twincities tussle - national nurses united...national nurse, (issn pending) the voice of national...

NationalNURSE

NEW EVIDENCEStaffing Ratios Save LivesCALIFORNIA GOVERNOR’S RACECash vs Care

APRIL 2010

TwinCities Tussle

Minnesotanurses areready todefend theirpatients andtheir practice…whatever it takes.

T H E V O I C E O F N AT I O N A L N U R S E S U N I T E D

Cover_FNL 5/7/10 9:31 PM

NATIONAL NURSE,™ (ISSN pending)

The Voice of National Nurses United,

April 2010 Volume 106/3 is published

by National Nurses United, 2000

Franklin Street, Oakland, CA 94612-

2908. It provides news of organization-

al activities and reports on

developments of concern to all regis-

tered nurses across the nation. It also

carries general coverage and commen-

tary on matters of nursing practice,

community and public health, and

healthcare policy. It is published

monthly except for combined issues

in January and February, and July

and August.

Periodicals postage paid at Oakland,

California. POSTMASTER: send address

changes to National Nurse,™ 2000

Franklin Street, Oakland, CA 94612-2908.

To send a media release or announce-

ment, fax (510) 663-0629. National

Nurse™ is carried on the NNU website

at www.nationalnursesunited.org.

For permission to reprint articles,

write to Editorial Office. To subscribe,

send $40 ($45 foreign) to Subscription

Department.

Please contact us withyour story ideasThey can be about practice or manage-

ment trends you’ve observed, or simply

something new you’ve encountered

in the profession. They can be about

one nurse, unit, or hospital, or about

the wider landscape of healthcare

policy from an RN’s perspective.

They can be humorous, or a matter

of life and death. If you’re a writer and

would like to contribute an article,

please let us know. You can reach us at

[email protected].

EXECUTIVE EDITOR Rose Ann DeMoro

ACTING EDITOR Felicia Mello

GRAPHIC DESIGN Jonathan Wieder

COMMUNICATIONS DIRECTOR

Charles Idelson

CONTRIBUTORS Gerard Brogan, RN,

Hedy Dumpel, RN, JD, Jan Rabbers, Donna Smith,

David Schildmeier,Ann Kettering Sincox

PHOTOGRAPHYJaclyn Higgs, Lauren Reid

as this issue of National Nursewent to press, nurses from aroundthe country were preparing forNational Nurses United’s annualstaff nurse conference in Washing-ton, DC. The theme? ‘RN

Heroes’—a tribute to the bravery and compassion of registered nurses who are making a difference in theirworkplaces, their communities and the world.

And wow, are they an inspiring bunch…starting withthe courageous nurses involved in contract negotiations allover the country who are refusing to give in to manage-ment demands to make patients pay for the country’s eco-nomic crisis. Our cover story this month highlights ourMinnesota colleagues who are standing strong in the faceof one of the toughest battles the state has seen, betweenRNs who have fought hard over the years to win protec-tions for themselves and their patients, and the hospitalswho want to take those gains away.

In Pennsylvania this month, RNs at Temple UniversityHospital displayed incredible heroism on the picket line,standing strong during a 28-day strike in which hospitalmanagement tried to force them to give up their right topublicly advocate for patients. Faced with unity amongnurses and other professional employees at the hospital, aswell as support that poured in from labor unions across thecountry, the hospital caved and RNs were able to settle on afair contract.

“Our union is stronger than ever,” Pennsylvania Associ-ation of Staff Nurses and Allied Professionals PresidentPatricia Eakin, RN, wrote us after nurses ratified the con-tract. “I watched all kinds of nurses and allied professionals

take leadership roles…Temple’s arrogance helped us createa stronger membership.”

You can read all about the Pennsylvania victory in thenews section.

In our features section, you’ll find stories about two RN heroes who are committed to standing up for nurses’and patients’ rights, under very different circumstances. Orsburn Stone, RN, drew on his experience facing perse-cution as a teenager in segregated South Carolina to helplead and win an organizing campaign at MountainViewhospital in Nevada. Clelie St. Vil, RN, also went back to her roots this year, when she traveled to Haiti with NNU’sRegistered Nurse Response Network …the first time she’dseen her homeland since immigrating to the United Statesat age 11.

Being an RN hero sometimes means taking patientadvocacy outside the hospital walls and into the politicalarena. This month, we offer a couple of takes on this year’sgovernor’s race in California—a matchup that will affectRNs and patients across the country, not just in the GoldenState. As you’ll see inside, RNs are having some fun educat-ing the public about the infusion of corporate money intothe campaign. We’re confident that our members will continue to speak out around this important issue, so thatwe can protect the gains in patient care we’ve made in California and take one step closer to our goal of a singlestandard of quality healthcare for all.

RN heroes, we salute you! It’s a tough job, but someonehas to do it.

Deborah Burger, RN | Karen Higgins, RN | Jean Ross, RNNational Nurses United Council of Presidents

Letter from the Council of Presidents

TOC_April FNL CX 5/8/10 3:01 PM

4 News BriefsTension Builds in Twin Cities Contract Fight6 | Study: Sta∞ng Ratios Save Lives 7 | TempleStrike Leads to Victory 8 | Massachusetts Passes Bill Punishing Perpetrators of Workplace Violence9 | Patient Care Rally Hits Home for BorgessMedical Center RNs 10 | Ready, Set, Organize!11 | Veterans Affairs Nurses Seek New Policy to Protect Needle Stick Victims 12 | CaliforniaElections Pit People Power Against Corporate Cash14 | Wrap-Up Report

15 Jerry Brown: The Nurses’Choice for California Governor

16 A Life-Saving Law, Under ThreatNurses fought for and won California’s staffingratios. Now we must defend them from corporatepoliticians. By Rose Ann DeMoro

17 Are You Listening?It’s hard to bond with patients when your eyes areglued to the computer screen. By Helen Greenspan, RN

18 The Long Road HomeA Haitian-American nurse returns to the countryshe left behind. By Erin Fitzgerald

20 Rock SolidEven the toughest of obstacles couldn't keepOrsburn Stone, RN from standing up for nurses’rights at his Nevada hospital. He'd seen muchworse. By Felicia Mello

22 Hospital Magnet Status:Impact on RN Autonomy and Patient AdvocacyWhat exactly are magnet hospitals, and how doesmagnet hospital status affect RNs and patients?Submitted by the Joint Nursing Practice Commission

and Hedy Dumpel, RN, JD

ON THE COVER: Hundreds of nurses rally inMinnesota in support of contract negotiationsaffecting 12,000 RNs. Photo by Ben Garvin

A P R I L 2 0 1 0 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 3

18

Contents15

4

TOC_April FNL CX 5/8/10 2:26 PM

MINNESOTA

As employers continue tostonewall in contract negotia-tions affecting over 12,000nurses in Minnesota’s TwinCities, RNs are stepping up

their campaign for a fair contract that wouldensure patient safety and a secure retire-ment. Hundreds of Minnesota Nurses Asso-ciation members have piled into negotiationsessions to show support for their bargain-ing team. Nurses’ anger is mounting asseveral sessions have failed to produce anyprogress on the contract, which is scheduledfor a vote May 19.

Nearly 1,000 Contract Action Team mem -bers have volunteered to spread the facts tomembers about negotiations. At a rally heldMarch 27 in Minnetonka, close to 1,000noisy nurses rocked the house, demandingcontracts that ensure optimum staffing levels.

“We showed them we stand up for ourpa tients in 1984 and in 2001,” said NationalNurses United Co-president Jean Ross, RN,who walked the line during both of thosehistoric strikes. “I guess we have to prove itto them again.”

The negotiations, which are taking placeat seven separate tables, affect nurses at

Allina Hospitals and Clinics, FairviewHealth Systems, HealthEast Care Systems, Children’s Hospitals and Clinics, MethodistHospital, and North Memorial MedicalCenter, in addition to the pension plan for the entire metropolitan area. Nosessions have been scheduled after May 13and Twin Cities nurses have never worked

4 N AT I O N A L N U R S E W W W. N AT I O N A L N U R S E S U N I T E D . O R G A P R I L 2 0 1 0

NEWS BRIEFS

Tension Builds in Twin CitiesContract Fight

NewsBriefs.REV_April 5/8/10 12:03 AM

beyond a contract’s expiration date. Thousands of lawn signs reading

“Minnesota Nurses—We Care For You,” wereimmediately snapped up and distributedwithin days of printing, and the demandspurred a reprint of the popular item. MNAhas also blitzed the roads and highways ofthe Metro area with billboards bearing thesame message. Many of the boards arestrategically placed where employers seethem every day driving to and from work.

Nurses are sporting stickers and signingpetitions in support of their bargainingteams, while social media forums arebuzzing with nurses and friends discussingthe negotiations. In less than an hour afterMNA posted a message on Facebook, morethan 160 people pledged support on anonline petition. Nurses continue to speakout on Twitter, Facebook, the MNA Blog andother outlets about their determination toadvance innovative staffing proposals thatwill keep patients safe.

The strongest message has been deliv-ered in person, however, by MNA membersrepresenting every bargaining unit whocrowd behind their negotiating teams inbargaining sessions.

The April 6 meeting with Allina HealthCare Systems included 500 nurses, spousesand children, dressed in a sea of red t-shirts.Nurses brought their toddlers to demon-strate to employers the impact of the negoti-ations on children’s futures.

“They are trying to take away our bene-fits. When that happens, everyone loses,especially patients,” said Lorna Eikelberg, a registered nurse at United Hospital in St. Paul. Eikelberg held up a document forhospital negotiators to see that calculatedthe financial effect of their proposal to raisethe number of days the hospital could sendnurses home due to low patient census. Thelost wages from such a change, Eikelbergsaid, would amount to six mortgagepayments for her family.

United Hospital Bargaining Unit ChairGlenda Cartney, RN announced at the tableshe was representing “all 6,000 RNs of Alli-na,” and said she had no plans to move back-ward. “I’ve lived the ’80s,” she said. “There’sno need to return.”

The union will conduct informational pick-eting at several of the hospitals on May 6 and12 to shine a light on the employers’ refusal todiscuss staffing issues. —Jan Rabbers

By Brenda Gieser, RN, United HospitalA version of the following commentaryappeared in the Minneapolis Star Tribune April 15.

More than 12,000 Minnesotanurses are in the midst ofnegotiating a new labor

contract with six Twin Cities area hospitalsystems. While the hospitals continue tobe about their bottom lines, the bottomline for RNs is quite different. Read on:

My name is Brenda, and I will be yourregistered nurse today.

I will be administering medicationsprescribed to you. I will make sure youdo not have allergies to these medica-tions, and if you do have an adverse reac-tion to the medication, I will take action.I will be watching for signs the medica-tion is working for you.

I will deliver your baby, or grandchild,in case the physician does not arrive ontime. I will assist you with breastfeeding,watch for hemorrhage and make sureyour bladder is functioning after thetrauma of childbirth, and I will interveneas needed within my scope of practice.

I will assess and address your painneeds before, or when, you ask for painmedications. I will help to re-intubateyour preemie neonate in the middle ofthe night when he extubates himself. Inother words, if your new baby stopsbreathing, I will save his life and helphim start breathing again. I will makesure your IV is running.

I will initiate CPR if your heartstops or take action if your heart hasirregular rhythms. I will check yournew surgical incision for bleeding, and reinforce the dressing and call the physician as needed.

I will apply a new bag to your colosto-my or other stoma, and do so in amanner that helps ease your discomfort,embarrassment, and anxiety.

I will educate you and your familyabout self-catheterization, in a respect-ful manner. I will lift the heavy CPM

machine, making sure you get yourtherapy as ordered, pre-medicating you with pain meds. I will educate youabout your new joint, pain manage-ment, importance of routine stretchesand exercise. I will remind you of limitations with your new joint.

