A Cambridge Health Alliance van stopped at the system’s Somerville campus June 22, 2022. (Photo: Marc Levy)

Cambridge Health Alliance is struggling to fill nursing vacancies, particularly in its psychiatric units and emergency department. One reason is that psychiatric nursing has become a dangerous job, CHA’s top employment executive said last month.

“Frankly, this is an area where people will be assaulted,” chief human resources officer Joy Curtis told trustees at an Oct. 24 meeting, explaining why the Alliance was having difficulty hiring psychiatric and emergency room nurses. “It’s not just CHA, it’s national,” she said.

The number of serious assaults on employees at Massachusetts hospitals rose sharply in recent years, to 80 last year from 45 in 2018, according to “serious event reports” submitted to the state Department of Public Health. Assaults at CHA declined, though, to three from nine. Hospitals must report incidents if the assault resulted in “serious injury or death,” though the definition of serious injury could differ from hospital to hospital.

Nurses described violent attacks from patients in testimony last month supporting a bill that would beef up penalties for assaults and require hospitals to offer time off to employees to deal with an assault, analyze the risks to workers and adopt plans to lessen the danger. None of Cambridge’s state legislators signed on to support the bill.

A year ago, nurses’ union leaders at CHA said many employees working in its Somerville psychiatric units came to the urgent care center in the same building for treatment when they were injured. Their comments came after the Alliance ordered work to strengthen walls, doors and other structural elements in the new units because of damage from aggressive behavior such as kicks. The Massachusetts Nurses Association, which represents local nurses and other health care workers, has called for violence prevention programs at all health care sites and has asked its members to report violent incidents to the union.

Health Alliance comments

CHA spokesperson David Cecere said that at the Somerville units, “violence and aggression are common reasons for admission, and our expert staff work as quickly as possible to diagnose and treat the underlying conditions.” The Alliance works to prevent attacks on staff with an “industry-standard de-escalation training” approved by the state Department of Mental Health, he said. “We train our staff to anticipate aggressive behavior, de-escalate dangerous situations, and intervene where necessary to maintain safety using the least restrictive means,” he said. The Alliance has “improved the orientation [for staff] across a variety of mental health care professions.”

The Alliance also provides “immediate medical care and emotional support” when staff are harmed, and debriefs with involved patients and employees “to understand triggers and prevent future events,” Cecere said. He also listed a variety of therapies aimed at helping young patients recover and “stay safe.”

Cecere also reiterated Curtis’ statement that violence against staff is a national problem. CHA’s young patients have severe mental mental disorders and the Somerville units “serve an important role” in treating youths “who would otherwise continue to board in emergency departments,” he said.

Fewer patients, but filled beds

The staffing vacancies at CHA come as patients in psychiatric crisis can wait for days in an emergency room for hospital treatment because no beds are available. The Alliance opened the inpatient units last year for child and adolescent patients at its Somerville campus to fill a statewide gap in treatment for young people. Curtis said “travelers” – high-paid temporary nurses who travel around the country to fill vacancies – are staff the units.

Even so, volume at the Somerville units lagged behind expectations for the first quarter of the current fiscal year, from July 1 to Sept. 30, according to a financial report presented to the board of trustees’ finance committee. Chief financial officer Jill Batty said the Alliance is using 20 percent more traveler and agency nurses than budgeted.

The Alliance laid off 84 workers and eliminated 254 positions July 1 to prevent more deep losses; none of the positions involved patient care, according to CHA. Five nurse-educators, who support newly hired nurses, were cut, despite union protests.

Despite the layoffs and a lean budget, CHA lost $11.6 million on health care operations in the first three months of this fiscal year, about $6.3 million more than expected. Batty said some signs were hopeful for finances, such as an “uptick” in hospital volume. Still, she said, Alliance managers would soon meet to decide on a response to the higher-than-expected staff expenses.