Everything you need to know

Strike Update & New Contract Proposal Details

The planned strike against Berkshire Medical Center by the Massachusetts Nurses Association for February 27th has been postponed. BMC negotiators have issued a new comprehensive proposal that resulted in the postponement.

PDF icon February 22, 2018 Contract Offer

PDF icon Proposed Salary Increases and Premium Adjustments

It has always been Berkshire Medical Center's desire to find a reasonable and mutually agreeable conclusion to our negotiations. We offered our nurses a comprehensive, fair contract package long ago, and have made favorable adjustments to that proposal over the last several months. Yesterday, our bargaining team made one last effort to bring the contract negotiations to a satisfactory end by presenting further enhancements. These included language promising to not change the RN staffing grids in a way that would increase the number of patients assigned to RNs between now and the proposed end date of the contract. We also offered language making it clear that Clinical Team Leaders and Permanent Charge Nurses generally would not be expected to take a patient assignment except under very limited circumstances, and then with limited duration. These offers would result in the first staffing language we have agreed to insert in any of our contracts.

It should also be noted that due to the length of time we have been working to reach an agreement - nearly a year and a half - that we proposed extending the contract to four years, to end on September 30, 2020. In addition, we continued to provide significant salary increases, including additional increases in the fourth year.

We are pleased that the strike has been postponed as a result of our new offer and we are proud of our negotiating team, which has worked so hard over the past year and a half, and yesterday met for an extensive period to offer a package that is fair to all. We are continuing to negotiate and hopeful that we can find a resolution.

What Background Information Might You Want to Know?

Every three years, we review the existing nursing contract terms with the Massachusetts Nurses Association, the Boston-based union that represents our registered nurses. This process is to make sure that we are providing our nurses with fair and reasonable pay and benefits for the essential work that they do.

This is the same commitment we make to every one of our employees who helps Berkshire Medical Center continue as the extraordinary community asset that it is.

Our current round of discussions with the MNA began more than 7 months ago. We have met 22 times, most of which have been full day sessions. We hoped to reach an agreement with the nurses’ union long ago, as we have with all the other labor unions representing our employees. We are disappointed that as of today, we have not reached an agreement on necessary contract revisions.

Because our nurses are a central part of the services that we collectively provide to our families, friends, and community, we believe it’s important to keep you informed of the progress and roadblocks in our discussions with the MNA. We are hopeful that this website, updated as developments occur, will keep you appropriately informed about this important matter that affects all of us and the community we serve together.

What Are the Unresolved Issues?

  1. What Might Be Helpful For You to Know About Staffing?

    The MNA is seeking to impose by law or by contract a rigid ratio of registered nurses to patients, as part of its statewide legislative agenda and negotiating strategy at every hospital around the state in which it has a presence. This strategy is similar to ones employed by organized nursing labor groups in other parts of the country. In those areas of the United States where inflexible, mandatory staffing ratios have been tried, quality of patient care and safety has not improved. We cannot agree to the demand by the MNA that we accept its fixed staffing ratios or similar language that has the effect of controlling staffing decisions or its proposal that nurses cannot be temporarily reassigned from less busy units of the hospital to more busy ones to perform basic nursing services in relief of their colleagues.

    Berkshire Medical Center and hospitals throughout the state and country are, of course, committed to optimizing the quality of patient care and safety, and recognize that, along with consideration of other essential clinical providers, the nurse-to-patient ratio is key to achieving that goal. For that reason, Berkshire Medical Center has long been committed to adhering to the guidelines developed by the American Nurses Association. The ANA, the "premier organization representing the interests of the nation’s 3.6 million registered nurses ... advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public." The ANA correctly states that it "is at the forefront of improving quality of health care for all."

    Unlike the MNA, the ANA is a professional standards organization and not a labor organization. Until a few years ago, the MNA was an important affiliate of the ANA. However, the leadership of the Massachusetts union decided to move in a different direction with a different agenda and the affiliation ended.


