Are Nurse Unions Needed to Fight Obamacare?

 

shutterstock_172496525Recently, I uttered words that I swore would never escape my lips: “I think, maybe, it’s time that the nurses come together and do something. Like … make a union.”

I have been vehemently and rabidly anti-union all my voting life. The daughter of a member of the California Teachers Association, I was introduced at a tender age to the many evils of unions. I was taught the different ways that unions manipulate members, abuse their dues, provide money to pet political causes, and make life difficult for the teachers. In public school, however, I was taught all of the ways that the teachers’ union was magnanimous, benevolent, and essential to a Good Education.

The hospital I work for has tried very hard to ensure that no unions take hold here. In conservative Orange County, this has not been too difficult: We are all afraid of the overreaching sight of Big Brother. We have rallied together to proclaim our independence from unions, our ability to directly negotiate with our managers, and to voice our happiness that we do not pay dues for services that we do not receive.

But new pressures mount on nurses in California on a daily basis. Standards of care are rapidly changing. While the state leads others in mandated nurse-to-patient ratios — one place I excuse governmental interference — this has not evolved with the healthcare landscape: Acute patients have more chronic illnesses with serious monitoring needs, and nurses are required to stay within ratio or lose their license.

One way that employers avoid passing the nursing ratio numbers is by manipulating the nurses aide (Clinical Nursing Assistant) to patient ratio. There may be one nurse for four patients, but an aide on that floor may be responsible for twelve patients. There are no laws, policies, or consequences for overburdening the clinical staff. With government emphasizing Value Based Purchasing, everything comes down to patient satisfaction and numbers.

It is only logical that number-crunching leads to pressure on the nurses. Looming costs, threat of non-repayment for Medicare patients, limits on what insurance will pay, reduction of MediCal patients — all pressure upper management to create catch-phrases and scripts for the nurses. When patients receive surveys such as HCAHPS, they can can answer questions about “hourly rounding” and “patient education” because the nurses have constantly reminded them of these terms.

But when patient satisfaction is key, patient safety is reduced. Studies are beginning to confirm that patient satisfaction actually coincides in a drop in patient outcomes, because patients receive the medication they want, rather than the medication they need. Hospitals rigidly deny these studies and affirm meaningless phrases such as “cost excellence,” repeatedly thrown at nursing staff for overuse of patient safety companions or patient care associates. Break nurses are treated as a luxury rather than a necessity, and staff nurses are burning out at an unprecedented rate, changing careers from healthcare shortly after their hospital care experiences.

Yet the safety measures that nurses ask for — beg for — are constantly denied. Those who seek these measures are pinpointed and maligned as troublemakers who aren’t part of the solution. Nurses who complain are scapegoated, and over time, the faces change. The number of those who were present before the ACA was enacted and Meaningful Use became a part of hospital life wanes. Nurses simply give up rather than risk their health and licenses to care for patients. “RN” is not meant to stand for “Refreshments & Narcotics,” no matter what the comics say.

The ultimate goal of hospital nurses is to provide compassionate, skilled, scientific, evidence-based care to their community, to educate their patients and their families, and to provide comfort for those during their most desperate times of need.

The government has been a hurdle to providing competent care. While increasing tracking and reporting, the outcomes have only increased government interference, reducing genuine care to care-by-the-numbers, the antithesis of the “individualized care” we are taught is the ideal. The only feasible hope for nurses appears to be to unionize down to the local, hospital level. In protecting nurses who complain, there is hope for change.

How else do we protect our patients and our nurses from Executive Administrators? How else do we ensure excellent care and — more importantly — safe care?

It is not the conservative way to want to limit the administrators who seek to keep the business afloat so it can continue to serve people. But surely there must be a limit to the unsafe practices that force nurses into the dark, protect dangerous work practices, and prevent patients from receiving care from healthy, educated, prepared nurses. There must be consequences for these actions and there must be a balance.

