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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Tuesday, April 29, 2008

CNA and SEIU fighting hurts us all.

I am a member of the NNOC the national arm of the CNA and I agree with your call for the two unions to make peace and see that their fights are hurting the nurses they are charged to represent. I have asked the CNA to stop their anti SEIU campaign and focus on the promotion of better working environments for nurses and safer patient care.

I support ratios and much of what is being proposed by the CNA and do feel that we have to be firm with hospital administrations as they are with us. We will not succeed if we continue to be our own worst enemy. There is so much to do and we will all lose if we focus on our differences as opposed to our common goals of making the acute care setting a safer place for nurses and patients.
I plan to post your comments on my blog at

On Wed, Apr 23, 2008 at 11:18 PM, The Nurse Unchained wrote:
The Nurse Unchained
Nurses alleged that nurses attack them!
Posted: 23 Apr 2008 12:13 PM CDT
Dateline Dearborn, Michigan – Nurses alleged that nurses attack them!Yes, you read correctly, the nurses and other members of the California Nurses Association/National Nurses Organizing Committee (C.N.A./N.N.O.C.) alleged that during their convention in Dearborn that members of the Service Employee International Union (S.E.I.U.), a rival nursing union, barged into their event and began to harass and attack their members. C.N.A./N.N.O.C representatives have alleged that at least one woman was injured during this altercation and had to be treated at a local hospital for her injuries.When I read this report in my e-mail and later in my local newspaper I thought what a sad, sad day for the nursing profession; and a sense of déjà vu came over me. Since several years ago I was very nearly “that” woman who had to be taken to the hospital after being accosted by a male RN who was a C.N.A. member.During a special election that had been called by our Governor the C.N.A., S.E.I.U. took issue with a request from the Governor to delay the implementation of phase two of the California mandated nurse/patient ratio law, asking that a review and report of the impact of phase one first; this request seemed reasonable to me since many hospitals were claiming the law had been at the heart of a series of hospital closure and the nurses were arguing that it had “solved” our state’s nursing shortage. A review of what phase one had or had not done seemed reasonable however some chose to interpret that to mean a rollback of the law. So the C.N.A. started its now famous campaign where it dogged the Governor and many other elected officials to various events throughout the state holding loud and boisterous demonstrations and even interrupting the “non-political” annual Governor’s Conference on Women. Historically this conference has placed a focus on women and women issues with little to no political agenda, a rare venue where divergent groups could gather for an open exchange of ideas – no more because since that day the conference has become like so many public meetings have become susceptible to “hijacking” by one group or another for its own political agenda.I was with a group of nurses who decided that we had had enough with members of the C.N.A. disrupting events through-out our state and when the C.N.A. decided to hold their post-election night event at the same venue as ours we decided to take our signs and hold a low-key, peaceful demonstration outside their room; since of course what’s good for the goose is good for the gander – no? As we stood outside the door of their event with our signs; members of the C.N.A. came out to demand that we leave, when that failed they tried to drown us out and when that didn’t work they tried kicking my cane out from under me so I’d fall.So, while I found it very distressing that nurses would resort to physically assaulting one another (as if they don’t experience this type of bullying enough in the workplace) I found it rather ironic that Rose Ann DeMoro would yell “foul” when treated to some of the same tactics she and some members of the C.N.A./N.N.O.C. was infamous for – talk about the pot calling the kettle black. This recent event also helps highlight what happens when people are intentionally “radicalized”, allowed to funnel all their frustration (both real and imagined) into a perceived “foe”, and then let lose to vent. The past several years have seen the C.N.A./N.N.O.C. aggressively recruiting for new nurse members throughout the country. In many of these recruitment activities there have been accusations made that the C.N.A./N.N.O.C. has engaged in union raiding, the use of State Board of Nursing mailing lists to recruit (this is usually prohibited), and even the attempt to recruit under the guise of emergency response, etc.There is little doubt that the C.N.A./N.N.O.C. has developed a reputation for “bare-knuckle” fighting and not being shy at calling out those that they perceive are hampering their agenda. Most organization members would welcome such aggressive “protection”, however sometimes when a group behaves in a way that is very much outside the societal norm and don’t face consequences then the groundwork is laid for the potential of even more outrageous behavior in the future and where does the line get drawn?Time for disclosure, for those who may be unaware of my personal bias let me make it clear I am not one who supports or promotes the idea of unions for nurses. I am however a firm believer that nurses should seek out, participate and join professional associations, but NOT unions. Strikes and the behavior exhibited by the rival nursing unions in Michigan are a good example of what happens when nurses adopt the no-holds barred mentality of unions.Another thing that has concerned me about the recent confrontations in Michigan is the silence from organizations that claim to be professional nursing associations and advocacy groups on the alleged nurse on nurse violence that was reported to have occurred in Dearborn, MI. You’d think that they would at least issued a statement denouncing such unprofessional, let alone poor human behavior. Of course, I’m sure that if this had been an episode of E.R. or House maybe we’d have received a denouncement.I’m also concerned at the fall-out from this violent encounter, since the S.E.I.U. and C.N.A./N.N.O.C. confrontation over the stalled unionization in Ohio I have received numerous mailers from the S.E.I.U. about the transgression; and now with the events in Dearborn one wonder if there will be an intervention or will things continue to escalate? However, Ms. DeMoro shouldn’t be allowed to cry wolf about the S.E.I.U. members “stalking” C.N.A./N.N.O.C. members since it has been my experience that the C.N.A./N.N.O.C. has engaged in this behavior, usually meant to coerce uncooperative nurses at hospitals targeted by the C.N.A./N.N.O.C. for union organizing. Don’t believe me just read the testimony of nurses from Cedars-Sinai hospital that describe what they experienced at the hands of C.N.A. representatives when they opposed unionization; as well as the documented threats made to some nurses’ families. This does not mean I believe such behavior is justifiable or acceptable but it is interesting that when C.N.A./N.N.O.C. members experience such hostility it is suddenly not so palatable. Maybe this might be a significant emotional event for both groups to step back and take a look at what has happened and what is happening and maybe alter the collision course they are both on. Of course there are some observers who also see this as an opportunity to expose the darker side of nursing unions, and it very well maybe but the question remaining is will the media report and investigate, or will they take their usual role of union sympathizer and sweep it under the rug? Meanwhile, this morning a brief news article revealed that a court official had lifted the temporary restraining order that had been granted to the C.N.A./N.N.O.C. against the S.E.I.U. The court official ruled that the restraining order was “not supported” by the evidence filed by the C.N.A./N.N.O.C. (source Los Angeles Times, April 23, 2008)

