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As the shuttering of 41 pediatric inpatient beds at Tufts Children's Hospital in Boston draws near, nurses rallied on Tuesday over their concern that the closure will severely limit access to care.

Though the Tufts Medicine Health System that it would convert 41 pediatric inpatient beds at Tufts Children's to "much-needed" adult beds, and that it had signed a letter of intent with Boston Children's Hospital "to ensure" continuity of care for pediatric patients and their families, nurses continue to worry since they first learned of the closure during an early-morning Zoom meeting at the beginning of the year.

The agreement with Boston Children's is set to take effect July 1, as the beds at Tufts Children's officially come offline. However, nurses say the demand for children's beds is already stretched as it is.

"Some of the services that we provided are highly specialized," Mary Havlicek Cornacchia, RN, an operating room nurse who has worked at Tufts for more than three decades, told MedPage Today. "I'm not sure where some of those parents are going to take their kids."

Specifically, the services that are being shuttered are the pediatric intensive care unit (ICU), a medical-surgical floor, and the pediatric bone marrow transplant unit, said Havlicek Cornacchia, who chairs the local bargaining unit of Tufts nurses represented by the Massachusetts Nurses Association.

She said the emergency room fields nightly calls from other facilities looking for pediatric beds. She questioned what will happen June 30, when the hospital stops taking those patients. "The kids are already filling up emergency rooms around the state ... I just don't know what's going to happen to everybody else once we shut our resources."

Tyra Dukes, RN, who works in the pediatric ICU at Tufts, and routinely hears many of the calls from nearby facilities looking for children's beds, concurred. "It's really scary and heartbreaking to think about when we're not an option," she said.

Dukes and her colleagues at Tufts also fear for the families of some of the sickest pediatric patients. She said she thinks of the uninsured children Tufts treats, adding that the hospital sees many new immigrants who have yet to establish resources or connections in the city, and that appointments for specialty care are full.

Havlicek Cornacchia worries that some physicians may not stay if they are not able to place a pediatric patient seen at their clinic in a bed at their own hospital under their own care. She also questioned what would happen to the neonatal ICU if a woman gives birth and the hospital is not able to perform the surgery the baby may need.

Her biggest fear, she said, is that the negative impact of the impending closure is "more far reaching than we see at this moment."

Tufts provided the following statement to MedPage Today: "Every day, we have the honor to witness the exceptional commitment, professionalism, and passion Tufts Children's Hospital nurses show for our pediatric patients and their families. Their decision to gather to honor the history of this great institution and the many children Tufts Children's has served over the years is one we both understand and respect. The closing of our inpatient units at Tufts Children's Hospital was an extremely difficult decision, and we share the heartfelt emotions of our nurses and employees throughout the medical center."

In its with the state Department of Health, Tufts stated that, for fiscal years 2019, 2020, and 2021, and fiscal year 2022 through February, the average daily census ranged between 40% and 60% of available capacity in the pediatric ICU and between 45% and 67% of available capacity in the pediatric unit, which includes pediatric bone marrow transplant beds.

Tufts added in the filing that it "understands the concern and inconvenience [the closure] creates for some patients and their families," but that it "does not anticipate significant impact." It said that comparable services are available at other hospitals, including Boston Children's Hospital, which is located less than 3 miles away from Tufts and opening additional inpatient services this year.

"There is certainly hope for a turnaround," Havlicek Cornacchia said of Tuesday's rally against the impending closure. "It feels more futile closer to the actual date."

Part of the problem is the loss of crucial staffing -- there have already been 95 nurses affected, Havlicek Cornacchia said.

Two dozen nurses opted for early retirement and some selected severance packages. Some have made the move to Boston Children's, while some will move on to other facilities. Others are being placed in different departments within Tufts.

Boston Children's did not immediately provide details on whether there is any concern about increasing patient volumes in the coming months or how many nurses have recently joined from Tufts.

Dukes, of the pediatric ICU, says she has decided to stay on at Tufts until the closure takes effect to help maintain services as much as possible. However, she acknowledged that the hospital has already lost approximately 25% to 30% of its affected nurses.

Just a few days shy of her 5-year anniversary at Tufts, a hospital she said she selected to join "for the community that's here," and that "we worked so hard to build," Dukes will leave for a new job in an emergency department at a different institution. She will continue to care for pediatric patients.

All the while, the dispersal of Tufts pediatric nurses is happening as facilities across the country report they are experiencing a nursing shortage. However, many pediatric nurses can't imagine making a change.

To be a pediatric nurse means taking care of not just the patient, but also the family, Havlicek Cornacchia noted. There is so much involved, she said. Sometimes it's fun, and sometimes it's hard.

"But to be able to take care of a child, it's just a gift," Havlicek Cornacchia said. "You're excited to go to work every day because you're trying to make a positive difference in these children's lives."

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