RN to RN: A Conversation of Gobal Concern March 29, 2009
Posted by rogerhollander in Health.Tags: aisha jahangir, california health, California Nurses Association, canada health, cna, eileen prendiville, health worker's union, health workers, healthcare, healthcare funding, national health service, nhs, northern ireland health, nursing, ontario health, ontario nurses association, patient care, patient ratios, patricia campbell, private health insurance, quality care, registered nurses, rns, roger hollander, single payer, unions
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People First! International Health Workers for People Over Profit (IHWPOP); March 29, 2009
Eileen Prendiville (RN – San Francisco, USA)
I’m struck by how similar our concerns are, even though we care for different kinds of patients in three different countries with different health-care systems. We are all facing budget cuts that are making it more difficult to care for our patients.
Aisha Jahangir (RN – Ontario, Canada)
Hospitals across the province of Ontario are chronically under-funded, and they are cutting nursing positions to balance their budgets. Every RN position lost is equivalent to 1,950 fewer hours of nursing care per year.
We are very concerned about this, because a higher proportion of RNs in a hospital has been shown to reduce patient deaths. For every ten percent rise in the proportion of RNs, patient deaths drop by five percent. Every patient added to the workload of an average RN causes the rate of complications and deaths to increase by seven percent.
Patricia Campbell (RN – Belfast, Northern Ireland)
I want to express my admiration for the work of the California Nurses Association (CNA) for winning legislation to ensure a minimum ratio of nurses per patient. That’s got to make it easier to practice safely and provide quality care for patients.
Our National Health Service (NHS) prefers to blame frontline workers than provide them with more resources. I’m eager to learn how the CNA achieved this benefit.
Eileen
Australian nurses won the first RN to Patient Ratios in 2001.
After a 12-year battle involving numerous rallies at the Capitol in Sacramento and meeting with legislators while facing fierce opposition from the hospital industry, the California Nurses Association (CNA) won the first RN to Patient ratios in the United States in 2004.
We won ratios of 1 nurse for every 4 patients in the ER – 1 to 2 for ICU patients and 1 to 1 for trauma patients. The ratios apply at all times, including meals and breaks. We also won restrictions on the use of unlicensed staff, restrictions on unsafe “floating” of nursing staff and no cuts to ancillary staff as a result of ratios. You can find out more by visiting the CNA website.
Aisha
We have a long way to go. In our ER, RNs have worked 24-hour shifts and been responsible for 15 patients at a time! Nurses are being forced to care for patients in hallways, and they are burning out.
Our local newspaper carried a front-page story about the deterioration in patient care at the hospital where I work. The hospital recently closed 16 beds and laid off 30 staff. The loss of beds and nurses means that patients are waiting much too long for care, and there aren’t enough nurses to provide the care that’s needed.
Too much work and too much stress are driving people out of nursing. More than one in four of the RNs currently working in Ontario are over age 55. Who will replace them?
Eileen
In California hospitals, safe RN ratios have improved the quality of care as well as nurse recruitment and retention.
Unfortunately, the California Department of Health Services, the government agency that regulates healthcare facilities and should be enforcing the law, is understaffed and beholden to the Schwarzenegger administration. As hospital administrators constantly seek ways to cut budgets in order to increase profits, we nurses must be diligent and insist on enforcing the law in our workplaces.
Also, California law states that the ratios must be reviewed after five years – in 2009. The hospital industry recently released two studies questioning whether the ratios really work, so we know that another is battle brewing to undermine the ratios again.
Patricia
I work as a Community Psychiatric Nurse, and CPNs are very concerned about the number of patients under our care. Can you tell me about community nursing in California? Does the nurse-to-patient ratio legislation protect nurses and patients in the community?
Eileen
I’m sorry to say that the law mandating nurse-to-patient ratios in California applies only to RNs in acute-care hospitals.
When patients with complex medical issues are sent home or to post-acute or skilled nursing facilities, the number of RNs is much lower. However, in the non-acute-care setting, we have gained improvements in nurse-to-patient ratios using our union-mandated staff nurse committees. Home health or visiting nurses who are unionized can also negotiate decreased case loads.