Sunday, April 27, 2008

Redifining Nursing

I am in the middle of a book titled the The Complexities of Care, Nursing Reconsidered. The book examines the definition of nursing as it is defined by it self, hospital administrations and the public. The Editors of the book make the point that nursing definition of it self is a large part of the current problem that face our profession. It asserts that because we allow and reinforce the virtue side of our profession instead of the science based, knowledge based and skill based profession that we are, we are able to be trivialized and have no real voice at the national and local tables that decide our professional fate.

I agree and ask every person who reads this blog to think hard about what they do. I care about my patients and I define that as giving great care. I assess my patients and report the findings to the appropriate physician so that treatment may be adjusted. That physician has already been there for the day, so without my eyes and ears and most importantly my knowledge and ability to understand what I am seeing and hearing my patient may experience a prolonged recovery, or even death. I am the patients advocate. We are the hub of all the other disciplines as they interact with our patients to include PT, OT, Speech, Case Managers, Social Services, Dietary and many others. The quality of the nursing that a patient encounters during their hospital stay is in my opinion as important as the quality of their surgeon or physician and in some cases more important. If you have a bad physician, a good nurse can be the difference between life and death for a patient. If you have a great surgeon and a bad nurse you are also at great risk of death. We should take both of those extremes and understand the great influence we have over the outcomes our patients experience.

We need to let our patience know what we really do. It may seem like patients should just see what we are doing and make the connection to the fact that we are helping them recover and that we in some cases are the difference between life and death but studies show that they appreciate and respect us for traits like caring and compassion but not for our knowledge and skill.

