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Thursday, April 10, 2008

Helpful study

Nursing Journal Study Shows Nurses Unions Improve Patient Outcomes in Hospitals. Patients Treated for Heart Attacks Have Lower Mortality Rate at RN-Unionized Hospitals
Patients with heart trouble would be wise to seek care at a hospital with a nurses union according to a recent study of the impact of nurses unions and the mortality rate for patients with acute myocardial infarction (AMI, the medical terminology for heart attack). The study, which was published in the March issue of JONA (Journal of Nursing Administration), studied hospitals in California and found that hospitals with a nurse’s union had a "significantly predicted lower risk-adjusted AMI mortality."
The study’s authors, Jean Ann Seago, PhD, RN and Michael Ash, PhD, concluded that "this study demonstrates that there is a positive relationship between patient outcomes and RN unions." Editor’s Note: for a fax copy of the study, contact the MNA at 781.249.0430.
"Thirty-five percent of hospitals in California have RN unions. The significant finding in this study is that hospitals in California with RN unions have 5.7% lower mortality rates for AMI after accounting for patient age, gender, type of MI, chronic diseases and several organizational characteristics. This result includes controls for number of beds, AMI-related discharges, cardiac services, staff hours and wages.
In discussing how unions impact the quality of patient care, the authors stated, "unions may impact the quality of care by negotiating increased staffing levels…that improve patient outcomes. Alternatively, unions may affect the organization nursing staff or the way nursing care is delivered in a fashion that facilitates RN-MD communication. This is the ‘voice’ function of unions…Yet another possible mechanism by which unions can improve care is by raising wages, thereby decreasing turnover, which may improve patient care."
The authors conclude, "perhaps having an RN union promotes stability in staff, autonomy, collaboration with MDs and practice decisions that have been described as having a positive influence on the work environment and on the patient outcomes."
"We at the MNA couldn’t have said it better ourselves,’ said Karen Higgins, RN, MNA President. "In fact, we have been saying this for years - a patient’s greatest advocate is a unionized nurse, because a unionized nurse has the protected right and the power to stand up for their practice and their profession. The fact that this same message is being delivered through a research study published in a journal for nursing administrators is even more telling. These are the folks who often fight tooth and nail to prevent nurses from forming a union. Perhaps now they will see the value of having a union at their facility. We know the staff nurses here in Massachusetts have seen the value."
Higgins points to a number of examples in recent years of where the strength of nurses unions, and the ability of nurses to stand up to health care administrators over patient care issues have had direct impact on the quality of care patients receive.
She points to specific provisions nurses have negotiated into MNA union contracts. These include:
Limits on the Use of Unlicensed Personnel - Throughout the early 1990’s hospitals across the country and throughout Massachusetts attempted to cut costs by implementing care delivery models that involved replacing registered nurses with lesser qualified, unlicensed personnel. In 1996, nurses at Brigham & Women’s Hospital drew national attention when they took a vote to go out on strike to prevent implementation of such a plan at their facility. The nurses won language in their contract to prevent this practice and since then, a number of other MNA hospitals secured similar language, which protects patients from receiving care from someone unprepared to meet their needs.
Limits on Mandatory Overtime - Again, as hospitals cut costs by laying off nurses and operating with a skeleton nursing staff, the practice of using forced overtime to compensate for lack of staff proliferated through Massachusetts hospitals. Patients throughout the state began receiving care from exhausted and overworked nurses, who were more prone to make errors. In 1997, nurses at Boston Medical Center voted to go out on strike over the issue. In 2000 and 2001, nurses at St. Vincent Hospital/Worcester Medical Center and Brockton Hospital did go out on strike over this issue. The result of these actions was the negotiation of landmark language in contracts to require appropriate staffing, limit mandatory overtime and to allow nurses the right to refuse overtime should they feel too tired to provide safe care.
Improvements in Staffing - The most important factor contributing to a nurse’s ability to provide safe, quality patient care is the number of patients he or she is assigned. Because of health care cost cutting measures, most nurses in Massachusetts are being asked to care for too many patients. Here again, MNA local bargaining units have been able to negotiate a number of provisions to help improve nurses staffing ratios. At Boston Medical Center, the nurses’ union and management work together to determine appropriate staffing levels, at St. Vincent Hospital/Worcester Medical Center actual staffing guidelines have been established. Unionized nurses are also leading the effort to pass legislation that will mandate safe nurse-to-patient ratios in all health care facilities, union or non union, to ensure that all nurses can practice safely, and that all patients have access to quality patient care.
Inappropriate Floating of Nurses - As hospitals have cut back on nurses, they have attempted to compensate for short staffing by forcing nurses to move from one area of the hospital to another to cover for vacancies on a given shift. Very often they move nurses from unit to unit without any effort to ensure the nurse being floated is prepared to practice in the new area. For example, a medical surgical nurse is moved from her floor to cover in the emergency room, even though she has no training or experience in emergency nursing. A number of MNA bargaining units have used the collective bargaining process to negotiate limits on this activity and/or to force the hospital to provide appropriate orientation to a nurse before he or she is floated to an unfamiliar unit. According to Higgins, the biggest and most obvious advantage unionized nurses have is the ability to say "no." "If you work in a non-unionized hospital and management decides it wants to impose mandatory overtime, replace your colleague with an unlicensed person, or ask you to care for 12 patients when you should be caring for five, there is really nothing you can do to stop them. In fact, many nurses in non-unionized facilities have found themselves without a job when they speak up about such conditions. When that happens, the patients being cared for in that environment are the ones who suffer. Their health and safety depends on the conditions the nurse is asked to practice in. If nurses lack a protected voice and cannot truly advocate to make those conditions safe, then the patient will not be safe."

