Hello NICU staff!

We are sending out this email to update you regarding a few things on the unit.

Staffing Plan:

In accordance with state laws, every unit must submit a staffing plan that is created in collaboration with the nursing staff and the unit's management. It is to be reviewed semiannually and resubmitted each time to be approved by the Department of Health (DOH). This is in accordance with the new bill that was signed into law a couple years ago. During bargaining of our current MB contract, we revised and created a new, very detailed, and well thought out staffing plan. There was a staffing plan in existence prior to the one that is currently in place. The previous staffing plan was not created in true collaboration with nursing staff. It was lacking extensively in detail and did not meet the requirements necessary to ensure safe staffing for our unit. We discovered this oversight during bargaining and created a new staffing plan document that was reviewed, signed by the CEO, and approved by the DOH. It is now time to review and make adjustments to our current staffing plan. Our next deadline is July 1.

Last month your union members created a group to collaborate on our staffing plan together before we presented it to our management. It was a diverse group - charges, senior, and newer nurses from both shifts.  The current staffing plan is available online on the DOH website.

The "hot" items on the staffing plan include the following.

1. Per the DOH, each staffing plan must include the maximum number of patients one nurse can be responsible for at one time. This includes the situation of a nurse covering patients for another nurse during their break. We proposed no more than 4 patients per nurse. As per our staffing plan, our patients will be sorted into no more than 3 patient assignments dependent on acuity.  
   
   Management did not agree with our proposal. Management proposed a nurse can be responsible for no more than 6 patients. Their reasoning was for break relief purposes- if a 3 combo assignment wanted to break another 3 combo assignment. Their concern was break timing flexibility and the preference of a nurse on who they hand off their assignment to. Management stated scheduled breaks may be in the future if nurses aren't able to take their breaks. More about this later. 
   
   Whatever number is listed as the maximum in our staffing plan is extremely important!  Assignments could increase to reflect that number as full patient assignments- 4 combos, 5, etc. regardless of any promise that it would not happen. If it's written in the document- it can happen. It is a legal document and corrective actions will be taken by the DOH if the unit is not in compliance with the staffing plan. Keep in mind some of the most important reasons for the creation of the bill is for patient safety, improve working conditions for healthcare workers, help resolve staffing shortages, and hold hospitals accountable for staffing violations.
   
2. We need to specify the number of NICU Support Nurses (NSNs) to be staffed on the unit each shift based on patient census. Previously management expressed specific numbers were needed to determine how many NSNs should be staffed. We included patient census ranges to determine 1 vs 2 vs 3 NSNs staffed per shift. We included these would be the minimum number of NSNs to be staffed, but it could be increased depending on the unit needs.

During our meeting, management did not want these numbers listed in the document.

Their reasoning was based on flexibility and charge nurse autonomy. If the unit doesn't have high acuity we could go down an NSN, or vice versa. They want the charge nurse role to be the deciding factor in how many NSNs should be staffed as they know the needs of the unit best.

Another topic of hot discussion in our unit and in our meeting was the Operational Charge role created by management. There have been multiple ADOs submitted and concerns from staff.  Per management the role was created for a few reasons. Mary Bridge requires their ANMs to fulfill a specific number of "clinical hours" each week. The ANMs on the other MB units fulfill their required hours by stepping into the charge nurse role. Your union members have received reports from various staff members that these ANMs regularly step in and help provide hands-on patient assistance on the units.  Our management created the OC role to fulfill the requirements from MB.

There were multiple issues with the OC role that were brought to the union's attention. When an ANM was fulfilling the OC role, they would include the ANM as a staff nurse, thus taking away a staff nurse from our overall staffing numbers for that shift. Assistant nurse managers are management, they are not included as a staff nurse, thus should not be included as a "nurse" to meet the staffing numbers for the shift. With the addition of an OC role being fulfilled during a shift, commonly a NSN was then taken away from the unit. This action violated our staffing plan.  During times that they fulfilled the OC role with a staff nurse, a NSN was taken away again. This violates the staffing plan but also goes against our contract. Because it is a role and not a position, management has the right to assign an ANM to that role; it does not have to be bargained in this specific instance.

Management has notified us and charge nurses they are in the process of removing the OC role due to the multiple issues reported. They have expressed they will be having ANMs step into the clinical charge role. This will take away "charge days" from charge trained staff nurses. Management has come to this decision on their own. The nurses who would like to express their concerns about this decision may direct those concerns to management. The union is not involved in this decision process. We understand the frustration and disappointment of this change but we are not responsible for this outcome.

Food for thought: With ANMs stepping into the charge role, and IF charges are deciding how many NSNs are to be staffed for a shift (which is what management wants per our discussion above about maintaining specific numbers to determine the minimum amount of NSNs), this could lead to the reduction of NSNs staffed on each shift. It is not a secret hospitals are always looking  for ways to save money and cut staff on a shift to do it. Our ANMs could receive pressure to limit NSNs staffed to achieve this, even though NSNs are how we ensure nurses are receiving their state mandated breaks. Having more specificity in our staffing plan is of the most benefit to us.

Your union leadership has been working tirelessly to fight for all of you to make our unit the best it can be, for nurses and patients. We couldn't count all the hours we have invested into researching, discussions, and meeting with management. We are doing everything we can on our end to improve working conditions for all of us. This is a bargaining year. We will be holding more unit meetings to discuss what that looks like when we have more information.

As always we are available for questions, concerns, or other needs you may have.

Sincerely,

Crystal, Michelle, Randi, and Rosie