We need to take credit were credit is due and stop giving it away to other disciplines. Stop covering for physicians and the administration. We are hurting ourselves every time we shelter our patients from the truth about their doctors lack of caring or the hospitals lack of concern when they jeopardize patient safety with poor staffing. If a patient ask what took so long let them know we are short staffed and I got here just as soon as I could. If they ask you why the physician has not called the family don't make excuses tell them you informed him or her three times that the family wished to speak with them and you don't know why they haven't called or came by. These excuses allow the system to avoid change. Or patients are entitled to know the risk and benefits of their care at the hospital they choose. Its time we gave out a little tough love to the administrations.

We are not their public relations people we are the nurses in their employee that have the right and responsibly to provide safe patient care to those patients that choose that particular hospital.

Thursday, April 24, 2008

Elinor Christansen - Waiting Lists and Universal Healthcare

Just another example of the truth.

Project Sin Alma: Linda Peeno on Denial of Care

view this video and thinkabout your own experiances both private and professional. I know we can do better. It comes down to the fact that it's just not right to treat people as you would any other expenditure. The insurance companies are in bussiness to make money and this is in conflict with our oath to cure illness, promote health and insure the dignity of our patients. Where do they get off thinking they have the right to make life or death decisions for me or my family, or your family.

Terminal Health Insurance

This is an example of a working person who is being screwed by the system and will probably die as a result of her cancer not being treated. The insurance company and the Doctors should be charged with negligant homicide. We as health care workers take an oath to advocate for our patients. Who advocated for her? Who will advocate for you?

Sunday, April 20, 2008

Union Myths

Visit this site for an examination of a few of the myths that are regularly promoted by some anti union administrations.

This post is intended for the purpose of general education and not as a direct rebuttal to any particular administrations position.

Other links relatedto nurse pay and the nursing shortage

Here are some additional links to articles that discuss nursing pay and issues related to the nursing shortage. Hope they are helpful and enlightening.

Inflation and rising cost of insurance versus the so called wage increases.

Nursing Shortage

This data is part of what your administrator's know but have failed to act upon. They complete their surveys through groups like Press Ganey but they usually always report fantastic numbers. We are all so satisfied. Have you ever wondered why you seem to be the only one on those polls that isn't completely satisfied.

They know why we are unhappy and how to fix it but are failing to act. Below is a snipet from an article related to the nursing shortage written in 2005.

According to Press Ganey and Associates, there is a perfect correlation between hospital employee satisfaction and patient satisfaction. Consider these numbers:
41% current nurses are dissatisfied with their job
43% scored high on a range of “burn out” measures
22% plan to leave the profession in the next year
55% would not recommend their profession to family or friends

The last stat tells the largest story in that we are so disappointed with the response of our administartors to the problems that face acute care we won't even recommend the profession to our friends or family and this is in contrast to what most nurses will describe as a love for the profession or a CALLING.

To view the full article go to:

Nursing Shortage

Visit this link for a full study that examines the causes of the nursing shortage and some ideas on what can be done to solve the problem. This is a 2000 study but you will see after reading it that nothing has really changed and in my opinion has only gotten worse. The address is The article is quite long but very well laid out.

Thursday, April 17, 2008

SEIU Healthcare in Tennessee

This is not an advocation for unions but an example of one way to deal with the safety issues that face our profession.

Are you suprised that a union exist in Tennessee and what is your opinion on unions? Post your comments.

TN Healthcare Crisis

Suprised to see this in your back yard? Im not. I wonder if any of our administrators would be suprised. Maybe the nearly blind woman should ask her friends. Should I be my brothers keeper? You tell me!

What you will hear from those in oposition to universal health care is that we already do millions of dollars in indigent care. I say that it is not enough. Plain and simple; we can do better and should!

Money Talks: Profits Before Patient Safety

Another example of the failure of our current system. Write your representative and ask that the FDA do it's job and protect the citizens of our nation.

Money is the Key. If you remove or at very least legislate the profit componet of our health care system we will be able to solve some of our current problems.

Get Involved, comment on this video.

Types of universal health care used around the world

This is a sumary of the models examined in the frontline presentation titled Sick Around The World. I hope this sparks discussion and gets people involved. Write your representatives and let them know you suppport a universal health care system. The statements below were copied and pasted directly from the PBS website. The address is listed in the posting below this one.

There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills.
But we don't have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns.

There are four basic systems:

The Beveridge Model
Named after William Beveridge, the daring social reformer who designed Britain's National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.
Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.
Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world's purest example of total government control.

