Negotiating Patient Safety

This week in the news I was really surprised to read the volume of stories about the hospitals in the middle of contract negotiations with their nursing staff all across the country- I was more surprised to read about the number of hospitals that face strikes from their nursing staff within the next few weeks.  I have always felt it to be an odd thing for nurses to unionize and to have to negotiate for job and patient safety.  (As a disclaimer- I am currently a represented unionized RN and I have been in the past as a staff nurse in other parts of the country as well) Working as a nurse is a well paying job-I will not dispute that, what is not appreciated, I feel, is that we have the education and training to be paid well for.  What we seem to need to always bargain for however, is working conditions that keep staff and patients safe. As an outsider, you would assume hospitals and nurses would both want the same outcome, safety; and they do. From the point of most hospitals increasing staffing levels by hiring more nurses is expensive…that is the bottom line.

Having worked across the country, I know that pay is always one of the last concerns for RN’s. For people who really want to be nurses, the amount we are paid is at the bottom of negotiating concerns.  What is my biggest concern, and I know is shared with colleagues of mine across the country is unsafe staffing levels and unsafe patient care conditions.  As staffing levels increase, and work loads increase the chances of making a mistake increase exponentially.  Nurses take ownership over the work they do. We take ownership and responsibility over the outcomes the units we work in have (blood stream infection rates, UTI rates, Pressure ulcers rates, falls, etc), the outcomes our patients have, and staff and patient satisfaction.

In Bangor, Maine the EMMC nursing staff has been working without a contract since last September and came to a tentative agreement in the final hours this weekend. Reading the news, it seems that staffing was a major point in negotiations.  Per a Bangor Daily News blog article, EMMC had posted on its website that it’s staffing levels had been in line with national staffing guidelines and practice standards and the Maine State Nurses Association as a member of National Nurses United had been disputing these staffing numbers in the news as inaccurate.  In November, they had a one day strike which initiated a 5 day lockout on the part of the hospital. The nursing staff was facing the same again this week.

I feel, as a nurse, being a part of a national labor organization is excellent in theory.  Nursing is the largest health care profession by far and having a united voice and working for the same goals across the country gives more power and strength to your position. However, I am not a fervent supporter of a large national organization calling for strikes, I feel strikes compromise patient safety and do not guarantee job security. It gives the hospital a chance to say “See you are all replaceable.” That is not the message I want patients to hear and hospital management to send.  A hospital lockout I have never heard of before.  I feel that move is as irresponsible as the nursing union calling for a strike. Neither are in defense of patient care.

For the safety of patients and the community that depends on this hospital being open; the nurses that are proud to make it successful; and the organization that relies on it’s nurses for practice excellence; I am very glad a tentative agreement was reached.

In Hawaii public nurses are in a battle to protect patient safety as well.  Of the 7 HGEA (Hawaii Government Employee Association) units the only one to reject the contract which called for a 5% pay decrease for all public employees was the unit for Professional Registered Nurses. The pay in private sector nursing vs. the public sector is already a 30-50% pay difference in Hawaii. That much of a pay difference makes it very hard to keep excellent Registered Nurses and staff your hospitals and patient care centers to adequate safe levels. The nurses are speaking out about why exactly they rejected it. They are hoping to return to the bargaining table. For the sake of quality patient care across the state of HI, I hope a realistic discussion can take place.  The retention of quality experienced nurses working for quality patient care is vital in any organization.

Nurses at 2 hospitals in Massachusetts have announced a planned 1 day strike on May 6th in demand for higher staffing levels. This article in The Boston Globe is the most direct and informative about the striking process from the aspect of the hospital I have read so far.  Because of the contract the hospital signs with the staffing agency that brings in replacement nurses, if the staff nurses strike, they will be locked out for 5 days because the hospitals are contracted to pay for 5 days of replacement staff no matter what.  This is another example of the strike/lockout process that makes me so angry.  While Tufts Hospital President, Ellen Zane, is quoted in the article from the Boston Globe

“We’ve made it clear that we will never agree to mandated staffing ratios for the self-serving purpose of increasing union rolls,’’ said Ellen Zane, president of Tufts Medical Center, an affiliate of Tufts Medical School. “It is an irresponsible request at a time when everybody in the country is looking under every rock for nickels for health care.’’

This strike and subsequent lockout staffed with temporary replacement nurses would be estimated to cost $4.2 million to Tufts Medical Center. I would assume, as an RN, it would be in the best interest of the hospital financially to avoid spending this amount of money for a very short term, temporary, non solution and put that money towards fixing the long term staffing issues within the institution.  I understand the frustration on the part of hospital management that a national organization that the Massachusetts Nurses Association belongs to (the same as in Maine) is a large corporation with it’s own interests.  I don’t feel however that increasing staffing levels or setting a mandatory staffing level is a corporate or political interest-the union may be a corporate and have its own financial interests but nurses themselves will never fight for anything other than what improves patient care.  It is very true that adding 1 or 2 more patients to your shift responsibility changes patient safety, nursing workload, nursing burnout rates, and patient and nursing satisfaction.  All of these should be in the interest of the hospital as it is looking under rocks and in couch cushions for dimes and nickels.

I am a believer in being proactive with patient care at the bedside. I have seen and experienced within my own professional practice that with better nursing staffing levels the amount of mistakes, pressure ulcers, UTIs, falls, and other hospital acquired complications are decreased. I know this is true because I have worked at hospitals with terrible staffing and have seen the negative implications and outcomes patients experience.  When you are responsible for providing care for 3, 4, 5, or 6 patients in the ICU it is not even possible to turn, cleanup, and properly provide care for patients.  These staffing numbers though rare- do happen and they never should.  With higher staffing-patients do get turned frequently, pain medication, oral care, peri care all get given and get done. They are each of them so basically important for nurses to provide in preventing all of the hospital acquired injuries and infections that medicare and insurance companies no longer pay for.  So by increasing staffing levels proactively a very significant decrease in injuries and infections do follow.  It is much more expensive up front, I know that, however being proactive pays off in the long run.

I know it’s pretty obvious I am on the side of the nursing staff at these hospitals. I am also on the side of the patients.  I feel very strongly that strikes, lockouts, and public fighting over contracts makes nurses and organizations look unprofessional and unappreciative.

We all have the possibility at any moment to become a patient at a hospital, that’s the viewpoint I take when I think about these issues.  I want the nurse taking care of me or my family member to be able to come to the bedside right away if I have sudden chest pain and be knowledgeable and experienced enough to know what to do.   Patient safety and nursing excellence are not just things an organization can demand and expect. They are part of a bigger culture that has to flourish.  Organizations that place value on education and training, increasing nursing retention at the bedside, and decreasing nursing burnout all see increased patient and nurse satisfaction.

I know this seems like a far off tangent from nurses striking but these topics are so closely interwoven.  You have to talk about all of it if you are going to explore any of it …. more to come…stay tuned

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