Crisis of staffing, crisis of confidence
Nursing staff at the Brattleboro Retreat staged informational pickets, such as this one 2018, to call attention to working conditions.

Crisis of staffing, crisis of confidence

You will not resolve the Brattleboro Retreat’s financial woes until you resolve the staffing problem — and that won’t happen until the hospital becomes a place where more qualified people want to work

BRATTLEBORO — While numerous newspaper articles and radio and television news stories have recently appeared about the financial situation at the Brattleboro Retreat, the members of the United Nurses and Allied Professionals, the Retreat's employee union, feel that the majority of these articles have missed the root cause of most of the Retreat's financial problems.

To state the Union's view directly, the mismanagement of funds, low patient census, high contract-labor rates and high staff turnover at the Retreat are a direct result of this administration's policies, procedures, and heavy-handed management style.

We want to make three points that have been missed, for the most part, in the press coverage of this issue:

1. About 18 months ago, the administration instituted a massive work scheduling change that affected so many, and was so disturbing, it resulted in an avalanche of staff leaving the Retreat and moving on to other jobs.

2. That, along with several other smaller but no-less-disturbing executive decisions and the current financial crisis, have left staff wondering if our administration knows what it is doing. We have a serious crisis of confidence in our leadership.

3. The administration's decision to handle most discipline issues by terminations, grievances, and expensive arbitration has had a devastating effect on employee morale, moving even more employees to seek new jobs. This approach is a huge waste of time and money. Labor issues that reasonable and flexible people should be able to resolve in a day or two now routinely take over a year to get to an impartial hearing.

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While Governor Phil Scott, Vermont Department of Mental Health Commissioner Sarah Squirrell, Agency of Human Services Secretary Mike Smith, state legislators, and others try to work out these issues with the Retreat's management, we feel they really can't resolve these problems until they understand how this administration has helped create them.

Two key examples of decisions by Chief Nursing Officer Meghan Baston and CEO Louis Josephson illustrate this.

As mentioned in point one, in early summer of 2018 the administration informed all the frontline nurses and mental health workers that all of them would be given new work schedules effective July 2018.

The new schedules were made without consulting the union or even the needs of the individual workers. More than 350 staff were simply handed arbitrary schedules and told to try to work out with their coworkers and unit managers any problems these new schedules created for them.

As you can imagine, totally new work schedules created havoc for many employees whose schedules were centered around their responsibilities toward their children, parents, other jobs, and so on.

Chaos and anger ensued, and dozens of core, longtime staff left. UNAP organized informational picketing, news conferences and union meetings in response.

While health care has long had issues finding adequate workers, Retreat staffing has never recovered from this particular misguided scheduling decision. Every unit lost valuable registered nurses and mental health workers, including many charge nurses. The effect on institutional memory and culture was devastating.

Baston's decision to disrupt the scheduling of hundreds of employees without consulting them, with the subsequent departure of dozens of staff, has led directly to the Retreat's current financial woes and its need to hire numerous national and international traveling nurses, each one at twice the cost of a staff RN.

This employee drain at the Retreat has only worsened since 2018.

From Jan. 11, 2019 through Jan. 11, 2020, more than 180 employees left the Retreat. The administration claims staff are leaving due to low wages, yet during that same period a new contract brought nurses and mental health workers (MHWs) one of the most substantial pay raises in the 186-year history of the Retreat. Many employees got from 15-percent to over-25-percent wage increases!

Yet the additional money has obviously failed to stem the tide of people leaving, with many taking positions for lower wages and greater travel times. As of this week, five more staff have given their notice.

The lack of staffing has also led to hundreds of unplanned mandated shifts hospital-wide, where frontline workers are required to work a second eight-hour shift in addition to their regularly scheduled shift. Refusing these shifts can result in termination, while working them results in exhaustion and burnout.

We feel that it is not wages, but rather working conditions created by management, that are causing most people to leave the Retreat.

In times when there is a staffing shortage, why would administration not work to keep their staff?

The Retreat is a prime example of what can happen to a large organization when, in just a very few years, more than a third of its highly educated and extensively trained staff leaves and has to be replaced. The financial impact of not retaining professional core staff is devastating.

These poor management decisions have also had another detrimental long term effect: They shook to the core employee confidence in the competency of our administration.

We had no doubt that there might need to be scheduling changes made for a variety of good reasons, and we were willing to work with management to solve those issues. But we also felt that trying to solve a handful of staffing problems by disrupting the long-established daily schedules of hundreds of employees was a very, very poor managerial decision.

