Providing quality patient care matters most to Cindy Menard.
The intensive care unit nurse has worked within the Concord Hospital system for 31 years, most recently at its Laconia location. She prides herself on helping restore patients to good health and, ultimately, to leave the hospital bed and go back home.
In the last few years, she’s noticed a shift: short staffing, limited resources. It’s taken a toll on her patients, she told Laconia Mayor Mike Bordes at a roundtable discussion on Tuesday.
“The values of Concord Hospital are leadership, caring, stewardship, integrity and continuous improvement,” Menard said. “I bring those to the bedside with me whenever I go, and it’s getting increasingly challenging when I’m feeling not in a culture where the leaders are embodying those core values.”
Unionized nurses from Concord Hospital’s Franklin and Laconia campuses shared their concerns regarding nurse-patient ratios, unequal resources and their impression of hospital leadership as being uncompromising.
Concord Hospital said in a statement that its acquisition of Franklin Regional Hospital and Lakes Region General Hospital in 2021 helped keep nearly 1,100 jobs and that it has made significant investments in both hospitals to “strengthen the care in these communities.”
“We are working through the issues thoughtfully and in good faith,” a spokesperson for Concord Hospital Health System said in the statement. “Reaching a first contract will require time, as well as movement and compromise by both parties, and we remain focused on making meaningful progress toward an agreement that works for our nurses, our patients and the communities we serve.”
Franklin and Laconia nurses voted to unionize last September, becoming the first private-sector hospital union in New Hampshire. The vote culminated from months of discussion around staff shortages and burnout, with patient safety a top concern.
Shauna Parish, a telemetry nurse in Laconia and the president of the nurses chapter within SEA/SEIU Local 1984, said the culture in the Laconia and Franklin campuses has deteriorated in the last five years, around the same time Concord Hospital acquired LRGHealthcare’s two facilities.
Lately, she often sees one nurse for every five patients on her floor and said there was once a push for even more patients to be assigned to one nurse.
“In healthcare, it has been normalized for nurses or healthcare workers to maybe not get a break, to take more patients than you think is safe, and when you speak up, you are being difficult as a nurse, essentially,” Parish said. “I hear often when I’m speaking with people, ‘Well, this is just how it is.'”
Nurse-to-patient ratios are similar in other departments in Laconia: medical-surgical nurses often have six patients each, and emergency department nurses take care of up to eight patients at a time.
The safe number of patients to one nurse depends on the department, but the union concluded that a one-to-four ratio is safe to sustain. Some states, including Massachusetts, stipulate what these ratios should be.
During the roundtable, nurses brought up benefits and amenities staff at Concord Hospital’s flagship location receive that Laconia and Franklin staff don’t. These benefits include paid time off for severe injury or major surgery, also known as extended illness time, and a childcare facility.
When these items were brought to the negotiation table, nurses said Concord Hospital leadership rejected both proposals.
“I feel like the nurses are not really able to speak up, and if we do speak up, we’re not listened to, which is why we are in this situation to begin with,” Parish said.
Bordes, Laconia’s mayor, said he meets with Concord Hospital’s chief executive officer on a regular basis and understands there have been investments made in Laconia’s campus, including its cancer center. He said the company should also be investing in its staff along with the facility.
“I think they need to come to the table with a proper proposal and negotiate a contract for these individuals, because without our nurses we have no hospital, and I think it’s very important to give them the benefits and the time off and everything else that they’re required,” he said.
The nurses presented a health and benefits offer during a negotiation meeting with Concord Hospital leadership after the roundtable. Parish and Menard said most of the language held true to their existing contract, with the addition of extended illness time. Leadership rejected most of the proposal in its counter-offer, according to documents reviewed by the Monitor.
Parish said nurse-to-patient ratios have not been discussed yet in negotiations.
Richard Gulla, president of the State Employees’ Association of New Hampshire, which represents nurses, said what struck him about the union was their focus on patient safety over benefits for themselves.
“They really wanted a seat at the table to be able to talk with the hospital administration on ideas they had to help improve the quality of care,” Gulla said.
Laconia and Franklin’s hospitals recently lost some experienced nurses to retirement or to jobs at other local hospitals. Graduate students who train there rarely stay beyond their program.
Menard said there are many great nurses at these hospitals and good leaders throughout the organization, but they encounter difficulties marrying the hospital’s philosophy with the day-to-day operations.
“I’m grateful for this opportunity during this decade of my life to be able to give that and hopefully gain some ground for nurses in the state of New Hampshire,” she said.
