[B]URLINGTON – UVM Medical Center nurses union again took to the streets outside the state’s largest hospital on Monday — this time armed with survey numbers alleging that many patients wait months for appointments.
Though the survey results were based in part on the opinion of union members, nurses say it highlights staffing shortages central to their contract dispute.
“It further solidifies our platform that we don’t have enough nurses,” said union President Laurie Aunchman. “We can’t offer the quality of patient care that we need to offer our patients.”
Hospital administrators acknowledged lengthy delays in certain specialties but said the union mischaracterized the cause and the severity of the situation.
Lisa Goodrich, vice president of operations for UVM Health Network Medical Group, said patients who get “urgent” referrals from primary care doctors don’t face long waits for speciality treatment.
“If there’s a true urgent need, we fit those patients in,” Goodrich said. “We always have.”
After more than four months of negotiations, demonstrations and public acrimony, nurses at University of Vermont Medical Center say they’re still not close to signing a new contract.
The Vermont Federation of Nurses and Health Professionals represents about 1,800 licensed practical nurses, registered nurses and nurse practitioners at UVM Medical Center.
The union’s last contract expired July 9, and nurses went on a 48-hour strike on July 12. Hospital administrators kept most services running via hundreds of replacement nurses sent to Vermont via a Colorado health care staffing company.
The two sides have talked twice since the strike and reported some progress after a session in late July. But the sticking points have remained the same – wages and staffing.
Nurses say they aren’t paid enough for the medical center to recruit and retain adequate staffing. On Monday, the union said there were more than 150 nursing vacancies. The union has asked for a 23 percent wage increase over the course of a three-year contract.
Hospital administrators contend their vacancy rate is on par with other health care facilities, and they have offered a 13 percent raise with bigger increases for certain categories. For instance, outpatient nurses will be paid roughly 16 percent to 24 percent more to achieve pay parity with inpatient nurses.
Beyond the numbers, patient care is a central point of contention. The union has said there aren’t enough nurses to adequately cover increasingly acute patient loads, leading to safety concerns.
Nurses on Monday pointed to an online survey they sent to their members to disseminate. More than 80 percent of 320 respondents said they “experienced difficulties getting an appointment in a timely manner,” the union said.
The results showed 42 percent of those who responded had “experienced delays in patient care,” the union said. And 44 percent said they had avoided receiving care due to high costs.
The results also included anecdotal stories of long delays – for instance, waiting a year and a half for a physical; waiting more than six months to see an ear, nose and throat specialist; and waiting almost nine months for a neurologist.
“That’s not acceptable quality care for our patients, and it’s not what we as nurses stand behind,” Aunchman said.
She also tied the survey results directly to nurse staffing. Aunchman cited vacancies among nurse practitioners – who can see patients and prescribe as a doctor does – and among outpatient nurses who are struggling to keep up with call volumes.
“If there aren’t enough nurses to answer these calls, they remain in a queue,” she said. “A nurse may have as many as 80 or 100 phone calls that they have to return in a given day.”
But the union also acknowledged the survey’s limitations.
There was a limited sample size and a small audience: Union members were asked to share the survey with their family and friends, and 132 respondents were themselves unionized nurses.
Also, there are no overall statistics on delayed treatment because the survey doesn’t ask about specific wait times. Instead, the questions feature references to “timely access to needed care” and “difficulty in getting an appointment in a timely manner.”
The union did, however, allege that “it often takes more than six months to obtain a medical appointment at the University of Vermont Medical Center.”
Goodrich said that statement is not accurate. “Out of 45 specialities, I have six where we struggle with access,” she said.
Wait times for those specialities – dermatology, rheumatology, pulmonary, psychiatry, gastroenterology, and ear, nose and throat – currently stand at, or above, the three-month mark.
Goodrich said that’s not a nurse-staffing issue, but “largely a physician-capacity issue” that’s affecting hospitals nationwide.
“In each of those areas … we have new physicians starting either in the next two months, or we have active recruitments under way to fill those vacancies,” she said.
Goodrich did acknowledge that boosting nurse practitioner numbers “could clearly help with access in some areas.”
The medical center’s contract offer includes “a major change in the pay grade structure for nurse practitioners,” Goodrich said. “I think that will help with both recruitment and retention.”
Union members say they’re trying to collect more data on patient wait times. They’re asking community members to fill out their survey.
In the meantime, both sides are preparing to return to the bargaining table next Monday and Tuesday. Aunchman said a second strike is “always a possibility,” but she said the union is focused on getting a new contract.
“There are some things that we’ve closed the gap on … but we’re not there yet,” Aunchman said. “There’s still a lot that’s been left on the table that we haven’t come to an agreement on, and one of them is the safe staffing.”
