Seachange Bulletin #126February 19, 2004Seachange Bulletin ArchivesEmail the editorSeachange Bulletin #126: Hardball Time for US Nurses Linda Aiken, PhD, one of the featured speakers at the recent national conference at the University of Florida on "Nursing and the Future of Health Care," says the oft-reported nursing shortage is not so much about numbers of nurses as it is about facilities' unwillingness to hire enough of them. Aiken, a professor and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, studies patient outcomes at hospitals in the United States, Canada and Europe and what makes a difference in getting people well. Here are some of her insights: Q: Do we have a shortage of nurses? We have more nurses than we've ever had before. But it's easier to blame the shortage of nurses than it is to solve the problems in the health care industry. We have a perceived shortage because hospitals have not budgeted enough positions. The average patient is sicker than they used to be. Shorter lengths of stay create this short cycle of admission and discharge that falls on nurses. Looking at the early '80s to the mid '90s, nationally nurses have declined by 7 percent (based on staffing at every facility). In some states it's been as much as 25 percent. Q: Isn't it a given that if you have too few nurses you will have lower quality care? There is now increased interest in trying to improve patient safety (at hospitals). An Institute of Medicine report found that medical errors are prevalent in our health care system and among the five main causes of death in the United States. Most efforts (to reduce errors) have not recognized the important role nurses play - the link between understaffing and problems in care. About two-thirds of nurses say their hospitals don't have sufficient numbers of nurses. Still, we find hospitals, when they get into trouble financially, reducing the number of nurses. Q: So how do you keep nurses from becoming a line item to be cut? Our research program has been trying to build an irrefutable data base that links nurse staffing and mortality rate. Journal of the American Medical Association published that for every patient added to the workload of a nurse the mortality following surgical procedures increases 7 percent. There is a 31 percent difference in mortality between hospitals where nurses care for eight patients compared to hospitals where nurses take care of four. Q: Those patients aren't dying because of nursing mistakes. No. (Nurses) are the surveillance system. Most errors detected in hospitals are detected by a nurse, about 85 percent. One of the things they bring to care is the ability to assess a patient's condition and to separate important signs ... from unimportant signs. ... California: Minimums for nurses necessary Deborah Burger, RN, Los Angeles Daily News, December 1, 2003 <http://www.pennanurses.org/12-1-04%20minimums%20for%20nurses%20necessary.pdf> For the first time in years, California patients and their families have a reason to look beyond the doom-and-gloom stories that have dominated reports about the decline in the quality of hospital care and a seemingly intractable nursing shortage. As of Jan. 1, all hospitals will be required to maintain safe staffing levels - minimum ratios of registered nurses to patients - as a result of a law sponsored by the California Nurses Association, and the advent of the ratios is helping spur significant growth in the state’s RN work force. In recent weeks, some in the hospital industry, who have never liked the new law, have fanned fears of closures or ambulance diversions by hospitals unwilling to comply with the law by claiming a lack of available nurses. It’s their hope that public alarm will encourage Gov. Arnold Schwarzenegger to delay or weaken the ratios. Any such moves would be shortsighted, could abort the progress California has made in tackling the nursing shortage and put patients at risk. Recent data show the landscape for nurses has changed in California. Since the Safe Staffing Law was signed in 1999, there has been a dramatic influx of RNs into the state. Coupled with the 5,100 new RNs graduated every year by state nursing schools, the number of active RNs is growing by 10,000 a year. ... Hospitals make last-ditch push against nurse-patient ratios Judy Silber & Andrew LaMar, Contra Costa Times, December 29, 2003 <http://www.pennanurses.org/hospitals%20last%20ditch%20effort%20against%20rati os%2012-29.pdf> The hospital industry has taken its frantic fight against the state’s new nurse staffing law to Gov. Arnold Schwarzenegger, but the pro-business Republican has signaled he won’t intervene. The industry says the new law, set to take effect Thursday, could shake the fragile health care system by forcing closures of emergency rooms and other units. Hospitals say they support the principle of the law - regulated staffing to ensure patient safety. However, they’re bothered by its stringency. At all times, in all wards, hospitals must meet required minimum nurse staffing rules. "There is not one ounce of flexibility in that law," said Jan Emerson, spokeswoman for the California Healthcare Association. "If a nurse has to go to the bathroom and there isn’t someone to fill in for her, technically, the hospital is in violation. It’s that continuous compliance that’s going to be problematic." But for the time being, the Schwarzenegger administration appears unmoved by the hospital industry’s stepped-up lobbying effort. That’s even though Schwarzenegger campaigned for office by promising to improve California’s business climate and criticizing unions’ influence over his predecessor, Gray Davis. ... Fines could make hospitals feel unwell Daniel S. Levine, San Francisco Business Times, January 12, 2004 <http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2004/01/12/story5.ht ml> As California's new nurse-staffing law took effect, the California Nurses Association has stepped up efforts to give the new law teeth. The nurses' union, the driving force behind the requirement that hospitals maintain specified nurse-to-patient ratios, expects legislation to be introduced this month that would create penalties of $10,000 per shift if a hospital demonstrates a pattern of violating the minimum staffing ratios. A pattern would be four or more violations within six months. An attempt by Assemblyman Daryl Steinberg (D-Sacramento) last year to do that died when the assembly couldn't reconcile differences with the state senate. The nurses' union blames this on a dispute between it and the Service Employees International Union, which was supporting a competing bill that also stalled. The two unions have since announced a truce and agreed to work together on legislative issues. "We expect this bill to sail through," said Jill Furillo, director of national affairs for the California Nurses Association. Hospitals, which opposed the previous bill as well as the one backed by the SEIU, expect to mount a strong campaign to defeat any new attempts to create financial penalties for hospitals out of compliance with the staffing law. ... (Cf. <http://www.revolutionmag.com/newrev2/engineering.html> - SE) Hospitals: Ratios leave us at risk Troy May, Silicon Valley/San Jose Business Journal, January 12, 2004 <http://sanjose.bizjournals.com/sanjose/stories/2004/01/12/story4.html> Most California hospitals say they can't heed the new nurse-to-patient-ratio law, meaning their lack of compliance leaves them vulnerable to lawsuits, loss of