Running a healthcare system such as Porter Medical Center is no easy job these days.
In addition to managing a budget of $69.8 million amid the continuing pressure to keep costs down, there is the looming prospect of cuts in Medicare payments and the uncertainties of a fluctuating patient population.
Little more than a year ago, Porter reported an annual operating loss of $6.1 million for the year. The hospital was below state requirements for cash on hand and had seen its patient census drop, at the same time it was facing the expensive task of digitizing its medical records.
Porter’s financial position appears to be better now. As of last month, it was projected to be slightly in the black for the fiscal year ending Sept. 30.
In addition to the 45-bed, not-for-profit hospital facility and the 105-bed Helen Porter nursing home, the system now includes 11 primary- and specialty-care medical practices.
Though the Porter system is small by national standards, it’s a big operation for rural Addison County.
Even with all these challenges, the system is widely thought to provide quality care. I’ve always felt I got excellent care as a patient who’s had checkups, diagnostic tests and minor surgery at Porter. They do a good job there.
But there’s another part of the human equation when it comes to how local healthcare is provided.
It takes more than hospital managers, physicians and support staff to run a healthcare system. It takes skilled nurses.
And the RNs within the Porter system say they’re near the breaking point.
Nursing is a demanding profession in the best of times. You’re expected to be a medical expert on a variety of conditions, work long hours for relatively moderate pay with few breaks and little control over your schedule, and you’re often dealing with very sick patients in life-and-death situations.
Driven by what they say are difficult working conditions, more than 70% of the approximately 140 Porter RN’s have signed cards asking for union representation. They want to form a collective bargaining unit under auspices of the Vermont Federation of Nurses and Health Professionals. The federation already represents more than 2,000 health professionals around Vermont including the nurses at Fletcher Allen.
Hospital management and the board of directors oppose the unionization effort. A union election under supervision of the National Labor Relations Board will be held next Thursday, Nov. 7.
Alice Leo, a Middlebury resident who’s been a nurse at Porter for the past 20 years, says nurses’ concerns about staffing levels are the biggest factor. “The top reason we want a union is safe staffing levels to assure safe, quality patient care,” she told me. “The issue is that there is not enough nurse staffing.”
Often staffing is so tight that nurses aren’t able to take their 30-minute (unpaid) lunch break, Leo said, for fear that there won’t be enough staff on hand to take care of patients. In one recent case, she said, the need to cover for short staffing required a nurse to work a 15-hour shift.
Staffing issues affect the quality of care, too, said Leo: “If you’re trying to take care of too many patients, you can’t give each patient the time and care they need.”
Porter nurses also feel unheard by when it comes to improving patient care, she said.
It boils down to one word: “Respect. We deserve respect for our professionalism” – a quality she said is often missing in the way nurses are treated by hospital management and physicians.
One of the most heated issues during the union drive has been the hospital’s efforts to present its side of the issue.
Nurses have been required to attend meetings at the hospital to hear presentations that give the hospital’s side. Hospital VP and spokesman Ron Hallman points out that nurses are paid for the time to attend the meetings. He says Porter has “the explicit goal of providing complete and factual information (as required by law) so that they can be informed voters. We want every nurse to vote and to vote with all of the information available from every perspective.”
Union organizers say the hospital has hired an outside law firm to advise it on how to block a nurses union, and that the mandatory sessions leave no doubt where Porter management stands – opposed to a union.
Indeed, as Hallman acknowledged, “We do not believe that a nurses’ union would be a positive thing for our organization, our employees or our patients.”
It’s a curious position in a community as politically progressive as Middlebury, where workers’ rights and voices are valued.
Indeed, Porter management is hearing from a vocal element of the community that supports a union. A group of about 10 community members showed up unannounced one morning at Porter to speak to management. I was a member of that group, and we were courteously received and heard by four members of management. There’s also a community petition drive in support of the nurses.
It’s an open question whether nurse staffing levels at Porter have hurt the quality of care.
But it’s an important question for everyone. Studies have consistently shown that inadequate nursing staff levels can be risky and expensive.
“When you don’t have enough nursing staff, errors increase and costs rise,” said Lincoln resident Mari Cordes, a nurse educator in the Fletcher Allen system and president of the Vermont Federation of Nurses and Health Professionals. “Hospitals pay for that because insurers won’t reimburse for errors. Unions help hospitals by reducing errors through better staffing levels and making sure nurses have enough training and education for the settings where they work.”
In my work of consulting to healthcare organizations (device makers and nonprofits), I’ve become keenly aware of the cost pressures and other challenges facing hospital leadership. It’s true that dealing with a nurses union can make leaders’ already difficult jobs more difficult.
But I’ve also seen how much harder nurses’ jobs have become in the current healthcare environment – and how, when they don’t have a union behind them, pressures increase and working conditions deteriorate for nurses and other healthcare staff.
That’s not a good situation for patients, healthcare professionals or hospital management.
Our nurses deserve to feel that they are respected and supported both by this community and by the leadership of our community hospital. It’s unfortunate that we’ve reached the point where many Porter nurses don’t feel that’s true.
If and when the nurses are represented by a union, I hope both nurses and management – including the community board of directors – will take it as powerful incentive to heal these wounds and move forward together.
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