These Poughkeepsie nurses say their hospital's staffing decision ignored patient care

On a Thursday evening in early October, Jennifer Fina, a registered nurse at Vassar Brothers Medical Center in Poughkeepsie, received an unexpected phone call.

A department in the hospital had been closed, and the seven ambulatory surgery nurses from that department were being moved to new positions, bumping her out of her job. She now had 24 hours to pick a new job from a provided list.

"Not a single conversation, email, anything from our leadership or management team indicated that this was a potential possibility," Fina said.

Vassar eliminated the ambulatory surgery nursing positions, along with seven positions on the hospital's vascular team, in October. All of the nurses directly involved in this shuffling are still employed at the hospital.

But since this occurred, three nurses told the Poughkeepsie Journal, the abrupt shift has left a gaping hole in patient care. It's a problem they believe could have been avoided if the hospital had involved nurses in its staffing decision.

While Vassar maintains the changes will ultimately lead to significant improvements in patient care, the controversy draws parallels to others across the country, where historically inadequate hospital staffing policies have been exposed since the COVID-19 pandemic.

"You'll see this kind of shuffling very frequently," said Ge Bai, Ph.D., CPA, who is a professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health.

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How 14 nursing positions caused strife at a Poughkeepsie hospital

In October, 14 Vassar nursing positions were eliminated — seven from the ambulatory surgery department, which was closed down, and seven from the hospital's vascular access, or IV, team.

The 14 nurses in those positions were moved into others, bumping less senior nurses out of their positions and causing a ripple effect across the staff. Fina was one of the less senior nurses who was bumped.

In the transition, Vassar's team of 13 board-certified vascular nurses was brought down to six. Kathleen Wilcox is one of them. "The whole team was extremely upset and devastated," she said. "It was very heart-wrenching to see people lose their jobs."

With less support from the IV team, Margaret Franks, another registered nurse at the hospital, said she was told floor nurses would receive a one-hour training class. An online video would be sent, along with a 38-page manual, "and we would be trained with a fake arm."

"When I went down to the fake arm class, I was there for less than 10 minutes," Franks said. "That was the training that was supplied to over 300 nurses."

Vassar believes changes will improve patient care

All 14 nurses originally affected by the changes are still with Vassar, said John Nelson, the assistant vice president of community, government and public relations at Nuvance Health, which operates Vassar, and the hospital is continuing to recruit for existing vacancies, with the goal of hiring more nurses.

"We believe this focused approach will lead to significant improvements in scheduling, resource allocation, and overall patient care," Nelson said in a statement.

Many hospitals do not have a dedicated IV team. In those cases, floor nurses are required to start their own IVs. Teams like Vassar's can be used as a referral if and when bedside nurses aren't able to place an IV line.

"This approach mirrors industry best practices and is consistent with the systems in place at all other Nuvance Health hospitals and most health systems nationwide," Nelson said. "There continue to be trained nurses available for placement of specialty IVs."

Nurses in Vassar's units do IVs regularly, Nelson said, and the hospital is in the final phase of shifting IV placement responsibilities to the remainder of their nursing units. "We firmly believe that having unit-based nurses proficient in IV placement will lead to higher-quality, more patient-centered care and foster a more cohesive healthcare environment."

Wilcox said, "If your bedside nurse is starting your IV, and they are proficient at it, then you get your medication in a timely fashion."

The problem, nurses say, occurs when nurses haven't previously been equipped to provide this service, and the transition to do so happens too quickly.

On Poughkeepsie hospital floor, nurses grapple with staffing shift

The ramifications of the IV team collapse, Vassar Brothers Medical Center nurses say, are hospital-wide.

"We are just not available to provide a backup service for IV," Wilcox said. "We used to go all over the hospital to help people with their IVs."

Even in the pre-surgical area, where Fina said the nurses have always placed their own IVs, they have at times turned to the IV team for help with some patients when lines are more difficult to place.

Now, Fina said, "I'm being told patients are coming down for surgery with nonfunctioning IVs or no IV at all because the nurses on the floors are not able to place them."

Wilcox said she's used to seeing three IV team nurses on duty during the day and two during the night, but that's now down to one during the day and one at night. Without the additional support, it takes double the time to do her regular duties, she said, and other nurses with less experience than the IV team are having to start the IVs she can't get to.

Franks said she has seen elderly patients with bruising on their arms after repeated unsuccessful attempts.

"It's not fair to the patients," she said. "They're not our guinea pigs, and that's what's happening."

An expert on health care accounting, finance, and policy, Bai said, "This happens a lot. Hospitals want to cut costs, cut expenses, so they try to imagine a fewer number of people doing more things."

The breakdown of the IV team, Franks said, is affecting just over 300 nurses who are not on self-start IV floors — where bedside or floor nurses directly administer IV medications — and the situation is exacerbated by what she called unsafe ratios at the hospital. One floor nurse, she said, may have up to seven or eight patients in their care at a time.

According to the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023, a bill to amend the Public Health Service Act, and National Nurses United, nurse-to-patient ratios should not exceed 1:6.

Bai said it's hard to determine the correct ratio. A multitude of factors can determine what is appropriate, including how adept the nurse is, their training levels, different experiences they've encountered during their career, the patient severity or the level of patient needs.

It is a fundamental truth, she said, that the fewer patients a nurse has will directly improve patient care and experience.

Nurses say hospital policy overlooked training needs

Nelson said the hospital assures their dedicated team members and the patients they serve that their decisions have been made with careful consideration of their impact. "Our unwavering commitment to providing exceptional healthcare remains steadfast," he said, "and we firmly believe these changes will contribute to an even higher standard of care in the long run."

Fina, Franks and Wilcox say Vassar's leadership team should have consulted their nurses on the frontlines to understand the appropriate length of training time needed before shifting staff.

"If they had talked to us, I think we would have been able to give them that feedback," Wilcox said.

The transition could have been phased in, Franks suggested, over a longer period of time to ensure all the involved nurses were prepared.

"This truly has affected the entire hospital," Fina said, "and every patient that walks through the door."

This article originally appeared on Poughkeepsie Journal: Vassar Brothers nurses speak out: Job cuts jeopardized patient care