Patricia
We don’t have a strong union leadership here in Northern Ireland, and this is reflected in the way our health service is being run down. I’ve been involved in forming a new union for health workers, because the existing unions are more interested in developing a relationship with management than in protecting the rights of patients and health workers.
Eileen
While you mentioned the cuts to the NHS, the idea that all patients can access health care is something that Americans want, but don’t have. As more people lose their jobs and their health insurance benefits, we’re going to see many more people with no access to healthcare.
How has the NHS changed since its original inception, and would the residents of the U.K and Canada ever give up the idea of national healthcare?
Aisha
After winning national medicare in the 1970s, Canadians never imagined that we would see such a severe and escalating deterioration in our health-care system. We have been fighting back, but we have to fight much harder.
Patricia
NHS has changed significantly since its inception. Privatisation has taken a stronger hold since the Thatcher years, and New Labour continued Thatcher’s policies, dismantling a health service that was once the envy of the world.
The idea that all patients would not have access to health care would be beyond comprehension for us. However, while all NHS patients have health care in principle, the waiting lists for essential procedures and life-saving operations are increasing. As a result, many people are forced to go private.
Mental health services in Northern Ireland are grossly underfunded. For example, young people requiring specialist treatment for eating disorders and personality disorders must go to England for treatment. They are effectively exiled from their own country, far away from their families and friends. So health care is not really available for all.
I cautioned US health-care campaigners at a recent Labor Notes conference. I told them if you are going to fight for health care, fight for quality health care. A half-baked health-care system isn’t good enough.
Aisha
In Canada, the reintroduction of for-profit competitive bidding is putting a downward pressure on wages, making it even more difficult to keep people in nursing.
Eileen
I think we are headed for a public health disaster if we don’t get the profit factor out of healthcare.
The demand for a single-payer healthcare system is growing in The United States. For-profit insurance companies shouldn’t be involved in our healthcare decisions and any healthcare reform that keeps them in the mix will surely fail.
Patricia
We need to build stronger unions so we can improve our working conditions and make sure that our patients get the quality care they deserve.
Aisha
All these cuts on the backs of patients have to stop. Only in solidarity can we win this tough battle. 
Aisha Jahangir is an RN in the Family Birthing Unit at the Guelph General Hospital in Ontario, Canada. She is also a local coordinator for the Ontario Nurses Association.
Eileen Prendiville is an RN at an acute-care hospital in San Francisco, USA. She is also on the bargaining team of the California Nurses Association.
Patricia Campbell is an RN and Community Psychiatric Nurse in Belfast, Northern Ireland. She is also a founder of the UNIVERSI health workers’ union.
roger hollander 
California Strike Highlights Hospitals’ Skewed Priorities June 26, 2011
Posted by rogerhollander in California, Health, Labor.Tags: California, california hospitals, california strike, democratic unions, executive salaries, healthcare workers, hospital management, kaiser permanente, labor, labor unions, labour, mark brenner, nuhw, organized labor, patient care, roger hollander, salinas california, salinas valley memorial, seiu, workers rights
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Hundreds of workers at a central California hospital return to work today, after a two-day lockout that provoked a complaint from the state labor board.
Workers at the Salinas Valley Memorial Hospital, two hours south of San Francisco, were locked out after taking to picket lines on Tuesday.
The daylong strike—the first ever in the hospital’s 58-year history—was called by members of the National Union of Healthcare Workers (NUHW) after stalled negotiations with hospital management.
The union, which represents techs, professionals, and service workers in the hospital, is fighting plans to cut more than 100 direct-care positions and trim pension and health care benefits for new hires.
The labor board’s complaint says the Salinas lockout was illegal retaliation for striking. A decision is expected within a month—and could net workers back pay for the days they were locked out.
It’s the third short strike this year by NUHW, which was founded in 2009 after SEIU placed its third-largest local, the dissident United Healthcare Workers-West, into trusteeship, prompting members and leaders to establish the breakaway union.
