As their numbers shrink, nurses gain clout
By Anne Barnard, Globe Staff, 2/7/2002
Think of nurses these days, and the image that comes to mind is as likely to be a frazzled worker
with a picket sign as a calm comforter in white.
But in recent weeks, a different picture has begun to emerge. From coast to coast, there are signs
that the turmoil in nursing and its attendant publicity have brought nurses a hard-won victory. With
hospitals desperate to hire them and politicians eager to embrace their concerns about medical
errors and emergency-room delays, nurses are now the most sought-after workers in the health
care world, with new, and some say unprecedented, clout.
In Boston, Tufts-New England Medical Center has agreed to raise nurses' pay 18 to 23 percent
over 21 months, a deal the nurses union called the state's biggest raise in nearly two decades.
In California, Governor Gray Davis has announced the nation's first state-mandated
nurse-to-patient ratios, tentatively set at 1 to 6 on regular hospital floors and 1 to 1 for trauma and
With 10 percent of the nation's nursing jobs empty and one in seven hospitals reporting a nursing
vacancy rate of 20 percent, 41 percent of hospitals are paying signing bonuses: $5,000 is common,
$10,000 not unheard of.
Even at Boston's Beth Israel Deaconess Medical Center, which announced 700 layoffs last month
to offset a $58 million operating loss last year, executives went against consultants' advice and
vowed not to fire a single bedside nurse.
''Finally, some hospitals are starting to realize that your survival depends on having the nurses to
staff those beds when the ER patients come in,'' said Karen Higgins, a nurse at Boston Medical
Center who is president of the Massachusetts Nurses Association, the state's largest nurses union.
Over the last year, unions and other groups have warned that nurses are increasingly overworked,
caring for too many patients, and afraid that their exhaustion will lead to a lethal mistake.
Given this grim picture, Kate Matulewicz, 26, seems to live in an alternative universe. At Tufts-New
England Medical Center, she cares for three or four cardiology patients a day, few enough that she
has time to laugh at their jokes about her red hair and to teach them how to take better care of
themselves at home. She never has to work overtime against her will, and she beams with pride
about the research project she recently worked on.
''I'd say I'm happy with both the pay and the benefits,'' she said Friday, as she whisked from room
to room changing bandages and testing blood pressure.
One patient, William Charbonnier, said he ran a home-nursing agency in St. Croix until last year,
when congestive heart failure forced him to move back to Boston. He said the medical center
seemed to have learned the same lesson he did: ''You need to pay them right and treat them right,
or you're not going to keep them.''
Shelley Reever, who negotiated the hospital's new contract for the union, said she expects that
message to spread.
''The nursing shortage is predicted to be so severe, nurses are going to be in a position to have a
huge amount of say over their working conditions,'' Reever said. ''We're not there yet, but I just see
this as a very different time. The Legislature, the state, the federal government, everyone is finally
starting to listen.''
And so is the marketplace. Newly hired nurses increasingly can choose their hours. Some hospitals
are giving nurse executives more leeway and more money to make changes that nurses want, from
creating new awards to reducing mandatory overtime.
''The workplace is becoming more attractive,'' said Barbara Monroe, dean of the Boston College
School of Nursing.
Word of mouth from disgruntled nurses and new opportunities for women have dampened interest
in the profession in recent years, Monroe said.
But in September, nursing-school enrollment rose 3.7 percent, ending a six-year slide, according to
the American Association of Colleges of Nursing.
At Northeastern University, applications to the nursing program are up 70 percent over last year.
Enrollment is expected to rise further, partly because of the sluggish economy. Recessions typically
lure people into nursing, as the profession's comparative stability becomes a selling point and as
higher salaries in other fields lose some of their edge.
But the workplace stresses are far from over, and nurses' recent gains won't solve all the problems.
There are still roughly 21,000 fewer students than in 1995, not enough to meet the demand for new
nurses or stave off a projected shortage of 500,000 registered nurses by 2020.
And there are limits to how fast the nursing schools can grow: BC's School of Nursing saw a 40
percent increase in applications this year, but the number of students who enter next fall will
increase by just 10 percent, Monroe said, because there is not enough faculty to handle more.
Meanwhile, some health care executives fear that too much power for nurses - and particularly for
nurses' unions - could weaken hospitals financially and thereby harm patients.
Dr. Samuel O. Thier, chief executive of the Partners HealthCare network, called the New England
Medical Center contract ''precedent-breaking.'' He said the deal would add to the pressures on
Massachusetts hospitals, already struggling with Medicaid reimbursement rates that pay just 70
cents on the dollar.
In California, hospitals are warning that the proposed nurse-to-patient ratios could be
counterproductive. The California Healthcare Association, an industry group, says that the
proposed ratios will cost hospitals an additional $400 million a year, when 64 percent of hospitals
in the state are losing money.
Hospitals may have to close some beds if they cannot find the staff required to operate them under
the mandate, said Jan Emerson, a spokeswoman for the group, which represents California's more
than 500 hospitals.
A similar ratio bill is being debated in the Massachusetts Legislature. Proponents cite studies
showing that care improves when there are more nurses per patient; critics say that those studies
are inconclusive and that state-mandated ratios rob hospitals of the flexibility they need.
Nevertheless, there is a broad consensus among health care executives and politicians that nurses,
the most numerous employees in the troubled health-care system, need a boost. Hospitals and
unions alike are thrilled that Congress and state legislatures are setting aside money for nurse
In Boston, hospitals more used to vying over whose doctors are best now compete for the title of
Massachusetts General Hospital, which has long been better known for its cutting-edge medicine
than its warmth, has made nursing a priority under Jeanette Ives Erickson, its senior vice president
for patient care and chief nurse. MGH also poached top nurse managers last year from its
financially struggling rival, Beth Israel Deaconess Medical Center, in a bid to steal its title as
Boston's premier nursing institution.
Meanwhile, Paul Levy, the new chief executive at Beth Israel Deaconess, said that protecting
nurses was key to the hospital's survival, even if it costs more in the short term. ''The place that this
hospital has in the community is based on a level of warmth and care that is fundamentally in the
hands of the nurses,'' Levy said.
Emerson Hospital has set aside more time for training and provided refresher courses for nurses
returning to work.
''For years, we just accepted the fact that we had more and more and more patients and there were
less of us, and it was getting more dangerous,'' said Higgins of the Massachusetts Nurses
Association. ''Finally, nurses are coming out freely and saying, `It isn't safe.' Nurses probably
always had clout. They just never used it.''
Anne Barnard can be reached by e-mail at firstname.lastname@example.org
This story ran on page A1 of the Boston Globe on 2/7/2002.
© Copyright 2002 Globe Newspaper Company.