Get The Facts

This page contains the position of Brigham and Women's Hospital on timely and relevant issues that may be misrepresented by other sources. We want to ensure that our Brigham community, our patients and the general public have the facts. We will update this page on a regular basis.

Merging of the PACU, Day Surgery Unit and Pre-op Areas and Professional Development Model

January 31, 2018

  • We met with the MNA on Nov. 17 to discuss the merging of these three perioperative patient care areas. Unfortunately, the MNA rejected our proposal to facilitate a smooth transition, but we have heard from several nurses who are interested in being trained to work in the new model, and some who would prefer to pursue other opportunities.  We are pleased to be able to make both options available to the 25 nurses impacted by this merger.   
  • To ensure that all involved feel comfortable that we can continue to provide the highest possible care to our patients and their families, the merging of the units will occur over time as nurses complete orientation and begin work in the new model. 
  • Having nurses in these areas care for patients in pre-op, the Day Surgery Unit and the PACU is a standard of practice across the country, and we have the utmost confidence that our highly skilled BWH nurses can work in this model. This model will provide more timely access for patients to the recovery unit and enable staff to flow throughout these areas to promptly respond to patients’ needs and manage changes in patient volume.

Employee Flu Vaccination Policy and MNA Lawsuit

December 11, 2017

The Massachusetts Nurses Association’s injunction to prevent the implementation of the Brigham’s mandatory flu vaccination policy was denied in late November by a Massachusetts State Superior Court judge. Following are facts about the Brigham’s flu vaccination policy and the hospital’s position:

  • The hospital updated its flu vaccination policy to require that all personnel receive a flu shot. Those with a documented medical contraindication or sincerely held religious beliefs may qualify for an exemption.
  • The MNA lawsuit claimed that BWH’s policy violated the Department of Public Health regulations by not allowing employees to decline to be vaccinated for reasons other than medical issues or religious beliefs.
  • The hospital’s position continues to be that the DPH regulations set the minimum requirements for what health care facilities must do in regards to employee vaccination, and hospitals are permitted to have more stringent requirements.
  • Ninety-four percent of nurses at the Brigham received the vaccine last flu season (2016/2017).
  • The deadline for BWH employees to receive flu vaccinations (or approval for a valid exemption) was Friday, Dec. 1. Employees vaccinated for flu represent the hospital’s first line of defense against cases of hospital-acquired flu.

Although our employee flu vaccination rates were high last year, BWH still sees cases of hospital-acquired flu each year. We want to better protect our patients – especially those with compromised immune systems – against the spread of flu.

Massachusetts Nurses Association Informational Picket Nov. 15

November 15, 2017

While it’s disappointing that the union is conducting an informational picket, it is their right to do so. Brigham and Women’s Hospital values our nurses and their incredible contributions to patient care, educating the next generation of nurses and other health care professionals, research and community outreach. Our perspective on the issues raised by the union is available below.

Nurse Staffing (Updated April 10, 2017)

  • BWH continues to explore ways to proactively identify potential staffing concerns as well as respond in a timely way when issues surface to ensure the right care is provided to the right patients. These include improvements in our staffing concerns form process. Specifically, we are educating staff about the best use of the staffing concerns form, and enhancing both proactive and follow up communication.  A daily handoff for nurse directors and nurse administrators has been implemented in an effort to ensure any concerns are addressed quickly, and a new review process as well as a new database to track any concerns has been developed.
  • The safety of our patients is among our highest priorities at the Brigham, and we take concerns about staffing very seriously. There have not been unsafe patient care situations related to staffing.
  • We determine the number of nurses needed to care for each patient based on acuity, meaning the severity of their illness.
  • In our intensive care units, we have a nurse-to-patient ratio of one nurse for each patient, or one nurse for two patients, depending on acuity. In our intermediate care units, we average one nurse for three patients. Detailed information about staffing ratios and how we compare to other hospitals in Massachusetts is publicly available on the Patient Care Link website. As the site shows, our staffing levels are very good. When we have challenges, we address them as quickly as possible.

Staffing “Cutbacks”

  • We have not reduced the number of nursing positions at the Brigham; rather, we have added positions. This year, BWH has hired 350 nurses to backfill vacancies created by the 230 nurses who accepted the hospital’s Voluntary Retirement Offering, as well as new, full-time positions that were added to accommodate recent increases in patient volume and acuity throughout the Brigham.