The Bismarck Model
Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system -- the insurers are called "sickness funds" -- usually financed jointly by employers and employees through payroll deduction.
Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model -- Germany has about 240 different funds -- tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.
The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The National Health Insurance Model
This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.
The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.
The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model.

The Out-of-Pocket Model
Only the developed, industrialized countries -- perhaps 40 of the world's 200 countries -- have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.
In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.
In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat's milk or child care or whatever else they may have to give. If they have nothing, they don't get medical care.
These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.
For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.
The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too.

Sick Around The World

Go to this site and view this documentary by Frontline a PBS news show. The program compares the US system to other nations in the delivery of health care. THIS IS A MUST SEE!!
The web address is

Comparison of the US System to that of Canada

For-Profit Health Care:
Expensive, Inefficient and Inequitable

Dr. Arnold S. Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School and Emeritus Editor-in-Chief of the New England Journal of Medicine

Presentation to the Standing Senate Committee on Social Affairs, Science and Technology

February 21, 2002

Mr. Chairman, Honorable Members of the Standing Senate Committee on Social Affairs, Science and Technology :

My name is Dr. Arnold S. Relman. I am Professor Emeritus of Medicine and of Social Medicine at the Harvard Medical School and former Editor-in-Chief of the New England Journal of Medicine. I have been asked by the Canadian Health Coalition to appear before you today to testify about the U. S. experience with private, for-profit health care.

I have been studying and writing about this subject for over two decades. In 1985 and 1986 I served on a committee established by the Institute of Medicine of the U. S. National Academy of Sciences to report on "For-Profit Enterprise in Health Care." During my editorship and afterwards, the New England Journal of Medicine published many articles in this field and, since I retired from that post, my own writings have continued to focus on this topic. I am now at work on a book that surveys the present unhappy condition of the U. S. health care system, with particular attention to the role of private enterprise.

My conclusion from all of this study is that most of the current problems of the U. S. system - and they are numerous - result from the growing encroachment of private for-profit ownership and competitive markets on a sector of our economy that properly belongs in the public domain. No health care system in the industrialized world is as heavily commercialized as ours, and none is as expensive, inefficient, and inequitable -- or as unpopular. Indeed, just about the only parts of U. S. society happy with our current market-driven health care system are the owners and investors in the for-profit industries now living off the system.

The U. S. may be a world leader in medical science and technology, and its major medical centers may provide some of the best and most sophisticated care available anywhere, but taken as a whole, our health care system is failing and will need major reform very soon. We have tried private for-profit markets, first in hospitals, in ambulatory care facilities and services, and in nursing homes, and then more recently, in the ownership of insurance plans - and the experiment has failed. Private health care businesses have certainly not achieved the benefits touted by their advocates. In fact, there is now much evidence that private businesses delivering health care for profit have greatly increased the total cost of health care and damaged - not helped - their public and private nonprofit competitors.

The U. S. experience enables students of health care policy to compare the performance of nonprofit and for-profit facilities as well as the performance of insurance systems, and the results are clear for all who want to examine the evidence. For-profit hospitals were much more expensive than their nonprofit counterparts when Medicare and private insurers simply reimbursed charges. That difference disappeared when the payers began to negotiate fixed prices, but there has never been any evidence that for-profit hospitals could provide similar services at lower prices than their nonprofit competitors. However, a recent study of Medicare per capita expenditures for all health services, including hospital care, found that they were much higher in regions served exclusively by for-profit hospitals than in regions where there were fewer or no for-profit hospitals.

There is no good evidence about the relative quality of hospital services in for-profit and nonprofit facilities, because such studies are difficult to do. Quality is easier to ensure in nursing homes and kidney dialysis centers. They are largely paid through fixed, negotiated prices by public insurance, and their products are more or less standardized. Studies that have looked at objective measures of quality of service show that public and private non-profit nursing and dialysis facilities provide significantly better and safer services to patients than their for-profit counterparts. This shows that when you fix the price and the services so that there is no wiggle room, non-profits clearly provide better care.