1 comment:

  1. This study shows that legislation and contracts are needed to ensure safe patient care. The numbers don't lie.


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My Story

My Story

I have been a nurse for just over ten years. I earned my degree with the support of my wife and financial assistance for the GI bill. I was drawn to the profession of nursing after a brief exposure to an advanced course in field triage while serving in the army. I find the human body fascinating and am always learning. I also was attracted to the profession for all the usual reasons that bring people to the profession of nursing. I enjoy the reward of giving to my fellow man.

I believe that health care and the advocacy of safe care is the foundation of nursing that was started by our founders like Florence Nightingale. Our practice act calls for our profession to advocate for our patients and against practices that puts their safety in jeopardy.

The healthcare industry has for the last twenty plus years constructed an environment to maximize profits at the expense of patient safety and our profession. We as nurses have stood by fairly quit and allowed for this to happen.

Recently, I and others voiced concerns related to patient safety and working conditions at Summit Hospital a hospital owned by Healthcare Corporation of America. Our issues included the working of nurse with approximately six month of experience for more than twenty four hours straight. This particular nurse did volunteer to work these hours but in my opinion should not have been ask to do so. She is a great nurse for her limited experience but put her license and the safety of her patients at risk that night. The manager of the unit failed her and the patients in her charge. Study after study has shown that the error rate goes off the chart after twelve hours. I and fifteen other nurses also expressed to management our concerns over the floating policies that were sending unqualified nurses to our unit. We noted several instances were these nurse made errors that put the patient in potential jeopardy. We also expressed our concerns over ratios of 3 to 1 becoming the norm in the unit when 2 to 1 is considered the norm in intensive care across most of the country.

We submitted these concerns in writing and signed by sixteen nurses from our unit. Management responded by holding meetings with a group of employees that they chose and their representatives which included the director of HR, our unit manager and the director of nursing. The meetings at their start gave us some hope that our issues might be taken seriously and dealt with. It was soon apparent that would not be the case and these meetings quickly moved away from our issues to their issues. They would agree that their were problems but would not put any solutions into writing, stating that they needed to be able to remain flexible and made statements like we will try instead of we will.

At around this same time I was informed of an organization called the NNOC or National Nurses Organizing Committee, that was holding meetings in the Nashville area to organize nurses to advocate for patients and against many of the problems that I expressed above. I met with their organizer and felt that their movement was something that I could support. I became a member of the NNOC and began attending meetings on a regular basis. I also began placing invitations to attend meetings in the break room of my unit and speaking with interested coworkers, while on break, about the need to organize and advocate for our patients and our profession.

After a short period of time I was ask by my manager about my involvement with the NNOC and my desire to form a union at Summit Hospital. I did not deny my association and did not hide my opinion as to why I felt that organizing was needed. I also informed them that I had the right as outlined in the National Labor Relation Act. The nursing staff at Summit was then subjected to mandatory anti union meetings and letter sent to our homes and to our email accounts at work. I was required to attend meetings with the hospital attorney and informed that because I was a charge nurse I was considered management and could not associate with the NNOC. I contested that I was a member of management but submitted to their demands to end my association with the NNOC. I never attended another meeting or recruited for the cause after that meeting. I did however continue to operate a blog, , that advocated for reform of the healthcare system and employee rights to organize. I did not use computers at work for this endeavor and did not use my real name on the blog or use any other names that would tell a reader where I worked or who I worked for.

I was ultimately terminated from Summit Medical Center on June 11th, 2008 for what I was told was the operation of a blog. I was given no specifics of what about the blog was grounds for my termination despite my asking. I appealed my termination through the hospitals employment dispute resolution process, attempting to get clarification as to what about my blog was cause for my termination. The peer panel dispute process was a sham. The panel as outlined by the hospitals policy was to be made up of my peers, who were “not familiar with the problem or have a close relationship with any of the parties involved”. The panel was anything but and was made up of persons who had expressed an open hostility to my rights to organize and to freely associate with the NNOC in the past. Two of the panel members were charge nurses from the ER also under the supervision of my manager, who had terminated me. These two persons were also at the meeting with the hospitals attorney and expressed anti union sentiment. Another panel member was a person who was well aware of my personal views related to unions and the right to organize and had been present at private settings outside the hospital were I had expressed my opinions related to the issues that started all this. This puts three of the five panel members in clear violation of the policy. I then was refused the right to seek any clarification as to what about the blog was grounds for my termination despite that being the stated reason for the panel. I was not given the right to hear the reasons as stated by my manager and the director of HR.

I am writing this because I believe that my fundamental right to due process has been violated. This is a right to work state and right or wrong that gives Summit the right to do as the please when it comes to hiring and firing of employees but most people believe and Summit attempts to mislead their employees that they are fair and just when it comes to matters of employee issues.

If Summit is allowed to get away with this and is not challenged then patients are at risk. Health care workers need to be free to advocate for safety for their patients and if they are scared into submission then patients will suffer.

Join me in fighting for our rights to free association and to advocate for our patients as our practice act requires. Support the employee free choice act, and send a message to Summit and other corporate bullies that feel you are entitled to the rights they give you and nothing more.
Also visit sited like Leap for Safety and support petitions to mandate stronger legislation that will ensure a safer environment. Visit to get involved.

I truly believe that our healthcare system is in dire trouble and we as nurses have a responsibility to get involved. Please join the fight. Your family may one day depend on what we do today.

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