Code Amber

  • Code Amber is not called due to lack of staff, but rather due to a number of causes, including high patient volume. This can lead to over-crowding in the ED and bottlenecks in the OR and Post Anesthesia Care Unit (PACU). Since January, the hospital has called a Code Amber three times due to high patient volume.
  • During the Nov. 8 Code Amber, three nurses (one in the OR and two in Peri-anesthesia) were asked to stay beyond their shift while leadership assessed patient needs across the organization. The hospital has reported this to the Department of Public Health, as it must do when staff are required to stay past their shift.

Nurse Education

  • The Department of Nursing is not eliminating nursing education; rather, we have created a new model that enhances education for all nurses. Ensuring that staff have the right education and training to care for patients and to develop new skills is critically important to quality and safety, as well as staff satisfaction. A new professional development manager role has been created to coordinate and oversee clinical education programs and professional development opportunities, as well as lead quality and safety efforts. The new model of nurse education offers many improvements, including:
    • 24/7 coverage, filling a current gap in education resources for nursing staff who work the evening and night shifts.
    • Consistency in evidence-based practice across divisions and service lines to better serve nursing staff, as well as patients and families. The previous model was focused on individual patient care units.
    • Greater flexibility and bandwidth in sharing clinical expertise and educational resources across the hospital.
    • More dedicated and protected time for nurses to pursue educational opportunities.

Safety in the Newborn Intensive Care Unit (NICU)

  • There have been some interpersonal challenges among the staff working in the NICU. We have contracted with an outside expert, who is a nurse, to help us address communication and teamwork within the multi-disciplinary team. The NICU continues to provide high-quality patient care, and there have not been adverse patient outcomes related to these interpersonal issues.

Safety in the Operating Rooms (OR)

  • In the OR, we have not reduced the number of nurses. We have hired 38 nurses since January to fill vacancies left by nurses who are retiring and to fill 20 new, full-time staff nurse positions that have been added to the OR budget. We provide robust education and extensive training during the orientation period for new nurses.
  • Overall, our surgical site infection outcomes are comparable to other hospitals and, for some types of surgery, are better than average.
  • There have been four cases reported this past year where specimens were not received by pathology, and a corrective plan has been put in place to address this.

Partners HealthCare Second Quarter Financial Results and Salary of Hospital CEOs

  • Partners HealthCare reported an overall gain of $406 million in the 2017 quarter. This includes a non-operating gain of $382 million, of which $323 million (80% of the overall gain) represents the net impact of adding Wentworth Douglass Health System, in Dover, New Hampshire, to the Partners system on Jan. 1, 2017. Accounting rules require the fair value of acquired net assets to be recognized as non-operating gains.
  • The salary of Brigham Health President Betsy Nabel, MD, along with the salaries of other hospital presidents in the Partners system, is set by the Partners Board of Directors. According to a recent statement from Partners HealthCare Board Chair Edward P. Lawrence, Esq.: “The market for senior health care executives, particularly physicians, is a national one and we must provide competitive wages and benefits in order to attract and retain the best individuals at a time when health care is undergoing sweeping change. The competition for excellent managers and leaders is especially strong at this time. …These leaders have helped ensure that Partners HealthCare and its hospitals remain at the forefront of medical science and continue to be a major economic engine for Massachusetts and the region.”

Magnet Designation

September 8, 2017

BWH is pursuing Magnet designation, which is considered the highest standard for nursing and clinical excellence. Currently, eight percent of hospitals in the U.S. have received Magnet designation from the American Nurses Credentialing Center (a division of the American Nurses Association). We already embody the rigorous standards of Magnet hospitals, which consistently deliver the highest level of care and patient experience. We are proud of our nurses and every member of the care team and would like to be recognized among our peers for the work we do every day.

Although we had hoped to partner with the Massachusetts Nurses Association, which represents about 3,300 nurses at the Brigham, we do not have the union's support. The MNA chooses to oppose Magnet rather than share our goal of recognizing Brigham nurses with the gold-standard designation that Magnet represents. This devalues the work of not only our nurses, but all staff at the institution, as Magnet is an institutional recognition.

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