Anonymous Letter from Nurses

Dear nursing staff,

I recently received an anonymous letter from striking nurses. In that letter, the nurses shared that they did not have a clear idea of what is keeping the parties from reaching an agreement. They asked me to address some very specific issues, and I have attempted to answer their questions below. I have also included the anonymous letter. For full transparency, if you are a Saint Vincent nurse and would like to see both the Hospital’s as well as the MNA’s most recent proposals, please email me at and I will send them to you.

We do not feel we have a clear idea as to exactly what the sticking points are from either side.

Answer: The main sticking point between the parties is strict 4:1 staffing ratios across all med-surg units.

The MNA has made false claims that these strict ratios are needed because the Hospital has not staffed according to existing contract guidelines and is unsafe. The Hospital has shared data on staffing by unit that has been validated by an independent third party that shows that our staffing on med-surg units is clearly in the middle of the range from 4:1 to 5:1 and is better than 74% of comparable hospitals in Massachusetts. We have also shared data on quality and safety that refutes claims that the hospital is unsafe.

The MNA has also made claims that other Massachusetts hospitals consistently staff 4:1 on all med-surg floors. We have spoken to hospital leaders and reviewed their CBAs and do not believe this to be true. You should ask MNA leadership to show you language in any CBA that provides for 4:1 staffing on a med-surg unit. We asked them in January and still haven’t seen anything to support this claim.

The Hospital made its most recent enhanced proposal on March 1 with more staffing concessions. In addition to the previously proposed critical care float nurses, the Hospital added a proposal to convert 23S and 24N to 4:1, and a proposal to limit the number of COVID patients a nurse can take in med-surg units and the PCU.

Unfortunately, the union made no movement and gave us the exact same staffing proposal as before. While we are willing to continue to attempt to compromise, the MNA’s bargaining team has made it very clear that they are not willing to negotiate in good faith to reach a reasonable agreement on this issue.

All we have received is verbal information and outdated MNA proposals. The last proposal we saw from the hospital does not go through every detail of what is being offered.

Answer: Attached is a detailed timeline of the negotiations that have occurred since October 2019. You can see the significant movement the Hospital has made since December 2020 versus the minimal movement from the MNA. The MNA bargaining committee has collectively spent over 1700 hours at the negotiating table in these 18 months, but few of those hours were spent working towards a compromise.

If you are a Saint Vincent nurse and would like to see both the Hospital’s as well as the MNA’s most recent proposals, please email me at and I will send them to you.

We are being told that the hospital wants to float nurses to unfamiliar areas with very limited training. Some nurses believe that means that under an emergency, they could go from a specialized area such as CWI to another specialized area such as the psychiatric ward. This is what the nurses believe. If this is not correct, it needs further clarification.

Answer: That is not true, and the letter that we sent to everyone’s home earlier this week addressed that point. The Hospital’s proposal simply clarifies some inconsistencies in the previous language regarding floating when there is an urgent need to float. The language specifically prohibits the hospital from forcing a nurse to work independently outside of his or her “cluster” if the nurse reasonably believes he or she is not competent to do so. If a nurse was floated outside of his or her cluster and could not work independently, they would take a role assisting other nurses in that area. In no way does the float proposal require you to work independently in an area that would put your license in jeopardy or cause quality concerns.

As far as flexing goes, we are being told that the hospital wants the ability to flex any staff, even those that do not hold flex positions. Is that correct?

Answer: That is not true. The Hospital initially made a proposal on flexing but withdrew that proposal on January 28, 2021. Currently, the Hospital is proposing no changes to the current contract language on flexing.

We understand that the hospital will not give us a pension plan.

Answer: That is correct. The hospital is not planning to adopt the MNA’s defined benefit pension plan. The MNA continues to propose the pension plan, even though it has never discussed it at the bargaining table in any detail. The most detail that the Hospital has about the pension plan is what the MNA shared with its nurses on pages 18 and 19 of the contract proposal comparisons document they circulated on January 28, 2021. That is the first and only time the Hospital has seen any details of the proposed pension plan. The actual proposal the MNA presented to the Hospital during negotiations was entitled “placeholder” and nothing further was ever provided.