    1. What Staffing Standards Does Berkshire Medical Center Follow?

      Berkshire Medical Center has long recognized the value of the staffing guidelines developed by the ANA. The hospital sets and adjusts its nurse staffing levels by taking into consideration the following factors identified by the ANA as important to achieving safe and effective nurse staffing:

      • Patient complexity, acuity, and stability
      • Number of admissions, discharges, and transfers
      • Professional nursing and other staff skill level and clinical care staff expertise*
      • Physical space and layout of the nursing unit
      • Availability of technological support or other direct care resources


      *Non-RN Clinical Care Support Staff at BMC:

      • Respiratory Therapist
      • Hospitalist (MD or DO)
      • IV Therapist
      • Wound Care Nurse
      • Nurse Educators
      • Case Management
      • Patient Transport Team
      • Physician Assistants/Nurse Practitioners
      • Licensed Practical Nurses (LPN)
      • Clinical Pharmacist
      • Monitor Technicians
      • Nursing Director
      • Clerical Support
      • Social Work
      • Crisis Nurse
      • Rapid Response Team
      • Residents/Interns
      • Nursing Assistants


      In addition to the guidelines published by the ANA, each medical and surgical specialty has developed its own similar recommendations for registered nurse-to-patient arrangements, also based upon factors similar to those identified by the ANA. Berkshire Medical Center is proud to maintain standards that meet or exceed what is promoted by these professional organizations.

      One such professional organization is the Academy of Medical-Surgical Nurses, a national organization that describes itself as "the only specialty nursing organization dedicated to the practice of medical-surgical nursing, [consisting of] more than 10,000 medical-surgical nurses who care about improving patient care [and identifies its] ... strategic goals [as focusing] on workplace advocacy; evidence-based practice, research and knowledge; professional development; national leadership and influence; and organizational health." The Academy of Medical-Surgical Nurses advocates for the following registered nurse-to-patient ratio on medical-surgical floors:

      • 1 RN to 4-6 patients on days
      • 1 RN to 6-10 patients on nights

      BMC maintains a staffing plan of:

      • 1 RN to 3-5 patients on days
      • 1 RN to 5-7 patients on nights

      After extensive bargaining with the MNA, the Commonwealth of Massachusetts adopted staffing requirements for critical care units in the state, effective in the fall of 2015:

      • 1 RN to 1 patient or 1 RN to 2 patients, based on patient acuity

      BMC maintains a staffing plan of:

      • 1 RN to 1 patient or 1 RN to 2 patients, based on patient acuity

      The MNA sought to have the mandated ratios for critical care units cover every single moment of the day, including lunch breaks and bathroom breaks. After careful consideration, the Commonwealth rejected that approach. The MNA has renewed its effort to force a required staff increase for those brief circumstances rather than promote a collaborative approach to safe patient care.


    2. What Role Does the Hospital Facility Layout Have in Staffing Levels?

      The ANA staffing guidelines reflect that how the hospital unit is physically laid out can impact the number of registered nurses necessary to care for the patients on that unit. The less efficient the space, the more nurses will be required to cover patient care needs. Berkshire Medical Center has paid careful attention to the efficiency of its patient care units and regularly invests in improving their layout to improve patient safety by providing access to important resources and the space needed to perform specific duties.


      The patient safety and efficiency elements of the physical layout of BMC units include:


      • Easy accessibility to necessary equipment and supplies
      • Recently renovated nursing stations, conveniently located near patient rooms
      • Medication preparation room that provides a quiet space and improves nurse efficiency and medication safety


    3. What Role Does Hospital Technology Have in Staffing Levels?

      The ANA staffing guidelines also identify the availability of technology as a core factor affecting recommended nurse staffing levels, because of the positive impact that key technologies can have on patient safety. Rapid access to decision making information through various technologies allows nurses to perform almost all of their duties more efficiently and effectively with greater patient safety and impact.


      The patient safety and efficiency elements of the BMC commitment to technology include the investments that BMC has made in:

      • A variety of electronic medical record systems, including MEDITECH, Allscripts, ARIA® and others.
      • Automated pharmaceutical administration procedures (including Omnicell®/Barcoding)
      • More rapid and effective inter-personnel communication through VOCERA
      • Emergency badge alarm and other electronic safety systems
      • Electronic and video patient monitoring systems


  2. What is the Result of BMC's Long-standing Commitment to Patient Safety?

    As you may already know, BMC has been repeatedly recognized by independent, national patient quality and safety organizations in recent years. This achievement is the result of the hard work and dedication of everyone at BMC who affects patient care -- in no small part, of course, our registered nurses.


    Here are a few of the patient care quality and safety achievements that we have collectively accomplished recently:


    Patient Safety Indicators (PSI-90)

    PSI-90 is a measure developed by the Agency for Research and Quality (AHRQ), an agency of the federal Department of Health & Human Services (DHHS), that provides an overview of hospital quality as it relates to a set of potentially preventable hospital related events associated with harmful outcomes for patients. Medicare (also a program overseen by DHHS) uses PSI-90 to rate hospitals on patient safety. The quality elements that make up the PSI-90 score include: overall mortality rates, overall complication rates, inpatient quality measures, core processes effectiveness, patient safety measures, and patient satisfaction measures.


