to the state Department of Public Health and Executive Office of Labor and Workforce Development. Whether this reported strike action was an attempt to influence contract negotiations, mandatory nurse staffing legislation, or both isn’t clear. But it is clearly the wrong thing to do for patients, other hospital workers, and the local communities involved.

We all need to work together to maintain universal access to quality health care in Massachusetts, and to make that care more affordable. For their part, hospitals are becoming more efficient while simultaneously continuing to improve patient outcomes. Measuring outcomes is the primary method to examine hospital performance — and the efforts of RNs are at the core of this process; yet it would be a serious mistake to undervalue or dismiss the contributions of other key members of the care team such as nursing assistants, technicians, patient sitters (who monitor patients at risk of falls and help them enter and exit beds, among other duties), pharmacists, respiratory therapists, physical therapists, and others who round out the care process. It still takes a team to care for patients. And the team’s performance as a whole should be taken into account.

The union wants fixed and inflexible staffing ratios for nurses. But clearly there is no “one size fits all’’ method for achieving high quality, safe patient care, nor should there be. Especially during this time of dramatic, fundamental change in health care, it’s time to think — and act — outside of the box, while keeping patient safety at the forefront.

Shackling hospitals with cookie-cutter methods for delivering care stifles innovation. It ignores the needs of individual patients. And it doesn’t acknowledge our nurses’ individual levels of expertise and experience. Nurses need to be treated fairly; likewise, nurse managers need the flexibility to use all of the resources at their disposal — including assistive personnel, RNs with different education and skill levels, even advanced technology — to ensure and improve the care hospitals provide. Hospitals also need to remain fiscally viable to fulfill their care-giving missions. None of these aims can be accomplished through acrimony, threats, or efforts to impose a restrictive mandate across hospitals with very different settings and diverse patient needs.

By pursuing innovative approaches to care delivery and quality improvement, hospitals can not only do right by their patients, they can also maintain a supportive work environment while providing good jobs with good pay and benefits, whether it is for a physician, a nurse, an administrative assistant, or a groundskeeper. Those jobs, in turn, will allow hospitals and their workforces to contribute to the economy in many ways. That helps everyone.

Lynn Nicholas is president and CEO of the Massachusetts Hospital Association.