Unions were once needed to prevent gross negligence and abuse. Health care may again find a real and desperate need for them, not only to preserve the American quality of care, but to preserve the health of the American nursing force.

Editor’s Note: The published version of this piece erroneously stated that there was an aide-to-patient ratio. This was a confusion by the editor, not the author and has since been corrected.

Published in Domestic Policy
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  1. DocJay Inactive
    DocJay
    @DocJay

    The problem will be that doc and nurse unions will be populated by lazy sheep with unethical leaders. Like our country. But nobody but nobody is looking out for you and it’s only going to get worse. You’re probably right in terms of abuse protection.

    Patient satisfaction. What a moronic idea for bean counters. I took two older people off benzos( an older couple) today. I’m sure they weren’t happy but I blamed Obama and they seemed to understand. Not kidding….I really blamed him and it felt righteous.

    • #1
  2. Fake John Galt Coolidge
    Fake John Galt
    @FakeJohnJaneGalt

    First off, let’s be honest here. A nurse’s Union or a doctor’s Union will not be about what is best for patients. It will only be about what is best for its members and the patients health or outcomes be damned.
    In the end I suspect that everybody will have to be unionized to protect ourselves from our friendly overly protective government. If for no other reason than so we can collectively purchase politicians that will not put us out of work.

    • #2
  3. Lucy Pevensie Inactive
    Lucy Pevensie
    @LucyPevensie

    Real Jane Galt:First off, let’s be honest here.A nurse’s Union or a doctor’s Union will not be about what is best for patients.It will only be about what is best for its members and the patients health or outcomes be damned. In the end I suspect that everybody will have to be unionized to protect ourselves from our friendly overly protective government.If for no other reason than so we can collectively purchase politicians that will not put us out of work.

    I think that’s the irony in the end, isn’t it?  The argument for unions has always been that you need a monopoly on labor to deal with the monopoly on employment created by big employers.  In real life, there were always other employers.  But the government is truly a monopoly.

    • #3
  4. Blondie Thatcher
    Blondie
    @Blondie

    “It is only logical that following number crunching comes the pressure on the nurses. Looming costs, threat of non-repayment for Medicare patients, limits on what insurance will pay, reduction of MediCal patients, all pressures upper level management to create catch phrases and scripts for the nurses. When HCAHPS scores are received, the patients can answer questions about “hourly rounding” and “patient education” because the nurses constantly remind the patients of these terms.”

    I hate this more than anything in this world! People are sick and don’t feel good when they are in the hospital, yet we don’t get paid unless they can tell the bean counters that their stay was as grand as at a 5 star hotel! You are the patient, your doctor and I provide the care for you that you need to get better so you can go home. Sometimes this is not the care that you think you need. You can be sure that this will be the patient that gets the phonecall. And don’t come tell me I have to say certain things to the patient and their families. I have been in nursing for 27 years. I have only been called a Nurse Ratched once. It was because I made a 2 day postop patient get up and walk to the bathroom and walk in the hall. Right after we got back to the room her doctor came and she “told on me” (or so she thought). She wanted another nurse. Her doctor told her she wasn’t going to get one because I was doing what was best for her and nobody else had gotten her out of bed. This was 20 years ago. If HCAHPS was around then, I might have been fired over that. She actually called me a “Blonde B****” to the doc. To this day, whenever I see this doctor she calls me her “Blonde B****”! Too funny!

    • #4
  5. Blondie Thatcher
    Blondie
    @Blondie

    I understand what you are saying, obviously, but I don’t think a union is the way to go for the reasons already laid out above. I don’t know how you guys that work on the floor do it. We don’t have a mandated nurse/patient ratio here in North Carolina. Not sure how I feel about that. It is so subjective. I mean, 4 patients on a fresh surgical floor is different than 4 patients on a mother/baby unit. As you have seen, I’d be afraid it would be used in a negative way. Maybe if they didn’t ahve that law to fall back on, you could lobby for more nursing help on the units that need it and take away a nurse or 2 from those that could do with less. It has to be a game of give and take. Not to take up for the administrators, but their hands are tied to a degree. All these rules are coming down from DC and if we don’t met their stupid “standards” then none of us gets paid. And most of this isn’t coming from O-care (can’t bring myself to even type the name). It is coming from CMS and the medicare/medicaid changes some of which are tied in but not all.