reimbursement dollars and cutbacks in patient services. In response, a hospital trade group has filed a lawsuit against the California Department of Health in an effort to ease the law, which took effect Jan. 1 and requires round-the-clock compliance. The specific nurse-to-patient ratios vary by unit within a hospital. The lawsuit filed by the California Healthcare Association specifically addresses the requirement that the ratio be met at "all times," including during breaks and lunches. Traditionally, nurse would cover for one another when one goes on break, to lunch or to the rest room. The suit seeks to loosen the regulation to require that the ratio me met only at the beginning of a shift. Hospital officials say the state's nursing shortage has made it difficult to hire enough nurses to cover breaks, says Jan Emerson, spokeswoman for the California Healthcare Association, which filed the lawsuit Dec. 31 in Superior Court in Sacramento. The association represents 350 hospitals in California. ... Nurse-to-patient ratio survey begins Union asks RNs Rebecca Vesely, Alameda Times-Star, January 14, 2004 The California Nurses Association - the country's largest union representing registered nurses - on Tuesday began a survey of RNs at every hospital in the state to determine if facilities are complying with a new staffing law that went into effect Jan. 1. "With the audit we hope to provide a more detailed answer for patients and their families to assess how their local hospitals are faring on compliance with the law," the association's president Deborah Burger said in a release. The staffing law, signed by former Gov. Gray Davis in 1999, establishes set ratios on how many patients can be assigned to each nurse. Ratios range from one nurse for each patient on the trauma unit to one nurse to every eight patients in the well-baby nursery. The ratios were determined by the state Department of Health Services with input from hospitals and nurses. The law is aimed to improve patient outcomes and reduce nurse burnout and turnover. Survey questions will address whether hospitals are providing the same staffing for all shifts, as required by the law. Nurses will also be asked whether hospitals are closing beds, limiting patient admissions or displacing aides and other caregivers to meet the ratio law. The audit will be completed at the end of January and the results will be made public. ... Too few nurses could very well mean too many deaths Deborah Burger, RN, Alameda Times-Star, January 14, 2004 Nearly 100,000 Americans die every year as a result of avoidable medical errors - at a time when insufficient monitoring of hospital patients, caused by poor working conditions and the assignment of too few registered nurses, increases the likelihood of patient deaths and injuries, reported the National Academies of Sciences last November. Inadequate staffing precipitated one-fourth of all unexpected occurrences that led to patient deaths, injuries, or permanent loss of function reported the past five years to the private agency that accredits hospitals. Dissatisfaction with staffing levels and heavy workloads are major factors contributing to a mass RN exodus from hospitals and the much discussed nursing shortage, the General Accounting Office informed Congress in 2001. ... Agency bogs down as nurses rush to register Kathy Robertson, Sacramento Business Journal, January 19, 2004 <http://sacramento.bizjournals.com/sacramento/stories/2004/01/19/story6.html> With hospitals across the state scrambling to find enough workers to meet new nurse-to-patient ratios, a record 220 nurses showed up at the Bureau of Registered Nursing in the first week of January to get state approval. Most were out-of-state nurses seeking temporary licenses. If appropriate credentials were sent ahead of time, most got what they wanted in a few hours. Permanent licensing is another matter. The wait time for that has grown to six weeks or more. Budget cuts at the state agency that licenses registered nurses reduced staff by 15 percent last year, creating a backlog of work at a time when demand for its services is at an all-time high. "We don't want to be a bottleneck in the process, that's for sure, but we are having to do things a little different," said assistant executive officer Susan Brank. "Licenses are not issued as quickly as we'd like." In October 2003 - the last time the backlog was reviewed - there were 2,100 applications pending. The oldest dated back five months. The board's goal is to issue most permanent licenses in 10 days to two weeks, although complex cases can run three or four months, Brank said. Due to the backlog, the work now takes four to five weeks longer than usual. ... Hospital lobby would undermine state's patient protection law Deborah Burger, RN, Pasadena Star-News, January 21, 2004 Executive insiders at the lobbying arm of the state's hospital industry are waging a high-stakes gamble in their drive to roll back a landmark patient protection law that if properly enforced almost certainly will save the lives of thousands of Californians. In an announcement widely disseminated by the industry lobbyists, officials at Santa Teresita Hospital in Duarte recently announced plans to close, blaming the new safe staffing law. The announcement failed to point out that the hospital has reported losses in six of the past nine years, an aggregate total of $11.1 million, and that the facility has been downsizing for years, all long before the new rules to protect patients were in effect. At best, the timing of the hospital's announcement six days after the operative date of the minimum registered nurse ratios raises questions that cry out for a broader context. Last fall the California Healthcare Association (CHA), the industry lobby group, held seminars across the state for local administrators, ostensibly to inform them about the law. But there was a hidden agenda as well, laying the groundwork for a strategic campaign to erode public support in hopes of persuading the governor and Legislature to repeal or weaken the safe-staffing law. In the seminars, the CHA handed out sample press releases with blanks to fill your name in here announcing a unit closure due to the reputed inability to adhere to the law. If hospital industry opponents of the law are encouraging hospitals to shut down or restrict access to care as a strategy for achieving political ends, that bears investigation by our elected leaders. Closures are just one apparent tactic. Some hospitals are also canceling or delaying elective surgeries and using lesser-licensed staff who do not have the professional expertise of registered nurses to meet the requirements of the law. The CHA has reportedly also been holding meetings of member hospitals in an effort to keep everyone in line on their interpretation of the law and coordinating common responses. ... County says quick closure violated law Report: Hospital violated state law Pasadena Star-News, February 3, 2004 <http://www.pasadenastarnews.com/Stories/0,1413,206%257E22097%257E1933823,00.h tml?search=filter> Duarte - Santa Teresita Hospital's abrupt closure violated state law, but officials have no authority to fine or penalize the facility, health officials said Tuesday. The hospital, which closed Jan. 9, "failed to comply with the law and county policy," according to a county health department report released Tuesday. "Even more egregiously, it failed to notify its patients, its community and even its own staff members of the