I will suction you if you are a patientwith HIV/AIDS, and I will attempt to be assigned to you for continuity of care,not because you are an easy patient to care for, but because studies showcontinuity of care is best for the patient.

I will also care for you if you haveMRSA, VRE, H1N1 or other communi-cable diseases.

I will put myself in harm's way whenan out-of-control psychotic teen threat-ens himself, his peers on the unit, mycolleagues or me.

I will care for an elderly patient withdementia who needs to be fed, bathedand lifted out of bed. I will crush her pillsand ask peers if she prefers applesauce or ice cream, so when I feed her themeds prescribed she might take them. I will assess for skin integrity each shift.

I will hold your hand when you aredying.

I will call a physician in the middle of the night to advocate for my patients,even though I know this particulardoctor might be perturbed.

I will conduct myself in a mannerbecoming of a professional RN, on- andoff-duty. I will attend seminars and readresearch articles and study while off-dutyto keep myself professionally astute.

I may go eight hours without taking asip of any beverage or using the restroom,or work overtime during a snowstorm or a weekend or a holiday, not because of overtime pay, but because otherwisepatients may not have adequate staffingand my colleagues will end up having an awful shift.

We are called to this profession. This is not just our job.

Nurses deserve a fair labor contract.Nothing more, nothing less.

A Message to the Public:We’re Fighting forYour Care

A P R I L 2 0 1 0 N AT I O N A L N U R S E 5

NewsBriefs.REV_April 5/8/10 2:28 PM


Four hundred and sixty-eight.That’s how many more generalsurgery patients might be alivetoday if New Jersey and Penn- sylvania had the same nurse-to-

patient ratio law as California from 2004 to 2006.

It’s just one of the findings of a majorstudy on California’s safe staffing lawreleased this month by researchers from theUniversity of Pennsylvania. The most far-reaching examination of the law to date, thestudy found that staffing ratios haveimproved nurses’ ability to provide qualitycare, reduced patient mortality, andincreased nurse job satisfaction.

“Thousands of deaths could be prevent-ed if we improved nurse-to-patientstaffing,” said lead researcher Linda Aiken,RN, PhD, director of the Center for HealthOutcomes and Policy Research at the

University of Pennsylvania. “In every singleoutcome we looked at for both patientsand nurses, mandated ratios led to better results.”

The study, published in the journalHealth Services Research, compared nursestaffing and patient mortality rates at hospi-tals in New Jersey and Pennsylvania—twostates without safe staffing laws—to those inCalifornia. Researchers surveyed more than22,000 nurses in 2006, asking them ques-tions about workload, job satisfaction andburnout.

What they found wouldn’t surprise anynurse on a hospital floor.

California RNs were able to spend moretime at the bedside, detect changes in condi-tion sooner and send patients home with abetter ability to manage their care than theircounterparts in the other states, accordingto the survey results.

The study found that New Jersey hospi-tals would experience 14 percent fewerpatient deaths in surgical units and Pennsyl-vania 11 percent fewer if they applied thesame safe staffing ratios as California. Thatremained true even after researcherscontrolled for 130 confounding factors,including the severity of patient illness.

“We knew when the study was done itwould show what we’ve been saying allalong,” said Malinda Markowitz, RN, Co-president of the California Nurses Associa-tion. “Finally, hospitals can’t dispute it andother state nursing associations can’tdispute it.”

Sponsored by CNA, the first-in-the-nation safe staffing law was passed in 1999and im plemented in 2004. Nurses beat backseveral attempts by the hospital industryand Governor Arnold Schwarzenegger toweaken or re peal it. It set minimum nurse-to-patient ratios by hospital unit—from 1:2in intensive care to 1:5 for surgicalpatients—that must be adjusted upwardbased on how sick patients are.

The study comes as National NursesUnited is working to pass similar laws inseveral states, including Pennsylvania, Flori-da and Illinois. NNU is also lobbying for S.1031/H.R. 2273, the National NursingShortage Reform and Patient Advocacy Act,which would mandate safe staffing ratios atthe national level.

Hospital industry executives haveargued that there was no real science to back up the effectiveness of ratios, and some previous research found only a weak relationship.

But this study, led by one of the mostprominent researchers in the field andpublished in a journal with a reputation forstringent peer review, puts the burden onthe industry to justify their opposition, saidJack Needleman, a professor of publichealth at the University of California, LosAngeles who studies nurse workloads.

“The weight of evidence is that the asso-ciation between nurse staffing and patientcare quality is real and causal,” he said.“Those that make the counter argumentneed to put data on the table and not justoffer theoreticals now.” —Heather Boerner

Study: Sta∞ng Ratios Save Lives

Eighty-eight percent of the medical–surgical nurses in California cared for fivepatients or less on their last shift.

The same was true of only 19 and 33 percent of medical–surgical nurses in New Jersey and Pennsylvania, respectively.

CALIF

ORNI

A

PENN

SYLV

ANIA

NEW

JERS

EY

NEWS BRIEFS


A P R I L 2 0 1 0 W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 7

PENNSYLVANIA

Healthcare workers atTemple University Hospital inPhiladelphia ratified a new con -tract April 28 after an energetic28-day strike that beat back the

medical center’s attempts to break their union. The new agreement for nurses and other

health professionals provides wage increasesthat will keep pay competitive with otherarea hospitals and partially restores a popu-lar tuition reimbursement benefit that thehospital had tried to unilaterally eliminate.Temple also withdrew its proposal to preventemployees from speaking out publicly aboutpatient care problems at the hospital andcompromised on changes to health benefits.

“Temple underestimated the strength of ourmembership,” said Maureen May, RN, presi-dent of the nurses’ union. “Their plan to weakenus did not work. Instead, we became more unit-ed in this strike, and we will return to work witha great amount of pride in what we achieved.”

The 1000 RNs and 500 other healthprofessionals, represented by the Pennsylva-nia Association of Staff Nurses and AlliedProfessionals, struck March 31 after work-ing without a contract for six months.

Workers kept the pressure on manage-ment all month long with rallies and soli-darity campaigns that forced the hospitalback to the negotiating table.

Spirited, raucous picket lines in front ofthe hospital each day inspired passers-by tohonk their horns, community supporters tobring water and pretzels, and other laborunions to pledge their solidarity. Hundreds of

strikers and supporters protested in front ofthe luxury condo of University President AnnWeaver Hart April 3, chanting “Ann Hart,you can’t hide, we can see your greedy side!”

Administration, meanwhile, engaged 850replacement workers at rates of up to $10,000per week plus meals and accommodations—spending as much in the first two weeks of thestrike as it would have cost to meet PASNAP’sdemands, the union estimates.

With Temple demanding to eliminate con -tract language making the hospital a unionshop, reserve the right to make further changesto health benefits without bargaining, and sep a-rate contract expiration dates for RNs and tech-nical staff—which are represented by dif ferentlocals—the strike became a referendum on theunion’s very existence, PASNAP leaders say.

The hospital drew negative media atten-tion early in negotiations for its proposed non-disparagement clause, which would haveimposed fines and discipline on the union, itsstaff and members who said anything negativeabout Temple in any public forum. Duringnegotiations about the clause, Bob Birnbrauer,Vice President of Human Resources, toldhospital workers, “If you want your constitu-tional rights, you need to go somewhere else.”

Union members said they refused to besilenced. “We are patient advocates, first,foremost, and always,” Carol Heyward, RN,a Temple graduate and 23-year employee,said from the picket line during the strike’sthird week.

The final contract, overwhelmingly ratifiedby a vote of 1045 to 30, did not contain thegag rule or other proposals PASNAP leadershad criticized as designed to weaken theunion. Union members’ dependents will be

eligible for up to six credits per semester oftuition reimbursement, effectively a 50

percent discount ontuition, which thehospital also extend-ed to employees notrepresented byPASNAP in the after-math of the strike.On healthcare, amajor sticking pointin negotiations, RNs

and professional employees will be eligible forthree different plans, paying between 10 and25 percent of the premium depending ontheir plan choice. The union will retain theright to bargain any changes to plans and costincreases will be delayed to give workers timeto budget for them.

The strike enjoyed widespread supportfrom organized labor and the universitycommunity. National Nurses United and itsaffiliates from Massachusetts, Minnesota,Michigan and Illinois sent solidarity andstaff. Philadelphia firefighters’ union presi-dent Billy Gault visited the picket line, tellingnurses, “Your strike is our strike,” along withpolice union president John McNesby, whodescribed the quality care his members havereceived from the hospital’s union workers.

Temple University students collected1,900 signatures on a petition to universitypresident Hart and passed a resolution ofsupport through the student senate. Highschool students from the PhiladelphiaStudent Union also walked the picket line.

“We support the Temple nurses. There aremany groups across the city fighting differ-ent struggles and we need to support eachother,” explained Gregory Jordan-Detamore,a senior at Masterman High School.

PASNAP members also worked to educatelocal and state elected officials about their fight.Strikers filled the weekly city council meeting tocapacity on the second week of the strike, andcouncilmembers ultimately passed a resolutioncalling on both sides to negotiate in good faith.

“We were able to win because our memberswere well-informed of the issues all along theway,” said PASNAP President Patricia Eakin,RN. “The organized and active picket line wascrucial in keeping everyone connected, andthe solidarity we got from NNU and otherunions helped keep people’s morale up untilthe end. Our victory shows that you can win ifyou stick together.” —Marty Harrison, RN

Pennsylvania Associa-tion of Staff Nursesand Allied Profession-als President PatriciaEakin, RN addresses a rally of strikingTemple UniversityHospital workers.

Temple Strike Leads to Victory



NEWS BRIEFS

MASSACHUSETTS

Massachusetts legislators havepassed a bill that will stiffenpenalties for those who assaultnurses and other healthcareworkers, one of a series of meas-

ures the Massachusetts Nurses Association isproposing to address the growing problem ofworkplace violence in healthcare settings.

“Violence against nurses is occurring atan alarming rate. This is an important firststep in our effort to make healthcare settingssafer for nurses and for patients,” said DonnaKelly-Williams, RN, president of the MNA.

The bill passed the Senate this month afterclearing the House March 31—the same daymore than 250 nurses from across the Com -mon wealth, many victims of workplace vio -lence, converged at the State House for a pressconference and lobby day, where they pushedfor passage of a package of safety-related billssponsored by the MNA. MNA members sharedwith legislators their stories of being assaulted,putting a human face on the problem.

At a press conference before the Housevote, Donna L. Stern, a registered nurse in amental health unit at Baystate FranklinMedical Center in Greenfield, told a packedhearing room how she has been punched,kicked, almost strangled and spit on duringher five years as a nurse.

Emergency department nurse LindaCondon described an encounter with anout-of-control patient: “I was head buttedin the face by a patient who I was attempt-ing to hold back as she attempted to kickanother colleague who she had thrown tothe ground.”

A 2008 study showed that workers in thehealthcare sector are 16 times more likely tobe confronted with violence on the job thanany other service profession. The problem isrampant in Massachusetts: A 2004 surveyof nurses in the state found that half hadbeen punched at least once in the previoustwo years, and a quarter were regularlypinched, scratched, spit on or had theirhand twisted.

Besides the trauma of the assault, nurseswho are attacked sometimes face additional

health risks. Ellen MacInnis, a nurse at St.Elizabeth’s Medical Center in Brighton,once was trying to put an IV into an HIV-infected patient when the patient took aswing at her, she said, dislodging the IV andspraying blood in her face, mouth and eyes.

“The hospital is the one place where,when you show up there, we have to takeyou in,” MacInnis said at the press confer-ence. “The behavior that we see, in any other

place ... people wouldbe thrown out.”

The event drewextensive mediacoverage through thestate. The next day’sBos ton Heraldopened its story with

the following characterization of the MNA’svictory: “They care. They converged.

