MNA Unsafe Staffing Form Examples 2022

Every day across Massachusetts, nurses fill out unsafe staffing forms out of concern for the safety of their patients, themselves, and the quality of their nursing practice. In 2022, nurses filled out more than 8,300 of these forms, at nearly every hospital from Berkshire County to Cape Cod. The MNA has filed legislation to help address this problem. Below are examples of unsafe staffing forms, with identifying information about caregivers and patients not included or removed.

St. Elizabeth’s Medical Center in Brighton
Emergency Room
June 7, 2022
# of nurses working: 4
# of nurses needed: 6
“Not given appropriate staff for census”
“Inappropriate number of professional staff”


Brigham and Women’s Hospital in Boston
Emergency Department (Boarding Patient Area)
December 8, 2022
# of nurses working: 14
# of nurses needed: 19
“Inadequate staff for patient acuity”
“Inadequate staffing for patient census”


Beth Israel Deaconess Hospital – Plymouth
Senior Behavioral Health Center
August 21, 2022
# of nurses working: 2
# of nurses needed: 3
“Given an assignment which poses a serious threat to my health and safety.”
“Given an assignment which poses a serious threat to the safety and well-being of my patients.”


Cape Cod Hospital in Hyannis
March 19, 2022
# of nurses working: 2
# of nurses needed: 3
“Transferred, discharges, or admitted new patients to unit without adequate staff”


Cooley Dickinson Hospital in Northampton
Emergency Department
December 18, 2022
# of staff working: 9
# of staff needed: 11
“Given an assignment which poses a serious threat to the patient’s health and safety.”
“Case load is excessive and interferes with delivery of safe and adequate care.”
“Not given appropriate staff for census.”


Lawrence General Hospital
Psychiatric Unit
June 3, 2022
# of nurses working: 3
# of nurses needed: 4
“Given an assignment which poses a serious threat to my health and safety.”
“Given an assignment which poses a serious threat to the safety and well-being of my patients.”
“Case load is excessive and interferes with delivery of safe and adequate care.”

“The day that Tenet broke me” by a St. Vincent Hospital nurse

Medical-surgical RN Deborah Collinge recounts an awful shift she experienced, with the danger and intensity of patient care and accompanying medical jargon explained by MNA Associate Director of Nursing Carol Mallia, MSN, RN.

Deb: *Covid pt with added peritoneal dialysis.

Carol: Peritoneal Dialysis is where they place a special catheter into the abdomen and instill dialysis solution at a carefully prescribed rate and dwell time.   They essentially use the patient’s own abdominal cavity to filter in and out the electrolytes abnormalities caused by renal failure.  They require frequent monitoring for pain, low blood pressure and heart rate alterations.   The fact that the patient was also being treated for COVID, complicates the issue because of the need to gown up and don off each time you evaluate the patient.  She did not mention it, but the patient was probably sick from the COVID itself and required oxygen support, multiple IV medications and close monitoring.  Patients on Peritoneal dialysis are at great risk for infection (sepsis, giving the direct access to the abdominal cavity) and hypotension.  The fluid must be infused at a very precise rate, then dwell in the abdomen for a carefully prescribed amount of time and they released back into a drain bag at a slow enough rate that the patient does not bottom-out their blood pressure. All of this patient demands require a great deal of monitoring and nursing time.  Any missed assessment, and the patient’s blood pressure can drop so suddenly they will have a cardiac arrest.

Deb: *500+ pound patient on Oximizer, trying to maintain some normalcy of adequate oxygenation.

Carol: An Oximizer  is a high-flow oxygen system used for critically ill patients with very low oxygen levels and respiratory failure.  It is used with COVID patients to attempt to avoid intubation and mechanical ventilation. Patients who require this treatment have exhausted all low-flow systems to maintain their oxygen level. This type of patient can deteriorate quickly and they require close observation of their vital signs and oxygenation levels.   If not monitored properly they can go into a respiratory arrest and at 500 pounds he would be a difficult intubation.

Deb: *confused patient with multiple attempts OOB… multiple grand mal seizures – one after the other with each following being so much more dramatic than previous one.

Carol: Grand mal seizure patients having recurrent seizures is usually an ICU level of care.   Each seizure requires nursing monitoring and intervention.  The fact they are escalating in severity is an ominous sign and sounds like they were not able to control them with medications.  No surprise the patient was confused and attempting to get out of bed, which adds a safety concern.  The patient needed to be monitored on a 1:1 basis.  It is negligent of the facility to have a patient having multiple seizures without close monitoring.  He/she should have continuous EEG monitoring and close observation.

Deb: *patient with multiple mucus plugs compromising respiratory status. Finally went for washout. Challenging to keep her pox wnl.

Carol: This patient is in acute respiratory distress and they are having multiple mucus plugs and high level of secretions. ( she did not say it but likely requiring frequent suctioning). Bronchoscopy lavage or “wash out” is used for severe pulmonary congestion. It sounded like the patient was unable to keep her pulse oxygen level (pox) within normal limits (wml).  This patient sounds like they were one mucus plug away from a respiratory arrest.

Deb: *multiple dressing changes s/p paracentesis.

Carol: A paracentesis is a procedure where you remove a sampling of peritoneal fluid.  I would guess the patient had ascites (fluid filled abdominal cavity, usually due to liver cirrhosis or cancer) and it was leaking from the paracentesis site.  It often does leak when the patient is very sick and fluid is accumulating too fast.  Often the drainage is so significant that you have to put an ostomy pouch on the skin and attached it to a drain bag).  With ascites comes a host of other issues: congestive heart failure, electrolyte imbalances and pain, just to name a few.

Deb: All told, 4 patients on continuous o2 monitoring with equipment that doesn’t work. 5th patient didn’t need cont pox. (Carol: Continuous pulse oxygen monitoring.)

Deb: Even with help from my colleagues, it was a tough day so here I sit in my car a weeping heap of a nurse. I really wanted to walk today.

Carol: I think she is amazing to have survived her shift with them all alive!!!  Each of those patients required close monitoring and a great deal of nursing intervention.   This was a “MISSION IMPOSIBLE” ASSIGNMENT.  All of those patient could turn-on-a-dime and be a full blown arrest.  Holy cow, she is my hero for surviving the day.