    • #5
  6. Pony Convertible Inactive
    Pony Convertible
    @PonyConvertible

    I am very anti-union.  However, my wife of over 30 years is a nurse.  There are times when I think organizing might help.  Part of the problem comes from elimination of the nurse’s uniform.  Now that everyone in the clinic wears the same scrubs, patients can’t tell who is who.  Thus the administration can get away with having someone with a high school education and 15 minutes of training give shots, take vitals, etc.  The patient assumes it is a qualified nurse.  It saves a lot of money for the clinic.  If the nurses were unionized this sort of thing would probably not happen.

    In the end the union would be only for itself and not for the patient, or hard working nurses.  Thus, I am not in favor of them, but I understand why many people are.

    • #6
  7. Blondie Thatcher
    Blondie
    @Blondie

    Pony, I hear what you are saying about the uniform thing. We complained about this at our hospital, also. One solution we came up with was to make the RN on our badge so big you couldn’t miss it. Not too sure that helps. A lot of places have started requiring nurses to wear the same color scrubs and other healthcare workers wear different colors. We’ve toyed with this idea but haven’t done it yet. The first person to suggest we go back to wearing caps I will haunt you forever!
    I just don’t trust a union. Most of our professional organizations are very lefty. I’m afraid a union (local or not) would just follow their lead.

    • #7
  8. MarciN Member
    MarciN
    @MarciN

    It’s been a while since I was in a hospital. Are you saying that insurance companies won’t pay for patient care if the patient gives a poor patient satisfaction score? In other words, no one gets paid if the patient complains?

    I thought the scores were used just for rankings.

    • #8
  9. Blondie Thatcher
    Blondie
    @Blondie

    If we don’t get good scores, it affects our reimbursement rates from medicare/medicaid. Insurance companies follow suit. And yes, if a patient complains enough, the hospital will eat the cost. You learn to catch the trigger words when they walk in the door. You smile and do your best for these folk hoping everything goes well for them in their stay. There is a reason it is called “practicing medicine”. There are things out of our control.

    • #9
  10. civil westman Inactive
    civil westman
    @user_646399

    RNs have been turned into data entry clerks. The more data the gov’t, JCAHO, and other regulators possess, the more rules they can make. Their incentive, in the name of care improvement, is actually to justify their own existence. This vicious cycle must be broken. Nurses are simply called upon to perform too many tasks per unit time and until they are freed from useless data entry, they can never be the nurses they wish to be and actually be able to care. In my opinion, this is the reason many nurses are doing jobs other then nursing. The very ones who care are the first to leave, since they can’t stand being in a constant double-bind: enter data or be human.

    I doubt unions will help much. What is needed is to remove the government and the regulators.

    • #10
  11. Asquared Inactive
    Asquared
    @ASquared

    No organization that can be defined as a Union will ever “fight” Obamacare, they will just fight to make it more expensive for the benefit of their members at the expense of patients.

    • #11
  12. Larry3435 Member
    Larry3435
    @Larry3435

    Pony Convertible:Thus the administration can get away with having someone with a high school education and 15 minutes of training give shots, take vitals, etc. The patient assumes it is a qualified nurse. It saves a lot of money for the clinic. If the nurses were unionized this sort of thing would probably not happen.

    It doesn’t take more than a high school education and 15 minutes of training to give shots or take vitals.  Much less to empty a pee bottle, adjust the thermostat, give a sponge bath, or tell the patient “No, you can’t have an aspirin because the doctor didn’t order it and the doctor has gone home.”

