Everything you need to know

BMC and Nurses’ Union Reach Contract Settlement: Five Year Contract Set for Ratification Vote on June 28th

From the beginning of contract negotiations 45 sessions and 21 months ago, Berkshire Medical Center has sought an agreement with its registered nurses that was fair and reasonable for them and sustainable for the hospital and the community. We are pleased to report that after three marathon sessions on June 12, 13 and 14, the hospital and the Massachusetts Nurses Association have reached just such an agreement. Having this contract finally settled is, of course, great news for the entire Berkshire community and all hospital employees. We appreciate the solid support that we received from our community and our employees during these challenging months, and the exemplary work of our negotiating team. With the distraction and divisiveness of strike threats now gone, we look forward to returning our focus solely to delivering the high quality patient care that our community rightly expects of us.

What Were the Major 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:


    The Leapfrog Group – Patient Safety Grading Program

    The Leapfrog Group is a national organization dedicated to improving healthcare quality and safety, and issues grades for nearly 2,600 hospitals twice yearly for Patient Safety, following a rigorous methodology and using its own survey and data from the Centers for Medicare & Medicaid Services.


    Berkshire Medical Center is one of only 49 hospitals in the nation to have achieved Straight “A” grades from Leapfrog for Patient Safety since the inception of its grading program in 2012.


    Healthgrades Patient Safety Excellence Award

    Berkshire Medical Center is the recipient of the 2017 Healthgrades Patient Safety Excellence Award, ranking the hospital in the Top 10% of Hospitals nationally for Patient Safety.


    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.


    Berkshire Medical Center is 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)

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.