CDH nurses say short staffing, pandemic pressures leading to burnout

  • Cooley Dickinson Hospital in Northampton is shown in March 2020. GAZETTE FILE PHOTO/JERREY ROBERTS

Staff Writer
Published: 9/30/2021 8:06:00 PM

NORTHAMPTON — When Cooley Dickinson Hospital nurse Monica Stillings first started as a floor nurse 16 years ago, staffing levels felt rational and appropriate.

But for more than a decade, Stillings said she has seen Cooley Dickinson, which is part of the Mass General Brigham system, and other hospitals increasingly rely on a staffing model that leaves nurses overworked and unable to provide the kind of care patients deserve. And that was before the COVID-19 pandemic flooded health care facilities nationwide.

“We’ve been working on skeleton crews since the first economic crash back in 2008 and 2009,” Stillings said.

She said nurses have suffered mental trauma and physical injuries, including from an increase in violent patients. It has gotten so bad that Stillings said she’ll be leaving the nursing profession.

“I will never be a nurse ever again. Just emotionally, trauma-wise, I just can’t handle it,” she said.

Stillings was one of five Cooley Dickinson nurses who spoke to the Gazette about their frustrations with Cooley Dickinson and Massachusetts General Hospital amid the continued staffing crunch made worse by the pandemic. They said that amid the COVID crisis, the hospital hasn’t done enough to retain burned-out staff, such as offering pay retention bonuses or implementing staffing ratios, and that management is not supportive of nurses, who feel fearful of retaliation for speaking out.

Across the state and country, hospitals are straining under labor shortages and beds filled to capacity due to the coronavirus, medical care that patients deferred for all of last year and other causes. The five Cooley Dickinson nurses who spoke to the Gazette stressed that staff-to-patient ratios have long been a concern for nurses, and that the further strain of the pandemic has caused patient care to suffer and burnout to sweep staff ranks.

“It’s hard to do your job well when you don’t have the resources to do it,” Cooley Dickinson emergency nurse Kaileen Canon said. “It’s hard to get everything done and it just makes you feel like a failure because you’re not set up for success.”

Well-being important

In a statement, Cooley Dickinson’s chief nursing officer, Angela Belmont, said she is impressed with the skill and commitment the hospital’s staff have shown during the pandemic. She said staff well-being is “extremely important” to the hospital, and that nurses and others are encouraged to access staff assistance programs such as workshops, support and education. She said the hospital also has taken steps to support staff and provide quality health care.

“The challenges facing hospitals across the nation are unprecedented,” Belmont said. “Businesses and organizations of all kinds are finding recruitment and staffing to be among their most important needs and biggest challenges.”

Several of the nurses interviewed said that hospital systems like Mass General have turned profits by operating on a thin staffing model for years predating the pandemic, leaving fewer nurses with more patients to care for. Now, the pandemic has led to a wave of patients, many of whom are arriving with more complex medical issues that require greater attention.

“Everybody is just feeling the frustration with how busy it is. And for nursing, it boils down to staffing,” said Candie St. Jean, a registered nurse case manager at Cooley Dickinson. “All these things were happening before the pandemic even started, and COVID just exacerbated it.”

The state’s largest nurses’ union, the Massachusetts Nurses Association, which represents nurses at Cooley Dickinson, has long pushed for safer patient-to-nurse limits in the state. In 2018, the union put forward a ballot initiative that would have mandated patient-to-nurse ratios. Voters overwhelmingly rejected the initiative after the Massachusetts Health & Hospital Association, which lobbies on behalf of hospitals, spent heavily to defeat it.

Recently, nurses have been leaving the profession or their hospitals for other jobs, the nurses said. The hospital’s response, they said, has been to encourage new hires by providing hiring bonuses. But the hospital has done little to retain the knowledgeable staff already there, they said.

“We are really dealing with a shortage of core, experienced staff,” said Chelsea Grybko, a nurse in the hospital’s telemetry unit. “We have a lot of experienced nurses who have left to go to other units because they are just burned out from the amount of physical and emotional labor we have to put in on our unit.”

Mentorship program

Belmont, the chief nursing officer, said that Cooley Dickinson offers competitive wages and benefits, and this week announced a $1,000 bonus for staff in “appreciation for everyone’s extraordinary efforts over the past 18 months.” She also said the hospital has piloted a successful mentorship program to onboard nurses and plans to roll it out across the hospital’s nursing units.

“Cooley Dickinson nursing leadership has created a staffing model that allows flexibility,” Belmont said. “We recently accommodated requests from nurses and worked with our labor union to create 12-hour shifts, while continuing to offer eight- and even four-hour shifts.”

One of those newer nurses is Olivia Moshier, who started at Cooley Dickinson in February on a COVID-19 floor. She said she finds herself “sprinting everywhere all night,” often working without enough other staff, leaving her exhausted at the end of every shift.

“The really difficult part is the deaths,” she said. “People are just dying left and right and that is not something I expected to deal with my first year of nursing — having patients die on me once a week or so from COVID.”

The ultimate answer, Moshier said, is to hire more staff.

“They’ll pay new nurses they hire instead of trying to keep the ones who are trying to stick it through,” she said. “The big problem is that everybody is leaving.”

Dealing with hostility

Nurses interviewed for this article said that the staffing shortage has been made worse by the more complex issues patients are presenting with at the hospital. Canon, the ER nurse, said that it is hard to watch so many people get sick with COVID-19 and not recover.

What’s worse, Canon said that some patients are coming into the hospital angry at medical professionals, distrusting of the coronavirus vaccine and getting mad at nurses for not providing treatments like Ivermectin, an antiparasitic treatment for horses, which the U.S. Food and Drug Administration has not approved for treating COVID-19.

Patient violence has also gotten worse, the nurses said, accusing management of not doing enough to address it.

“In the time I’ve worked there, I have been punched in the face, I have been kicked and spit on, I’ve been sexually groped,” said Canon, who has worked for nearly three years at the hospital. “They’ve made small efforts like putting more cameras in and trying to have security have an office in the department, but that only does so much … We’ve been asking for more security and more staffing since I’ve been here.”

Belmont said that the hospital has a dedicated task force to address workplace violence, composed of leaders, nurses and other staff who have met over the years to strategize best practices.

“Several recommendations have been implemented, including staff training, an alarm system, a new incident debriefing tool to evaluate and improve on responses, improved workflows, and video capabilities,” Belmont said.

In a recent op-ed published in the Gazette, St. Jean and six other nurses union leaders at Cooley Dickinson noted that Mass General Brigham has “immense financial assets,” pulling in $250 million in profits in the second quarter of this year, according to the Center for Health Information and Analysis. Nurses interviewed suggested using that money to hire more nurses, retain others and pay staff better, including CNAs and other critical hospital workers.

Instead, Stillings said, hospitals’ business models have led to CEOs pulling in profits, and big pay packets for themselves, while “cutting their costs down low.” That may not be a bad model for a business, but when you’re in the business of caring for human beings, it isn’t black and white, she said.

“I think things are getting normalized in a way they shouldn’t be,” Grybko said. “I don’t think health care is trending in a great direction and I would like to see more money go into it and more money go to the right places — the patients, and not the pockets of upper management.”

Dusty Christensen can be reached at dchristensen@gazettenet.com.

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