The Massachusetts Nurses Association announced late Wednesday night that it has reached a tentative contract agreement with Mass General Brigham that includes limitations around the use of temporary nurses at Brigham and Women’s Hospital.
The agreement averted an indefinite strike that was set to begin early Thursday morning.
While the proposed contract, which has yet to be voted on my union members, includes wage increases for nurses, a major focus was on visiting, or traveling nurses that many hospitals rely on to fill staff shortage.
Diana Bowser, a health economist and professor of nursing at Boston College, said temporary nurses played a “key role” during the pandemic, especially as large numbers of hospital staff were out sick at the time.
“That’s why they’re still being utilized today, and it is true that in big hospitals, there are times when people … are out for different reasons,” she said. “It is a benefit to these hospital managers to have the travel nurses be able to come in and take shifts when people are out. But that being said, there is some tension, I think, between nurses working in hospitals and then these travel nurses.”
Bowser said that hospitals need to control costs, and sometimes believe visiting nurses will save them money.
“They can tweak that equation with the different types of staff that they bring in and out,” she said. “Sometimes, on paper, it may be less expensive to have a travel nurse come in instead of a full-time nurse because there are other costs embedded in the full-time nurses.”
Permanent, full-time nurses have benefits built into their salaries and can receive overtime pay, Bowser continued.
“In some situations, I could see where bringing in a travel nurse for a certain situation might be more beneficial to the revenue of the hospital than maintaining a full-time nurse in that situation,” she said.
The nurses’ tentative agreement comes after months of negotiations that included a one-day strike and four-day lockout in July. In September, the MNA overwhelmingly voted to authorize an open-ended strike.
The hospital has committed to not intentionally replacing permanent Brigham nurses with temporary nurses, according to the tentative agreement. Brigham and Women’s Hospital will also post 20 new floating nurses positions to reduce its reliance on temporary nurses.
The use of temporary nurses will be tracked by the hospital, along with the number of nurses floating into and out of each unit. This data will be provided to the MNA for review to determine ways to reduce floating and the use of temporary nurses.
The tentative contract also addresses the nurses’ other priorities, including preserving affordable health insurance and protecting their wage scale while remaining competitive to help recruit and retain a nursing workforce.
Michelle Hassler, an oncology nurse at Brigham and Women’s Hospital, said that temporary nurses can come from anywhere in the country and may not have the same type of training that permanent nurses do.
“They show up, and they are not necessarily trained correctly for the area they go into, or trained the same way that we are … because that hospital has many areas with very specialized care that people come all over the world for,” she said. “They do not take care of our patients the way that we do, and sometimes the lack of their care has definitely led to detrimental circumstances.”
Hassler said that while many hospitals began recruiting more travel nurses during the COVID-19 pandemic, “the time for that now has passed.”
“Yet, there are still some nurses that are still there from COVID,” she said. “They just keep renewing their contracts rather than taking a position. That’s a position that could be posted and given to somebody who wants to work at the Brigham and give it their all and be trained properly.”
Limiting temporary staffing supports continuity of care by keeping more patients with nurses who know their units, colleagues, hospital policies and specialized care practices, according to the MNA.
A spokesperson for Mass General Brigham said the hospital agrees that ongoing staffing needs should be filled by permanent nurses, not temporary nurses. But the hospital administration contends that travel nurses are not relied upon heavily.
“Travelers make up only about 1% of our nursing workforce, and over the past few years, we have reduced traveler FTEs by 70%, from 147 in the third quarter of fiscal year 2023 to 67 as of a few weeks ago,” a spokesperson said.
Travel nurses are typically used to address temporary staffing needs, including coverage for permanent nurses on leaves of absence and periods of increased patient demand, the hospital explained.
Hassler said the union is pleased with the limitations around travel nurses listed in the tentative agreement, and feel that it will make a difference.
“We’re really happy about that, as well as the hospital adding in 20 new positions into the float pool, which is very well needed,” she said. “It will take a little time to hire into those positions and, and get those nurses up and running and functioning in the role, but it will definitely be worth it.”
