Archive for March, 2015

The End of an Error

March 28, 2015


74,000 babies have started their lives in my wife’s care during the past 37 years as a neonatal nurse at St Vincent Hospital in Worcester. Today she gave up her biggest baby, her department, and resigned. She resigned because working twelve hours a day, five days a week and being on-call 24/7 was not enough for her bosses; her bosses who have enjoyed excellent bonuses based on her department’s profitability, client and staff satisfaction, and her leadership.

She was the manager of the neonatal nursery and post-partum care and took patient assignments as well so she could lead from the trenches. Four times the director of the Center for Women and Infants left and four times Pam became the acting director with less and less pay each time. This last time was for a year and a half with no additional compensation. Her body compensated her with cancer, a type of cancer commonly triggered by high levels of stress. Most of her coworkers and none of her bosses know as she poisons herself weekly with a low dose of chemo to control it. She won’t let the cancer beat her.

Pam is a St Vincent School of Nursing graduate. I met her when she was in school. I helped her escape the top of Vernon Hill during the Blizzard of ‘78 and we have been together ever since. We have two children, Zach and Addy. Pam was diagnosed with Myasthenia Gravis a few years after Addy’s birth. M.G. is a neuromuscular disease affecting her voluntary muscles. Surgery and the ability to tolerate very high doses of Mestinon keep her going. She hasn’t let Myasthenia Gravis beat her.

Saint Vincent was building a new facility, a brand new hospital in downtown Worcester. Pam was on the committee that flew around the country to see the latest in medical malls and worked with the architects on the design and layout of the new Center for Women and Infants. Her pride was evident in the pictures we still have of all phases of the construction; much like those ultrasound pictures the moms-to-be get, except these show metal studs, pipes, cables and duct work. And as soon as the new St V’s opened the newly unionized nursing staff staged their first strike. As management, Pam lived at the hospital for the 49 days of the strike; teasing me that she was enjoying the big Jacuzzi tub (for mothers who wanted a water birth) and wasn’t coming home. She understood some aspects of why the nurses went on strike, but not others. She felt supporting the needs of her patients, the mothers and their babies, was most important and many of her staff crossed picket lines and lost friends to help keep the department running. After the strike was settled she struggled to pull her staff together to again work as a unit and move on. She received the Robert Maher Manager of the Year Award that year. She hadn’t let the strike (and the threats) beat her.

Babies don’t understand staffing guidelines. When everybody’s bundles make a group decision to be born on the same shift, Pam would bake cakes, cookies or brownies and bring them to work the next day because she knows how much everyone stepped up. She knows how important it is to be appreciated and have the extra effort acknowledged. She also knows chocolate is the key ingredient in a good thank you. She kept chocolates with a mix of other sweets in a basket in her office so people could stop by for a quick fix. Work is work, but that doesn’t mean you can’t indulge in a little treat now and then. She knows a happy crew is willing to pitch in to smooth out those rough spots.

The babies come in their own time and, as every mother knows, you can’t beat them back to fit your schedule. This staff achieved a 97% productivity rating by the hospital’s own metrics. Those measures don’t account for the ladies who labor but aren’t admitted or other patient anomalies that still require attention, but aren’t putting a head in a bed at midnight. The folks get taken care of, but aren’t counted for staffing purposes.  And senior management sniffs at this level of performance. They have set a goal of 98% for the year. Or to put it another way – a 1% increase in profit margin for them. The upcoming two quarters should be especially profitable since there is an anticipated increase in deliveries of nearly 30% and no plan to increase staffing.

Knowing even chocolate can’t make this right, Pam presented the need for a minimum of twelve full time nurses to meet the current staffing guidelines to her boss who presented something to her boss. Then two bosses returned to announced “Problem solved!” They would bring in four travelling nurses to cover Labor and Delivery. That means none for the Nursery or Postpartum units, because once the babies are born the mothers and newborns can fend for themselves, right? The four travellers will end up in those other areas because the regular staff will have had more L&D experience. That means 2/3rds of the time the Center for Women and Infants will be severely short staffed.

The Center for Women and Infants has a superb reputation as a modern facility with a Level II nursery and excellent patient satisfaction reports (except for the food). These satisfaction reports are not only some of the highest of any unit in the hospital, but highest amongst all the Tenet owned facilities. The Center is consistently one of the top profit centers for Tenet and hospitals know that birthing centers are the gateway to continued use of that hospital by the new family brought into the world there; a good experience at birth creates a repeat customer.

For 37 years my wife has given her life to make that happen; to help every mother and baby get what they need to start life safely and to teach them enough to make going home to the awesome responsibility of raising that baby just a bit easier. She has been there long enough for babies she helped come back to have their babies. Now, in the interest of short term gain, her bosses will not allow her to deliver the safe, caring experience she has led her staff to provide. Simply because there won’t be enough staff.

They said to her, “So, what are you going to do about it?” She thought about it. Did they expect she was going volunteer what little life she had left to fill in for the short staffing? She thought about what she had been a part of: building a new hospital, developing their model of care and their excellent reputation. And all the lives – all 74,000 of them.

One thing I can tell you about my wife is you don’t want to challenge her. One of my wife’s old bosses said she didn’t deserve respect because she didn’t have her BSN, just her RN from St V’s. Faster than you can say “bite me” she graduated summa cum laude. Myasthenia? No problem. Knee and ankle surgeries? That’s why there’s physical therapy. Cancer? Lesions under control.

They challenged her, “So, what are you going to do about it?” She thought about it. Her reputation? Her dignity? Her life’s work? Like I said, you don’t want to challenge my wife. She wasn’t going to let them beat her. She resigned.

Postscript – Pam will hate that I wrote this about her, she doesn’t like being the center of attention. She hopes that her action will galvanize those with more power to pressure the top layer of management to initiate positive change. One change I know will happen is they will need to hire at least two people to replace her. Perfectly, this NY Times article was in my Facebook feed today.

Thanks for all the well wishes and heartfelt notes – I read them to Pam and my chin quivers. I choke up too because for 37 years you (the staff) have been part of my family. You were there for us when we had our babies at St V’s and we have grown up (not old) together. Our love to you all.