Mary-Murphy Walsh shouted into a megaphone across Blackstone Boulevard, her voice gradually rising to a roar as a chorus echoed back in her direction.
“Out here on the picket line/Butler must have lost its mind,” Walsh and Butler Hospital workers sang as they marched in single file on opposite sides of the boulevard in Providence’s East Side.
Walsh, a labor organizer with SEIU-1199, led about 200 unionized employees of Butler Hospital in an informational picket Monday, with workers arriving and departing in waves as they finished or started their shifts at Rhode Island’s only private, nonprofit psychiatric and substance abuse hospital.
On a walking path situated in between the boulevard’s opposite lanes, passersbys, including dog walkers, a pack of Brown University runners, and other amblers, turned their heads toward the picket’s noise. The busy road’s passing cars honked often. A kid on his bike stopped to watch and tap along with the drumbeat played by picketers.
Contrasting the workers’ almost celebratory sense of solidarity were their sobering complaints. According to the union, incidents of violence against staff have risen 41% since 2022. A union survey suggests that 95% of Butler caregivers think Care New England, the hospital’s parent company, “is not doing enough to keep them safe at work.”
Catherine Maynard, a registered nurse in the hospital’s geriatric unit, said in a statement ahead of the picket that a 2023 injury acquired while restraining a patient herniated discs in her back.
“Two years later, I still work with pain and, at 29, I may be dealing with back problems for the rest of my life,” Maynard wrote.
SEIU 1119 has four contracts with Butler, which cover professional and clerical staff, registered nurses, mental health workers, and housekeeping and dietary staff. All four contracts expired on March 31.
Workplace violence, union members say, is exacerbated by staffing shortages and low wages. Butler employs a little over 1,000 people annually, according to reports filed with the federal Occupational Safety and Health Administration (OSHA) in 2023. Right now, the hospital has about 116 open positions.
Workers are also dissatisfied with their wages. Under the recently expired contract, mental health workers started at $18.27 an hour. Housekeeping and dietary staff started at $16.08, clerical workers started at $19.76, and professional staff and registered nurses started at $32.50.
6.2% wage hikes offered
Starting wages could increase by about 6.2% under Butler’s recent proposals, depending on employee classification. A mental health worker’s initial wage could rise to $19.40 by 2028, under a proposal illustrated in hospital documents released April 2. Existing mental health workers could see incremental increases over the course of the four-year contract, from around 13% to 16%, for a total of about $23 or $24 hourly.
Under Butler’s April 2 proposal, starting wages would rise as follows by April 1, 2028:
- Housekeeping and dietary staff would start at $17.06 an hour.
- Clerical workers would start at $20.97 an hour.
- Professional staff and registered nurses would start at $34.49 an hour.
The proposed starting wages, according to the hospital, “represent the highest opening wage increase offer from Butler in over 10 years of negotiations.”
Mary E. Marran, Butler’s president and chief operating officer, said the six-hour picket occurred despite the hospital’s “ongoing commitment to open and constructive negotiations,” in a statement Monday.
“From the start, Butler’s leadership has been fully engaged in the bargaining process,” Marran said. “We recognize the importance of wages, benefits, and workplace safety, and we have worked diligently and in good faith to address these issues. Our goal remains a fair and equitable agreement that supports our employees while upholding the exceptional care our patients deserve.”
Part of the hospital’s initiative to be transparent in negotiating included a website, ButlerInfoForYou.org, expressly designed to share information on the negotiation process. The domain was registered on Jan. 30, shortly before contract negotiations were to begin. It includes the hospital’s proposed terms and revisions for each of the four contracts. According to a site calendar which lists meeting dates, the most bargaining talks were on April 15.
Our goal remains a fair and equitable agreement that supports our employees while upholding the exceptional care our patients deserve.
The website also includes a question and answer section in which the hospital responded to questions, such as “Why can’t Butler Hospital retain staff to work the inpatient units?” and “Why is it that when a nurse manager gets assaulted, the cops are called and patient gets arrested but when an mhw [mental health worker] is assaulted, no one bats an eye?”
Ian Lacombe, a registered nurse in Butler’s emergency department who has been with the hospital for over two decades, described the union’s next steps in an emailed statement Tuesday.
“Our goal is to reach a fair contract agreement and we look forward to returning to the bargaining table on April 29,” Lacombe said. “But we refuse to settle if we are unable to make concrete gains that significantly improve staffing and safety concerns that continue to put us in harm’s way. Our patients come to Butler in need of mental health and substance abuse support but we can’t adequately meet their needs due to short staffing. We do not want to strike but are prepared to take that step to protect our patients from the current environment.”
Punched, pushed, kicked and headbutted
Problems with inpatient violence are not new at Butler or psychiatric institutions elsewhere. An OSHA filing recounts a Jan. 29, 2021, incident in which a patient flipped a table, “began wielding colored pencils as weapons,” and spit bloody phlegm in one employee’s eyes.
During 2024, OSHA logs show that Butler workers were punched in the groin, struck in the chest, pushed against walls, and kicked in various body parts. Another employee received three headbutts to the nose. A patient flung a dinner plate at an intake coordinator. A staff nurse was grabbed from behind and choked by a patient. One patient tried to attack another, and when an employee intervened, the aggressor bit down on the worker’s tricep, destroying his diabetes monitoring device.
Many recorded incidents occurred during attempts to restrain patients, but not all. The OSHA logs relay an incident from Feb. 24, 2024, when an “unprovoked” patient “repeatedly punched (an employee) in the face, nose, mouth and right eye.”
Marran wrote in her statement that “safety is non-negotiable” at Butler.
“Like all Care New England hospitals, we have comprehensive protocols in place to protect staff and patients from workplace violence,” Marran stated. “Our nurses, clinical teams, and security personnel are trained in de-escalation techniques, and high-risk behavioral health areas receive enhanced support and staffing. We do not tolerate violence in any form. Our staff are committed professionals who work tirelessly under challenging circumstances, and we will continue to advocate for their safety and well-being.”
Patient violence toward staff, a common occupational hazard in psychiatric settings, intensified during the pandemic. A 2022 article in the journal AIMS Public Health noted that, during the pandemic’s height in June 2020, psychiatric hospital workers reported the highest rates of inpatient violence, with 57% of workers having experienced it. The authors’ analysis of previous research noted that the more beds were occupied in health care settings, the more likely it was that patient aggression would occur.
“Although the clinician’s right to refuse treatment of violent patients is allowed by law, many practitioners still treat all patients who need our help, regardless of their actions or abusive potential,” the article noted in its conclusions. “Unfortunately, no matter what data are presented, medical and psychiatric facilities consistently stand out as some of the most dangerous workplaces in the United States.”
Documents shared by the union give even more specific details on incidents, including 111 assaults recorded thus far in 2025. These workplace incident reports include dialogue, actions taken by staff, and at times, hint at patients’ struggles, like on Jan. 27, when a patient packed her bags and headed for the door, yelling that she didn’t need to be at the hospital. Two staff members closed the door to prevent her escape, and the patient pushed them both. The workers were not injured.
According to the log, after the patient had been dosed with the strong tranquilizer Thorazine and her parent notified of the incident, she came up to the worker she had pushed into a wall, and apologized.
This story was originally published by The Rhode Island Current.
