Some Important Topics: Boarding, Vacancy Rates and Union Promises

December 20, 2022

Dear Colleagues:

I want to start by saying thank you – so many of you have nicely reached out to me with well wishes for my retirement next year.  It is a privilege to call each of you a colleague; because of that, it was an incredibly difficult decision to leave this work behind.  But that moment has not yet arrived.  Until March, I, along with Jane Foley, our team of Associate Chief Nurses, and Nurse Directors, will continue to stand together with you in caring for our community and advocating for our nursing team in an environment that I know is historically challenging for all of us.  I know and understand how hard you are working for our patients.

I promised several weeks ago to be direct and transparent about the Massachusetts Nurses Association (MNA) and what happens in a union hospital.  I know many of you have talked to your nurse managers and our ACNOs about these topics, and I hope these conversations have been helpful.  A few misperceptions about the union and its role have come up more than once, and I thought it would be helpful for you to hear directly from me.

Union contracts happen as a result of collective bargaining. That process has no guarantees and is impacted by the same environmental, financial, and practical limitations that govern BIDMC’s operations today.  And often, the results (such as work rules, timeline for wage increases, and defined processes for addressing complicated issues) are inflexible or make it more difficult to provide care.

I do want to provide you with accurate information regarding some of the promises that the MNA appears to be making.

Patient volume and boarding: The MNA appears to be claiming it can stop hallway boarding.  That is not true.  Hallway boarding is a difficult reality at most hospitals, including MNA hospitals across the state.  Multiple years of COVID-delayed care; the triple-demic of RSV, flu and COVID-19; a mental health crisis; and a lack of beds in skilled nursing facilities are creating high volumes in all community, regional and academic hospitals. By federal law (EMTALA), all emergency rooms, including ours, cannot turn patients away. There is no language in a union contract that can change this national problem.

Wages:  The MNA also appears to be making promises of significant wage increases.  Again, that is a promise not based in the reality of collective bargaining.  As I believe BIDMC has demonstrated, we strive to respond to market changes – with 3 market adjustments for RNs in 18 months.  And while a union may promise to get you the same rates as the top paid hospital in the region, financial realities often make that impossible.  Nonetheless, our current RN pay rates are, in most instances, equal to or higher than Tufts and BMC, two Boston MNA hospitals.  Many of you have also raised a question regarding pay for senior nurses.  MNA contracts often pay rates that top out at year 17-19, and do NOT pay more senior nurses, such as 25-, 30- or 35-year nurses, more than those mid-career nurses.

Weekends:  The MNA is promising less weekend work.  Our weekend commitment is the same as many MNA hospitals.  In an environment in which there are more patients than hospital beds, and fewer nurses, ask yourself how can the MNA promise you that you will work fewer weekends?  Of course, the answer is they cannot.

Vacancy rates:  Retaining staff is an issue at every hospital in Massachusetts, including those with unions.  Nurse vacancy rates (the percentage of unfilled nursing positions) in acute care hospitals are currently double normal rates (13.6%) and all hospitals – including other Boston academic medical centers – are having trouble retaining and recruiting staff.  In the face of a global nursing shortage, BIDMC continues to focus on competitive wages and benefits.  We also have an advantage over union hospitals in retaining and recruiting staff – nurses value our professional, collaborative, and quality-focused environment.

I know that it does not make the day-to-day reality of our work easier to hear that the problems we face are national, hard to solve, or reflective of the worst global health crisis most of us have seen in our lifetime.  I know that you come to work committed to our patients every day, even as you are tired and looking for light at the end of the tunnel.  My words of gratitude, respect, and appreciation are not enough to balance out these issues, but I want to assure you that both I and the entire leadership team appreciate the importance of these issues and are working hard to address them. We thank you for your continued professionalism.

Despite the difficult, national nature of many of the challenges we are facing, the BIDMC leadership team is constantly identifying and implementing creative solutions both large and small. There is no single answer, but rather a series of changes that are designed to make our entire hospital a healthy place for all clinical care providers to work.  Pete Healy and I will share more about some of these efforts in early January.

I continue to believe firmly that no union contract can negotiate a fix to challenges facing hospitals across the country.  And the downsides to a union – to our culture, our flexibility, and  our patient care focus – simply seem too great to risk for empty promises.

Your Nurse Directors continue to welcome any questions you have. Our goal is to provide you with accurate information.  And given the importance of the issues I raised above (and others!), please look for more communication from me as we work to solve these areas that are important to all of us.


Marsha L. Maurer, DNP, RN, FAONL, FAAN
Senior Vice President, Patient Care Services
Cynthia and Robert J. Lepofsky Chief Nursing Officer