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Tuesday, December 14, 2010
The debate rages on in the field of nursing about the quality of patient care and after care and the impact of unionization on our current system. With the shortages of nurses becoming severe in this country and the institutional stresses and pressures, many nurses feel disenfranchised both by physicians and healthcare administrators.
With California, Massachusetts and Maryland RN unions teaming together and still other RN unions following suit, whether to organize or not and the implications this has on patient care is becoming a real institutional issue.
Opinion is certainly mixed about the issue, with some nurses skeptical about the changes a union can produce when faced with hospital bureaucracy and the dwindling supply of new graduating nurses while more experienced nurses reduce their work time. Some nurses in unionized environments see no improvements in staffing and are concerned about high union dues. Other RNs agree unions are essential to pay nurses top wages in order to support health care and reduce turnover. Hospital administrators who oppose unionization announce that there is in fact no reason for hospitals to become unionized. Hospitals that provide poor patient care will simply lose to other more productive hospitals.
But do independent studies support the idea that unionization will reduce patient care and after care and decrease productivity? Actually independent studies confirm that patient care actually increases, and for reasons apart from just fairer wages. Nursing unions have been pushing to establish RN to patient staffing ratios as well as reduce the overburdening of nurses who often have to perform tasks that aren’t at all their responsibility, and have them focus on their own duties. Patients are also being pushed out sooner, forcing nurses to do more work with their available time and take on more patients. This in turn elevates the risk of patient death.
Establishing RN to patient ratios through unions is actually one way of addressing nurse shortages in hospitals. However, nursing shortages continue to be a problem all across the country in both unionized and non-unionized environments and this has critical implications for patients. While patient care can arguably increase in unionized hospitals, it still won’t increase a lot with the few nurses that currently work in hospitals.
Traveling nursing services can help make up for the shortfall in non-unionized environments and travel nurses can and do work in unionized environment. Traveling nurse agencies send out travel nurses who supersede the union requirement for temporary assignments.
Travel nurse jobs can help ensure the continuity of patient care since travel nursing agencies are experienced and can help relieve a temporary shortage while a hospital deals with more serious organizational issues, since travel nurses can be employed for weeks on end, offering high quality care for an extended period, even up to a year. Hospitals can save money as well, while not having to pay benefits, insurance and sick leave, and most crucially, not have to close their beds due to nurse shortages, which is the first step at providing quality patient care.
Article written by a guest blogger and client of:
Tuesday, December 7, 2010
Last week, President Obama—whose healthcare ideals had heretofore earned the loyalty of reformist RNs across the continent—disappointed many of them by proposing a two-year pay freeze for civilian federal employees, including the 16,000 physicians and medical personnel who care for our veterans.
National Nurses United co-president Jean Ross called the move, “salt to the already festering wound” of the administration’s lack of cooperation in expanding collective-bargaining rights for VA nurses. The union (comprising of 160,000 RNs, including 7,000 VA RNs), shook their heads at the pay freeze proposal and declared that “ending the costly wars in Afghanistan and Iraq once and for all” was a better avenue for cutting federal expenditures than punishing the nurses that care for those who come home from the wars.
A Political Move
In announcing his proposal, President Obama said, “In these challenging times, we want the best and brightest to join and make a difference. But these are also times when all of us are called on to make some sacrifices, and I’m asking civil servants to do what they’ve always done—to play their part.” The move received nods from Republicans, who will take the House in January 2011.
American Federation of Government Employees National President John Gage retorted, “A federal pay freeze saves peanuts at best and, while he may mean it as just a public relations gestures, this is no time for political scapegoating. The American people didn’t vote to stick it to a VA nursing assistant making $28,000 a year.” He added, “It’s unconscionable for him to attack the wages of federal working people while the millionaires and billionaires on Wall Street not only get their bailouts and astronomical bonuses; they also get their tax cuts.”
The peanuts being proposed to be saved amount up to $2 billion in the current fiscal year, and because the scheduled raises will not be retroactively implemented after the fiscal crisis, the pay freeze schedules to save $28 in five years and $60 through 2021.
More Harm Than Good?