closure in the manner required by law." The county investigation will continue to determine the credibility of allegations made by nurses who worked at the facility that the hospital's obstetrics unit violated state law by operating without pediatricians for 10 births in November and December, officials said. A state investigation into the closure is ongoing, said Lea Brooks, spokeswoman for the California Department of Health Services. Santa Teresita Hospital CEO Mike Costello gave health officials three days' notice before closing its 39-bed acute care facility. Employees and residents were given less than 24 hours' notice. State law mandates that a facility with an emergency room give 90 days' notice and hold public hearings before closing. Costello said he had to close the facility immediately because of a financial crisis that threatened bankruptcy and the closure of its 150-patient skilled nursing facility. Costello blamed the closure on a state-mandated law increasing the nurse-to-patient ratio, which he said was too costly for the financially troubled facility. Costello did not return calls for this story, but previously said he knew the immediate closure violated state law. ... Staffing Improved at Nearly 70% of California Hospitals Safe RN Staffing Law 'Off to a Good Start,' Says CNA California Nurses Association, February 4, 2004 <http://www.calnurse.org/cna/press/2404a.html> Just one month after its effective date, California patients are already benefiting from the state's landmark law requiring safe registered nurse staffing ratios in California hospitals, the California Nurses Association said today. Staffing conditions are improved at 68% of the hospitals surveyed by CNA, and 59% were generally in compliance with the requirements of the law. The CNA survey covered 111 hospitals, nearly 30% of the general acute care hospitals in California from mid to late January. The results were based on interviews with RNs in the hospitals. "Our survey demonstrates that the Safe Staffing Law is off to a good start," said CNA President Deborah Burger, RN. "A sizable majority of hospitals we looked at are making a good faith effort to abide by the law, and most have already seen results with improved conditions. That should be welcome news to all Californians and their families who are in need of hospital care." "If we continue this trend," said Burger, "the law will undoubtedly save the lives and promote the safety and therapeutic healing of thousands of Californians." ... New staffing law helps, nurses say Evan Pondel, Los Angeles Daily News, February 5, 2004 <http://www.dailynews.com/Stories/0,1413,200%257E20950%257E1938501,00.html> The California Nurses Association said Thursday that nurse-to-patient staff ratios have improved at hospitals throughout the state, though hospital officials themselves say they've seen no change. Since Jan. 1, California hospitals have been scrambling to meet the new state requirements for fewer admitted patients for every nurse. Though the law encountered resistance from hospital operators who continue to grapple with rising health care costs, the California Nurses Association says ratios are improving. A CNA report says more than half of the 111 hospitals it surveyed in California are "generally in compliance with the requirements of the law. ... This information shows we are making progress. It also disputes the hysteria and destabilization that is being promoted elsewhere," said Chuck Idelson, a union spokesman. The CNA surveyed its members by gathering anecdotal information about each hospital's nurse-staffing situation. Many of the nurses revealed scenarios that vastly differed from the grim realities depicted before the ratio laws went into effect. Myrna Valmeo, a registered nurse at Glendale Memorial Hospital, said not only does she see the difference in ratios, she feels the difference. "I'm happier now, and so are the other nurses around here," Valmeo said. "Because of the nurse staffing ratios, the quality of care has greatly improved." That sentiment isn't echoed by the California Healthcare Association, a Sacramento-based organization that represents the interests of hospital operators. The group has been collecting questionnaires from about 300 hospitals since Jan. 1. The most recent data available reveal that 86 percent of the hospitals surveyed are not in full compliance with the law. ... Survey: Most hospitals meet safety, nurse-to-patient ratio requirements Annette Wells, San Bernardino County Sun, February 5, 2004 <http://www.sbsun.com/Stories/0,1413,208%257E12588%257E1938284,00.html> San Bernardino - A year ago, it wouldn't have been uncommon for a registered nurse to handle up to a dozen patients at St. Bernardine Medical Center. That is no longer the case. "Today, it is down to six, and I really have to hand it to our administration because I know some hospitals are still dragging their feet," said Beth Holzberger, an intensive care unit nurse at St. Bernardine about her employer meeting the state's new nurse-to-patient ratios. "It's not like we don't still have some problems, but things have improved tremendously at St. Bernardine." St. Bernardine was one of three hospitals in San Bernardino County surveyed by the California Nurses Association last month in compliance with the new law which took effect Jan. 1. Community Hospital of San Bernardino and St. Mary Medical Center in Apple Valley were the other two hospitals, said Chuck Idelson, a California Nurses Association spokesman. In all, 111 hospitals, about 30 percent of general acute care hospitals in California, were surveyed from mid- to- late January. The results, based on interviews with registered nurses, showed that 68 percent of the hospitals have improved staffing conditions and 59 percent of them are generally in compliance with the requirements. "There's still a lot of misinformation being propagandized by the hospital industry against the law, but what needs to be understood is without it, it could mean severe consequences for public health," Idelson said. "When this law is fully implemented it has the potential for saving thousands of patients' lives as well as promoting health and safety. That is certainly what the public wants and deserves." ... Nurses' working conditions improving Union study shows Rebecca Vesely, Alameda Times-Star, February 5, 2004 <http://www.timesstar.com/Stories/0,1413,125%257E10859%257E1936772,00.html> Registered nurses at California hospitals are reporting improvements in staffing conditions since a nurse-to-patient ratio law went into effect Jan. 1, the largest union representing RNs said Wednesday. The California Nurses Association is interviewing nurses at hospitals around the state to gauge compliance with the new law. Out of 111 acute care hospitals - 30 percent of all hospitals in the state - surveyed so far, registered nurses are reporting improved conditions at 68 percent of those facilities. Nearly 60 percent of those hospitals are in compliance of the new law, the nurses reported. "A sizable majority of hospitals we looked at are making a good faith effort to abide by the law, and most have already seen results with improved conditions," Deborah Burger, president of the California Nurses Association, based in Oakland, said in a statement. CNA praised Kaiser Permanente and the University of California Medical Centers for their preparedness in meeting the ratio law. Enacted in 1999, the law made California the first state to establish the maximum number