    There is far too much over-training and over-qualification for routine heath care tasks.  Nurses’s time would be better spent doing tasks that actually require the years of schooling they take, and compensating them commensurately, rather than using them to perform tasks that could be done much more economically.  If hospitals are looking to cut costs, that would be the first thing they should do.  And (you are right about this), it will also be the first thing that unions would try to prohibit.

    • #12
  13. civil westman Inactive
    civil westman
    @user_646399

    The unstated but obvious goal of our government is to turn us all into ventriloquists’ dummies, whose every word is scripted and every move choreographed – by the metastatic administrative state. Health “care” represents the cutting (bleeding) edge of this undertaking. One can most easily observe this process in action by noting the regulation of nurses’ activities. There are posters in hospitals telling staff at what distance to begin smiling at patients. No kidding. Appended are instructions on how to deal with “cultural sensitivities” of various oppressed patient groups – in effect, nurses are told to focus on the differences, rather than the commonalities, between their patients; to tread on ever more fragile eggshells.

    If I were asked to design a system in which no actual human caring (feeling) would take place, this would be it.

    • #13
  14. Z in MT Member
    Z in MT
    @ZinMT

    The problem is exactly as anonymous stated. You might get by for a while if instead of calling yourself a union you call your self the “XYZ Hospital Professional Nurses Association.” But even then over time O’Sullivan’s law will engage.

    • #14
  15. Ryan M Member
    Ryan M
    @RyanM

    Real Jane Galt:First off, let’s be honest here.A nurse’s Union or a doctor’s Union will not be about what is best for patients.It will only be about what is best for its members and the patients health or outcomes be damned. In the end I suspect that everybody will have to be unionized to protect ourselves from our friendly overly protective government.If for no other reason than so we can collectively purchase politicians that will not put us out of work.

    This is spot on.  The reality is that unions only ever fight against the customer, never the employer.  Their sole interest is employees, and while such a thing might actually help some nurses (at the expense of those pushed out of the market), it will only pile on to the list of harm done to patients by Obamacare.

    • #15
  16. user_130082 Member
    user_130082
    @JamesAtkins

    As an RN at a federal government hospital (I prefer not to say which) who just left a large state hospital that relied heavily on Medicare payments, I have a few insights.

    1.       Patient satisfaction survey scores are ruining the practice of nursing. As some have already stated, the nursing management is more concerned about patient satisfaction than they are about patent outcome and safety. Many times these things are not compatible, and the bottom line is the bottom line.

    2.       Unions are not the answer. At hospitals that have to rely on Medicare reimbursement, the union cannot change the equation of survey score to hospital reimbursement.

    3.       The national union at my facility (of which I am not a member, due to factors I will name later) is outstanding in making sure the hospital follows already existing OSHA/government regulations concerning work conditions, breaks, and patient to RN ratios.

    4.       The reason I will not join is because the union will use my dues for political (Democrat) purposes, is only concerned about the members, and not the taxpayers that we swore an allegiance to serve.

    5.       As far as Obamacare is concerned, the union is foursquare and openly advocating for Single payer, so your desire to see Obamacare eliminated would be achieved. Unfortunately it would be replaced by a national health service that would deliver the same level of care we see in Great Briton, and at that point our patients will start to truly suffer a d die.

    • #16
  17. user_130082 Member
    user_130082
    @JamesAtkins

    Bottom line is I don’t know what the solution is to the problems until our customers become educated and savvy enough to demand better outcomes, rather than personal satisfaction, i.e. give me what I want when I want it. I don’t see this happening before I retire.

    • #17
  18. Blondie Thatcher
    Blondie
    @Blondie

    Bumper sticker on a car in my hospital parking lot: “I am a nurse. I am not here to kiss your a**, I’m here to save it.”