They conquered.”Massachusetts law

already treats anyassault on an emergencymedi cal technicianwhile the tech nician isproviding care as a sepa-rate crime with its ownset of penalties. The billthe legislature passed

extends those same protections to nurses. MNA is working to resolve slight differ-

ences between the House and Senateversions of the bill, and hopes to get it to thegovernor’s desk within the next few months.

Throughout the lobby day, nursesdressed in their scrubs and lab coats madevisits to their legislators to seek theirsupport for the assault bill and two othermeasures: S.B. 988, which will requirehealthcare employers to develop and imple-ment programs to prevent workplaceviolence, and H.B. 1931, which will create aspecial “difficult to manage” unit in theDepartment of Mental Health to treatrepeat perpetrators of violence. The othertwo measures are currently making theirway through the legislative process.

MNA Vice President Karen Coughlin,RN, said she has been a victim of a numberof assaults during her years working at oneof the state’s mental health facilities.“Patients, family members and others mustget the message that violence against health-care workers will be treated seriously,”Coughlin said. —David Schildmeier

Massachusetts Passes BillPunishing Perpetrators of Workplace Violence

Massachusetts NursesAssociation memberslobbied hard for a bill increasing penalties for thosewho assault nurses.


N AT I O N A L N U R S E 9

MICHIGAN

Imagine that you are at the negotiat-ing table ready to start the bargainingprocess for your union contract. Thisisn’t the first contract you’ve negotiat-ed with this hospital. In fact, you’ve

been represented by the Michigan NursesAssociation since 1974. Over the years,you’ve fought hard to gain protections in theareas that affect your ability to provide safepatient care, such as floating and staffing.Now, management puts a proposal on thetable that essentially strips away all of thosehard-won patient and employee protections,turning them into policies that can changeat management’s whim. And then refuses tobudge on its proposal. At all.

That was the situation this spring forregistered nurses at Borgess MedicalCenter in Kalamazoo, Michigan. So when abusload of Borgess RNs arrived at theLansing Center for the 2010 MichiganNurses MARCH! on March 24, they wereready to rally for safe patient care. Freshfrom a recent Town Hall meeting with stateRep. Robert Jones, they had heard eachother’s stories about what short staffing

was doing to their units. For them, theMichigan Nurses MARCH!, a day of politi-cal advocacy at the state capital, was achance to recharge and receive the supportoffered by nurses and nursing studentsaround them.

“Many of you know that we’re goingthrough a difficult time right now with ourcontract negotiations at Borgess,” saidShawn Shuler, RN, president of the union,as he addressed over 1,000 nurses and nurs-ing students. “We are standing together toprotect our contract so that our patients aresafe and nurses have a voice at Borgess. Weneed your support.” The crowd burst intoapplause.

Dressed in teal t-shirts stating “RNsUnited for Safe Patient Care,” the BorgessRNs joined other RNs at the gathering ingaining knowledge regarding currentlegislative issues in Michigan and at thenational level. Topics included a look athow nurse-to-patient ratios would saveMichigan hospitals money, what the Michi-gan Department of Community Health istrying to do in the face of severe financialcuts, and an overview of National NursesUnited.

Keynote speaker and leading author on

nursing issues Suzanne Gordon fired nursesup with her comments on the importance ofwinning safe staffing. When it comes tostaffing, she said, hospitals “get away withwhatever they can.”

“There is no special hospital sleep fairy todeal with weekends and evening staffing,”she told the applauding nurses.

The event culminated in a rally on thesteps of the Michigan State Capitol. Chanti-ng, dancing to music, and waving signs, thecrowd roared its approval as speakersincluding NNU Co-president Jean Ross,RN, challenged nurses to fight for safepatient care. The Borgess nurses returned to Kalamazoo encouraged and inspired.

Within weeks of the MARCH!, theBorgess RNs were holding their own rallyfor safe patient care outside Borgess MedicalCenter. With still no movement frommanagement and now an expired contract,the nurses wanted to make sure that boththe Kalamazoo community and the admin-istration knew the issue of safe patient carewas not disappearing. On April 10, over 400nurses and supporters gathered in front ofBorgess Medical Center. Signs waved andpeople cheered after speakers ranging fromnurses to a city commissioner to labor lead-ers expressed their support for the nurses’issues. Cheers of “We are union! Let’s stayunion! MNA!” rang across the front of thehospital.

The fact that Borgess Medical Center isnow owned by St. Louis-based AscensionHealth has dramatically influenced thecurrent negotiations. For years, MNA hasbeen able to bargain contracts with Borgessmanagement that met the needs of bothpatients and nurses. But now, nurses say,corporate profits have taken priority overthe needs of workers and patients.

“I was born at Borgess,” said Pat Meave,RN, a member of the negotiating team, atthe April 10 rally. “My kids were born atBorgess. I’ve been a nurse at Borgess myentire career. I love Borgess. But that,” shesaid, pointing at the hospital, “is no longerBorgess.” —Ann Kettering Sincox

Patient Care Rally Hits Homefor Borgess Medical Center RNs


10 N AT I O N A L N U R S E

NATIONAL

As a registered nurse inNorth Dakota, Barb Warren-Bloms never paid much atten-tion to the union organizingdrives that periodically

happened at her hospital. “I never went toany meetings, but word would spread abouthow bad the union was,” she said.

Then Warren-Bloms started working at ahospital in Minnesota, where RNs wererepresented by the Minnesota Nurses Asso-ciation, part of National Nurses United.There, she discovered, pay was based on anurse’s experience, instead of “random” likeit was in North Dakota, and working condi-tions were better. The difference, sheconcluded, was union representation.

“Once you learn what power you can have,it’s hard not to do more,” she says. “My goalused to be to be in management. Now I realizeI want to be a leader among my fellow nurses.”

Warren-Bloms was one of over 75 nursesand staff organizers who gathered in Berkeley,California over three days in March to discusshow to organize nurses around the countryand strengthen RN unity in healthcare facili-ties that are already unionized. At the first-everNational Nurses United Organizing Institute,RNs shared their experiences in organizingcampaigns, got fired up to take on new chal-

lenges, and learned concrete skills that theycould bring back to their own hospitals.

The conference kicked off with presenta-tions about the state of the labor movement andthe dire need for organizing. Only 19 percent ofRNs nationally are organized, compared with51 percent of teachers and 65 percent of fire-fighters, National Nurses United organizingdirector David Johnson told the group.

“Imagine what the world would look likeif we had 65 percent of nurses under unioncontract,” he said. “We would have a differ-ent political climate.”

The nurses then broke up into smallgroups for role-playing, followed by panelswhere newly-organized nurses talked abouthow they gained union representation attheir workplaces.

On one panel, Kansas City RN SandyBaldrie explained how she and her colleaguesat Menorah Medical Center, a hospital ownedby HCA, recently organized with the help ofother HCA nurses from around the country.The show of solidarity helped overcome someof the resignation and cynicism of nurses ather facility, she said.

“Nurses said ‘Oh yeah, like we’ll ever getrelief nurses so I don’t have to bring my cellphone to lunch.’ We showed them, yes, wecan, we can put it in our contract. I feltinvigorated,” she said.

Role-playing exercises helped RNs under-stand the first rule of organizing: listening. Inone small group, nurses sat with former Cali-fornia Nurses Association/ National NursesOrganizing Committee president Kay McVay,RN, who played the part of a shy, quiet nursecolleague. Through careful probing, groupmembers discovered that McVay’s characterwas worried about new technologies thatwere interfering with her ability to connectwith patients, and the group engaged in adiscussion about how to solve the problem.

A key theme at the conference was theneed to engage newer nurses, who oftendon’t understand that the benefits theyenjoy at their facilities have come as a resultof years of struggle. One of those youngernurses was Rosie Holland, RN, a formerpolitical science major who said she hadlearned more at the institute than she had in years of studying for her degree.

“I didn’t realize everything the union hasdone to affect my work environment andpatient safety,” she said. “I’m going to sharemore of those stories and ask newer nursesto be more involved, even if it’s something assimple as passing out a leaflet.”

Katie Oppenheim, RN, said the con fer-ence had inspired her to do more walk-throughs at the University of Michigan,where she leads the local bargaining unit, toorganize members around issues like swineflu and the erosion of benefits at the hospital.Massachusetts RN Betsy Prescott, a cardiaccase manager at a Catholic hospital, said shehad realized that some of the problems sheand her colleagues were contending with,such as management demands that nursesuse inflexible scripts while talking topatients, were trends around the country.

“We’re all fighting the same battles, andwe’ve got to fight them as one,” she said. “Mygoal is that every nurse in my hospital systembecome a member of NNU.” —Staff Report

NEWS BRIEFS

Ready, Set, Organize!



NATIONAL

Suzanne seta, rn, says she’salways been a careful nurse. Butthat didn’t stop her from beingstuck with a needle contaminatedwith the blood of one of her

patients at a Veterans Affairs hospital. It was 1999 and Seta was working on a

research project, drawing the blood of apatient she knew well, an older man whohad Hepatitis C and had recently hadunprotected sex. There was no sharpscontainer in the exam room, so Seta went torecap the needle until she could dispose of itproperly—and stabbed her finger instead.

“Oh my gosh,” she remembers thinking.“It was one of those moments where you justwant to stand there and cry.”

The patient agreed to be tested for HIV.But because test results weren’t availablequickly at the time, Seta had to make a split-second decision about whether to starttaking antiretroviral drugs that couldprevent her from becoming infected—with-out knowing whether the patient had actu-ally tested positive. Seta chose to take themedicine—a decision she now says left herwith crippling side effects from the powerfuldrugs that she still suffers to this day.

Today, testing for HIV and other blood-borne diseases has improved dramatically.But some registered nurses who may havebeen exposed to such diseases still face anagonizing decision about whether to startpreventive drug therapy, because of hospitalpolicies that don’t require the source patientto be tested, or don’t grant affected nursesaccess to test results. The National VeteransAffairs Council says it’s a dilemma nursesshouldn’t have to contend with, and islobbying the Department of Veterans Affairsto change its position on the issue.

“We want the VA to recognize thathealthcare workers have a right to know thepatient’s infectious disease status if there isan exposure,” said council president Alice

Staggs, RN. “Chemotherapy as prophylaxisis quite effective for HIV if you start takingit within a couple of hours of being exposed.If we have one more piece of information, ifwe know the person is positive, that can helpin making an informed decision.”

Veterans Affairs policy requires thatpatients provide separate, verbal or writtenconsent before being tested for infectiousdiseases, including in needle-stick cases.

Antiretroviral drugs can save the life of anurse exposed to HIV, but the side effectscan be severe. Becky Johnson, RN, was stucktwice with a needle while working withpatients in an HIV clinic in the VA system.The drugs she took the first time raised herliver enzymes to dangerous levels andfrequently made her vomit, she said. “Ithink my husband thought I was going todie,” she said. The second time around,

Johnson said, she opted against themedicine and “just prayed to God.”

But the consequences of nottaking preventive medicine can bejust as serious, nurse advocates said.Ken O’Leary, RN, president of thenurses’ union at a VA facility inNorth Carolina, said he once repre-sented a nurse who contracted hepa-titis from a patient. The office ofemployee health at the hospitalobtained test results for the patientsbut didn’t show them to the nurse,only reassuring her that everythingwas fine, he said. It was only monthslater, when the RN started turningyellow from liver failure, that shediscovered she was infected.

VA Council leaders emphasizethat they recognize patients’ privacyconcerns, but want a policy thatbalances those concerns withhealthcare workers’ rights.

Some private hospitals, for exam-ple, have patients sign a blanketconsent form when they begin treat-ment granting the hospital the right totest their blood for infectious diseases

in the event that a healthcare worker is exposedto it. Several states, including Ohio, Florida andGeorgia, have laws granting healthcare workersexposed to a patient’s blood the right to knowwhether the patient tests positive for HIV.