of patients that can be assigned to each nurse. Ratios range from one patient per nurse in trauma and intensive care units to eight patients per nurse in well-baby nurseries. ... Nurses file suit over fast layoffs Marshall Allen, Pasadena Star-News, February 9, 2004 <http://www.pasadenastarnews.com/Stories/0,1413,206~22097~1946268,00.html> Duarte - Seventeen nurses have sued Santa Teresita Hospital, claiming they were sacked without notice when the maternity unit and acute care facility were abruptly shut down in early January. The nurses claim CEO Mike Costello broke labor laws by providing no notice before a mass layoff. The hospital is already under county and state investigation for possibly failing to follow legal guidelines before closing. Chris Sayler, a maternity nurse on the night shift, said she initiated the lawsuit after she applied for unemployment benefits. On investigating the labor code, Sayler said, she realized that institutions with more than 75 employees must give 60 days' notice before a layoff of more than 50 employees. In all, more than 100 employees were laid off when Santa Teresita closed Jan. 9. No one got more than one day's notice and some weren't notified until afterward, Sayler said. Under the provisions of the labor code, the employees are entitled to 60 days' severance pay, plus compensation for benefits they would have accrued during that time period, said Charles Zetterberg, the plaintiff's attorney. He called it a "clear-cut case.' Sayler said she was off duty when the maternity nurses were laid off Jan. 2, so she received no notice. According to Sayler, the on-duty nurses said it never was clear they were being laid off. Someone just took their timecards and issued final checks. Of 26 maternity nurses laid off that day, only 10 received any severance, and no one was paid more than two weeks salary, she said. The next layoffs occurred a week later, when Costello who's also named in the lawsuit announced that a financial crisis forced him to close the 73-year-old hospital's 39-bed acute treatment facility the next day. Costello said the crisis was caused by a new law mandating higher nurse-to-patient ratios, which would have been too expensive for the hospital. The closure was the only way to save Santa Teresita's 150-patient skilled nursing facility and stave off bankruptcy, Costello said at the time. ... In addition to running Santa Teresita, Costello operates two other companies, Regis Real Estate Holding Co. and 120-employee Apollo Healthcare Corp. ... Staff infection Downstroke, CN&R Newsreview.com, February 12, 2004 <http://www.newsreview.com/issues/chico/2004-02-12/down.asp> At the beginning of the year, Enloe Medical Center was under pressure by law to meet new nurse-to-patient staffing ratios, and despite the hospital’s initial doubts, it is apparently meeting the requirements. "It’s going as well as could be expected, given the amount of work it took to implement the law[‘s requirements]," said Ann Prater, Enloe’s public relations director, adding that that requirement has sent hospitals across the state "into a tailspin." She said a couple of hospitals closed their doors last year, anticipating that they would not be able to meet the requirements. If found "steadfastly" out of compliance, Prater said, a hospital would be punished not by fine but by possible loss of its license to operate or restrictions on its ability to collect payments from the government. The ratio is enforced by the Department of Health Services and by California Nursing (sic) Association monitors working in the hospitals. Prater said that as of Jan. 31 Enloe employs 644 registered nurses as compared to 622 one year ago. Another 54 are scheduled to begin work before the end of May. HEALTHCARE Rally to Protect RN Staffing Ratios RNs from around California are being asked to plan now to join a rally, sponsored by CNA, in Sacramento March 19 to protest a lawsuit by the hospital industry to roll back the new RN-to-patient staffing ratios. The California Healthcare Association, the lobbying arm of the hospital industry, filed suit against the safe staffing law December 30, 2003, just hours before the final implementation of the ratios. The rally coincides with the first Superior Court hearing on the case. Date: Friday, March 19, 2004 Time: 8:30 am - 9:30 am and 12:00 noon Where: Sacramento Superior Court 720 9th Street, Sacramento CHA wants the court to throw out the requirement that the hospitals must adhere to the ratios "at all times." The industry wants hospitals to have free rein to understaff in any unit whenever an RN is on break,when a patient emergency occurs elsewhere in the hospital, when new patients present in the ER, and at other unspecified times. In other words, the hospital could be out of compliance with the ratios "at all times." If CHA succeeds, this would seriously undermine the ratio law, and would be a first step in a broader industry campaign to drastically revise or repeal the new patient protections established by the law. Sign up now to join the rally For more information, contact your labor rep and see the CNA website, www.calnurse.org. Save the Date – March 19 Hawaii: Scheider stepping down at nurses' union Pacific Business News (Honolulu), February 13, 2004 <http://pacific.bizjournals.com/pacific/stories/2004/02/09/daily71.html> The chief negotiator for the Hawaii Nurses Association, which represents 3,700 registered nurses, licensed practical nurses and other health care workers, will step down in less than a month. Sue Scheider is director of the Collective Bargaining Organization of HNA. She has notified the board of CBO-HNA that her last day will be March 5. Scheider took the post in January 2002. Union participation rose during her two-year tenure and negotiated member wage increases worked out to about 20 percent. "The Collective Bargaining Organization has made some very significant and progressive improvements under the tenure of Ms. Scheider and will continue to recognize the benefits of her influence long after her departure," CBO Board Chairman Bill Richter said. Latest News from Hawaii: * The three staff-nurse dissidents who had been expelled from the nurses union, the Collective Bargaining Organization (CBO) of the Hawaii Nurses Association (HNA), have been reinstated by the arbitrator. Gail Ramiscal, Michelle Paik and Mary Hackney had been charged with "dual unionism" and summarily expelled by the CBO board meeting in kangaroo court. Gail had been the chair of that body at the time and is now reinstated to her leadership position. * CBO director Sue Scheider, seeing the handwriting on the wall, has announced her resignation. Imported from DC early in 2002, she had precipitated a wave of poorly prepared and weakly conducted strikes. She has been a strong advocate of HNA’s CBO joining ANA’s labor arm, the United American Nurses (UAN). * ANA is intensifying its campaign to prevent disaffiliation of HNA from the ANA federation. Just like nurses from Maine to California had experienced when preparing their own departure from the elitist and moribund ANA, the deluge of false claims and hollow promises has begun, including the usual big lie that ANA has surveyed the nurses of Hawaii and found that the majority want to stay in ANA. For background on developments in Hawaii, go to Seachange Bulletin #121. Iowa: Nurses in Dubuque choose to join union Nurse-patient ratios at Finley Hospital and other patient care issues were the focus of the organizing effort, one