HARTFORD — Connie Fields, an administrative assistant at Lawrence and Memorial Hospital in New London, told CT Examiner that she’s had patients she knows from the community call her at home to ask for help.
“[The patients] have said, ‘I’ve been sitting in my own urine and feces for over two hours. Get me help,’” said Fields.
Fields, who is also the President of AFT Local 5123, was one of multiple nurses — many also union leaders — who came to the Capitol on Monday with numbers affixed to their shirts symbolizing the number of patients that nurses or other hospital staff members have to care for at one time.
For Fields, that number was 27 — the number of patients she said that some of the Patient Care Assistants she represents have had to take on. She highlighted the pressure that this places on the workers.
“I see the PCAs extremely tired, exhausted,” she said.
The group gathered with legislators from the state’s Public Health Committee, Sen. Richard Blumenthal, and AFT national president Randi Weingarten to advocate for legislation that would benefit hospital workers.
The legislation at both the federal and state level would create staffing requirements at hospitals, ban mandatory overtime for nurses and add protection for nurses from acts of violence in the workplace.
In his remarks, Blumenthal told the group about two bills on the federal level that are aiming to improve the quality of the workplace for nurses — the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act and the Workplace Violence Prevention for Health Care and Social Service Workers Act. Both bills were originally introduced last year.
The first bill would mandate staffing levels, and the second would require hospitals and treatment facilities to have a “workplace violence prevention plan” that would include emergency response systems, ways to report violence and things like alarm and security systems that could help decrease potential risks.
But Blumenthal also warned the room that he couldn’t promise what would happen at the federal level, particularly since the House of Representatives now has a narrow Republican majority. Blumenthal’s message to Connecticut legislators was to be the example for the rest of the nation. “Connecticut can help show it is possible to win — for patients, for nurses, for everybody,” said Blumenthal.
State Sen. Saud Anwar, D-South Windsor, who is the chair of the public health committee, said that the committee is planning to take up legislation that would require certain minimum staffing ratios depending on the type of care.
Connecticut is not the only state considering this type of legislation. Last week, lawmakers from Massachusetts filed a bill that would create minimum staffing levels in hospitals.
A draft bill currently proposed would require a 1:1 nurse-to-patient ratio in the operating room and for trauma patients in the ER, a 1:2 ratio for intensive care units, labor and delivery and non-trauma ER patients, a 1:4 ratio for pediatric units, pre- and post- birth units and other special care units, a 1:5 ratio in medical-surgical units and a 1:6 ratio in psychiatric units, among others.
John Brady, a nurse and the vice president of AFT Connecticut, said that under current law, the hospitals are required to have a staffing plan, but each hospital is responsible for enumerating its own staff-to-patient ratios. He also said that the hospitals aren’t held accountable for those staffing levels.
According to statistics from the Department of Public Health, there were over 81,000 registered nurses in Connecticut in 2021, up from around 73,000 in 2020 and about 68,000 in 2019.
But those numbers do not differentiate between nurses who are and are not actively practicing. According to the CT Data Collaborative, of the approximately 86,500 registered nurses and licensed practical nurses who were licensed in the state in 2020, about 44,000 were actually practicing in Connecticut.
Dale Cunningham, president of the local union for Registered Nurses at Lawrence and Memorial hospital, said they were having problems with staffing shortages mainly because many nurses had retired during the pandemic. She said that they teach the staff at the hospital how to file reports on staffing shortages. Sherry Dayton, an emergency room nurse at Backus Hospital in Norwich, said she can receive 25 to 30 of these reports in a month.
Dayton, who is the vice president for healthcare for AFT Connecticut, said that the shortages meant she was seeing her patients less frequently.
“Every interaction I have with a patient can take at least 10 to 15 minutes, but that’s helping ’em through commode, doing a dressing change, giving them medications, taking their vitals. If I have eight patients, am I going to see them every hour? There’s just no way. And every time I’m not seeing them every hour, their risk of having a poor outcome goes up,” said Dayton.
Cunningham and Dayton told CT Examiner that they also had patients waiting for hours in emergency departments. Dayton said that they could have 90 patients in the emergency department waiting to be admitted to a 33-bed unit.
“I have had nurses in the ER who have had 12 to 15 patients at one time,” said Dayton.
Hospital Association responds
Paul Kidwell, president of the Connecticut Hospital Association, told CT Examiner in an email that he believes the mandatory staffing ratios will actually make the bed shortage worse. He said that many times, patients coming in through the emergency room have to be cared for by people with specialized training.
“If there are government mandated nurse staffing ratios on inpatient floors that hospitals are not able to meet, they will be forced to close beds on those inpatient floors, backing up care in the emergency department and potentially delaying care for patients that require inpatient care and those waiting in the emergency department,” Kidwell wrote in an email.
He added that he believed the requirements would prompt corporate staffing agencies to raise their rates, meaning that the cost of care would also go up.
“Instead, let’s focus on solutions that support patients and the healthcare workforce, set aside policies like staffing ratios that would harm patient care, and work together on advancing legislative action to support recruitment, retention, and safety,” said Jennifer Jackson, CEO, Connecticut Hospital Association, in a statement.
MaryEllen Kosturko, chief nursing officer for Hartford HealthCare, said in a statement that the hospital system was engaged in a “robust recruitment and retention strategy” as well as working with local schools and universities on tuition reimbursement and lowering education costs. She said the hospitals also had a 24-hour nursing peer support hotline.
Limiting overtime hours
Another bill the public health committee will consider would remove an exception in the current law that allows for mandatory overtime that is negotiated by collective bargaining units. This would limit nurses to working the shift they had been scheduled to work at least 48 hours in advance.
Bill Garrity, currently union president for University Health Professionals at UConn Health, told CT Examiner that he’s been arguing against mandatory 16-hour shifts for 20 years. Before being union president, he worked as a nurse in the emergency room and in the oncology department with bone marrow transplant patients.
The mandatory 16-hour shifts, he said, is dangerous for patients because it increases the risk that the nurse will make a mistake with things like medication.
“You are asking me at 15 hours awake to calculate drugs to give to a patient. And these drugs are what we’ve considered super lethal,” he said.
Anwar said that the state needed to encourage the people who were currently working in healthcare to remain in the field by showing them that the state would support them. Beyond that, he said, there was a need for a longer-term plan that would create a pipeline for people to enter the nursing profession. He said there would be another bill that would take a greater look
“We have to intervene and take care of the people right now. So we support and encourage the current workers to stay in the field and recognize that you are not alone. We will fight for you,” said Anwar. “Step number one. Step number two is a much more long-term comprehensive plan, but we cannot go to the comprehensive plan if we are in [the] dire straits that we are moving towards.”