State laws don’t apply to the VA system,however.

“It doesn’t make sense that we’re treatingdisease, yet we don’t have the right to knowwhat we’re exposed to,” said O’Leary.

Nurse leaders are preparing to meet withVA officials to discuss the issue.

Seta, meanwhile, has undergone treat-ment for liver disease and had two kneesreplaced due to rheumatoid arthritis. Thoughshe cannot prove her ailments are a result ofthe cocktail of antiretroviral drugs she took,both are known side effects of the medicines.

The patient whose blood she was exposed to,it turns out, was HIV-negative. —Felicia Mello

Veterans Affairs Nurses Seek New Policy to Protect Needle Stick Victims



NEWS BRIEFS

CALIFORNIA

As the nation’s most populousstate prepares for a June 8primary election, nurses aremobilizing around a hotlycontested governor’s race and

ballot propositions that will help determinethe future of democracy in the state. Thisyear’s balloting is awash with corporatemoney, with two multi-millionaire guberna-torial candidates vying for the Republicannomination and companies using paidsignature-gatherers to qualify ballot initia-tives tailor-made to boost their profits.

Nurses are push-ing back, supportingcurrent AttorneyGeneral and long-time advocate forworking people JerryBrown in the gover-nor’s race, candidatesfor other state officesthat will advocate forpatients and nurses,and a ballot proposi-tion that will providepublic campaignfinancing to level the playing field in futureelections.

“There’s only one thing that can over-come money, and that’s people,” Rose AnnDeMoro, Executive Director of the Califor-nia Nurses Association and National NursesUnited said at a recent staff-nurse confer-ence on the elections. “And who is the bestin the state of California at talking to peopleabout politics? Nurses.”

The Governor’s RaceThink a billionaire former CEO should be ableto buy her way into the governor’s office with a$150-million campaign treasury? Neither doesCNA. When former eBay head Meg Whitmanannounced she was running for governor on aplatform of firing workers, cutting benefits andrepealing workplace regulations, CNAresponded with a satirical campaign to show

just how out of touch Whitman is with thereality of ordinary Californians.

“Queen Meg,” Whitman’s imperious alterego, has showed up at Whitman campaignfundraisers across the state, asking Californi-ans to crown her governor because, well,she’s rich. “California can’t afford a democra-cy, but I can afford California,” Queen Megtold the press outside a Beverly Hills event,after arriving in a horse-drawn carriage. Her platform: Healthcare for the Nobility,Education for the Few, and Prisons for All.

The light-hearted campaign has a seriousmessage, said CNA Co-president MalindaMarkowitz, RN. “Nobody should be able tobid on California, whether it’s a pretend

queen or a billionaire CEO,” Markowitz said.CNA’s Board of Directors has endorsed

Democratic candidate Brown, who in hisprevious terms as Governor in the 1970s andearly 1980s signed into law nurse-to-patientstaffing ratios for intensive care units, collec-tive-bargaining rights for University of Cali-fornia employees, and a host of otherworkplace-safety and environmental meas-ures. (For more on Brown’s record ofsupport for nurses and patients, see p. 15.)

The PropositionsCNA is supporting Proposition 15, the California Fair Elections Act, which wouldcreate a pilot program of public financing

California Elections Pit PeoplePower Against Corporate Cash

Queen Meg, a ficti-tious candidate creat-ed to protest formereBay CEO Meg Whit-man's run for gover-nor, arrives at aprotest sponsored bythe California NursesAssociation with hersidekicks, BishopMcCain and LordRomney.


for the election for Secretaryof State in 2014 and 2018.The program would givecandidates who can showpublic support, by collectinga certain amount of $5contributions from regis-tered voters, up to about $2million to spend on theircampaign. Candidates wouldbe banned from spendingmore than that amount. Theprogram would be paid forby a tax on lobbyists, andcould serve as a model forfuture elections.

Similar programs alreadyexist in Arizona and Maine.

The spending limits clear-ly represent a shift from busi-

ness-as-usual: candidates and electedofficials in California have directly raisedover $1 billion since 2001, according to thestate’s Fair Political Practices Commission.

CNA strongly opposes Proposition 17, fund-ed by Mercury Insurance Group, which wouldroll back state regulations on auto insurance,allowing insurers to discriminate against driv-ers who weren’t previously insured. CNA alsoopposes Proposition 16, a deceptive measure

sponsored by Pacific Gas and Electric Compa-ny that would make it harder for voters togrant cities and counties the authority todirectly provide electricity to residents.

The RatiosWhat do these elections have to do withCalifornia’s first-in-the-nation safe staffinglaw? Everything. For one thing, gubernato-rial candidate Brown supports the ratio law; his likely opponent, Whitman, wouldprobably try to repeal it if elected.

These elections also mark a turning pointfor United States Senator Barbara Boxer (D-CA), who is sponsoring legislation to extendCalifornia’s staffing ratios to the rest of thecountry. While Boxer looks to be safe in theprimary, Republicans have targeted her fordefeat in November.

“Barbara Boxer has been there for us andwe need to be there for her,” said DeborahBurger, RN, Co-president of CNA andNational Nurses United. “Our very nursingpractice is going to be at stake.”

With patient care standards hanging in the balance, every nurse in the countryhas a stake in these elections—not just thosein the Golden State. (For more on staffingratios and nurses’ stake in this year’s elections, see p. 16.) —Staff Report


US SenateBarbara Boxer, California*

California Statewide OfficesJerry Brown – GovernorGavin Newsom – Lt. GovernorJohn Chiang – State Controller*Bill Lockyer – State Treasurer*Tom Torlakson – State Superintendent of Public Instruction Kamala Harris – Attorney GeneralDebra Bowen – Secretary of State*DUAL: Hector De La Torre – Insurance Commissioner /

Dave Jones – Insurance Commissioner Betty Yee – Board of Equalization, District 1*

*Indicates incumbent candidate

Proposition 13 – Property Tax: new construction exclusion: seismic retrofitting—OPPOSE

Proposition 14 – Elections: Open Primaries – OPPOSE

Proposition 15 – Political Reform Act of 1974: California Fair Elections Act of 2008 – SUPPORT

Proposition 16 – New Two Thirds Requirement for Local Public Electricity Providers – OPPOSE

Proposition 17 – Allows Auto Insurance Companies to Base their Prices on a Driver’s History of Insurance Coverage.– OPPOSE

For a complete list of endorsements, please see www.calnurses.org/legislative_advocacy/

June 8 Statewide Direct Primary Election Qualified Measures

California Nurses Association2010 Election Endorsements


14 N AT I O N A L N U R S E

WRAP-UP REPORTFloridanurses continue to actively support theFlorida Hospital Patient Protection Act of2010, state legislation that would mandateminimum RN-to-patient staffing ratios inhospitals. Florida has a relatively short legisla-tive session, so nurses are writing letters to theirlegislators as well as making weekly trips toTallahasseeto speak to them about the urgentneed for safe staffing and improvements in RNrights to advocate for patients.

There has been ongoing phone bankingwith nurses talking to other nurses aboutwhy the bill is important and asking them tojoin the campaign. More and more nursesare filling out the NNOC-Florida/NNUNurse Report Form to keep track of what isreally happening in the hospitals and shar-ing those stories with legislators.

Nurses are clarifying the differencesbetween the NNOC-endorsed bill that callsfor mandated ratios based on the individualacuity of the patient and set through auniform Patient Classification System, andthe bill endorsed by the Florida NursesAssociation that leaves the final decisionabout staffing in the hands of hospitaladministrators rather than nurses.

Illinoisregistered nurses at University of Chica-go Medical Center held a press conference April23 demanding that the hospital improve RNstaffing and citing a new study that shows RN-to-patient staffing ratios save lives in California,where they have already been implemented.

State Representative Mary Flowers, whohas introduced a safe staffing bill in thelegislature modeled on California’s law, alsoattended the press conference.

“Hospitals in Chicago care for the mostacutely ill patients in Illinois,” said MurielLee, BSN-RN, a UCMC nurse who works inthe multi-specialty unit. “With shorterhospital stays and sicker patients, improvednurse-to-patient ratios are a must.”

OhioOn March 12, ten nurses from across thestate attended a meeting convened by theOhio Department of Health to discuss whichhospital quality measures should be reportedto the public on a new website, Ohio Hospi-tal Compare. Dayton NNOC member JanetMichaelis, RN argued that RN-to-patientstaffing ratio information is an important

aspect of patient care that can be easilyreported to the website.

The next step for NNOC will be participat-ing in a subcommittee composed of hospitalindustry, nursing union, and consumer repre-sentatives. NNOC’s goal is for the public to beable to compare hospitals’ actual, existingstaffing ratios on the site. Nurses would also beable to check the website for their own hospi-tals’ ratio reporting and take action if thehospitals are not reporting truth-fully.

On another front, HeatherIves, RN organized a healthcareforum attended by 120 people inLorain County March 24, whichresulted in the formation of anew Lorain County chapter ofthe Single Payer Action Network of Ohio.

Massachusettsregistered nurses and health profession-als at Morton Hospital in Taunton reachedagreement on a new contract with the hospitalin late April, averting a strike vote scheduled forApril 28. The pact includes strong language tolimit mandatory overtime, protection of thedefined benefit pension plan, a salary increaseto allow Morton’s professional staff to keep pacewith other hospitals in the market, and payparity for Morton’s home care nurses.

“We are thrilled to have achieved thissettlement, which is a victory for all of us—nurses, health professionals, management,and most important of all, ourpatients, who will benefit fromnurses having safer practiceconditions,” said Joyce Wilkins,RN, chair of the nurses’ localbargaining unit of the Massa-chusetts Nurses Association.

The 400 nurses and healthprofessionals had been negotiat-ing since last October, with thelast eight sessions overseen by afederal me di ator. The caregiverseducated the community abouttheir cause, leafleting at local

shopping centers and sporting events andconducting informational picketing outsidethe hospital.

Texasnurses at Cypress-Fairbanks Hospital inHouston voted this month to remainmembers of National Nurses OrganizingCommittee-Texas, defeating an attempt toremove the union at the hospital, the firstprivate-sector medical facility in the state tounionize.

NNOC-Texas represents about 300 regis-tered nurses at Cypress-Fairbanks, who firstvoted to join the organization in 2008. Thenurses hope they will now be able to negotiate

a first contract with management. “We stand together to make a

better workplace for our patientsand for ourselves,” said EricaRamhatal, an RN at the hospital.“We are so proud to be part ofNational Nurses United.”

Texas RNs at Cypress-Fairbanks Hospital are all smiles afterdefeating an attemptto repeal their unionrights this month.

Nurses and communitymembers rally for safepatient care duringcontract negotiationsat Morton Hospital in Taunton, Mass.



“Jerry Brown is the only candidate forgovernor who will fight for ordinary people,and who understands the nursing profes-sion,” said Zenei Cortez, RN, Co-presidentof CNA/NNOC.

If the past is prologue, nurses and pa -tients would fare very well if Brown, a for mergovernor and current attorney general of thestate, is elected governor in November.

In his first tenure as California governorfrom 1975 to 1983, Brown substantiallyimproved patient care standards as well asthe workplace rights for millions of Califor-nians. He implemented the nation’s firstnurse-to-patient ratios, in intensive careunits, and enacted collective bargainingrights for employees of the University ofCalifornia, including thousands of nurses.

A consistent ally of the labor move-ment, Brown signed the first agriculturallabor relations law in the country, andcreated an innovative job training programfor low-income Californians, the CaliforniaWorksite Education and Training Act.

He also made California a national modelin environmental and energy regulationsand created the California ConservationCorps to provide the state’s young peoplewith employment in environmental stew-ardship and disaster response. Consumerprotections enacted under Brown’s leader-ship include the right to purchase genericdrugs, and the nation’s first affordable “life-line” utility rates for seniors.

