Friday, June 11, 2010

Okay, I'm finally forming an opinion on the MN nurses' strike.

For those of you who don't know, I work in a non-union shop. Texas as a whole has not been friendly to unions; we're considered at work-at-will state (though whose will that is is sometimes in contention). The whole union/nonunion thing is therefore a little bit of a closed book to me.

I've stated in the past that I will not scab for the management of a union shop during a strike. I've gotten a couple of emails and one comment in the past week or so asking why that is. First, it's because I believe strongly in what unions have accomplished in the past and what they continue to do now. The value of unions in certain industries is debatable, as are the actions of certain union leadership, but let's be clear: the forty-hour work week, safety standards in industries like construction and mining, and fair pay and benefits did not come out of the goodness of business leaders' hearts.

Second, the key to an effective strike is that management feels some discomfort. If people are willing to break a strike, that means the discomfort doesn't happen. Yeah, management will feel the pain in paying those people a C-note per hour, but it's not as uncomfortable as seeing and feeling the effects of other workers refusing to break the strike.

And now you all can picture me in my red T-shirt, fist in the air, singing "Solidarity Forever".

As for the nurses' strike in Minnesota (and the concurrent one in California): I've read the proposal from the Minnesota Nurses' Association (PDF can be found here) and am flummoxed.

It's not any different from the staffing guidelines we have at Sunnydale and in the Ginormo Research And Education System, Incorporated as a whole. Right down to the ten percent wiggle room in beds for OB and ER patients, it's what we do. Yes, there are times we go on divert and have to reschedule elective surgeries, though it's not common. Yes, there are times that ICU nurses have to work overtime (though there are guidelines in place for that, as well: I can't work more than four days without a break, for instance). Yes, there are times that managers have to come in and work at the bedside, though that's *exceedingly* rare. Overall, though, it seems to work pretty well.

We have some flexibility in how we staff, not just according to patient numbers, but also according to patient acuity. People on continuous dialysis, for instance, always are one-to-one, as are complex kiddos in the NICU. If a charge nurse decides that a patient needs to be one-to-one or two-to-one for some reason, that happens. (Don't ask me how; I'm not a critical-care charge nurse, thank Frogs.)

Though we float from place to place, we do so within reason. A neuro-critical-care nurse like myself is not going to float to a transplant unit or to OB. Likewise, a med-surg nurse from an oncology floor isn't going to end up in a neuro or orthopedic unit. We have a pool of float nurses who are trained eight ways from Sunday to handle damn near everything, and the OB and baby-people have their own float staffs.

Is it expensive? You bet your ass it is. Is it labor-intensive in terms of training and scheduling all those people? Yep. Does it result in some of the best patient outcomes in the country? As my six-year-old neighbor would say, "Well, DUR."

We have had no--I repeat, no--cases of hospital-acquired pneumonia, central line infections, or UTIs in the past three quarters in our critical care units.

So. Given my own experience with what seem to be very reasonable demands on the part of the Minnesota nurses, I have to say: my primary opinion on this strike is that it was warranted. I support their demands. I support their right to strike. I hope like hell they get the staffing levels they want and need.

But then, I'm a pink-socked Marxist with a poster of Che above her bed.

18 comments:

nurse XY said...

Wow, 3 years!? That's great!

We're at 120 days and counting since our last BSI.

Jo said...

XY: Three *quarters*. I had to re-read to make sure I hadn't mistyped.

nurse XY said...

Eek, I apparently misread. I was duly impressed. Although, 3 quarters is impressive as well.

Sue B. Buffalo NY said...

Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to research funded by the Agency for Healthcare Research and Quality (AHRQ) and others. (www.ahrq.gov)

For this and other reasons, I also support the MN nurses. Why in the name of Florence Nightengale is this still an issue?

Anonymous said...

Is he above the bed on the wall, or above the bed on the ceiling?

You gotta prove your love for Che.

R

woolywoman said...

You have good staffing levels. Thank you for wearing your pink socks.

Heidi said...

I can't believe their strike didn't get more attention from major news sources. Safe staffing is HUGELY important and is often one of the first things to go when a hospital is trying to cut costs. When someone complains to me about poor nursing care they've received I usually tell them that yeah, maybe they had a bad nurse, but more likely that nurse was also caring 6 or 7 other very sick patients and doing her best to avoid a nervous breakdown. The news stories I read did not do justice to the nurses' grievances, even the piece on NPR was brief and trite, AND cited "healthcare reform" as one of the reasons behind understaffing.
Bah. Pisses me off. And hells yeah to not scabbing. Yes those patients still need care, in fact, every patient deserves safe competent nursing care all of the time, but they won't get it if their hospital operates with unsafe ratios.

Moose said...

So here's my question. It comes from the heart and I really hope it doesn't offend, but I'm very curious and serious about this.

It's very clear that staffing levels for nurses is a problem in a lot of places, and clearly in some places the problem is on the short-sighted business end of the medical world. But some areas and places claim a nursing shortage. So where can the staffing come from?

I have friends in nursing school, or recent graduates, and they all say the same thing: There's a demand for conformity. Even in "softer" classes, you are expected to regurgitate what the teacher tells you [whether it's correct in the "real world"]. Now, there is a level of this in any schooling, but one bad grade and you are out, which is uncommon anywhere else, even medical school. There is an air of "shut up and do as you are told." Every semester they seem to throw out another handful of people for whatever reason until the class is down to 25% or less of what started. People were removed for being overheard to say things like, "I dislike doing oncology."

On the one hand, nurses rule the medical world. Anyone who has spent any time in a hospital understands this. On the other hand, you need nurses who can draw conclusions, make logical leaps and think for themselves, not robots.