nurse says. William Ryberg, Des Moines Register, December 16, 2003 <http://desmoinesregister.com/business/stories/c4789010/23026705.html> Nurses at Finley Hospital in Dubuque have voted in favor of being represented by Local 199 of the Service Employees International Union. Finley nurses will join the same union local that represents nurses and other employees at University Hospitals in Iowa City. The Dubuque hospital employs about 300 nurses. The union representation vote was 169 to 115, union officials said. Contract talks are expected to begin after the holidays. Linda Merfeld, a Finley nurse and a leader of the union movement at the hospital, said patient care issues such as nurse-patient ratios, rather than wages and benefits, were the main focus in the organizing effort. The union believes the hospital needs more nurses to adequately care for patients, Merfeld said. Today's treatment practices mean that patients in hospitals are sicker than they were 10 years ago, she said. In addition, hospital stays are shorter, meaning patients have less time to be taught about treatment practices they will have to follow when they return home. ... Kentucky: Kentucky Labor Cabinet Fined Norton Hospital for Overtime Violation Nurses Professional Organization, December 22, 2003 Louisville - The Kentucky Labor Cabinet fined Norton Hospital $500 for violation of overtime law and required the hospital to issue back pay of $2,413.55 to employees. Last February Norton Hospital ordered hundreds of nurses and other employees to remain in the hospital overnight after their shifts were completed. The hospital claimed it needed to assure that there would be staff for the following day in the face of a bad weather forecast. The hospital threatened discipline if employees did not stay overnight in the hospital, and the hospital did not pay employees their regular wage, but instead paid them $3 an hour. When nurses arrived at the nursing stations in the morning in their clothes from the day before, they found that management had placed tubs of new underpants for those who wanted them. The Nurses Professional Organization assisted employees in reporting the events to the Kentucky Labor Cabinet which found that the hours spent at the hospital would have to be counted as time worked. While not finding any violation in the forced overtime nor in the $3.00 an hour payment, the Kentucky Labor Cabinet did find that there was a violation when the hours were counted and there was no time and a half paid after 40 hours. Twenty-seven people received the additional overtime pay. Sue Yost, NPO Executive Director, and a registered nurse at Norton noted that excessive hours hurt recruitment and retention of nurses as well as posing a risk to quality patient care. She cited the recent finding by the National Academy of Sciences that reported that fatigue was a major cause of errors that harm patients. The report, from the academy's Institute of Medicine, said, "Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, decreases energy, diminishes attention to detail, and otherwise contributes to errors." NLRB: Norton Healthcare Must Allow Employees to Discuss Grievances Nurses Professional Organization, January 12, 2004 Louisville - In response to a National Labor Relations Board (NLRB) decision to issue complaint against it for violation of federal law, Norton Healthcare must post an NLRB notice to employees in the five Louisville Hospitals - Suburban, Norton, Audubon, Southwest, and Kosair Children’s. Norton Healthcare had placed in its employee handbook a rule that prohibits employees from discussing their grievances. Such a rule violates workers’ rights under federal law to act together with others for mutual benefit or protection. Speaking with each other about their job concerns is a crucial right under the federal law that protects the right to organize. The Nurses Professional Organization filed the unfair labor practice charges against Norton Healthcare pointing to the hospitals’ continuing efforts to curtail the freedom of speech of nurses and others employees. The NPO has long contended that this freedom to act together to improve conditions is vital to nursing and to patient care. The NLRB notice to be posted for 60 days in each of the five hospitals affirms that federal law gives employees the right to form, join or assist a union and to act together with other employees for mutual benefit and protection. The NLRB notice which must be signed by a responsible official of Norton Healthcare, asserts: "We will not maintain in our employee handbook any rule or policy that prohibits employees from discussing their grievances." The notice also includes the commitment that: "We will not in any like or related manner interfere with, restrain, or coerce you in the exercise of the rights guaranteed you by Section 7 of the Act." Norton Healthcare has a poor record of compliance with labor law. The NLRB has previously found that Norton Healthcare violated the law on a number of occasions. Norton Healthcare has not yet reinstated NPO activist, Jane Gentry, RN, nor settled other outstanding compliance issues. Nurses Professional Organization Wins RN Jane Gentry’s Case at Highest NLRB Level NLRB Orders Reinstatement, Back Pay and Reimbursement for Legal Fees Nurses Professional Organization, February 4, 2004 Louisville - On January 30, 2004, the highest level of the National Labor Relations Board (NLRB) ruled unanimously for the Nurses Professional Organization (NPO) and ordered Norton Healthcare to reinstate RN Jane Gentry with back pay and other benefits plus interest. Norton Healthcare had appealed a lower level decision rather than comply with it. In addition, the NLRB ruled that because Norton Audubon Hospital unlawfully reported Gentry to the Kentucky Board of Nursing, the hospital must also reimburse her for the expenses she incurred in defending her nursing license from Norton Healthcare’s charges. Gentry is an officer of the NPO and an outspoken advocate for her patients, her co-workers, and her union. She worked in the Coronary Care Unit, and later the Open Heart Unit, at Audubon Hospital for 18 years. In July of 1999 Norton Healthcare terminated Jane Gentry and reported her to the Kentucky Board of Nursing accusing her of administering a medication without a doctor’s order and without charting it. The "medication" was normal saline. Nurses routinely use normal saline to flush IV lines without an order and without charting. There was no harm to any patient. Gentry won the long legal battle for her license when Jefferson Circuit Court and the Court of Appeals ordered the Kentucky Board of Nursing to dismiss the charges and the Kentucky Supreme Court let that ruling stand. The NLRB upheld Judge Arthur Amchan’s strongly-worded decision, signed December 9, 2002, that Norton Healthcare "has a proclivity for violating the Act (Federal Law)" and that Norton Healthcare’s "egregious misconduct" demonstrates "a general disregard for the employees’ fundamental rights." The judge ruled that the testimony of "Cis" Gruebbel, the Chief Nursing Officer at Norton Audubon Hospital, "is generally incredible." He also deemed Nurse Manager Randa Bryan, the supervisor who fired Gentry, "not to be a credible witness." Norton Healthcare has repeatedly violated the law in its effort to block nurses and other employees from speaking out and winning collective bargaining. This NLRB decision is final unless Norton Healthcare takes it to the 6th Circuit Court of