The struggles are a critical part of the union’s development, as NUHW members work against intense opposition from employers and their former union to secure first contracts for its 10,000 members statewide.
TOP HEAVY
“We’ve never operated in the red,” said Ester Fierros-Nuñez, the Salinas union chairperson. “But now top administrators are treating this hospital, and the community, like their personal ATM.”
Hospital executives have been under close scrutiny after the union uncovered a deal which provided the recently departed CEO more than $5 million in pension and severance on top of the $150,000 a year he collects from the state pension plan.
Outrage over this taxpayer-funded golden parachute has spurred a state audit of the hospital’s finances. According to Fierros-Nuñez, six additional executives have the same kind of deal, which allows recipients to bypass IRS tax shelter rules by funneling money through multiple pensions.
“It’s like Enron,” she said. “They want to cut folks at the bottom so they can pay more to people at the top.”
NUHW has also criticized the hospital’s decision to spend $12 million on outside consultants, most notably Wellspring Partners, a Chicago-based firm. The consulting company, under prior ownership, was involved in the takeover and closure of St. Vincent’s hospital in New York City.
In St. Vincent’s bankruptcy proceedings, it emerged that the consultants had billed the hospital for everything from groceries and dry cleaning to opera tickets and club memberships. Union activists worry that Wellspring is milking their hospital as well.
LEAN AND MEAN
The biggest concern voiced on Tuesday’s picket line was for the hospital’s patients.
According to Debbie Prader, a 38-year licensed vocational nurse at the hospital, staff cuts that started a year and a half ago have sent workloads skyrocketing.
Previously, Prader typically worked her entire shift on a single floor, with an average of 10 patients. Now she’s covering two or three floors, and caring for up to 19 patients.
“They’re dismantling the whole hospital,” Prader said. “There’s no way to give good care in these conditions.”
Lily Garner, a 30-year medical transcriptionist at the hospital whose sister is currently a patient, said she’s seen the impact first hand. Basic help, like bathroom assistance, is lacking, she said.
“The people making all the decisions aren’t in contact with patients,” said Linda Vallez, a certified nursing assistant for 31 years at the hospital. “All they see is numbers on a spreadsheet.”
Salinas Valley Memorial is just the latest example of a profitable hospital looking to take advantage of the recession and lower staffing standards.
The same drive for concessions led 2,500 NUHW members in Southern California to launch their second one-day strike at Kaiser Permanente facilities on May 18. The health care giant made more than $1 billion in profits last year but is pushing for layoffs and major pension and health benefit takeaways.
“Kaiser executives are making more money than ever and are giving themselves huge raises, but they refuse to provide nurses with the staff we need to take care of our patients properly,” said Roxana Valadez, a pediatric nurse in Los Angeles. “And now, they’re not just keeping us understaffed, they also want to cut our benefits. Kaiser is becoming a worse and worse place to provide patient care.”
NUHW’S NEXT STEPS
The fights at Kaiser and Salinas hold the promise of stabilizing NUHW’s financial future, if they can win the union a first contract—and dues checkoff. (The union is hand-collecting dues in the meantime). Tight resources have hampered the union’s expansion, leading it to withdraw from numerous elections in recent months.
But even more important, the struggles are defining NUHW’s identity independent of SEIU.
There is no question the union will continue to run and win elections in SEIU bargaining units across the state, and extend their reach into non-union hospitals and nursing homes. NUHW’s recent victory in three of the four California Pacific Medical Center facilities in San Francisco is the latest example of its enduring appeal.
But the union’s most important challenge right now is to make good on its founding promise—that workers can build a democratic union willing to stand up and fight.
This task is doubly difficult when unions everywhere are ducking for cover, and when taking concessions is the norm. SEIU’s California leaders have agreed to health care cost-shifting and pension takeaways at health care facilities, giving management yet more reason to take a hard line against NUHW.
For NUHW’s members, there is no going back to the union they once had. And workers from Santa Rosa to San Diego have demonstrated they’re ready to build something new, and hopefully better, in its place.