A little over a decade ago, for-profit investor-owned businesses took over the private insurance field, and now they cover more than half of our people - mainly through employers. More than a quarter of our population is covered by Medicare and Medicaid, which are largely financed by government. Comparisons of these private and public systems are instructive. The Medicare system has administrative costs of less than 3 percent, with all the remainder of expenditures going to physicians, hospitals and other providers. The private insurers, on the other hand, have corporate and administrative costs of 15 to 30 percent, and in addition outsource many other services they use to control costs by restricting the use of expensive resources. As a result, it can be estimated that only 50 to 60 percent of the premium dollar ends up with the providers, who themselves must pay additional administrative costs to deal with the regulations of the multiple insurers they must bill. And, while the private insurers at first held down premium prices by drastically cutting utilization, they have now run out of cost-cutting options and are meeting increasing resistance from providers and the public. Recently, premium prices of private for-profit insurers have again begun to increase at double-digit rates, more rapidly than the costs of Medicare and Medicaid.

A remarkable demonstration of the failure of the commercial, HMO insurance system was seen a few years ago when senior citizens covered by Medicare were encouraged to obtain their care from private, for-profit HMOs that would be paid by the government. It soon became obvious that the costs of care under the private system were much greater and that senior citizens were dissatisfied with the care they received. A wholesale exit of senior citizens from the private system ensued. They voted with their feet for the public system.

In short, the U. S. experience has shown that private markets and commercial competition have made things worse, not better, for our health care system. That could have been predicted, because health care is clearly a public concern and a personal right of all citizens. By its very nature, it is fundamentally different from most other good and services distributed in commercial markets. Markets simply are not designed to deal effectively with the delivery of medical care - which is a social function that needs to be addressed in the public sector.

PHOTO: Taken during Dr. Arnold S. Relman's testimony before the Standing
Senate Committee on Social Affairs, Science and Technology (February 21, 2002)

We in the U. S. are belatedly learning this lesson and soon may be ready to try other options that will depend more on public action. Many of us south of the border have always believed that you Canadians had the right idea in deciding that the financing of health care is primarily a public responsibility. We still think you are right and that we ought to emulate you, rather than vice versa. I am surprised and disappointed in your Committee's Interim Report, which seems to favor policy options dependent on private market involvement in Canadian health care. Before making your final recommendations, I hope you will look more closely at the U. S. experience - which ought to convince most evidence-driven observers that markets can't solve public problems like health care - and in fact make them worse.

However, to make a publicly financed system work effectively, I believe both our countries need to begin reforming their medical care delivery systems. That is where we both ought to be looking for ways to optimize our use of resources and improve the quality of our health care.

I believe that splintering the delivery system into many different, highly specialized facilities, as has been proposed in both our countries, is not in general a sound option for improving quality and effectiveness. A much better approach would be to re-organize how physicians work together. Both our countries now depend largely on independent solo medical practitioners to provide ambulatory and hospital services on a fee-for-service basis. We should both begin to encourage physicians and other health care professionals to organize themselves into self-governing, multi-specialty and multi-disciplinary teams to deliver comprehensive care at prepaid, capitated rates. Physicians provide the best care when they work in teams, not as competitors. Furthermore, to discourage over service, they should be paid primarily for their time, and not on a piecework basis. That would reduce both fraud and the resources wasted on the processing of claims.

Finally, I want to say just a word about "consumer choice," which is now being touted in the U. S., and I gather in Canada, too, by believers in the magic of the market as a mechanism for controlling costs and improving the quality of services. While there is much to be said for making more information available to people about their health care, it is a fundamental misconception to imagine that sick patients can or should behave like ordinary consumers in commercial transactions, selecting the services and prices they want. Health care is totally different from most goods and services, and that's why we have medical insurance and why sick people need the professional and altruistic services of physicians and other providers.

I suspect most Canadians understand why health care is special and why it needs to be insured by a public system like the one you now have. I would be surprised if they want the fundamental fairness of their Medicare system to be changed by the introduction of market forces.

Thank you for your attention.

Click here for more information on Dr. Relman

Printable Copy of Dr. Arnold Relman's Speech (in PDF format)

Parliamentary Transcript of Dr. Arnold S. Relman's Testimony
to the Standing Senate Committee on Social Affairs,
Science and Technology, February 21, 2002

Click here for more info on Senator Kirby's Controversial Committee

Wednesday, April 16, 2008

Special Report: Nursing Shortage

This video is an important piece of information. We know the problem and we can fix it but it will cost money time and effort. We need to force our legislators, the hospitals and the Universities to pony up and get started on the solution.