If you throw out the majority of the students who are trying to enter a profession that needs more people aren't you [the global nursing "you", not you personally :-)] self-creating a problem?

Or have I just wasted your time with babbling over a non-existent problem?

nurse XY said...

Moose--

Currently in nursing school I feel almost qualified to comment. Personally I wish the administration would throw a few of my classmates out. I have classmates that the day they graduate and step into the nursing profession will be a dark day for patients everywhere. I have classmates who say things like, "I don't really want to be a nurse, but my parents insisted I get a degree, and this seemed the best option since we get to wear cute scrubs, and I plan on marrying a rich spouse and never working a day in my life."

I started with 100 people in my class. At the end of the first semester we lost 8, but gained about that many from the class ahead of us (for us it's 2 bad grades and you're out). To date my class has 106 members, and I'm currently a semester away from graduating. We may lose a few on the way. To whittle down a class to 25% of the start size seems a little excessive to me, and I haven't heard of that happening, around here anyway.

Recently the government of my state mandated that all state affiliated nursing schools double their output of new grads in response to the shortage. My school is scrambling to find a way to accommodate 200 students per class when we barely fit 100 students...

Riddle me this then, if there's such a shortage how come the class from my school that graduated this May has less than a 50% employment rate to date, when historically at graduation that number has been >95%?

Anonymous said...

Jo,

Thank you for your support. I am no longer in the state of MN but spent the bulk of my career working with nurses from one of those striking hospitals. If I was there, I would be walking the line right along with them. It is really unfortunate that the media isn't really getting the picture yet.

Heidi said...

Moose,
Sounds like your friends are in a bad nursing program! That's definitely not how it is everywhere, and I don't think that overly-strict standards in nursing schools are what's causing the shortage (in the places where a shortage still exists, and I'd love to know where those places are... it's hard to get a job in Illinois!). We need more nursing professors if we're going to have more nursing students, as a start. There are huuuge waitlists to most of the programs in my state, and they simply can't let more people in because they don't have the faculty to handle them.
As for one bad grade and you're out... that's sorta how my program worked: if you got below a C as your final grade in any class you were out. And I have to say that I agree with that. Do you really want someone who repeatedly got D's caring for you or your loved ones? The ol' "A = Excellent, B = Good, C = RN" joke is already embarrassing enough.

Anonymous said...

Lower Medicare/Medicaid reimbursement rates, increasing numbers of patients unable to pay coupled with the financial mess our goverment has allowed is a reciepe for doom. In my state almost half of all hospitals lost money last year. Truth is patient ratios will get much worse if the funds continue to get cut. More hospitals will close, fewer nursing jobs will be available and for much less money. We are approaching a very difficult future in healthcare and it is about to get VERY BAD!

Moose said...

Heidi, never forget the even worse joke: What do you call the person who was ranked at the bottom of their medical school class? Doctor.

RehabNurse said...

Good for you! We have staffing ratios and I'm glad.

And I will not scab, either. It's just not right. I only had to cross once, and I will absolutely never do it again if possible.

Anonymous said...

so yippie you have state mandated ratios. Now, guess what? The administration is going to take away the unit secretaries so get ready to put in all your orders and answer those pesky phones. Also, no more patient techs, IV team or phlebotomy the nurse can handle all of those tasks. Transport techs? you gotta be kidding!!

Hey while we are at it lets reduce the housekeeping staff and have those ratioed nurses empty the trash and clean the rooms after the patients are transferred or discharged. You know what, ratios still provide room for administration to screw the nurses over!!!

A nonny said...

@Moose: If you'd really like to know what's happening when it comes to nurses being able to find job, I'd suggest you visit www.allnurses.com The site is an excellent resource and will give you an overview of the nationwide struggle many nurses, particularly new grads, are facing today when it comes to finding work. In most areas of the country today, it's a nursing surplus, not a shortage, that rules hiring.

I'm no "pinko commie" type, but scabbing is a big no-no in my book. Striking and unionizing freed American workers from terrible practices by employers in the past. I've seen up close the harm that weak and corrupt union leadership can do, but we as employees are all weaker and more vulnerable to employer coercion with the waning of union influence.

Anonymous said...

I am curious at how things work in Texas. Do you really staff your units for 100% of the beds to be filled 100% of the time?

I work in one of the striking hospitals, on a med surg unit. The staffing ratios for my hospital are that the nurses take 4 patients on days/eves and 5 on nights. They do have NA assistants (1 NA per 2RN's), as well as housekeeping and unit secretaries. My unit frequently drops the patient load to 8 patients for it's 29 beds. If I were to staff for 100% of the beds as the union wants (with a 1:3 ratio as well) I would have 10 RN's(plus a charge RN with no patients) on for that shift with 8 patients. I don't think that makes sense either. I wish the two sides could come to a better middle ground as I don't think all of the hospitals in MN have such good staff ratios on their units, but mine does. I think they need to start talking, but unfortunatly because some of the starting points are such extremes, it's not happening.

Sue G said...

I am a Minnesota nurse but not in an MNA hospital. Thank you anyway, for your support. Most of Minnesota seemed to either yawn or express disgust. The contract is settled, apparently with no gains but no losses. Better staffing=better patient outcomes=saved money. Why do they not get the math?

Btw I googled "loving and hating a being a nurse" tonight. You might see that string in your stats. It was me. I had a hard day at work and feel better after reading some of your blog. Thank you for your sense of humor and your obvious commitment to the profession. You seem to me like what I call my favorite nurses, "a nurse's nurse."