As far as ratios go, we believe the hospital is saying 5:1 is adequate except for the ICU, 23 South, 36 North, and 24 North. It is very unclear what is being proposed from either side regarding the Emergency Department.

Answer: The Hospital is proposing to maintain the current staffing guidelines on 21S, 22S, 33S, 34N and 35N, which provide a mix of 4:1 to 5:1 depending on the census point. The Hospital’s proposal extends the 4:1 staffing that is currently on 36N to both 23S and 24N.

The current 4:1 to 5:1 on a med-surg unit is not only adequate, it is competitive. Only California has mandatory ratios, and their ratio on med-surg units is 5:1 (with no resource nurses or ancillary support). No states or hospitals that we are aware of consistently staff at 4:1 on med-surg units.

In the ED, the MNA has proposed increases in staffing that would result in the hiring of 86 more people just for that unit. The Hospital believes the current staffing in the ED is appropriate but has attempted to compromise by adding critical care float nurses who would be able to float to the ED (or other areas) as needed. In addition, increased security measures have been proposed for the ED over and above the metal detector that we have already installed. The MNA changed its ED staffing proposal from adding 106 more people to only adding 86 more people on February 11th.

Also, even if we were to go to a 4:1 ratio, it would mean increased flexing when the census goes down. We know the hospital is not considering an across the board 4:1 ratio. We have verbally heard that the MNA has conceded somewhat on this point, but have no details.

Answer: The Hospital believes that across the board 4:1 ratios does not make sense for many reasons, including the flexing issue you identified. The MNA’s only concessions in this area were to move 36N from a 3:1 in their initial proposal back to its current 4:1 in their February 11th proposal, and to move 23S and 24N from a ratio under 4:1 to a ratio of 4:1 in their February 11th proposal. So, there has been no concession at all in its demand for 4:1. In fact, the MNA’s proposal has always included 4:1 or stricter in med-surg units throughout the course of negotiations. As mentioned above, even after the Hospital attempted to avoid the strike by compromising with the union on staffing March 1st, the MNA made no additional changes to its staffing proposal. The MNA has not compromised on 4:1 staffing at all. However, if MNA is willing to compromise and back away from 4:1, the Hospital is very interested to hear the MNA’s updated proposal.

We would also like to know what was decided with the other union in regard to staffing ratios for PCAs, and the possibility of sitters returning. We also want to know if there is language in regard to having a secretary on every unit.

Answer: There is no language in the UFCW contract requiring a secretary on every unit.

The UFCW did initially propose staffing ratios for PCAs. However, they were willing to listen to alternative approaches and compromise when the Hospital explained that while it would not agree to the proposed ratios, it was willing to compromise. Part of that compromise was to bring back sitters by creating a sitter pool with 35 people. The purpose of the pool was to reduce the number of times PCAs are pulled from the floors, so they can focus on patient care in their units.

Lastly, both sides are saying they are willing to come to the table to negotiate, but it is the other side that needs to make the first move. Does that even matter?

Answer: The Hospital continues to remain willing to compromise and will come back to the table at any time, but the ball is in the union’s court to revise its unreasonable staffing proposal.

The Hospital called the MNA back to the table on March 1st and attempted to compromise on staffing by agreeing to 4:1 on 23S and 24N. At that meeting, the Hospital also proposed COVID staffing and put retro and the lump sum bonuses back on the table. In response, the union did not make a single change to its prior staffing proposal. That response made it clear that the only resolution the MNA will accept is 4:1 staffing.

I hope this helped address the questions posed in the anonymous letter. If any of our Saint Vincent Hospital nurses have further strike-related questions, please let me know, and I will address those as well.

Carolyn Jackson Signature
Carolyn B. Jackson