In his current role as California’s Attor-ney General, Brown oversees corporationsand charities, including hospitals, and has

blocked the sale of community hospitals to for-profit chains. His office is conductingan investigation into the denial of claims byinsurance companies, sparked by a CNA/NNOC study showing denial rates as highas 39 percent.

“As Attorney General, Jerry Brown isworking to crack down on the unconscion -able practices of insurance industries deny-ing healthcare and access to care,” Cortezsaid at the organization’s board meeting, be -fore offering the motion to endorse Brown.

At the meeting, Brown decried corporatehealthcare’s emphasis on cost-cutting andskill-degrading technology at the expense of patients. “We’re in the midst of an effortto replace people with formulas, with proto-cols, with computer software,” he said. “Thatreally is inhuman. I see it in healthcare. Wehave to put the patient, the caregiver right inthe forefront. A sense of morality, socialjustice, and a true spirit of democracy has tobe the spirit going forward.”

Brown’s effective enforcement of work-place protections includes suing unscrupu-lous employers for denying workers wagesand benefits required by state law, shuttingdown companies that have jeopardizedworker safety, and prosecuting businessesthat have bilked California’s workers’compensation system or otherwise circum-vented state tax and employment laws.

It’s an unmatched record on behalf ofworking families. And it’s a critical timefor California.

Having failed to solve the budget crisisfor over two years—a crisis largely created

by current governor Arnold Schwarzeneg-ger’s givebacks to the richest Californiansand excessive borrowing prior to the finan-cial collapse—the state faces another $20billion deficit this year. Unemployment is ata modern record of 12.5 percent. We’re justnow seeing an increase in consumer spend-ing but no significant uptick in hiring.

Brown’s public service experience willbring Californians together to solve theseproblems. A Brown victory in the nation’smost populated state would also pave theway to enact nurse- and patient-friendlylegislation that could serve as a model forthe rest of the country.

As California heads towards a June 8primary election, the two multi-millionairesvying to become Brown’s Republican chal-lenger boast that they will run the state ‘like abusiness.’ Arnold Schwarzenegger’s adminis-tration has shown what corporate-style ruleby a rich autocrat does for California nurses,patients and workers. Continuing with thisapproach is contraindicated.

Fortunately, California has an effectivealternative: experienced leadership with a proven record on behalf of the state’sworking families.

The california nurses association/

National Nurses Organizing Committee

executive board unanimously endorsed

Democrat Jerry Brown for governor of California

at its March 20 meeting.

Jerry BrownThe Nurses’ Choice for California Governor

Commentary_FNL CX 5/8/10 3:16 PM


“More nurses, lessdeath.” The succinctheadline in thePhiladelphia Inquir-er April 20 about thefirst major study on

California’s historic law summed up whatnurses and patients have known for a longtime. Minimum, specific, numeric RN-to-patient ratios, augmented by a genuine patientacuity system, are the single most effectivesafeguard for hospital patients.

It’s why California’s ratio law has becomethe national model for safer nursing care, acritical part of addressing the unfinishedbusiness of national healthcare reform,which includes establishing a single stan-dard of quality care for all in hospitals.

It’s also why nurses and patients fromcoast to coast have a lot at stake in the criti-cal California governor’s race this fall.

Lower mortality rates, understandably,are the calling-card achievement of the ratiolaw. But ratios, the study proves, also meanRNs have more time to spend with patients,more time to observe changes in their condi-tion, more time for educating them and theirfamilies to promote better post-dischargecare. And, by assuring nurses the ability tosafely practice their profession, they reducenurse burnout, keep nurses at the bedside,and promote recruitment of new RNs.

The documentary evidence, provided incompelling detail by the eminent nurse re -searcher Linda Aiken and her University ofPennsylvania research team, dismantledreams of anti-ratio rhetoric from the hospitalindustry and its acolytes in academia and theAmerican Nurses Association. Case closed—the law works. As we always said it would.

There was only one major element miss-ing in the study: agency. California’s life-saving ra tios would never have become law,and sur vived wave after wave of healthcareindustry assaults, without the CaliforniaNurses Association.

It was CNA, with all the power, focus,

creativity, and unity of our direct-care nurseleadership and staff, that wrote the law, mobi-lized thousands of nurses and patients to fight to enact it, produced unprecedented research toassure strong, specific ratios were adopted, de -feated a hospital industry lawsuit and regulatoryattacks, and stopped the most famous governorin the world when he tried to roll back the law.

Further, it’s CNA and other NationalNurses United and National Nurses Organ-izing Committee affiliates who have ledefforts to pass similar legislation in morethan a dozen other states styled on thesuccessful California experience. And it isthe coming together of NNU that inspiredthe creation of a national ratios bill, S 1031,the most comprehensive legislation fornurses and patient advocacy in U.S. history.

But all our efforts to pass and defend thelaw, and to build a powerful national model,should also serve as a sober reminder. Nursesand patients have powerful adversaries in themulti-billion-dollar hospital industry, with allits economic and political clout, and only thecontinued vigilance of our leaders andmembers, and support from the public, willprotect the law and its life-saving benefits.

It’s a lifeline that can be very tenuous, aswe were reminded when California Gov.Arnold Schwarzenegger issued his infamousemergen cy regulation in November 2004 atthe bidding of the hospital industry as a firststep to overturn the law.

It took the most herculean effort CNA hasever mounted to save the law. For those whomay not recall, Schwarzenegger issued his fiattwo days after a Presidential election in whichhe was widely credited with helping re-electGeorge W. Bush and was at the apex of his pop -ularity. Many of the supposed experts counseledus to accommodate and conciliate, not fight.

But RNs knew how much was at stakeand refused to be silent. We decided to targethis fundraisers, drawing the links betweenhis corporate contributors and his corporate,anti-patient, anti-nurse, anti-worker agenda.As we held protest after protest, others

began to join us. Soon it was no longer justRNs, it was a mass movement.

Schwarzenegger lost in court, he lost in thearena of public opinion, and then he lost at thepolls with all four of his anti-union special elec-tion initiatives crashing to humiliating defeat.

If we had not acted, the Terminatorwould have won—a prelude to eroding otherpatient-care and workplace protections.

Today, we face a similar challenge.Billionaire CEO Meg Whitman, who somehave characterized as “Arnold on steroids,”threatens to buy the governor’s office inCalifornia and ram through an even moreamped-up corporate agenda.

Whitman’s avowed program includes“streamlining” regulations to create a more“business-friendly climate” in California, suchas eliminating workplace standards thatmight interfere with accumulation of profits.

So it should come as no surprise thatWhitman says she wants to roll back Univer-sity of California staffing to 2004 levels. Thathappens to be the very year when the ratioswent into effect, and Schwarzenegger, incollusion with the California Hospital Asso-ciation, sought to overturn them.

We will need every ounce of that samepeople power and street heat again toprotect California’s law. Now that theevidence is in, we know that silence trulydoes mean death for hospital patients.

From Arizona to Massachusetts, the hos -pital industry and its allies have con tributedto the attacks on the California law whichthey, too, know serves every day as a living,effective model solution to the patient carecrisis for nurses, patients, and legislators inother states and Washington as well.

We will have to summon all the creativity,energy, and dedication of our national nurs-es movement to re-secure the law in Califor-nia, and to extend its life-saving benefits tothe rest of the nation.

Rose Ann DeMoro is executive director of National

Nurses United.

Rose Ann DeMoroExecutive Director, National Nurses United

ALife-SavingLaw,UnderThreatNurses fought for and won California’s staffing ratios.Now we must defend them from corporate politicians.

RAD_April 5/7/10 9:38 PM


office every day to drop off charts, or nothaving to spend hours in the office search-ing for paper charts only to find that anurse had taken them home and forgottento bring them back. All of this soundedpretty good, even to me, a kind of minimal-techno type. However, now four years intoit, I can honestly say I don’t think any of usreally understood what real-time use ofcomputers in home care would look like.

The use of laptops in hospice has present-ed many unexpected challenges. Securityand confidentiality of private health infor-mation is a top one. Suddenly, the “Oh cool,I’ve got all my patients’ information righthere in my laptop!” became “Uh-oh, I’ve gotall my patients’ information here on mylaptop!” No one, not even the managers, wasprepared for this. Who knew that it would bea federal issue when a laptop was stolen orlost? Field staff have been scolded, disci-plined, and even terminated for lapses injudgment which might allow for privatehealth information, or PHI, to be, well, notso P. Should you find yourself in the unfortu-nate position of being held at gunpoint withsomeone demanding “Your computer oryour life,” you’d best give up your life so youcan hang onto your job. And there’d betterbe signs of a struggle!

Apart from all the security issuessurrounding the use of laptops in hospice, my

biggest objection to it is this: While I see theimmense benefit from having my patients’records literally at my fingertips (and I imag-ine would fight like heck if they ever tried totake our computers away from us for thatreason alone), I cannot reconcile the use oflaptop computers in patients’ homes, espe-cially in hospice, for one reason alone—itinterferes with the capacity to connect fullywith our patients. Call me a holdover fromthe past, but I still believe in the kind of nurs-ing where we hold someone’s hand whenthey are frightened, versus documenting“anxiety” on a scale from 1-10. Or listeningdeeply as a dying person searches our eyes forconnection, which, by the way, they can’t findif our eyes are glued to a monitor.

Most of all, I value the practice of deeplistening and full presence, which requires aminimum of two people and no electronicdevices. When my 16-year-old daughter tellsme “I’m listening!” while her iPod is blaringin her ears and her fingers are manipulatingbuttons to find the perfect song, well, call meoverly sensitive, but I don’t feel like I’m beingheard. Likewise, when I am sitting in mypatient’s home plunking in information onmy computer, my attention is not fully withmy patient. It’s true, I can look up everyminute or so and give a reassuring nod to letthem know I’m really listening, but we allknow the quality of attention is differentwhen a third, electronic party is present.

There are nurses who will defend theirability to handle both patient and computerin the home setting, claiming that they canmaintain connection with their patientsdespite their fingers and their brain doingtwo separate things at the same time. Thereare other nurses, and we all know them, whohave literally left the profession scratchingtheir heads wondering what happened. Me,I’m somewhere in the middle. I value the useof computers at home or in the office, but Istruggle with laptop use in patients’ homesand am outraged at the haphazard PHIprotocols and the fear that the PHI godshave implanted in home care nurses. Mostly,though, I am saddened by what looks likethe replacement of heart-based listening andattention for those who are physicallyvulnerable by speed and efficiency which,ultimately, don’t heal a damn thing.

I know one thing for sure, though. Mymother was right when she told me yearsago, “It’s nice to listen, when you’re beingtalked to.”

My mother taught me to be on

time, to send thank you cards for gifts,

and to always help those less fortunate

than I am. Most importantly, she taught me about

Are YouListening?

By Helen Greenspan, RN

kindness, and the importance of humanconnection. My career in nursing hasallowed me a perfect playing field tonurture these qualities. Throughout my21 years of nursing, nothing has beenmore meaning ful to me than the times Ihave been able to step outside of theflurry of tasks, data, and time con -straints and enter into a space of quietintimacy with my patients, simply bybringing my attention to our sharedmoment without distraction and with-out agenda. While so many other partsof my job as a hospice nurse are de -manding, draining, and stressful, thistype of connection is the nectar thatsustains me as a nurse.

But as nursing gets more regulated,even hospice is being forced to move toa more corporate model for care. Enterthe laptop.

What were we thinking? For manyof us, it sounded like a good idea atthe time. More ease and efficiency,access to patient information at ourfingertips, a quick click of the mouserather than all that writing. The daysof suffering from numb hands andstiff necks as we sat charting in ourcars, limbs twisted in ergonomicallynightmarish positions, would be over.The ease of not having to return to the

1-Page Feature_FNL CX 5/8/10 3:17 PM

On the plane to haiti,

Clelie St. Vil, RN, is quiet. Ina bouncing truck ride acrossrutted roads on the way toSacre Couer Hospital out-side Milot, she is the onlynurse not laughing aboutbeing tossed around theback seat on what another

nurse calls, “Mr. Toad’s Wild Ride.” Instead, she looksout the dusty windows, studying everything she sees.