    With a PSI-90 score of .44, Berkshire Medical Center is currently tied at number one in the nation. (Becker’s Hospital Review, April 11, 2017.)


    Additional Berkshire Medical Center Quality and Safety Ratings:

    • Overall Hospital Care: Ranked #1 in Massachusetts for medical excellence (CareChex® Quality Rating System)
    • Composite quality and safety score at the 90th percentile representing the highest quality rating (CareChex® Quality Rating System)
    • Overall Hospital Care: Ranked #56 in the nation for medical excellence (CareChex® Quality Rating System)
    • Straight "A"s in Hospital Safety Scores since 2012. One of only 63 hospitals in the nation to achieve this level (The Leapfrog Group).


    CareChex® is a nationally recognized, independent medical analytics and rating organization that compares hospitals nationally for the delivery of safer, higher quality of care, as well as superior value for healthcare expenditures.


    The Leapfrog Group, founded in 2000, is an independent, national non-profit organization created by large employers and other purchasers of healthcare services to promote quality and safety in American healthcare, and to identify the highest-value caregivers. As The Leapfrog Group describes on its website, “the Leapfrog Hospital Safety Grade ...assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents, and infections.”


    2017 Patient Safety Excellence Award

    Berkshire Medical Center is proud to have achieved the 2017 Patient Safety Excellence Award, presented by Healthgrades®, the nation's leading online source for comprehensive information about hospitals and physicians.


    This award has placed BMC in the top 10% of hospitals in the US for patient safety.


  3. What Does the Offer Mean for Our Nurses?

    On May 2, after 22 separate bargaining sessions, we came to believe that our nurses and the entire BMC family would be best served if we brought the negotiations to conclusion by putting forward the best offer that we reasonably could.  Our best offer included the proposed adjustments to the existing contract that have been on the table for some time, plus several additional enhancements for the nurses. A summary of the offer as well as its full text is available below.

    Our goal is to provide our nurses, like all of our other employees, with a fair and reasonable wage and benefit package.

    • Wages and Benefits
      • 10% increase in pay over the three-year contract term made up of:
        • General wage increases of 1.0% in years one and two of the agreement and 2.0% in year three;
        • Step increases of 2.0% per year for those within the wage scale; and
        • Lump sum payments of 2.0% per year for those at the top of the salary scale.
      • Retroactive proposed general and lump sum payments if agreement is reached by May 31, 2017
      • Increase in the evening and night differential premiums
      • Adjustments in the contribution that our nurses make to the premium costs for individual health plan coverage, so that it is the same as that made by all other BMC employees, including management, physicians, and other clinical and support staff who chose individual health plan coverage.

    • Illustration of Wage Improvement for Typical Nurse
    • Increased Participation by Nurses in Staffing Decisions

      The Hospital will ensure that each unit in the Hospital has identified a Unit Council comprised of at least two members of the nursing staff in each unit and at least the nurse manager of the relevant unit.  The Unit Council will meet on an as-needed basis, but at least quarterly, to address specific unit shift staffing guidelines, trends and/or changes in average workload, census, and acuity, the existing ancillary support in each unit, staffing challenges (vacancies, absence rates, etc.) and other factors that impact the provision of safe patient care.  Each Unit Council will prepare a written report of its analyses and submit such report, at least twice a year, to the Hospital-wide Staffing Committee. The Hospital-wide Staffing Committee will be comprised of up to three members of the MNA bargaining unit selected by the bargaining team, and up to three members of nursing leadership selected by the Chief Nursing Officer.  The Staffing Committee will meet on a bi-annual basis beginning no later than July 1, 2017.

What Else Would Be Helpful For You To Know?

As events continue to evolve with the MNA, we will provide updates at this site for you and the community that we collectively serve. Please check back often.

We also believe that it is important to share with you additional information for you to review if you choose to. You can click on the links below to get more information about our discussions with the MNA and about the patient safety and quality awards that Berkshire Medical Center has received.

Earlier Information About the Negotiations

PDF icon A Letter to the community 2.24.17     PDF icon A Letter to all employees 3.24.17     PDF icon Financial Update 4.5.17    PDF icon Summary Letter 5. 3.17    PDF icon BMC Best and Final Offer and Summary Letter

BMC Patient Safety and Related Awards

Patient Safety Excellence Award - 2017 - Healthgrades

2017 Patient Safety Excellence Award

Berkshire Medical Center is proud to be a recipient of the 2017 Patient Safety Excellence Award, presented by Healthgrades, the nation’s leading online source for comprehensive information about hospitals and physicians.

This award has placed BMC in the top 10% of hospitals in the US for patient safety, indicating we have surpassed expectations in preventing safety incidents.