Speak up, get involved.

This post is a call to action on the many issues that we are facing in our health care system.
  • Universal Health care- single payer system: the videos posted below all tell very powerful and moving stories of the victims of our current system. The insurance companies and the pharmaceutical companies stand to lose billions if the US adopts a universal health care system. So keep your eyes and hearts open when you think about supporting this issue. I believe if you ask your self what is the right thing to do, you will come to the same conclusion as I have that single payer is a better, fairer way to deliver health care services.

  • Mandated staffing ratios: I believe the evidence is clear that legislated ratios are whats needed to force the hospitals to do whats right. We all know that our patients are getting sicker and sicker as the years go by yet our ratios have stayed the same. There are videos and postings below that give examples of the harm that comes from nurses caring for too many patients at one time. For one the nurses eventually gets burned out and leaves acute care or nursing all together or patient dies or has a less than optimal outcome. Don't be fooled all these issues are about money. It will take money to solve these problems. What is your safety worth, what is your life worth. Ask your self that question every time the thought of cost enters your mind. Also consider the fact that we are not talking about breaking the bank but just reducing profits. There's a big difference between the two. All the experts have said it can be done. It is working in California and in Victoria, Australia. If they can afford it and then why can't we all. There's a new book by Suzane Gordon titled "safety in numbers: Nurse-to-patient ratios and the future of health care." Take some time and investigate how ratios have worked for others and see if its something you think we all need on a national level.

  • More Nurses: If the above occur we will need many more nurses to fill the gap. We need to increase the size of the nursing school programs to accommodate that need. Even if nothing change as far as universal health care or staffing ratios we still need to increase the number of new nurse just to keep up with those that are retiring. Professors at most colleges make about 60-70% of what you would make working acute care or for a pharmaceutical company or insurance company, (watch the pbs video below on health care in crisis for a good example of the problem). We need to demand that more be done to solve this problem and remind our representatives that one day they will need a nurse and their won't be one their to care for them unless they triple the funding to our community colleges, increase the pay for our nurse educators and offer incentives to attract people to our profession. Not band aids but real reform is what is needed and again its going to cost money.

The money is available to make these changes. It's about our priorities and where we choose to spend our money. I believe we should spend the money now or we will spend much more later.

Please become educated on the subject and give your support to this cause by writing your representatives and speaking to your family and friends about these issues whenever the opportunity presents itself. All big changes and reform start as grass root movements. Your voice is important.


Nurse Advocate

Anybody Can Get Sick

Another example of real working people caught in the middle of a system that lacks compassion for the sick.

Please write your representatives to let them know we need a universal healthcare system and we need it now.

Physicians for a National Health Program

Another example of a single payer idea.

Tuesday, April 15, 2008

patient stories and universal healthcare proposol

This may not be the answer but it is at very least a start to the discussion. We can use this model when discussing the issue with our Congressman, Senators, Govenor and President. Get active in the debate now.

Deb Peters Speaks to Community Forum

This video is a great example of the tactics of management. Beware of hollow promises. Look at the actions of your administrations. Talk is cheap, actions speak louder than words. Demand safe patient care.

P.O.V. - Critical Condition by Roger Weisberg | PBS 2008

Says alot about who we are and what we care about. Get involved and remember that the 47 million they are talking about are our neighbors, friends, and family. Without health insurance most people wait to get treatment until it's nearly to late making their hosptal stays longer and their possibily of survival less. Would you want yur mother or father to wait to seek treatment because they were concerned about how to pay the bill?

Critical Condition: America's Nursing Shortage

Watch this video and write your congressman and senator below and demand that they properly fund our community colleges with special funding dedicated to the education of nurses. It is a tragety waiting to happen. If we don't act now things are only going to get worse. Remember this is our Democracy and it time we take it back. The politicians work for us, demand that they do what they were elected to do.

Friday, April 11, 2008

ANA Tips for contacting your representative

Tips: Contacting Members of Congress

Political power. It's what allows individuals, organizations, and associations to ensure that elected officials address their concerns. With issues such as health care reform, patients' rights, and access to care at the top of the political agenda at the Capitol and in the White House, turning on your political power as a nurse has never been more important.