Appeals. The NPO calls on Norton Healthcare to comply swiftly so that nurses can organize to address their crucial concerns on patient care, staffing, conditions of practice, overtime, respect, fairness, pensions, and benefits. For further info: Kay Tillow (502) 459-3393 Nurses Professional Organization 1169 Eastern Pkwy, #2200, Lou. KY 40217 nursenpo@aol.com Norton to let nurses discuss grievances NLRB ruling settles charge lodged by union Patrick Howington, The Courier-Journal, January 13, 2004 <http://www.courier-journal.com/business/news2004/01/13/biz-front-norton13-293 4.html> Norton Healthcare has agreed to rescind a company rule admonishing employees not to discuss their grievance cases. The agreement settles a National Labor Relations Board case that was brought by the Nurses Professional Organization. NPO, which has been seeking to organize nurses at Norton Audubon Hospital since 1989, claimed Norton's employee handbook broke the law by making workers keep grievance matters confidential. The law gives workers the right to act together for their protection and benefit. "This has been a real problem, that they keep telling people, `You can't talk about things,'" said NPO organizer Kay Tillow. "A part of how you organize is, you're able to speak with fellow workers about your concerns. So if you can't talk about your grievances, how are you going to organize?" Earl Ledford, acting director of the NLRB regional office in Cincinnati, said his office approved the settlement last week. It requires Norton to post a notice at its five Louisville hospitals saying it will not prohibit employees from discussing their grievances. The notices must stay up for 60 days. In addition, Norton will remove the no-discussion rule from its employee handbook. ... NLRB orders Norton Healthcare to reinstate nurse, pay legal fees Patrick Howington, The Courier-Journal, February 5, 2004 <http://www.courier-journal.com/business/news2004/02/05/biz-frontB-nurse05-357 5.html> The National Labor Relations Board has ordered Norton Healthcare to reinstate a nurse the board says was fired from Audubon Hospital in 1999 for union activity. In addition to paying Jane Gentry her lost wages, the board said, Norton must pay Gentry's legal expenses from her successful fight to keep her nursing license. Norton said yesterday it will appeal the ruling to a federal appeals court. The labor board's Jan. 30 order upheld a December 2002 decision by an NLRB administrative law judge and added the requirement that Norton pay the legal fees. Gentry's lawyer, Irwin "Buddy" Cutler, said it is unusual for the NLRB to order an employer to pay legal fees. Gentry, who worked at Audubon for 18 years, was legislative director of the Nurses Professional Organization at the time of her firing. The NPO has been trying to organize nurses at Audubon since 1989. She was fired for flushing a heart patient's intravenous line with saline solution without clearing it with a doctor first. Such flushing by nurses is routine, but Norton said she did it as a placebo and acted outside the scope of her license. In addition to firing her, Norton reported the incident to the Kentucky Board of Nursing for possible disciplinary action. ... Healthcare for All! You’re invited to a powerful movie: "Damaged Care" "Laura Dern (Jurassic Park, Blue Velvet) gives a scintillating performance in DAMAGED CARE, the true story of Dr. Linda Peeno, a woman pushed to the edge, risking her career and family to punish the ruthless companies who valued profit over human life." From DVD Paramount Meet Dr. Linda Peeno Following the film Dr. Linda Peeno will answer questions and lead a Call to Action. Thursday, March 4, 2004 Film: 6:00 PM to 8:00 PM Dr. Linda Peeno: 8:00 to 9:00 PM Central High School 1130 West Chestnut Street Louisville Admission free Everybody has a right to quality healthcare! There is a solution! Learn how you can help pass HR 676, Medicare for All, legislation by Congressman John Conyers, Jr. (D-MI), which provides for a single-payer system with universal coverage. Event sponsored by: Kentuckians for Single Payer Healthcare Contact persons: Kay Tillow (Nurses Professional Organization) 459-3393 nursenpo@aol.com Laura McSpedon (Jobs with Justice) 625-3724 kyjwj@kyjwj.org Jan Taylor (KY Rainbow/PUSH) kyrainbow@att.net Massachusetts: Nurse-patient staffing ratio bill progressing Shaun Sutner, Worcester Telegram & Gazette, December 7, 2003 Legislation that would require hospitals to hire more nurses is moving again on Beacon Hill after languishing since the 1990s. The progress of the bill that would mandate what advocates say is a safe level of nursing care comes as California hospitals prepare to comply with the nation's first nurse-patient ratio law, which goes into effect Jan. 1. The measure received a unanimous vote of approval Nov. 19 from the Legislature's Joint Committee on Health Care, and was sent to the House Ways and Means Committee. A key obstacle was removed when state Sen. Richard T. Moore, D-Uxbridge, the health committee co-chairman who opposed the legislation, agreed to let the bill out of committee and abstained from the vote. Backers, including the state nurses' union and many patients' and health care groups, maintain that patient care has slipped dangerously because hospitals have refused to put enough nurses on patient floors. "The average number of patients assigned to a nurse on any given day is much too high and we cannot provide on a consistent basis safe patient care," said Sandy A. Ellis, a member of the Massachusetts Nurses Association board of directors and a psychiatric nurse at St. Vincent Hospital at Worcester Medical Center. Supporters concede that imposing specific ratios of nurses to patients would increase hospital overhead costs, but say "safe staffing" would save money in the long run by preventing medical errors and rehospitalization. "What's the cost of a patient's life?" Ms. Ellis said. "What's the cost to a health care system or hospitals when a patient gets sicker and has to be hospitalized again or requires greater health care intervention?" The hospital industry, one of the best-organized political lobbies in the state, has vigorously fought safe staffing bills for years. Hospital officials say cost is not their major objection, but rather that such legislation would restrict their ability to move nurses from floor to floor and among units to best handle patient levels. "We're opposed to the bill for the simple reason that mandated staffing ratios limit the availability of hospital professionals to decide how best to assign nurses," said John G. O'Brien, president and chief executive officer of the Worcester-based UMass Memorial Health Care Inc. system. "Ratios are too simplistic and too rigid as we plan for patient care." Mr. O'Brien said, however, that UMass Memorial Health Care recognizes the need for more nurses as the number of patients with serious illnesses increases. Meanwhile, the hospital system - which runs Central Massachusetts' largest hospital, in Worcester - is trying to reduce turnover by providing more support to nurses and to recruit more nurses into the profession by working with colleges and high schools, he said. "We are looking at nurse-to-patient ratios and strengthening them," Mr. O'Brien said. The city's other major hospital, St. Vincent Hospital at Worcester Medical Center, implemented contractual nurse staffing guidelines after nurses struck for 49 days in 2000 over issues including mandatory overtime and