The Measure of a Man

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.

- Martin Luther King, Jr.

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Thursday, October 2, 2008

NNOC testimony to TBON

Can I get a witness?

The text below is only one small part of the testimony that six RNs with the NNOC presented before the TN Board of Nursing on the morning of September 25, 2008. Issue topics were unsafe floating, short staffing, nurses fired for refusing to sign anti-organizing agreements, and institutional pressures on employees to not join pro-union associations. We received a cordial reception which later turned lukewarm. We were told that the proper way to do it was to file for an "Advisory Ruling". Perhaps we'll do that next...

SEPTEMBER 25, 2008


My name is Mark. I work as a staff RN at Tennessee hospital. I'm concerned that patient safety is being put at risk because of inadequate staffing levels. Nurses are being put in the position of either refusing a patient assignment and risk losing their jobs, or accepting more patients than they can safely handle. When a nurse has six, seven, or more patients on a medical-surgical floor, it's quite likely that some aspect of patient care will be missed. Charge nurses are frequently assigned a full patient load, rendering them unavailable to be a resource to the nurses under them. A patient has fallen on the floor after a bed alarm was not answered fast enough, another aspirated some food because no one was assisting with feeding, decubitus ulcers got worse when an incontinent patient was not cleaned up often enough, MRSA isolation procedures were incompletely followed in an attempt to save time, and a PCA continuous morphine dose was not turned off before the patient was stuporous. These are only few specific examples. While they may have turned out to be less than sentinel events, they are still very serious.

In addition to direct adverse events to patients, under-staffing has other consequences affecting delivery of safe care. Many experienced nurses have gotten fed up with the workload, and left hospital nursing. New nurses come in to fill vacancies, but many of these don't stay long because of the stressful conditions. We end up with a high percentage of relatively inexperienced nurses doing their best to care for too many patients. It's a recurring situation, one that management is aware of and has said they will address, but so far, nothing much has changed. It's not unique to my hospital; according to reports I've heard, under-staffing may be even worse at other facilities. As a possible solution to the problem, in the interest of patient safety, the retention of experienced professional nurses, and the recruitment of future nurses, would the Board of Nursing be willing support legislation as proposed by the CNA/NNOC for safe nurse to patient ratios?

Thank you for your time and consideration.
The following was not part of the testimony to TBON:

Below is an excerpt from a discussion board posting, written by the nursing instructor of an RN-BSN course I'm taking, Professional Role Development. It may reflect a typical managerial point of view.

"3) Unions-I am not a union fan in hospitals (note my husband is a union member outside of healthcare). As a CNO, I work every day to provide the best ratios, pay, benefits and work environment for my staff that our facility can afford. I don't see how a union would do any thing in our organization other than complicate things. I have to agree with Jennifer [last name withheld] posting that ultimately if you are not happy with your environment and feel that it is not safe than perhaps it is time to look elsewhere."

So, if conditions aren't safe for patients where I work, I should get a job somewhere else, right? Where should the patients go?


  1. I wish we could get every nurse with a story similar to the ones we presented that day to show up at the next open meeting. Hundreds of nurses would bring the attention that this issues deserves.
    I plan to complete the advisory form and to be at the next Board meeting to hear their response.

  2. The law that went into affect.. where Medicare and Medicaid will not pay for Hospital Aquired Conditions, went into effect October 1st..

    October 1st - What's New at Your Hospital?
    Starting October 1, 2008, Medicare will stop paying hospitals for complications arising from ten preventable Hospital Acquired Conditions (HACs).
    HACs Which CMS Will Not Pay For
    Pressure ulcers stage III & IV
    Severe Falls & Trauma
    Vascular Catheter Associated Infection
    Poor Glycemic control
    Catheter Associated Urinary Tract Infection (UTI)
    Deep Vein Thrombosis & Pulmonary Embolism (DVT)
    Surgical Site Infection after Ortho and Bariatric
    Surgical Site Infection after CABG
    Foreign Object Retained after Surgery
    Blood Incompatibility

    How will CMS decide when not to pay hospitals?
    Unless the condition was "Present on Admission (POA)," or, at the time of admission a complete workup was done which neither confirmed nor ruled out the condition, CMS will no longer move patients whose condition worsens while in the hospital to the higher, more lucrative DRG that reflects these complications.

    Why is Medicare Changing How it Pays Hospitals?
    CMS's goal is to "transform Medicare from a passive payer to an active purchaser of higher quality, more efficient health care." In addition to not paying for HACs, Medicare's other new hospital "Value Based Purchasing" initiatives include

    (a) Public Reporting. At , CMS publishes how hospitals score on 42 quality measurements, including patient satisfaction surveys.
    (b) Pay for Performance. Hospitals will be paid extra for high rankings, or for showing improvement; they will be penalized for low scores. CMS has sent Congress a comprehensive Pay-for-Performance plan and is awaiting approval.
    (c) Other initiatives. More HACs will be added to Medicare's "do-not-pay" list next year; for example, Ventilator Acquired Pneumonia, with annual costs of $4 billion, is under consideration. Also in CMS's sights: penalizing hospitals for failure to rescue, and for 30-day readmission for heart failure, heart attack and pneumonia.

    How will these changes affect nurses and healthcare workers?
    In theory, Medicare's paying hospitals based on patient care quality SHOULD be a major incentive for hospital executives to listen to their nurses about how to fix the root causes of poor quality - eliminating problems like short-staffing, abuse of OT, and over-use of temporary nurses and travelers. The entire patient care team matters: If there is not enough EVS staff, there will be cleanliness and infection-control problems; if there are not enough nursing assistants, patients are at risk for falls and bedsores. So also with shortages in respiratory care, imaging, laboratory and pharmacy staff.

    In practice, will hospitals instead put their focus solely on charting and documentation - adding even more paperwork burdens that drain even more of nurses' time away from caring for their patients?


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You can post your comments anonymously if you like or use any name you choose. We are not interested in knowing who you are but what you think!!

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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