It is critical that nurses speak up-about quality patient care, adequate staffing, safe workplaces, and the multitude of concerns you and your colleagues face every day. Who better to advocate to Congress about the need for quality health care than those who are on the front lines?
Your letters, phone calls, and visits to members of Congress truly make the difference. There are many ways to make your voice heard:

Visit your members of CongressMembers of Congress are often available for meetings with constituents when they are at home in their district. To set up a meeting with your member of Congress, contact the district office and speak with the scheduler. Attending the town meetings that members of Congress often hold during congressional recess is another great way to learn where your member of Congress stands on the issues important to you.
Make phone callsGet the phone numbers for members of Congress from the U.S. Capitol switchboard at 202/224-3121, government pages of your phone book, House and Senate websites and, or public policy staff.
Send e-mail and write lettersBecause of the anthrax decontamination process now in place, delivery of U.S. mail to Congress and the White House is routinely delayed by as much as three months. Using e-mail or sending a fax is really the best way to make sure your voice will be heard in time to make a difference.

Tips on effective e-mail and letter writing:

Be brief Short, direct letters are the most effective. Be specific Deal with just one subject or issue in your letter, and state your topic clearly in the first paragraph.
Be personal -Letters are most effective when they reflect your personal experiences and views in your own words. Form letters don't carry as much weight as a letter that you have written yourself.
Be sure to give your name and address.Legislators and other decision makers pay most attention to letters that come from their constituents-people who will be voting for or against them-so it's important to let them know you are from their district. Including your contact information also enables elected officials to respond to your concerns.
Be persistent-Write often, especially to legislators who are undecided on an issue.

Worker's Rights - Take Back The Courts

This is an interesting video that demonstrates how our rights or what we think are our rights have been eroded. This is only one example. We must fight back!! There are many good deeds done every day by individuals and even corporations but we should not have to depend on the kindness of our employers but have laws that require they do the right thing every time the issue comes up. Its not about the culture at our individual facilities but the culture as a whole. The prevailing culture has no respect for me or you and is focused on the bottom line at the expense of the person.

Nurse-to-Nurse: Why You Need to Be Involved

This is a great video that speaks to why we need to get involved.

Thursday, April 10, 2008

Nurse Safe Staffing - New RN Story

This video gives a good example of why we need to keep pushing for safer staffing ratios. They don't get it and most of our fellow nurses have accepted the way things are and think they have to take it.


new book released this month

The latest book by Suzanne Gordon will be released this month. The book titled Safety in Numbers examines ratios and the effect of legislated manditory ratios in California and other places in the world. The bio for the book is copied and posted below. I encourage everyone to read it. The other books I have read of hers including Nursing against the odds have proven invaluable in my understanding of how we arrived in this situation, in health care today.

Safety in Numbers
Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs.Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. Their book shows how hospital cost-cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients—leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation.With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors’history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in America and the world.Advance Praise for Safety in Numbers:“Anyone who’s been in a hospital lately knows there aren’t enough nurses, but probably doesn’t know why. Safety in Numbers does a great service by portraying in a graphic and compelling way the origins of the current crisis in nursing and the effect not only on nurses but also on patients.”
—Mary Lehman MacDonald, Director, AFT Healthcare, American Federation of Teachers

Here is the link to her website

Hope you are able to read and we can discuss in this forum.

Listen to this

Listen to this radio interview with Suzanne Gordon an author on the subject of nursing and managed cares effect on health care.

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."

a place to share information and advocate for what is right.

This site is dedicated to the protection of our right as professional nurses to advocate for the safety of our patients and our profession. Please keep all post free of personal attacks and specific names of institutions our administrative leaders. Also for the protection of those posting, do not use names in your comments.

I hope this site allows for a free exchange of information that will benefit our desire to influence meaningful change for our profession. Fill free to post any content you see relevant to the discussion. Unlike the administrations we work for their will be no filter on content other than what was described above.


Nurse Advocate

Share your opinion

The post are designed to evoke conversation that leads to action. GET INVOLVED!!!, lets us know your opinion, post your comments today.
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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