St. Vil is in Haiti with National Nurses United’sRN Response Network experiencing “déjà vu.”

“It’s like I’ve done this same trip before in anotherlifetime, and I’m seeing it all over again. It’s like I’vebeen here before,” she says.

St. Vil has been in Haiti before. She was born here,but swears she can’t remember anything about her lifebefore age 11. That’s when her mother brought her tothe United States. But when her mother became toosick to care for her, St. Vil was taken away from her,leaving St. Vil to a life in and out of foster care homes.After difficult years bouncing from family to family, St. Vil becamepregnant at 16 and lived in a group home during her pregnancy.

Some would have called her future bleak, but St. Vil was unstop-pable. While she was pregnant she took a high school nursing edu-cation class, and later, she worked as a nurses’ aide. She quicklydiscovered her passion for nursing. At 17, she got her own apartmentwith her young daughter Abigail and her little sister and beganworking toward her degree, starting with an associate degree in psy-chology and completing a B.A. in nursing.

In the United States she works at University of MassachusettsMedical Center at Lowell in cardiac med-surg and is proud of whatshe has achieved. Her daughter Abigail is now 14 years old anddances professionally. Her second daughter, Savannah, is two.

The desire to adopt a third child orphaned by Haiti’s earthquakewas just one of the things that drew St. Vil to notice RN ResponseNetwork literature in the National Nurses United brochure given toher by her union, the Massachusetts Nurses Association.

“I’ve always wanted to do disaster relief,” she says. Because she wasorphaned herself, St. Vil says she is more empathetic towards patients.The ten-day trip to Haiti seemed like a good fit. So she volunteered.

Since being in Haiti, her happiness is palpable. St. Vil’s journeyback to herself began before she ever volunteered. Long a member of

a predominately white church, she joined a Haitian church severalmonths before the trip, and immersed herself in Haitian culture.

Before her departure, she fretted that Haitians wouldn’t under-stand her mix-and-match Creole dialect—part Haitian Creole, partU.S. Creole, and everything in between.

But once in Haiti, it soon becomes clear to St. Vil where shebelongs. After her first shift at Sacre Couer Hospital, talking to andcaring for patients in the intensive care unit, the worry on hermouth breaks into a broad smile. “It works!” she says, beaming.“They understand me!”

“I love it here,” she says.A few days later she is in Sacre Couer’s ICU helping pull surgical

staples out of a girl’s infected leg. She holds the girl’s hand, andknows everything about her. “She was orphaned as a girl. She worksas a vendor,” she says. Her mothering instincts have sprung to life.During the operation she comforted patient Enise and held herhand tightly, calling her “Cherie,” or “Dear.” Later, she will advocatefor Enise with the fierceness of a lion, saying she must stay in theICU and continue care.

One orphan protecting another.

Erin Fitzgerald is a videographer and writer for National Nurses United.

The Long Road HomeA Haitian-American nurse returns to the countryshe left behind. by erin fitzgerald


Haiti_2 5/8/10 3:16 PM

Clelie St. Vil, RN (right)arrives in Haiti for the first time since leaving the country at age 11. Opposite, St. Vil comforts a patient at Haiti's SacreCouer Hospital.

Haiti_2 5/7/10 9:49 PM

t was a summer evening in 1965 when 13-year-old Orsburn Stone saw the men in the familiar white sheets gather on the front lawn of his family’s home in South Carolina.As the Ku Klux Klan members lit and burned a cross, Stone, furious, grabbed a shotgun andran towards the front door. He wanted to do something, anything, to stop them.

“My mother and grandmother grabbed me around the legs and said please, don’tgo out there,” Stone, now 58 and a registered nurse, calmly recalls. “They probablysaved my life that night.” Instead, Stone went to the back door and fired a few shots inthe air. The men left, he says… and never came back.

The trials of the segregation-era South may seem like a long way from the corri-dors of MountainView Hospital in Las Vegas, Nevada, where Stone works as a critical-

care nurse. But Stone says experiences like that night prepared him to withstand the pressure ofa contentious, year-and-a-half-long organizing campaign that led to the first unionization vic-tory for the newly-formed National Nurses United in January. And Stone’s colleagues say hisquiet determination, coupled with kindness and respect for those around him—even when hedisagreed with them—helped give nurses the moral high ground in the campaign.

“Stone was relentless; he didn’t let anything get in the way of what he knew was right,” saysJulia Gomez, a pre-operative nurse at MountainView, where Stone is known by his last name.“When he believes in something, he puts everything in.”

Tall and immaculately dressed, Stone is a familiar figure in the hospital, where he currentlyserves on the team negotiating MountainView RNs’ first contract. He has worn many hatsthroughout his life, from military officer to Catholic deacon. Through it all, he says, he has beenguided by the simple lessons his mother and grandmother passed down to him: “There’s no onegreater than you and no one worse than you. We’re all human beings. And, make sure you getyourself an education, because once you do, no one can take that away from you.”

That sense of dignity got the teenage Stone in trouble that summer of 1965. He had workedodd jobs for a local white man by the name of Peebles, who alwaystreated him fairly. But then Mr. Peebles referred Stone to a friend of hiswho ran the county fair and the local general store, and wasn’t as good-natured.

“He rode me like a workhorse and degraded me,” with racial slurs,Stone says. “By the end of the first day, I had had enough. I said ‘Mr.Nash, I apologize because I know Mr. Peebles went to great lengths toget me this job. But I am quitting effective immediately. Whatevermoney you have set aside to pay me for today, you can keep it.’ “

It was that night that Stone’s family received their visit from themen in white. Soon after, while still in junior high school, Stonemarched in a civil rights protest called by Martin Luther King, Jr.

He later joined the United States Air Force, working his way up tocaptain and attending nursing school in his off-duty time. He earnedboth a bachelor’s of science in nursing and a master’s degree in man-agement, then left military service for nursing in 1991.

At MountainView, he quickly became known as a source of support for hisstressed-out coworkers. “We all have big workloads but yet he’ll listen tosomebody’s problem with their patient and make a suggestion, when he’s justas busy as we all are,” says Jacque Weise, RN, who works with Stone in thehospital’s float pool. Recently, one of Weise’s patients, a large man, was havingtrouble breathing and kept trying to get out of bed. Stone came into the roomand “just his presence seemed to help,” she says.

Rock Solid

Even the toughestof obstacles couldn’t keep Orsburn Stone, RNfrom standing up for nurses’rights at hisNevada hospital.He’d seen much worse.By Felicia Mello


Profile_FNL CX 5/8/10 3:14 PM

In 2008, MountainView nurses deter-mined to improve staffing and patient careand win a greater voice in hospital deci-sions began discussing with the CaliforniaNurses Association/National NursesOrganizing Committee about joining theunion. Stone was one of the first to sign up.A float nurse, he had developed relationships with nurses in manydifferent units at the hospital. He quit his part-time job teachingnursing at two local colleges and was soon spending his days off atMountainView, talking to RNs about the benefits of being part of aprofessional organization like CNA/NNOC.

“I was doing it mainly for the benefit of the nurses coming behindme, and the patients they will be serving,” says Stone, who plans toretire within a few years.

“Stone is not the kind of person who says, ‘I’m going to take the lead,you guys need to stand behind me and do what I tell you,’ ” says Gomez.“If anything, he has a way of empowering people to speak up for them-selves, by asking very poignant questions that inspire self-reflection.”

From the beginning, a small minority of anti-union nurses triedto derail the campaign, MountainView RNs say, harassing and evenphysically assaulting union supporters.

Because he had been outspoken, Stone became known as a nurseleader among both his coworkers and the hospital administration. Onone occasion while he was campaigning at the hospital during non-workhours, the police arrived and asked him to leave. Stone explained that hehad a legal right to be there, politely complied with their request…thenreturned another day. The event became legend at the hospital.

“Some people thought I was the heart of the whole operation,”Stone says now, “but in reality there were a lot of people who madethis happen, both within CNA/NNOC and at MountainView.”

When in January the MountainView nurses finally voted over-whelmingly to join CNA/NNOC, “it was one of the most joyous times inmy life,” says Stone, laughing with glee at the memory. “It was extremelyexhilarating. But I recognized that the true work had just begun.”

Stone, who is studying to become a Catholicpriest, had put his education on hold duringthe campaign, but is now on track to becomeordained within a year. Like many of the clergyinvolved in the civil rights movement and othermovements for social change, he sees hisorganizing work as intimately connected with

his faith; building National Nurses United, he says, is part of his calling. “My faith as a Catholic calls me to bind the other’s wound and

care for my brethren, and that’s what this organization does,” hesays. “I’m supposed to help those that are helpless, and there are alot of helpless people in healthcare.”

Saying mass at the 300-member St. Thomas’s Catholic Church inLas Vegas—deacons like Stone are allowed to fill in for priests in apinch—keeps him in touch with the struggles of low-income peoplein Nevada, where the recession has hit hard. A few weeks ago, one ofthe congregation members approached him asking for assistance.The man explained shyly that he had a job, but hadn’t eaten in threedays. Could Stone do something to help?

“I look out over the congregation and say, how many people are in thesame situation but don’t have the courage to come forward?” says Stone,who connected the man with a parish program that helps the needy.Nurses can be part of the solution to these larger injustices, he says.

“I honestly believe that as nurses united, we can change the courseof this country and the world,” Stone told a group of RNs at a recentorganizing school sponsored by NNU. Shortly afterward, he was on aplane to Texas to help organize another hospital owned by HCA,MountainView’s parent corporation. Though he only spent four daysin Texas, he speaks of “the brothers and sisters in El Paso,” with thesame affection and sense of solidarity with which he talks about hiscolleagues at MountainView, or the members of his church.

“Just like I did here, I’ll do whatever it takes to make sure theyend up with proper representation,” he says.

Felicia Mello is acting editor of National Nurse.


Orsburn Stone, RN, helped lead a successful organizing campaignat MountainView Hospital in LasVegas, Nevada. Here, he listens toa presentation at National NursesUnited's Organizing Institute.

Profile_FNL CX 5/8/10 3:14 PM


DESCRIPTION: This home study examines the impactof hospital magnet designation on the independentprofessional judgment of direct-care registered nursesand their right and duty to advocate for their patients.

Background

In 1990 the american nurses association (ANA)approved a proposal that recognized excellence in nursingservices. This was based on an earlier research done by theAmerican Academy of Nursing on practice in U.S. hospitals.The variables used in the study were called “Forces of Mag-netism” and the facilities were called “Magnets” because they

allegedly attracted and retained registered nurses.The Magnet Recognition Program was developed by the Ameri-

can Nurses Credentialing Center (an ANA subsidiary) to recognize“health care organizations that provide nursing excellence.” The pro-gram also provides a vehicle for “successful” nursing practices andstrategies.

The Magnet program is based on quality indicators and stan-dards as defined in the ANA Scope and Standards for Nurse Admin-istrators (2004). The Magnet designation process includes 14qualitative factors in nursing also known as the 14 “Forces of Mag-netism” which were first identified through the research done in1983 (See Appendix A). The stated intent is to provide “consumerswith the ultimate benchmark to measure the quality of care thatthey can expect to receive.”

In an updated (2009) edition called Nursing Administration:Scope and Standards of Practice, nurse administrators are requiredto embrace the concepts reflected in the Five ModelComponents associated with the Magnet Recogni-tion Program. They include: Transformational Lead-ership; Structural Empowerment; ExemplaryProfessional Practice; New Knowledge, Innovation,and Improvements; and Empirical Quality Results.The Five Model Components incorporate the 14qualitative factors in nursing.