Nevertheless, the Economic Policy Institute (a Washington think tank with organized labor sympathies) declared that the proposed pay freeze would not only harm morale and save “chump change,” it would also reinforce conservative myths that federal workers are overpaid. “Such a policy also ignores the fact that deficit reduction and loss of pay at a time when the unemployment remains above 9% will only weaken a too-weak economy.”
For nurses already suffering funding (or perceived funding) shortages and hardship at the workplace, this could mean little good.
Bio: Maria Rainier is a freelance writer and blog junkie. She is currently a resident blogger at First in Education, where recently she's been researching different bsw degree programs and blogging about student life. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.
Thursday, December 2, 2010
Many of the causes of the nursing shortage stems from one fundamental problem: a lack of understanding and respect for registered nurses on the behalf of hospital decision-makers, physicians, and even the general public.
To review, the American (and worldwide) cutback on public and private insurance reimbursement rates in the 1990s steeped healthcare in hot water, and many hospital higher-ups restructured so that, theoretically, fewer registered nurses performed a greater number of tasks. Underempowered nurses were and remain unable to fight back against this manner of tyranny. The overwhelming image of nurses today—despite heroes like Florence Nightingale and Mary Breckinridge—continues to evoke a fluffy, semi-useless Caucasian woman in an adorable uniform. They are the stuff of Halloween costumes and sexual fantasies, not respected and functional members of the medical community as they ought to be.
This seemingly innocuous, if not exasperating, misconception leads to much more devastating causes of today’s nursing shortage.
Funding (or Perceived Funding) Shortage
If nurses are undervalued, it is no surprise that the National Institutes of Health budgets only 0.5% of its funds to the field. With funding in short supply, new nurses cannot be trained, and nursing schools daily turn away countless qualified and eager applicants.
There is also little pay to be doled out to those who do make it—in fact, nurse educators only earn three-fourths of what faculty in other academic disciplines earn. Whereas women—as nursing has retained, as per stereotype, a heavily female-dominant demographic—in other fields have at least cracked through the glass ceiling, nurses have made little progress over the years.
It becomes obvious that it is not funding shortage, per se, but rather a perceived funding shortage that leads to the lack of education of new nurses and short-staffing of current ones. The common view is that money simply cannot be spared on those seen as non-essential personnel. Even if hospitals with perspective want to hire more nurses, they do not have the funds—or the desire to use funds—to pay them.
Poor Work Conditions
With hospital decision-makers devaluing RNs, it is no surprise that nurses are short-staffed and expected to perform more with less. This workload causes stress and, inevitably, mistakes. Many physicians treat nurses as if they were non-essential personnel, leading to lack of respect and trust between the two and often major communication failures that can result in anything from minor annoyances to patient deaths. Add poor salaries and chronic stress to the mix and you have a handful of very unhappy nurses.
Simply because fewer nurses are on duty does not mean their actual duties go away. Without nurses to pay to perform these duties, however, the responsibility has fallen to unlicensed assistive personnel. Sometimes, these duties are not even performed.
This goes back to funding (or perceived funding) shortages. Too few nurses today receive too little training and social empowerment skills to truly excel in their field. Researchers note that formal education and more efficient and pleasant work environments make for nurses with better patient outcomes. Such expertise cannot be taught on an existing nurse shortage.
Gender and Age
Meanwhile, current (female) nurses are only aging, leaving behind few apprentices to take up after them. The world of women has grown in past decades to the point that nursing is no longer a popular occupational choice, and although men have slowly joined ranks among women in nursing, they only account for 6% of American RNs. This accounts for the shortage of individuals who even want to become nurses.
Recently, efforts toward scholarships and loan forgiveness for nurses have been made, but such will not improve the underlying cause of these shortages: the misunderstanding of an RN’s role in the medical field in general.
Since media has proved to be an effective tool in changing public and professional views on healthcare and the medical field, such must be employed to improve the general public’s understanding of nursing. In order to improve healthcare in the US and the world, the nurses must shake off their dusty image of ages past and advance with the times.
Bio: Maria Rainier is a freelance writer and blog junkie. She is currently a resident blogger at First in Education, where recently she's been researching different pharmacist degrees and blogging about student life. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.
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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, http://www.calnurses.org/nnoc/about-nnoc.html 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, http://nurseadvocates.blogspot.com/ , 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, http://www.freechoiceact.org/page/s/aflcio 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 http://www.leapforpatientsafety.org/ 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.