nurse-patient ratios. The contract states that "the hospital will ensure safe registered nurse staffing levels on all shifts within each patient care area." The clause gives nurses the right to file a grievance if they believe the hospital is not doing its best to maintain safe staffing levels. For Ms. Ellis, the contract, while a step in the right direction, is limited because it includes no threat of fine or penalty for noncompliance. "We're the lucky ones because we at least have that, but there is nothing binding the hospital to maintain them," she said. Ms. Ellis also countered hospital officials' arguments that ratios would be too restrictive, pointing out that the bill provides for different ratios depending on the type of hospital unit or department. For example, the proposed law calls for one nurse for every four patients in medical and surgical units. In emergency departments, the measure would require between a 1-to-1 and a 1-to-3 ratio depending on the severity of the patient's condition. Ratios are 1-to-1 in labor and 1-to-2 for intensive care, while other units range from 1-to-1 to 1-to-5 ratio. Mr. Moore said he remains opposed to the safe staffing bill and is pushing what he said is a more thorough legislative approach to meeting the nursing shortage. However, the Uxbridge legislator conceded in a statement after the committee vote that the measure "may offer a start toward improved quality of patient care." Mr. Moore called the legislation short-sighted because it ignores the complexity of patient care delivery. Some nurses are more experienced or physically strong than others, and some patients are sicker than others, he noted. It would also financially burden hospitals, which are already struggling, as well as the state, by further driving up Medicaid costs, Mr. Moore said. "I don't think it solves the problem. It's only a piece of the problem of providing quality care," he said in an interview. "And our costs will go up. Some of the hospitals will end up closing, so there will be fewer options, and insurance will go up." For patients' advocates, though, putting more nurses on the hospital floor is a simple matter of taking better care of patients. "If you're a nurse and standing there trying to mind 20 patients and three buzzers go off, someone's going to go to the bottom of the list," said Carlos Alvarez, executive director of the American Lung Association of Massachusetts. "Most people need an acute level of care." Hospitals need adequate number of nurses Sandy Eaton, RN, Quincy, The Patriot Ledger, January 1, 2004 <http://ledger.southofboston.com/articles/2004/01/01/opinion/opin03.txt> Your Dec. 20 edition highlighted the small number of bills enacted into law so far in the current legislative session. One reason may be the intense pressures applied to legislators by champions of the status quo. Take health care, for example. After seven years of increasingly intense efforts by nurses and other patient advocates, with steadily mounting evidence that proper staffing saves lives, H-1282, An Act Ensuring Quality Patient Care and Safe RN Staffing, finally emerged from the Joint Committee on Health Care on Nov. 19 with a favorable report, moving on to the next stage, the House Ways and Means Committee. If the Massachusetts Hospital Association and its constituent institutions expended as much energy on supporting fundamental health care reform, such as S-686, the Massachusetts Health Care Trust, as they are spending to block passage of appropriate RN-to-patient staffing ratios, we would have achieved a just health care system in Massachusetts by now, one in which there would be virtually no one without health insurance, and health care financing would be stabilized. How much is a life worth? Editorial Comment: A short while ago, the chief lobbyist of the Massachusetts Hospital Association sent a message to all affiliated hospital executives affirming the intensity of the war ahead: "As has been indicated in previous communications, the MNA is putting all of its resources into passing this measure. Your continued efforts over the coming days, weeks, and months are needed to counter their efforts and to help defeat this harmful legislation." Attached to that email was a copy of the most recent weekly propaganda piece being sent to all two hundred Massachusetts legislators. Either the executives of MHA have not yet read H1282, or they don’t care a whit for the truth. They’re desperate. Their statement highlights the following fallacies: * Nurse managers need the flexibility to make the right decisions for their patients. (Well, nurses at the bedside have continuously demanded flexibility in staffing as acuity and numbers of patients rise, only to be told by nursing executives and managers to "do the best you can" and "there isn’t anyone else to send, but you must take those admissions anyway." Hospitals staff according to budget and according to average daily census, and rarely have any backup plan for bumping up.) * We have to grow our workforce and ensure that we have the educational and training programs to produce an adequate supply of caregivers. (Of the fifty states, California ranks 49th in per capita nurse population, and CNA reports that most facilities have succeeded in hiring and retaining enough nurses to meet the demand. Massachusetts ranks first, with many of its RNs having been driven from the bedside by incredible workloads, but willing to return to the bedside or increase hours or defer thoughts of early retirement if safe staffing standards are guaranteed.) * Because the nurses that would be needed to satisfy the ratios do not exist, hospitals would have to close units to ensure an adequate number of staff. (See above.) * Nearly every hospital in the state was out of compliance with the law the moment it went into effect. And one hospital - Santa Teresita in Duarte, CA - has closed because of it! (Simply not true. Some independent hospitals and systems dragged their feet, hoping that safe staffing legislation would be defeated or revoked. Others, such as Kaiser-Permanente and the University of California systems, have been working on improving their staffing ever since the law was passed in 1999, and are doing just fine. As to the one hospital that has closed in California since January 1st, its CEO is under investigation and litigation on several fronts. If this is the best MHA can do to discredit safe staffing and sow panic, it should give up now and join the nurses in implementing basic patient protections.) * There are no scientific studies that conclude that specific mandated staffing ratios are a requirement for assuring high-quality patient care. (Regular readers of Seachange Bulletin are well aware of the growing pile of unimpeachable studies to the contrary. Most can be accessed via the MNA web site <http://www.massnurses.org>.) * Do we know the true medical or financial costs? (We have a pretty good idea. The nurse-economist who did the original number-crunching for the California Healthcare Association analyzed the available figures from Massachusetts and concurred with our initial judgement that start-up costs for implementing safe staffing ratios would amount to a 1% to 1.7% increase in a hospital’s budget initially, but would soon be offset in better patient outcomes, shorter hospital stays and reduced number of RN turnovers. MNA’s estimate was presented as part of its presentation before the Joint Committee on Health Care last spring, and the MHA did not attempt to