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Tufts, nurses union OK pact

But staffing level issue remains unresolved

Nurse staffing levels were a key sticking point in contract negotiations between Tufts Medical Center and the nurses union. Nurse staffing levels were a key sticking point in contract negotiations between Tufts Medical Center and the nurses union. (Suzanne Kreiter/Globe Staff)
By Robert Weisman
Globe Staff / May 7, 2011

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Tufts Medical Center and the Massachusetts Nurses Association stepped back from the brink yesterday, avoiding a threatened strike at the Boston hospital. But the issue that divides them — nurse staffing levels — isn’t going away soon at Tufts or other medical centers.

“It’s become a national issue: nurses being overwhelmed and overworked and not giving patients the kind of one-on-one care they prefer,’’ said health care consultant Jon Kingsdale, a managing partner in the Boston office of Wakely Consulting Group.

The agreement on a new, 18-month contract early yesterday morning, only hours before 1,100 Tufts nurses were to walk off the job for five days, indicated that both sides knew they could be hurt by a work stoppage. Negotiators reached their tentative pact after 15 hours of nonstop bargaining Thursday and overnight, averting what would have been the first strike at a Boston hospital since nurses at Dorchester’s Carney Hospital threw up picket lines in 1986. The union yesterday withdrew its strike notice at Tufts and scheduled a May 19 ratification vote.

The contract won’t resolve the parties’ dispute over the union’s demand for mandatory staffing levels, the key sticking point in contentious talks that began last fall. But without setting specific ratios, management and labor leaders agreed that the hospital will continue its current staffing guide lines for the life of the new pact. Those guidelines suggest that patient assignments for a single nurse be no more than five on the day and evening shifts, no more than six on the night shift, and two in intensive care units except under unusual circumstances.

Tufts, a 415-bed affiliate of Tufts Medical School, will retain the flexibility to increase patient loads in some cases, but the specific number of patients assigned to nurses on any given shift will be worked out by a nurse manager or supervisor in collaboration with nurses.

Other contract terms include the addition of “charge nurses’’ to supplement staffing and coordinate patient flow on the busiest floors, limits on mandatory overtime, protection for nurses who “float’’ from one unit to another, and a 2 percent wage increase. The wage hike was narrowed, and the contract extended six months beyond what had been planned, to offset the costs Tufts incurred preparing for the threatened strike. The hospital said it spent about $2.6 million to hire 200 replacement nurses and bring them to Boston in anticipation of a walkout.

Hospital and union officials offered somewhat different interpretations of contract terms yesterday. But their tones were notably conciliatory after six months of often charged rhetoric.

“On the whole, our goals and thinking are on remarkably common ground,’’ said Tufts chief executive Ellen M. Zane. She acknowledged that unionized nurses were afraid Tufts was planning to increase their patient assignments but maintained “that was never, ever in our thought process.’’ Zane said the contract seeks to build a more “collaborative relationship’’ and give nurses “a sense of comfort.’’

At the same time, Zane said, “Our position at the end of the negotiations was the same as our position at the beginning of the negotiations. We’ve believed all along that our staffing levels are appropriate, which is why we wouldn’t agree to staffing ratios.’’

David Schildmeier, spokesman for the union, said the contract gained nurses some staffing protections.

“Our real fear was that Tufts would go to six patients per nurse on days and evenings on the medical surgical floors,’’ Schildmeier said. “This contract prevents that from happening. These nurses have made a stand that says the one thing you can’t cut is the level of care patients receive. We hope this sends a signal to other hospitals that nurses won’t allow patients to be placed in jeopardy for the sake of the bottom line.’’

Schildmeier noted that the union has begun contract bargaining with Cape Cod Hospital in Hyannis and plans to open talks later this year with Brigham and Women’s Hospital, a Boston teaching affiliate of Harvard Medical School. While it’s too soon to predict whether staffing levels will dominate those negotiations, he said, the issue was at the forefront in recent talks at Saint Vincent Hospital in Worcester and Eastern Maine Medical Center in Bangor. Strikes were authorized at both hospitals before negotiators reached eleventh-hour deals.

While the nurses at Tufts will receive modest raises if they agree to the pact, money wasn’t a prominent issue during contract talks. The average salary for a full-time nurse at Tufts is currently $114,543, while those at the top of the scale earn $126,032, according to the hospital. The majority of the hospital’s nurses work part time.

Robert Weisman can be reached at weisman@globe.com.