In October 2021, the Massachusetts Nurses Association (MNA) organized a demonstration to raise awareness of the poor working conditions of nurses at the hospital, saying the limited number of nurses in the emergency room was causing overcrowding and excessive waiting times for patients.
Then in December, the deputy filed a complaint to the Centers for Medicare & Medicaid Services (CMS) who conducted an investigation into the conditions at the hospital.
CMS’s investigation revealed several areas where the hospital did not follow the rulesincluding inadequate patient documentation and check-in due to lack of reception staff and a “dangerously overcrowded” waiting room with wait times of up to 2 p.m., as noted in the report.
CMS gave the hospital several recommendations to address the issues when it released its findings Feb. 9, but according to the MNA there have been no adequate improvements in the past eight months.
“They just haven’t increased staffing and made any improvements needed to ease the burden on patients and their caregivers,” said MNA spokesman David Schildmeier.
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“We still have too many patients who are not seen in time.”
Good Samaritan, whose parent company Steward Health Care, did not respond to repeated phone and email requests for comment.
Inside the ER
Liz Erwin, a nurse on the cardiac floor above the emergency room and co-chair of the local MNA bargaining unit, has worked at Good Samaritan for eight years.
She said that when elderly patients came up to her floor after their long wait in the emergency room, sometimes up to 48 hours, they hadn’t eaten or taken their medication and often sat in their own urine or feces.
“It’s disgusting,” she said. “They’ve been understaffed in the ER to the point where it’s impossible for them to provide acceptable care.”
According to Erwin, there is usually one ER nurse for every 15 to 17 patients. Understaffing issues existed even before the pandemic — at least since 2018, she said.
Good Samaritan has 46 beds in its emergency room. According to the CMS survey, 673 ambulances brought in patients in five days, or about one ambulance every 10 minutes.
The CMS report says that sometimes patients are not registered when they arrive and some have to be transferred to other hospitals immediately.
On one particular day that was investigated, there were 83 patients on the ward, 26 of whom were waiting to be admitted. Two of those awaiting admission needed intensive care.
A patient admitted with diabetic ketoacidosis, a life-threatening complication of diabetes, “did not have a nurse and was in the hallway”, along with five other patients admitted without a nurse.
Twenty-one patients in the waiting room had wait times of five hours or more.
“Screaming into an Empty Well”
The results of the survey were published in February, along with recommendations to address the issues – such as the use of the HELP code, during which non-admitted patients can lie down in hospital beds to ‘decompress’ and prioritize the most urgent cases over stable cases.
However, over the past eight months, “nothing tangible has been done,” Schildmeier said.
“Our goal is not to file complaints. Or the goal is…to try to solve problems and fix things.”
Erwin said the hospital struggled to retain new staff and did not listen to MNA’s retention solutions.
“It’s like screaming into an empty well,” Schildmeier said.
In the second complaint, the NMA asked CMS to continue its investigation into the working conditions of nurses.
“We see this as an opportunity to discuss with management and hopefully work together to resolve this issue,” Erwin said.
Corporate staff reporter Chris Butler can be reached by email at [email protected]. You can follow him on Twitter at @Chr1sButler. Support local journalism by purchasing a digital or print subscription to The Enterprise today.