refute it.) Answer to MHA Propaganda about Layoffs of Ancillary personnel Massachusetts Nurses Association, February 17, 2004 The latest propaganda by MHA against H. 1282 claims that if the bill passes, there will be massive layoffs of LPNs and other ancillary personnel. The answer to this claim is quite simple: this is specifically prohibited under the bill. See paragraph below. We intend to develop postcards with this information for distribution to fellow employees in the bargaining units. The Truth about H. 1282: Contrary to a recent MHA statement that H. 1282 would result in the layoffs of support personnel and LPNs if passed, a close reading of the bill shows that such practices would be prohibited. Specifically, subsection (L) of the bill states: "The setting of staffing standards for registered nurses is not to be interpreted as justifying the understaffing of other critical health care workers, including licensed practical nurses and unlicensed assistive personnel. The availability of these other health care workers enables registered nurses to focus on the nursing care functions that only registered nurses, by law, are permitted to perform and thereby helps to ensure adequate staffing levels." Editorial Comment: For the text of the bill, go to <http://www.massnurses.org/safe_care/Safe_Staffing/billtext.pdf>. New York: Association calls for more nurses during liver transplants Eric Durr, The Business Review (Albany), December 3, 2003 <http://albany.bizjournals.com/albany/stories/2003/12/01/daily26.html> A state Department of Health plan to mandate nurse to patient staffing ratios for live-patient liver transplant operations doesn't go far enough, the New York State Nurses Association said Dec. 3. The state should set new nurse to patient staffing ratios for every procedure, said Janet Haebler, senior associate director of the association's practice and government affairs program. The New York State Nurses Association will be pushing hard during the 2004 state legislative session for legislation which mandates these staffing ratios and would force hospitals to hire more nurses. "What about all the patients in New York? Aren't they entitled to the same level and standard of care," she said. On Dec. 4 the State Hospital Review and Planning Council expected to approve mandatory nurse-to-patient staffing ratios for operations involving live liver donors. The staffing ratios - calling for one nurse for every two donors in intensive care and post-anesthesia unit, and one nurse for every four donors in general medical units - are part of a larger series of regulations addressing the procedure which involves taking part of a healthy person's liver and transplanting it. The state's living liver transplant programs came under scrutiny after the Jan. 13, 2002, death of Times Union reporter Mike Hurewitz at Mount Sinai Hospital in New York City. The call for mandatory staffing ratios piggy-backs a Nov. 13 press conference held by the Nurses Association in which they called on hospitals to hire more nurses in response to a survey conducted by the state Department of Education. According to that survey, New York is short 15,420 registered nurses and almost 37,000 of the 165,640 RNs working as nurses will retire in the next few years. Hospitals should eliminate mandatory overtime for nurses and pay more in order to encourage more of the state's 225,000 registered nurses to practice the profession full time, Haebler said. Mandatory staffing ratios would go a long way towards eliminating mandatory overtime which chases nurses away, she said. ... Pennsylvania: Deal could end MCP nurses' strike Philadelphia Inquirer, December 17, 2003 <http://www.philly.com/mld/inquirer/news/local/7510126.htm> Striking nurses at Medical College of Pennsylvania Hospital in East Falls and Tenet Healthcare Corp. yesterday reached a tentative agreement on a labor contract that could end a five-week-old strike by nurses. A spokeswoman for the hospital said the tentative agreement was reached during a negotiating session that also included a mediator. Details of the agreement were not disclosed last night. A ratification vote has been set for tomorrow, the hospital spokeswoman said. The strike, which began Nov. 11, involved the facility's 268 nurses and centered on the workers' opposition to mandatory overtime. The strike has had a significant effect on the hospital. Last week, the hospital said it would lay off 165 workers and reduce the hours of 35 because of a lack of patients it blamed in part on the strike. One of the region's oldest hospitals, MCP began in 1850 as the nation's first medical college for women. Drexel University now controls the medical school, which uses the campus for teaching and research, and Tenet owns the hospital. MCP, nurses reach tentative accord Simone Weichselbaum, Philadelphia Daily News, December 17, 2003 <http://www.philly.com/mld/dailynews/news/local/7510069.htm> Nurses at the Medical College of Pennsylvania Hospital have reached a tentative agreement with hospital officials, possibly ending their month-old strike. MCP spokeswoman Maria Iaquinto confirmed last night that the two sides have reached an agreement, but it won't be finalized until the nurses vote tomorrow. The main dispute between the two sides was over mandatory overtime and staffing issues. Iaquinto would not comment on what issues were roughed out by negotiators. The Daily News was unsuccessful in contacting union spokesman Mike Bodinsky. On Dec. 1, nurses voted down a proposed contract because it gave the hospital the right to ask nurses to work beyond their scheduled shifts. Web Directory: AARN <http://www.aarn.org> Australian Nursing Federation <http://www.anf.org.au> California Nurses Association <http://www.calnurse.org> Canadian Federation of Nurses Unions <http://www.nursesunions.ca> CCDS <http://www.cc-ds.org> Committee for Health Care for Massachusetts <http://www.healthcareformass.org> Irish Nurses Organisation <http://www.ino.ie> Labor Party <http://www.thelaborparty.org> LabourStart <http://www.labourstart.org> Maine State Nurses Association <http://www.mainenurse.org> Massachusetts Ad Hoc Committee <http://www.MassDefendHealthCare.org> Massachusetts Green-Rainbow Party <http://www.green-rainbow.org> Massachusetts Nurses Association <http://www.massnurses.org> MASS-CARE <http://www.masscare.org> New York Professional Nurses Union <http://www.nypnu.org> New Zealand Nurses Organisation <http://www.nzno.org.nz> PASNAP <http://www.pennanurses.org> PNHP <http://www.pnhp.org> Québec Nurses’ Federation <http://www.fiiq.qc.ca> Revolution Magazine <http://www.revolutionmag.com> Saint Louis Area Nurses Coalition <http://www.slanc.org> Seachange Bulletin <http://www.seachangebulletin.org> Southern Arizona Nurses Coalition <http://SAZNC.homestead.com> Union Web Services <http://www.unionwebservices.com> Women’s Universal Health Initiative <http://www.WUHI.org> FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. I am making such material available in an effort to advance understanding of environmental, political, human rights, economic, democracy, scientific, and social justice issues, etc. I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 US Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. For more information go to: <http://www.law.cornell.edu/asked/17/107.shtml>. If you wish to use copyrighted material from this site for purposes of your own that go beyond 'fair use,' you must obtain permission from the copyright owner. |