It is difficult for staff to understand how anyone in the administration would have considered this a good idea.

Time has shown that it wasn't.

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The second major area of concern, financially and morale-wise, is this administration's approach to discipline.

The Retreat's labor contract discusses the need for training and mentoring, and it lays out a step-by-step discipline process. But management frequently deals with discipline issues by moving directly to the final step - termination of employment - and skipping over the rest of the process.

This has resulted in numerous contract violations by this administration. These violations have proven very expensive for the Retreat and are a serious factor in its current financial crises.

Baston's standard response to concerns about contract violations is “grieve it.” What has this resulted in? While UNAP has a total of 6,500 members, the Retreat's local 5086 and 5087, with a combined total of just 500 members, have more grievances than the entire rest of the 6,500-member UNAP combined!

Gone are the days when Union members and management could sit down and resolve problems with mutually acceptable results and with limited expense. Nearly every labor issue now is resolved via expensive and time-consuming arbitration.

Last year, our local had nine grievance arbitrations - more than the previous 25 years combined - and we have six more slated for 2020. This costs tens of thousands of dollars.

To date, the union has won one employee six months of wage compensation for violation of due process, and another employee 15 months of wage compensation for wrongful termination. We have won the variance arbitration, which will have significant compensation for our members.

These three arbitrations alone represent over $100,000 in compensation for our members.

We also feel that the Retreat's board of directors bears a substantial responsibility for these problems.

Several months ago we directly warned the board that Baston's and Josephson's management approach has been creating serious morale and staffing problems at the Retreat for the past two years, and that it could lead to even more serious future financial problems.

The board chose to ignore our warnings, failed to talk or meet with union reps even once to discuss this, and dismissed our concerns in a letter to the union last fall, stating that the current Retreat administration has their full support.

The present financial crisis is the result.

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Other matters that concern us about the administration include:

Josephson sent a letter to Scott, at the request of the board of directors, saying that the Retreat was in danger of closing. Josephson then told the employees at the Retreat that the possibility of closing was just a rumor.

Josephson recently told the media he has a strong relationship with the union, when, in fact, he has not met with the union to discuss any of these issues in over a year.

Baston has made multiple changes (including locked bathroom doors, locked kitchens, extensive additions to required paperwork) that affect the practice of patient care and working conditions for the staff, with no conversation with the union.

The census of patients being admitted to the Retreat has dropped by almost 35 percent. Many patients are saying, “Send me anywhere but the Retreat.” They are citing the changes Baston has made as reasons for not wanting to come.

The administration claims staff are leaving due to low wages. This is not the case. Working conditions, unfair treatment of staff, and an often-hostile work environment are stated time and time again as the main reasons for staff leaving.

Low census, the cost of travel staff, locum staff ($8 million), training new staff, implementing new processes and procedures, and defending management's violations of the contract have combined to create a huge strain on the Retreat's budget.

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All of these matters the administration and the board could have handled differently - with accountable financial responsibility and less cost to the taxpayers of Vermont.

You can give the Retreat millions of dollars more in financing. You can add dozens more beds. But you will not resolve the Retreat's financial woes until you resolve the staffing problem.

And you will not resolve the staffing problem until the Retreat becomes a place where more qualified people want to work.

That is going to require much more cooperation and respect between the administration and the frontline workers than we have seen in recent years.

The average Retreat patient never sees the CEO, CNO, CFO or anyone else in the administration. To our patients, the nurses and MHWs are the face of the Retreat, and the majority of nurses, MHWs, and other union members feel targeted right now by management.

We encourage journalists, legislators, and government officials to come and talk to these frontline staff at the Retreat before you decide how best to proceed going forward.

Truthfully, there hardly seems a recent administrative decision - from keeping track of our work hours, asking for time off, how mandate shifts are handled, if or how we get breaks and lunch time, the list goes on and on - that doesn't seem deliberately designed by management to make it as onerous as possible for employees.

The recent wage increase for many Retreat workers was wonderful and very much needed and appreciated. To continue turning the Retreat around, however, there needs to be a similar seismic change in the culture of how Retreat management works day to day with its employees.

We are not expendable. You cannot lose hundreds of longtime staff without significant consequences. The administration is increasingly aware that there are not enough replacements for the holes they've left on unit after unit due to their failure to retain our best people.

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