NORTHAMPTON — Leaders of Cooley Dickinson Hospital expressed dismay that registered nurses represented by the Massachusetts Nurses Association have taken to the streets issues best discussed at the bargaining table. At issue is how the union can work with the hospital to preserve quality and safety and make care more affordable for members of the community.

The MNA’s choice to conduct informational picketing today is disappointing given that negotiations between the hospital and nurses have continued in good faith and another session is scheduled for tomorrow, said Chief Nursing Officer Carol Smith, RN, BSN, MBA.

Top Quality and Safety, Nurse Staffing Increased
Of particular concern to hospital officials is the nurses’ complaint that “an increase in patient assignments” requires that the hospital give the MNA staffing language that mandates staffing ratios. Smith said there are several reasons she does not agree that ratios are needed:

• Smith said she is very proud of the care nurses provide. “Cooley Dickinson nurses and their colleagues in other disciplines had, in fact, made Cooley Dickinson one of the top 5 percent hospitals in the nation when it comes to patient safety and quality,” Smith said. She explained that HealthGrades®, the country's leading independent health care ratings organization, named Cooley Dickinson as one of just 13 hospitals in Massachusetts to earn the HealthGrades Patient Safety Excellence Award™. CDH is one of only 99 of nearly 5,000 hospitals nationwide to achieve the award for three consecutive years.

• Nurses may perceive there has been a change in staffing, but in fact the number of inpatient nursing hours per patient day increased by 3 percent for the first nine months of the 2011 fiscal year compared to 2010. Within the past year, the hospital has eliminated two vice president  positions because of the its priority to keep nurses at the bedside

• The MNA notified us they have prepared a new staffing proposal for our consideration, but they declined to present it at last night’s bargaining session.

• Cooley Dickinson nurses who have worked at other hospitals are aware that often they care for fewer patients at CDH than at other hospitals.

The Massachusetts Nurses Association and its parent, National Nurses United, have staffing ratios as part of their agendas. The Massachusetts Legislature has failed to pass legislation calling for ratios every year since it was first introduced by the MNA 14 years ago. Smith said legislators recognize that mandated staffing does not take into account individual patient needs, the skill level and expertise of particular nurses, nor the availability of non-nursing personnel to perform some non-clinical tasks and contribute to overall patient care.

The hospital plans staffing patterns based on historical data and trends, Smith explained. However, the hospital can’t predict accurately on any given day how many people will become ill or have an emergency that requires hospital care or how many nurses will make last-minute sick calls. The hospital makes every effort to cover illness and other unplanned absences, but nurses are not always available to come in to cover for their peers.

Making Care Affordable
One of Cooley Dickinson’s top priorities is to make care more affordable for community members. Cooley Dickinson prices are high enough that some area residents who want to use hospital services can’t because their co-pays are lower elsewhere. In fact, patients have canceled appointments at CDH due to that issue.  In order to reduce prices, expenses must be lower, too.

One of the issues in the negotiations related to affordable care is the hospital’s request for new nurses to join the hospital’s defined contribution 403(b) retirement plan instead of a defined benefit plan. Volatility in funding defined-benefit plans has contributed to a trend in a decline nationally in the percentage of employees with such a plan. Nationwide, 70 percent of employees do not have a defined benefit plan, according to the Employee Benefit Research Institute.

Three other factors favor the hospital’s retirement proposal:
• The hospital’s proposal allows current MNA members to retain the hospital’s defined benefit pension.
• Recruits and newly hired nurses often say they would prefer to receive the hospital’s core contribution and employer match in the 403(b) plan because those accounts are portable.
• The MNA originally requested that its members be moved to a proposed MNA Taft-Hartley defined benefit plan. The hospital hired an independent actuary to calculate the monthly retirement benefit nurses would get through the hospital defined benefit plan and the MNA plan. For 253 of  259 nurses, the Cooley Dickinson plan was better than the MNA plan, with monthly benefit amounts as much as $500 more with the Cooley plan.

Also at issue is the MNA’s request for a successor clause in the contract that would require a new owner to recognize the union and honor its current contract. The hospital told nurses it would agree to MNA successor language — exactly as the MNA proposed it — if the nurses agreed to the hospital’s pension proposal.

Agreeing to that would be a concession on the hospital’s part, Smith explained, because it would make commitments for a future owner. The hospital is in discussions with three potential merger partners.

“We are committed to continue working with the Massachusetts Nurses Association to ensure what I believe the nurses and the hospital both want,” Smith said. “We must continue to provide top quality, safe care, but do that more affordably. I look forward to returning tomorrow evening to the bargaining table, where these discussions belong.”

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