Temple University Hospital lost 1,500 skilled employees Wednesday when registered nurses and allied health professionals went on strike.
At the same time it gained, en masse, 850 temporary workers recruited from around the country. That means it has 850 new employees, all of whom are getting a crash course in its computers, layout, and rules while meeting its 400 doctors and 3,000 other employees.
Is this a good time to be a patient there?
The hospital says yes. The union - PASNAP, the Pennsylvania Association of Staff Nurses and Allied Professionals - says no. Experts say there's reason to wonder.
"I think nursing is often the key point in patient quality," said Robert Field, professor of health management and policy at the Drexel University School of Public Health. "It's the point of most extensive contact between the hospital and the patient. Nurses provide most of the hands-on care that patients actually receive. They're the ones who are closest to the patient and most likely to notice if there's a problem. . . .
"So using nurses less familiar with the hospital would be a cause for concern."
Field guessed it would take a few weeks for the new nurses to become fully integrated into the teams that research shows deliver the highest-quality care. He would worry most about jobs involving complex treatment or tight teamwork, such as those in intensive care units and operating rooms.
"There's a learning curve every time there's a new patient and then there's a learning curve for the institution, for procedures, for personalities, for the way things get done," he said.
Temple has done most of its strike hiring through HealthSource Global Staffing, a California agency that specializes in strike forces. On materials released by the union, HealthSource promised temporary workers pay of $2,862 to $10,388 a week to replace the striking nurses and other professionals. In addition, the strike workers would stay in "luxury" hotels with transportation provided to and from work.
The replacement workers must meet state certification rules. They began training on Temple's computer system and procedures Sunday. However, they did not enter the North Philadelphia hospital, which has 450 staffed beds, until Wednesday morning.
Sandy Gomberg, Temple's chief executive officer, said care throughout the hospital would continue. She said the training the temporary workers received was similar to that given nurses hired through staffing agencies at other times.
Executive Chief Daniel Williams of the Philadelphia Fire Department said Temple's emergency room went on divert from 7 a.m. when the strike began until 9 a.m. It accepted one critical patient.
Stacy Kriedeman, a spokeswoman for the Pennsylvania Department of Health, said the state was satisfied with Temple's strike plans but would monitor the situation daily "to ensure that the regulations are being followed and patient care is not impacted." The state will make unannounced visits and investigate complaints, she said. She declined to say whether a Health Department employee was at Temple on Wednesday.
Dawn Andonian, a Fitzgerald Mercy Hospital nurse, said she was called at home Friday night by a recruiter seeking nurses to start at Temple on Wednesday. She said she was told she would need to work a minimum of 80 hours a week and could earn $100 an hour. Andonian, a union vice president, said she was "appalled" by the hours, which she considered "dangerous."
Gomberg, a nurse, said two-thirds of the replacement workers were nurses. They will work three to five 12-hour shifts a week, she said. She said that the hospital's nurse-to-patient ratio would be "whatever is safe" and that supervisors were working around the clock on all units to ease the transition for new workers.
By mid-afternoon Wednesday, she said, the hospital was running well. "I'm not going to say it's a walk in the park, but I can absolutely assure you we have gone to extra efforts to make sure our patients are safe."
Temple was prepared, she said, because it routinely drills for disasters and has been planning for a strike for months. "When we got this 10-day strike notice, we were very, very, very far ahead of the curve."
Jerry Silberman, a union staff representative, said that under normal circumstances new nurses work alongside more experienced nurses in their units for six weeks. He foresees problems with short training and long hours. "Obviously," he said, "our view is that things will run anything but smoothly."
Peter Buerhaus, a nurse and health-care economist at Vanderbilt University, said the temporary workers likely could do their nursing duties but the fact that so many were starting at once and were unfamiliar with the facility could make efficiency "challenging." He said a hospital could overcome that problem by slowing down the work and restricting admissions.
Linda Aiken, director of the Center for Health Outcomes Research at the University of Pennsylvania School of Nursing, said research showed that nurses "can certainly move from institution to institution quite competently."
However, she said, 850 new people at once raises questions. "Clearly, that would be a major upheaval in any organization of any kind," she said.
She thinks the most important questions are how nurse-to-patient ratios at Temple will be affected and how many hours the replacement nurses will work. On average, each nurse in Pennsylvania cares for 5.5 to 6 patients. California requires minimum ratios: one nurse for five patients on medical and surgical units and one nurse for two patients in ICUs.
Penn researchers found a direct correlation between long hours and mistakes. "When nurses work beyond 50 hours per week, there's a very significant spike in errors of all kinds," Aiken said. "The more hours, the higher the error rate goes."
She said workweeks of 80 hours or more "would not be . . . condoned by any safety expert anywhere."