HISTORY OF MAGNET HOSPITAL RECOGNITIONThe Beginning—“Forces of Magnetism”Aligned with Patient Intereststhe magnet program began in the early 1980swhen health care provider services were funded byfee-for-service and indemnity insurance methods.

Hospital and medical group revenue and profit were generated byproviding services to meet patient needs as determined necessary byphysicians and other professional caregivers, including direct-careregistered nurses. Fee-for-service financing of hospital care deliverygenerally aligned the interests of physician and hospital providerswith patients in ways that promoted trust, continuity, and financialincentives to provide necessary care for patients.

In this economic scheme, the original magnet hospitals were rec-ognized on the basis of superior RN staffing ratios and significantadministrative support for direct-care RNs. The staffing ratios andadministrative support provided the necessary foundation for effec-tive, RN-friendly scheduling policies and a nurse-patient relation-ship which allowed competent practice under professionalstandards of care. As described by the American Academy of Nurs-ing in 1983:

In magnet hospitals there is a low patient-to-registered nurse

ratio, with adequate staff to provide total nursing care to all

patients.

Furthermore, the quality and complexity of patient care needs

are taken into consideration when the staffing is planned; this is

important in minimizing stress. The nurse does not feel over-

worked and has an opportunity to meet all of the patient’s needs

— psychological, interpersonal, and physical. There is also time for

interaction among nurses so that continuity of care is insured and

nurse-to-nurse consultation is encouraged. The nurses express

great satisfaction in their opportunity to provide good care and in

administration’s support for it.

The 1983 Study by the AAN interviewed nursesworking for hospitals that were part of the originalmagnet selection process who summarized theirexperiences by identifying the most important fac-tors in promoting recruitment and retention of staff.The key factor and driving force for all factors was “a nurse-patient ratio which assures quality patientcare,” followed by “flexible staffing to support patientcare needs,” “flexible scheduling,” and the practice of“primary nursing.” Staffing ratios were the absoluteand mandatory condition of magnet hospital nursingservice that enabled nurses to care for their patientsin a manner consistent with their professional prac-tice obligations, ethical norms, and personal careermission as registered nurses. The AAN summarized

CE Home Study Course

Hospitals are increasingly looking to the American Nurses Associa tion’s magnet hospital

program as a way to boost their reputations. But what exactly are magnet hospitals, and

how does magnet hospital status affect RNs and patients? To find out, take this home-study

course and submit the attached quiz by mail for 2 continuing education credits.

Hospital Magnet StatusImpact on RN Autonomy and Patient Advocacy

Submitted by the Joint Nursing

Practice Commissionand Hedy Dumpel,

RN, JD

Provider Approved by the California

Board of RegisteredNursing, Provider

#00754 for 2.0 contact hours (cehs)

CE_April 5/7/10 11:59 PM

the essential finding of its study in unequivocal terms: “The nursesspeak of being able to deliver safe, adequate care as a result of thesestaffing patterns.”

Sharing similar operational interests driven by fee-for-serviceeconomic incentives, nursing and hospital management at the origi-nal magnet hospitals broadly agreed with nurses regarding the cen-tral factors that had an impact on recruitment and retention, citing:“adequate staffing and flexible scheduling,” “good salaries and bene-fits,” “participative management with active involvement of staff inplanning and decision making,” “primary nursing,” and “a predomi-nantly RN staff that is fully supported by nursing administration.”Nursing executives emphasized the importance of RNs being able tocarry out skilled nursing tasks themselves, without delegation to lesstrained individuals. And, the original magnet hospitals were found-ed on a commitment to maintaining a sufficient complement ofdirect-care RN staff to meet patient needs at all times, with virtuallyno use of agency personnel.

This was the meaning and workplace reality of the “forces ofmagnetism” identified by the American Academy of Nursing twen-ty-five years ago, at a time when institutional providers and physi-cian groups were generally thriving in a dominant “fee-for-service”market characterized by a close alignment of provider, direct-carenurse and patient interests and institutional economic incentives toensure safe, therapeutic, effective and competent nursing care.

Managed Care Financing of Healthcare Services—Forces of Magnetism Abandon Patients managed care capitation financing arrangements have

become the dominant means for funding hospital and physicianservices. HMOs/insurers provide a share of the monthly premiumdollar for a negotiated split between medical and hospital providerorganizations, transferring to physicians and hospitals the risk ofincurring costs for providing patient care services in excess of premi-um revenue, and the corresponding opportunity to gain surplus revenue by limiting services to ensure premium revenue exceedscosts. This radical change in hospital economics imposes opera-tional mandates which determine the nature and methods of delivery of hospital patient care. The revenue generation priority of capitation-financed hospital service creates an inherently adver-sarial relationship between patients and institutional providersoperating under financial incentives to limit hospital access, ignoreindividual patient needs, deny necessary services, and disregardminimum standards of safe, therapeutic, effective and competentnursing care. The financial imperatives require massive cutbacks in nursing budgets and concomitant reduction in the direct-care RN staff and administrative support that were the fundamental prerequisites for magnet hospital recognition as it was originallyconceived.

Managed care economics motivated a significant restructuringand downsizing of hospital nursing services and decimated theranks of direct-care registered nurses in hospitals. At the same time,managed care imposed barriers to hospital access, producing aninpatient population that is far sicker and more medically fragilethan ever before, and requires more intense, experienced and spe-cialized nursing care. Managed care strategies to increase revenuegeneration by downsizing the direct-care registered nurse workforce


AP

PH

OT

O/D

ON

WR

IGH

T

CE_April 5/8/10 2:47 PM


and restructuring patient care methods also set in motion a continu-ing deterioration of working and practice conditions which acceler-ated registered nurse flight from direct-patient-care positions inhospitals and discouraged new registered nurse interest in suchpositions. Hospital nursing practice today is severely burdened byexcessive patient loads, mandatory extended work hours, unsafepatient handling practices, and routine exposure to risks of profes-sional license discipline and/or malpractice liability inherent inworking and practice conditions created and maintained in deroga-tion of prevailing community standards.

The new Magnet recognition program is bound by the economicimperatives and operational incentives of a method of health careservice financing which transfers to health care providers the insur-ance risk of incurring costs for providing patient care in excess ofpremium revenue from participating groups. The essential hospitalmarket conditions which were prerequisite for achieving a nursingenvironment eligible for magnet recognition no longer exist andcannot be replicated on an institutional basis.

Shared Governance—Compromising RN Duty of Loyalty to Patient Intereststhe new ancc core criteria for magnet hospital accreditationreflect a significant emphasis on staff nurse decision making andinfluence over the delivery of patient care.

While labels differ, the evidence is conclusive that a shared gover-nance model is a key component in structuring professional nursingpractice to achieve magnet recognition. Virtually all the hospitalsthat achieve “magnet status” use a “shared governance” structuralmodel for sustaining professional nursing practice.

The ANCC magnet accreditation process begins with a potentialapplicant’s “Organization Self-Assessment for Magnet Readiness”according to a detailed set of standards and inquiries. A thresholdcondition to demonstrate “readiness” for magnet status considera-tion is: there must be “congruence between the mission, vision, val-ues, philosophy, and strategic plan of the nursing department andthose aspects of the organization.” (ANCC, Organization Self-Assessment for Magnet Readiness.)

The shared governance imperative of “congruent interests”requires staff nurse loyalty to the operational priorities of commer-cial health care institutions. RN professional licensure responsibili-ties and ethical duties require exclusive loyalty to patient interests.Magnet/shared governance “enterprise loyalty” is antithetical to thedirect-care RN’s fiduciary duty to provide care in the exclusive inter-ests of patients.

The structural imperatives of magnet hospital governance overnursing services cannot be harmonized with nor incorporated intocollective bargaining representation. Nursing shared governance is amanagerial innovation that legitimizes nurses’ control over practice,while extending their influence into administrative areas previouslycontrolled only by managers. Proponents of magnet recognitionview union representation of nurses as a barrier to successful sharedgovernance because “union restrictions may prohibit managementfrom implementing shared governance model.” More importantly,participation in magnet-acceptable shared governance proceduresand committees requires staff nurses to assume expressly statedmanagerial and supervisory responsibilities and authority. Such par-ticipation provides presumptive evidence of exclusion from laborlaw rights to organize for collective bargaining.

Today’s Magnet Hospital Imperatives are in Fundamentaland Irreconcilable Conflict With the RN Duty of Loyalty to Patients.the economic incentives of institutional providers and the com-mercial mandates of the healthcare industry conflict with the inter-ests, health and safety of patients and the professional and ethicalresponsibilities of direct-care RNs.

Today’s ANCC Magnet Status Recognition certification programand its various components, including Shared Governance, are thedirect and exclusive creation of the commercial priorities and eco-nomic incentives of corporate health care.

The stated “goals and objectives” are deceptive and are meresmokescreens for the fundamental commercial priorities of the pro-gram. Neither these priorities nor the economic interests of thehealth care industry as presently constituted can be reconciled withthe interests of patients or the rights and obligations of direct-careregistered nurses.

Moreover, any concession to Magnet Status Recognition/SharedGovernance and similar schemes provides continuing cover for anill-conceived healthcare system and significant obstruction to win-ning single-payer healthcare reform.

Consistent with the essential purposes of the California NursesAssociation/National Nurses Organizing Committee as a voice fordirect care RNs and the Code of Professional RN Practice adoptedin the CNA/NNOC Bylaws, the position of CNA/NNOC must beunqualified opposition to Magnet Status Recognition and similarprograms, including categorical rejection of any form of participa-tion or support for such programs and their deceptive entrapmentslike Shared Governance. The responsibility of patient advocacy andaffirmative obligations of collective patient advocacy offer no oppor-tunity for such concession.

Standards for Evaluating Whether ANCC “Magnet Hospital” Designation Is in the Interests of Direct Care RNs and Their Patients

CNA/NNOC Code of RN Professional Responsibilitythe cna/nnoc bylaws code of rn practice include the followingstandards:

1. The nurse assumes responsibility and accountability for com-petent and appropriate performance of the RN Duty of PatientAdvocacy, acting in the exclusive interests of the patient, as thepatient’s advo cate, by initiating action to improve health care or tochange deci sions or activities which are against the interests orwishes of the patient, as circumstances may require, and by disclos-ing informa tion and providing patient education as necessary forinformed patient decisions about health care before care is providedto the patient.

2. The nurse recognizes the importance of collective patient advo-cacy to the public health and the integrity of professional nursingstan dards of care, and participates in necessary and appropriateactions and exercises of collective patient advocacy to protect the pub-lic health and safe patient care standards against erosion, restructur-ing, degradation, deregulation, and abolition by the large health carecorporations, hospital chains, HMOs, insurance companies, phar ma-ceutical corporations, and other powerful economic institutions andinterests which today seek to control the availability, access, and quali-ty of health care services for purposes of profit and surplus revenue

CE_April 5/7/10 11:59 PM

generation against the interest of patients and health care consumers.

Independent Professional Responsibility to Act in the Exclusive Interests of Patients – Direct-Care RN Fiduciary Duty to Patientsstate nursing practice acts and Registered Nursing Boardregulations, practice standards, and professional license guide-lines generally impose a “fiduciary responsibility” on registerednurses who accept assignment to a direct-care RN-to-patientrelationship in which nursing care is provided. The fiduciaryobligation is to provide care in the exclusive interests of thepatient without compromise or surrender to other interests,including the commercial, operational, revenue generation, orbudgetary interests of health facility employers, physician prac-tice groups, healthcare systems, managed care organizations, orhealth insurers/HMOs.

The fiduciary relationship and related professional fiduciaryduties of direct-care registered nurses to assigned patients are fun-damental public health and safety regulations created to protectpatient safety.

