State finds 'smooth' transition to replacement nurses at BMC

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PITTSFIELD — Halfway through an usual week, life goes on inside Berkshire Medical Center.

The patient census rose to 246 Wednesday from 211 the day before. And those patients are telling representatives of the state Department of Public Health — as well as the hospital's own teams — they are pleased with the quality of care during a nursing strike and lockout.

Ann Scales, a DPH spokeswoman, said the Pittsfield hospital's coverage plan for striking registered nurses has been properly implemented.

Though the Massachusetts Nurses Association's one-day strike ended at 7 a.m. Wednesday, a crew of 247 replacement nurses will continue to provide care until 7 a.m. Sunday.

Medical procedures have been taking place on time and arriving patients have had no trouble gaining access to the center's programs, according to Diane Kelly, the hospital's chief operating officer.

"Things are going really well," Kelly said.

One exception: Noise from passing trucks whose drivers are using their horns to signal support for the union.

"I had several patients complain this morning," Kelly said. The windows of some patient rooms face onto North Street, the scene of the most active and visible picketing.

A DPH survey team had interviewed 91 patients and families over two days as of 2 p.m. Wednesday and reported to the hospital that care was termed "smooth." Separate interviews with 51 of the replacement RNs found the hospital had been "proactive and transparent" in its transition to alternate providers.

"I think it's correct to say that the overall coverage plan has been working," Scales said in an email to The Eagle.

That 48-page plan took shape over the last two months after MNA nurses voted in July to authorize a strike.

The hospital worked with U.S. Nursing Corp. to provide the RNs now at work in alternating 12-hour shifts inside BMC. They arrived last weekend and spent a full day training in the hospital's procedures, part of a coverage plan that is expected to cost more than $4 million.

The handoff

Early Tuesday, MNA members clocking off before their strike reported on the day's patient cases to some of the 84 supervisory nurses not in the union. That group then briefed arriving replacement nurses on individual patients.

The U.S. Nursing Corp. contract requires that the out-of-town nurses not interact with those they are replacing. They are also camera shy. The hospital must turn off a video surveillance system that monitors the outside of its intensive care unit when replacement nurses pass by.

Outside, another surveillance is kicking in. Members of the stepped-up security details carry video cameras. The hospital's contract with the security team requires it to gather certain visual evidence related to the strike and lockout.

In groups, the replacement nurses received 20- to 30-minute orientations on individual units, then dove into caring for patients, according to a group of physicians interviewed by The Eagle. The orientations covered practical matters, such as the physical layout of the units and where supplies are stored.

All of the replacement nurses are licensed to practice in Massachusetts. Those working in specialized areas, such as surgery, carry additional training and certifications, according to Kelly.

Doctors in some cases personally introduced the replacement workers to other unit staff.

Dr. Daniel Doyle, the hospital's chief of staff, said preparations paid off. "There was a lot of careful planning that happened," he said Wednesday.

The U.S. Nursing Corp. teams weren't starting from zero. Many knew each other from other temporary assignments, including the July strike at Tufts Medical Center in Boston.

Dr. Gray Ellrodt, chief of medicine and chief of quality, said he and others increased the reach of the normal rounds.

"Just to be sure that patients have a voice outside of their usual channels," he said.

Ellrodt said the strike has not been the first thing patients mention. "If you don't bring up the job action, patients don't bring it up at all," he said, describing his interactions.

Most patients' questions have been direct: How long will the strike and lockout last?

Dr. Robert M. Lincer, chief of the department of surgery, said he's encountered few questions from patients.

The use of the 12-hour shifts, he noted, simplifies the relay of information from one group of nurses to another.

"It's just two transitions instead of three," he said.

Lincer noted that surgical teams always meet at a patient's bedside before beginning a procedure — a practice that continues this week with new faces.

Physicians say the replacement RNs adapted quickly this week to being part of existing medical teams. Though new to the hospital, some of the nurses have been offering suggestions.

"It's a credit to the people in the building working this week," Doyle said.

Ellrodt praised the work of the hospital's licensed practical nurses, who belong to another union and are required by their contract to remain at work. Ellrodt called their service so far this week "incredibly helpful and professional," while noting that "from their perspective [these are] not ideal conditions."

Incoming calls

Michael Leary, a hospital spokesman, said calls from patients with questions about the strike were routed to a special team from the center's main phone number, 413-447-2000.

The hospital also deployed "greeters" to 11 locations to help arriving patients. While most were stationed at BMC, others offered assistance at the Hillcrest Campus of BMC off West Street in Pittsfield and at the North Adams Campus of BMC.

The phone response team reports to a command center located at an undisclosed location on the hospital grounds, where eight to 15 people track issues related to the absence of the institution's normal roster of roughly 800 RNs.

The state DPH surveyors started Tuesday with an eight-member team. Some of them focused on specific aspects of care, such as mental health and substance abuse. A smaller team will remain on the grounds until Sunday to continue monitoring hospital operations.

Come Sunday, the transition that took place early Tuesday will work in reverse. Replacement nurses will report on patients to hospital nurse supervisors, who will then work, once again, with members of the MNA.

Reach staff writer Larry Parnass at 413-496-6214 or @larryparnass.


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