Tacoma General and Mary Bridge NICU fighting for ratios

In Tacoma, MultiCare nurses are in a fight for nurse-to-patient ratios — the gold standard for nurse and patient safety.

Nurses at Tacoma General don’t want to lose them and nurses at Mary Bridge want them back.

The nurses held a picket outside Tacoma General Jan. 23 to raise awareness on their fight for patient safety after stalled negotiations with MultiCare.

Tacoma General is one of the only hospitals, if not the only hospital, in Washington state to have nurse-to-patient ratios in their contract. When MultiCare moved the NICU nurses out of the Tacoma General contract to the Mary Bridge contract, the NICU nurses lost their ratios.

The Washington State Nurses Association (WSNA), the union representing more than 1,100 registered nurses at Tacoma General and Mary Bridge, won ratios for nurses at Tacoma General in 2017.

After ratios went into effect, the workload for Matthew Dustin, a nurse in the intensive care unit at Tacoma General, went from three severely sick patients to one or two patients, depending on the patient’s acuity.

For Dustin and other nurses, keeping these ratios is vital.

“Our workload is increasing. Charting is more complex, and patients are getting sicker and sicker,” he told WSNA. “The worst thing for a nurse is having a patient that needs your help and you can’t do anything.”

Tacoma General attracts nurses because they have these ratios, but MultiCare wants the nurses to make a choice between keeping the ratios or ensuring basic protections for nurses on the Hospital Staffing Committee. Nurses want both.

As required by state law, staffing plans are created by a committee with 50 percent direct patient care representatives (nurses and CNAs) and 50 percent administration. WSNA wants staffing committee protection to ensure that no staffing plan is passed without a WSNA nurse voting in favor of it.

Babies in the NICU, can get sick in a moment and nurses want to be sure they are not asked to care for more than three babies per nurse, as recommended by experts in neonatal care. If nurses are pushed to take care of more babies, they said there will be worse outcomes.

Currently, staffing plans can be passed even if every single nurse on the committee thinks doing so would endanger patients.

Nurses say they reject the false choice that pits ratios against protections for staffing plans in the Hospital Staffing Committee.

ER nurse Lina Delacorte told WSNA that the ratio in the Emergency Department is 4:1 because it’s in their contract.

“If we get a critically sick patient, that ratio drops to 2:1. This ensures we have the resources to take care of these critically sick patients and not abandon other patients. You never know what is going to walk in the front door.”

She said without ratios, she would be very worried about her license and outcome of her patients.

“As an EMT, I saw nurses scramble to check on noncritical patients if there was a CPR in progress,” she said, “It’s not just big-picture scary. It’s as basic as passing out meal trays. Not having time to clean up a dirty brief on an incontinent patient. Discharge paperwork, pain meds are going to be late.”

Although major nursing organizations, such as the American Nurses Association, support mandated nurse-to-patient ratios, just three states have them – California, Massachusetts, and, most recently, Oregon.

Other major issues in the picket include the following:

No more managers acting as charge nurses

Nurses want to end MultiCare’s recently instituted practice of having clinical assistant nurse managers filling the role of a charge nurse. These managers are not part of the union contract. Nurses say these managers are often pulled away into all kinds of management duties, such as attending publicity events and administrative meetings, leaving a unit without a skilled charge nurse who can do bedside care.

Fair, competitive wages

Nurses are asking for wages that recruit and retain nurses, not wages that push experienced nurses out the door to nearby hospitals.

Nurses hope the pressure of hundreds of nurses preparing to picket moves management to do the right thing.