Necessary Conditions for Safe, Therapeutic, Effective and Competent Registered Nursing Practice in the Interests of Patientsprotection of working and practice conditions for direct-care RNs that are essential for safe, therapeutic, effective and com-petent nursing care:

(1) an RN-to-patient relationship which allows for competentperformance of all aspects of the nursing process, enforced by objec-tive minimum standards for safe patient care (i.e., numeric, unit-based RN-to-patient staffing ratios);

(2) the right and practical ability to exercise independent profes-sional responsibility and judgment to determine and implementnursing care in the exclusive interests of patients, uncompromisedby and without interference arising from the conflicting commercial

and revenue-generation interests and demands of the healthcareindustry.

Magnet Recognition and Replacement Technologyto achieve and maintain “magnet” status, hospitals are requiredto demonstrate they have a mechanism in place which collects andanalyzes patient outcome data with input from the nursing staffwhile incorporating clinical decision-making technologies.

Hospitals seeking such designation have deployed these clinicaltechnologies, which incorporate Computerized Physician OrderEntry (CPOE) systems, computerized charting programs—includingcomputerized medication charting—and decision-support technolo-gy, which is based on rigid standardization of the decision-makingprocess of the direct care RN.

RNs have a unique patient advocacy role in the health care deliv-ery system and technology can only be used to augment this uniquerole. In analyzing the safe, therapeutic and effective values of anytechnology, RNs must be able to explore the potential of technologyreplacing human interaction in the delivery of patient care and thesupplanting of critical thinking and independent clinical judgmentwith rigid clinical pathways or RN displacement and/or overridetechnologies.

Technology-driven care depersonalizes the RN relationship withher/his patients. Unfettered use of technology will have a chillingeffect on the RN’s ability to advocate in the exclusive interest ofher/his patient. Undue reliance on technology can jeopardize theaccuracy of diagnosis and treatment of patients.

Such reliance will also create erosion of skills for the next genera-tion of RNs who (unless stopped) will be trained in tasks instead ofeducated in skills. It has the potential of destroying the art and sci-ence of professional registered nursing.

Human cognition is still superior to so-called “machine intelli-gence.” One fact is certain: Computers and machines are only goodfor storing information; they cannot think critically as registerednurses do, nor are they capable of making split-second judgments incrisis intervention situations. Computers and machines are capableof quantifying data, but it will take a qualified RN to synthesize andinterpret the data, otherwise it is meaningless.

In order to be competitive in a market-driven healthcare system,“Magnet” recognition schemes have endorsed technologies thatdegrade skills, replace RNs, obliterate individual advocacy and avoidunions.

The Healthcare Reality and Context of Magnet Hospital Recognitionin response to the imperatives of capitation financing and con-solidation of the hospital and health insurance industries over thepast two decades, aided significantly by federal policies supportingeconomic concentration in HMO and provider markets, the hospitalindustry abandoned safe, therapeutic, effective and competent nurs-ing care as an operational priority and restructured hospital nursingservices to accommodate predominantly revenue-generation pur-poses.

Key elements of this restructuring of hospital nursing care are asubstantial cause of the current shortage of hospital direct-care reg-istered nurses, including the following:

(a) mass layoffs and permanent reductions in force of hospitaldirect-care registered nurses beginning in the early 1990’s;

The 14 “Forces of Magnetism”FORCE 1: Quality of Nursing LeadershipFORCE 2: Organizational Structure FORCE 3: Management Style FORCE 4: Personnel Policies and Programs FORCE 5: Professional Models of Care FORCE 6: Quality of Care FORCE 7: Quality Improvement FORCE 8: Consultation and Resources FORCE 9: Autonomy FORCE 10: Community and the Healthcare Organization FORCE 11: Nurses as Teachers FORCE 12: Image of Nursing FORCE 13: Interdisciplinary Relationships FORCE 14: Professional Development


CE_April 5/8/10 2:48 PM

(b) work “redesign” measures to fragment and deskill hospitalregistered nursing practice in order to transfer registered nursefunctions to unlicensed personnel and other non-RN caregivers;

(c) elimination of the direct-care registered nurse assessment-controlled, transparent and verifiable patient acuity system method-ologies for determining registered nurse staffing levels based onindividual patient needs;

(d) implementation of new, “proprietary” patient classification sys-tems for determining nurse staffing levels and “skill mix” which pur-port to rely on registered nurse assessment of patient needs, butconceal methodologies and determinative functions from staff nursesand government licensing authorities, are incapable of scientific veri-fication and validation, and routinely produce outcomes forecastingnurse staffing levels which objectively serve revenue generation tar-gets and bear no relation to registered nurse patient assessments; and

(e) introduction of new technologies which override the independ-ent professional clinical judgment of direct-care registered nurses.

Essential Elements of the Magnet Recognition ProgramnStrategic avoidance of hospital direct-care nursing regulation;nApplication of “evidence-based” deceptions to hospital nursing

service patient care/practice standards;nRip-off of high public trust in nurses (to provide care in exclu-

sive interests of patients) to cover commercially-motivated, decep-tive redesign of direct-care practice standards intended to restrainindependent judgment and action by direct-care RNs, obstructpatient advocacy, and subvert direct-care nursing process with man-date to serve commercial interests over patient interests;

nMarketing gimmick to promote false appearance of superiorhospital nursing practices and quality patient outcomes (the “goldstandard”);

nStrategy to gain market advantage for public and private reim-bursement for hospital nursing services; and

nMost importantly, a strategy to compromise the direct-care RNduty of exclusive loyalty to patients by making commercial enterpriseloyalty to hospital employers a condition of RN employment for thepurpose of eliminating a significant barrier to unchecked profiteeringon individual and family health care risk presented by an independentdirect care RN voice, professional responsibility, and patient advocacy.

ConclusionThe conflicts between commercial and revenue generation interestsand patient interests cannot be reconciled by marketing gimmicksand workplace deceptions—Direct-care RN participation inschemes to conceal this reality and enable industry priorities is afundamental conflict of interest and repudiation of professionalethics.

CNA/NNOC Positionoppose any and all accreditation or recognition (including “Mag-net” designation) schemes that:

Directly or indirectly interfere with or compromise direct-careRN professional responsibilities to provide care in the exclusiveinterests of patients and take all necessary and appropriate actionsto ensure patient safety even if such actions conflict with employerinterests, policies, or orders.

Establish or permit sanction or recognition of different standardsof nursing service or patient care performance which allow for

substandard or different classes of competent care in derogation ofthe universal health principle of one standard of care.

Purport to replace or in effect operate to replace governmentalregulation of hospital services for the public health and safety.

Directly or indirectly coerce, intimidate, induce, or encouragefront line caregivers to accept assignments, duties, or responsibili-ties which require enterprise loyalty and/or apparent assumption ofmanagerial or supervisory authority that would disqualify themfrom collective bargaining representation.

Apply Total Quality Management/Shared Governance schemesfor the strategic purpose and effect of individual and collectivepatient advocacy suppression and union avoidance.

Deploy technologies that override the independent professionaljudgment of the RN and restrict the RN duty and right to advocate;degrade skills; or are purposely developed to maintain a healthcareindustry driven by private interest rather than the individual health-care needs of the patient.

Fail to establish and promote safe staffing standards based onindividual patient acuity of which objective, unit-specific hospitalRN-to-patient staffing ratios are the minimum.

Fail to establish or allow for an objective, transparent process fordetermining and establishing direct-care RN control over workingand practice conditions demonstrated to improve quality of RN-patient therapeutic relationship, reduce errors and adverse out-comes, and improve recruiting and retention.

Deceive and confuse direct-care RNs with Total Quality Manage-ment/Shared Governance schemes, including pay for performanceincentives to engage support for and suppress direct-care RN resistanceto benchmarking schemes that redefine disease, treatment and out-comes, cutbacks in safe, therapeutic, effective and competent direct-carenursing service, reductions in staff and nursing service budgets, prioriti-zation of surplus revenue generation and other anti-patient practicesunder the cover of “gold standard” redesign of patient care standards.

—CNA/NNOC position on hospital magnet statusAugust 2, 2007


Magnet Hospital Bibliography and ReferencesWhat’s the Attraction to Magnet Hospitals, Valda V.

Upenieks, RN, PhD in Nursing Management Febru-ary 2003 www.nursingmanagement.com

The Magnet Recognition Program, Recognizing Excel-lence in Nursing Service 2005. The American Nurs-es Credentialing Center

Overview of ANCC Magnet Recognition Program® NewModel American Nurses Credentialing Center

History of the Magnet Recognition National StudentNurses’ Association NSNA Leadership University www.nsnaleadershipu.org/nsnalu/

Implementing Shared Governance: Creating a Profes-sional Organization, Tim Porter-O’Grady

CE_April 5/8/10 2:48 PM


Name:_________________________________________________________________________________________

Address:_______________________________________________________________________________________

City:__________________________________________ State:______________ Zip:__________________________

Day phone with message machine:_______________________ Email:______________________________________

RN license #:_________________________________________________________ (for processing CE certificate only)

Hospital Magnet StatusImpact on RN Autonomy and Patient Advocacy For continuing education credit of 2.0 hours, please complete the following test, includingthe registration form at the bottom, and mail to CNA/NNOC, Attention: NP/Home StudyCE, 2000 Franklin Street, Oakland, CA 94612 postmarked no later than July 1, 2010.

1. CNA/NNOC opposes any and all accreditation or recogni-tion (including “Magnet” designation) schemes that deceiveand confuse direct-care RNs with Shared Governanceschemes, including pay for performance incentives, as wellas cutbacks in safe, therapeutic, effective and competentdirect-care nursing service.

❏ True ❏ False

2. In analyzing the safe, therapeutic, and effective values of any technology registered nurses must explore thepotential of technology to replace human interaction in the delivery of healthcare.

❏ True ❏ False

3. Magnet designation is an excellent alternative to local,state, and federal governmental regulation of hospital services for the public health and safety.

❏ True ❏ False

4. Magnet hospitals improve patient care by collecting and analyzing patient outcome data with input from the nursing staff while incorporating clinical decision-making technologies.

❏ True ❏ False

5. Magnet hospitals improve wages, pensions, and other eco-nomic benefits for recruitment and retention of RNs.

❏ True ❏ False

6. Registered nurses must take all necessary and appropriateactions to ensure patient safety even if such actions conflictwith employer interests, policies, or orders.

❏ True ❏ False

7. The CNA/NNOC position opposes any and all accreditation(including “Magnet” designation) that purports to replaceor in effect operates to replace governmental regulation of hospital services for public health and safety.

❏ True ❏ False

8. The economic interests of the health care industry as present-ly constituted, the interests of patients, and the rights andobligations of direct-care registered nurses are the same.“Magnet” status is the “gold standard” of these interests.

❏ True ❏ False

9. The Magnet Recognition Program promotes superior hospi-tal nursing practices and quality patient outcomes. SharedGovernance empowers nurses to achieve this goal.

❏ True ❏ False

10. Undue reliance on technology can jeopardize the accuracyof diagnosis and treatment of patients. Such reliance willalso create erosion of skills for the next generation of RNswho (unless stopped) will be trained in tasks instead ofeducated in skills. It has the potential of destroying the art and science of professional registered nursing.

❏ True ❏ False

Contin

uin

g E

ducatio

n T

est

CE_April 5/8/10 2:48 PM

Sponsored by National Nurses United

The radio show for nurseswith RN hosts Casey Hobbs, Dan Grady,

and Maggie McDermott—Sundays 2 PM/PST on Green 960 AMLive streaming at www.green960.com—

On-demand podcasts at www.nursetalksite.com

’CAUSE LAUGHTER IS THE BEST MEDICINE

ListenLaughLearn

Cover 4_April 5/7/10 9:28 PM

twincities tussle - national nurses united...national nurse, (issn pending) the voice of national...

Documents