A man showed up at Beth Israel Deaconess Hospital-Plymouth’s emergency room one morning last month suffering from Covid and struggling to breathe.
He remained in the ER for more than 12 hours while waiting for an intensive care unit bed.
But at 1 a.m., the patient went into cardiac arrest, according to a report filed by an emergency room nurse.
A team of nurses tried to save him, but he died the next day, after finally making it to intensive care, according to the nurses union.
The incident, while particularly tragic, illustrates what the union says are common chaotic conditions at BID – for patients and staff.
Bed alarms beep. Confused patients wander the hallways. Patients languish in the emergency room for hours even after being deemed sick enough to be admitted.
These are some of the problems nurses at the 170-bed hospital described in forms called “Objection and Documentation of Unsatisfactory Staffing,” commonly referred to as “unsafe-staffing reports.”
BID-Plymouth nurses filed 85 unsafe-staffing reports in January alone — more than the 62 they filed in all of 2024.
“The entire hospital is short-staffed,” wrote one nurse in a Jan. 13 unsafe-staffing report. “No help available. No response when texted for anyone to come in for OT.”
Nurses file the reports when they feel they are unable to give patients appropriate care. They complain of having too many patients, and not enough help from technicians and certified nursing assistants.
The reports are shared with management and the Massachusetts Nurses Association, which represents the hospital’s nurses. If the conditions described in the forms aren’t addressed, the forms may be shared with agencies that oversee hospital safety, according to David Schildmeier, the MNA’s director of public communications
The reports were filed by nurses working in all corners of the hospital — from the emergency department to the ICU to inpatient units. In all, more than 420 work at BID-Plymouth. They earn $50 an hour, on average, with the high end of the scale topping out at $70.85.
Nurses’ pay is “middle of the pack right now for area hospitals,” Schildmeier said, and10 to 30 percent below major Boston hospitals, “where a lot of nurses go.”
The ER was sized to accommodate 27,000 patients a year when it was expanded more than three decades ago. It now processes more than 46,000 patients annually. The new one under construction will be double the size, at 29,000 square feet – large enough for about 65,000 patients.
To get an idea of how congested the emergency room can become, you need only look at Facebook posts from frustrated patients, who describe exasperating visits to the hospital.
“I had the most horrible experience overnight at Beth Israel Deaconess Hospital in Plymouth,” wrote one woman in a Feb. 4 date post that generated hundreds of comments.
“Went in with chest pains and waited over nine hours in the waiting room that is under construction and is cold. There were elderly people there in wheelchairs waiting hours with loved ones trying to put blankets over them…One elderly gentleman was crying out because he was so hungry and had been sitting there alone with just socks on his feet for over five hours. Thank God one other patient waiting found a granola bar for him in their bag. I felt like I was in a third world country.”
“I will never return to that hospital,” she added.
BID-Plymouth nurses reacted strongly to the post. Some commiserated with the woman, while others felt like they were under attack, saying they have dedicated their lives to helping people.
But they acknowledge it has become increasingly difficult for them to do their job.
By filing reports, nurses are essentially pushing “their own call button for help,” said Schildmeier. They are “letting management know in real time that their patients’ health and safety are being placed in jeopardy by the hospital’s failure to heed the nurses call for significant improvements in the hospital’s staffing levels,” he said.
“This is absolutely unprecedented, said Liz Taylor, co-chair of the MNA’s local bargaining unit for BID-Plymouth nurses. She said the standards of care have been lowered because there’s only so much overworked nurses can do.
“Everybody is exhausted,” she said. “We want to be able to take care of the community. That’s why every single one of us went into nursing. But we can’t in these conditions.”
BID-Plymouth president Kevin Coughlin agreed that there is a staffing shortage — which he called a nationwide problem — but said the hospital is taking “aggressive steps to both retain and recruit the best staff to support the delivery of high-quality community care.”
In addition, he said in a written statement, BID-Plymouth, like other hospitals in the region, is caring for increasing numbers of patients this winter, largely due to high levels of flu and other respiratory illnesses.
“While this trend has put stress on our clinical teams, we have focused on quality, safety and the patient experience throughout the continuum of care we provide,” Coughlin said.
“We are confident that BID Plymouth remains a highly valued, accessible health care resource for our local community.”
Privacy restrictions, he added, prevent him from commenting on specific complaints outlined in the unsafe-staffing reports, but he said the hospital “thoroughly” reviews concerns and takes necessary action.
The nurses say they recognize other hospitals face similar problems but argue that they’re worse here because BID-Plymouth, part of Beth Israel’s sprawling Boston-based health care network, is investing in expansion not in improving the working conditions for nurses.
MNA also represents nurses at Signature Healthcare Brockton Hospital, and Morton and Tobey hospitals, where working conditions for nurses are better, union officials said.
Cape Cod Hospital, they said, also has staffing issues.
Conditions became “significantly worse” last summer and fall, Schildmeier argued, when a hiring freeze took effect — something Coughlin asserts did not happen — and vacancies went unfilled. Several managers and support staff were laid off in September, Schildmeier said.
The increase in unsafe-staffing reports comes as the union and hospital management are in negotiations for a new contract. Nurses want pay raises and key staffing improvements such a cap on the number of patients they can be required to handle.
They also are asking for a ban on mandatory overtime and an agreement that the hospital will comply with a state law that limits to one the number of patients an ICU nurse can care for, except in special cases.
So far, they say, their proposals have gone nowhere.
But in an emailed statement, chief nursing officer Donna Doherty said the hospital is “committed to reaching a fair agreement with the MNA to invest in our nurses at BID Plymouth who provide high-quality, compassionate care to our community.
“Our current economic proposal would provide among the most competitive nursing pay rates in the region and supports our goals for retaining and recruiting outstanding nurses,” she wrote.
Tensions between the nurses and the hospital flared up last week after Coughlin outlined the hospital’s $116 million expansion plan — which includes the new emergency department — in the Plymouth Independent.
The nurses felt he glossed over the staffing shortage and implied that the hospital’s problem stemmed from a lack of space, not a lack of staff.
“We know it’s a hard place for patients and a hard place for all of the staff to work. It’s loud. It’s not private,” Coughlin said in a Feb. 10 story. That comment sparked an outcry from nurses who last Tuesday sent Coughin a letter saying they were “appalled.”
“While we agree it is a hard place to work,” said the letter authored by the two union co-chairs, Taylor, and Robert Doughlin, “it is not due to the lack of space, but it is due to the untenable conditions you have created for the those struggling to provide care, and made worse by your administration’s refusal to work with us to improve those conditions. “
The union leaders called for “an immediate and concrete plan to address these issues. The hospital’s current approach is unsustainable and puts both nurses and patients at risk,” they wrote.
“Thank you for your recent communication,” Coughlin wrote in response two days later. “The entire leadership team of this hospital is focused on assuring that clinical staffing levels support our goal of safe, high-quality patient care.”
But Coughlin’s seven-paragraph letter did little to assuage the nurses’ frustration. They questioned the timing of the response which came shortly after an Independent reporter asked the hospital about the union’s letter.
“We can only hope this is not a cynical ploy on their part to feign interest in responding to the nurses’ concerns,” Shildmeier said. “But regardless, the proof of their commitment to address this crisis will be their willingness to accept the staffing proposals the nurses have put forth in the ongoing negotiations.”
Andrea Estes can be reached at andrea@plymouthindependent.org.