The nursing shortage in Rhode Island has been a mixed blessing for unions representing
those in the field.
On one hand, smaller staffs have created extra work and frustration among nurses at hospitals and elderly care facilities across the state. Situations like 16-hour days and mandatory overtime became a breaking-point issue for many in the profession.
On the other hand, frustration and fear of negative consequences of too few healing hands has shed light on the importance of retaining adequate nursing levels.
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“It speaks to the essence of the problem – difficult working environments,” said Rick Brooks, director of the 4,000-member United Nurses & Allied Professionals union based in Providence.
“I think hospitals have seen the value of working together rather than fighting,” he said. “Once they prioritized topics like recruitment and retention they’ve been working better with us.”
According to a report by the Hospital Association of Rhode Island, there are roughly 300 vacant nursing positions in the state. That number is down from 2002 when the figure hovered around 500. There are currently about 4,500 nursing positions at hospitals in Rhode Island.
At nursing homes, between 20 percent and 25 percent of the nursing positions are unfilled.
The labor shortage has kept nursing unions busy over the past decade.
Brooks said that in United’s case, it’s been a fight to improve workplace conditions that have grown more difficult as the shortage continued.
“Frustration surfaces when there is not enough staff, there’s not enough people on a shift or there are concerns the hospital administration is not doing enough to recruit and retain nurses,” Brooks said.
Stan Israel, vice president of the New England Health Care Employees Union 1199 in Providence, said the shortage has made the job less appealing to the 1,300 registered and licensed nurses at his union.
“There really are not enough good jobs,” he said. “If there were, there wouldn’t be so many people leaving the profession.”
Brooks said the nursing shortage was an offshoot of the managed-care days in which patients with less serious ailments would be shifted away from hospitals, leaving these facilities to handle only severe cases. Hospitals looked at the projections and reacted by cutting nurses. But the plan didn’t work out as anticipated, he said.
“The projections were wrong and the nurses that remained were working more hours,” he said, adding that many in the field decided to leave because conditions were too onerous.
Now there are enough registered nurses in the state to fill the vacancies but they are choosing to work in other sectors to avoid the difficult working conditions, particularly at the hospitals, Brooks said.
But as time has elapsed, progress has been made.
Unions have seen gains in getting nurses better wages, cutting mandatory overtime and providing adequate staffing ratios. Negotiators have been armed with studies like that done by Linda H. Aiken, a University of Pennsylvania nursing professor, which appeared in the Journal of the American Medical Association in October 2002.
The study found that a patient was 31 percent more likely to die when the patient-to-nurse ratio is 8-to-1 compared to 4-to-1. It also found a 7 percent greater incidence of death for each surgical patient added to a nurse’s care after the fourth.
Israel said hospital administrations have recognized the value of Aiken’s study and others like it. Such research has led to more harmonious collective bargaining as the spotlight has focused on issues such as retention and recruitment of nurses.
Israel’s union recently secured a three-year contract for nurses at Butler Hospital and a five-year contract for those at Women and Infants’ Hospital.
“I don’t know if this is a trend or done out of necessity because they need nurses,” he said. “Our relationships have been off and on in the past.”
H. John Keimig, president and CEO of St. Joseph Health Services of Rhode Island, said the nursing shortage helped to put his administration and unions on the same page.
“We have common goals, although for different reasons,” he said.
The administration and the two unions representing nurses at the health services’ two hospitals, St. Joseph Hospital for Specialty Care in Providence and Our Lady of Fatima Hospital in North Providence, placed an emphasis on recruitment and retention.
The compensation scale was adjusted to “acknowledge” more experienced nurses as a means of keeping them at the hospital. On the recruitment end, mentor programs were created and tuition was reduced for students at the health services’ school of nursing if they continued with the hospital group.
In terms of the Aiken’s report, services’ officials said they question the implication that the one-size-fits-all approach to nursing ratios. The ratios are not always the right mix depending on the volume of patients at a facility, the officials said.
Suzanne Martin, spokeswoman for the American Nurses Association, said the nursing shortage across the nation is on par with what is happening in Rhode Island.
“Cost-cutting measures have forced out higher paid, more experienced registered nurses and they are replaced with cheaper unlicensed nurses,” she said. “This has led to nurses becoming more active as they try to gain more control of their profession.”
The association includes a membership of 100,000 registered nurses from across the nation, or roughly 17 percent. However, growth has been slow over the past couple of years.
Brooks said enrollment in the United union has remained stagnant, despite gains made in the workplace. Although still considered one of the more powerful unions in Rhode Island, laws in place make it difficult to break into non-union hospitals.
“For instance, public money can still be used to hire anti-union consultants,” he said. “Another reason is that non-union hospitals follow the lead of union hospitals. They don’t want to be at a competitive disadvantage.”
The membership at United has seen an increase of about 60 members as various professions in the nursing field have joined the ranks from union hospitals.
Israel said the Service Employees International Union, of which 1199 is an affiliate, is the fastest-growing union in the nation. He claims frustration caused by the nursing shortage has helped to increase the rolls at the national organization, which includes nurses in hospitals, nursing homes and home-care businesses.
“There has been a steady increase in membership over the years,” he said. “Problems created by nursing shortages has definitely been a reason for the growth.”