    • #18
  19. Pilli Inactive
    Pilli
    @Pilli

    Several years ago, I went through a hip replacement.  I was very nervous.  The only other surgery I have had was a tonsillectomy when I was 5.   The hospital and staff  were very good.  The nurses explained why I needed to get my butt out of bed and walk even though I was terrified of what I was doing.  I found they were right.  I could stand.  I could walk.  It hurt like hell but I could. I got better by doing it.  Listen to your nurse.

    • #19
  20. Ricochet Member
    Ricochet
    @FrontSeatCat

    I think, we as a country, have become too willing to let government grow so huge, so over-reaching in every sector, and we have folded under pressure from well-funded and organized liberal groups, and Washington,  that our country is losing what has made it great, free and prosperous.

    Our healthcare system, while not perfect, was fine. It needed change, not overhaul. Doctors and nurses on the front lines are being impeded by foolish regulation and bureaucratic bull, like teachers having to follow Common Core, military chaplains having to walk on eggshells when speaking, police afraid to do their jobs, control over school lunches, even state workers having to meet impossible numbers to get federal money. Also the large influx of immigrants is adding to the work load. Professionals are dropping out because things have changed so quickly, and not in favor of those serving and those being cared for. James is right about union dues going to Democratic party. No good.

    But there is still power in the collective voice – using social media, a march on Washington, letting the public know what is going on. While everyone is trying to do their jobs and make ends meet, the powers-that-be are changing the rules under our noses. Freedom and joy in work has been replaced by worry and stress, rules and more rules. Thank you nurses and all who serve – you make a difference! Read story on Ben Carson by Max Ledoux,  July 8th!

    • #20
  21. Instugator Thatcher
    Instugator
    @Instugator

    Blondie: Ratchet

    Her name was Nurse Ratched.

    Regarding the OP – I would remind you that once you pay the Dane-Geld you are never free of the Dane… and Unions are worse than any Dane.

    It is always a temptation to an armed and agile nation
    To call upon a neighbour and to say: —
    “We invaded you last night–we are quite prepared to fight,
    Unless you pay us cash to go away.”

    And that is called asking for Dane-geld,
    And the people who ask it explain
    That you’ve only to pay ’em the Dane-geld
    And then  you’ll get rid of the Dane!

    It is always a temptation for a rich and lazy nation,
    To puff and look important and to say: —
    “Though we know we should defeat you, we have not the time to meet you.
    We will therefore pay you cash to go away.”

    And that is called paying the Dane-geld;
    But we’ve  proved it again and  again,
    That if once you have paid him the Dane-geld
    You never get rid of the Dane.

    It is wrong to put temptation in the path of any nation,
    For fear they should succumb and go astray;
    So when you are requested to pay up or be molested,
    You will find it better policy to say: —

    “We never pay any-one Dane-geld,
    No matter how trifling the cost;
    For the end of that game is oppression and shame,
    And the nation that pays it is lost!”

    Dane-Geld, Rudyard Kipling, 1911

    • #21
  22. Blondie Thatcher
    Blondie
    @Blondie

    Thanks, Instugator. Fixed. Spelling is not my strong suit.

    • #22
  23. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Instugator, you are correct. But what are unions at their truest foundation than a group of people working together to prevent abuses and safety hazards? I’m not talking about AFL-CIO type unions (I believe CNA is under that umbrella). I am talking about the root of what inspired people to ensure the safety of others. I am not talking about fair wages or that nonsense. I am talking about making sure nurses, aides, and patients are safe.

    The wish list, I assure you, is much, much longer.

    • #23
  24. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    DocJay:The problem will be that doc and nurse unions will be populated by lazy sheep with unethical leaders.Like our country. But nobody but nobody is looking out for you and it’s only going to get worse. You’re probably right in terms of abuse protection.

    Patient satisfaction.What a moronic idea for bean counters. I took two older people off benzos( an older couple) today. I’m sure they weren’t happy but I blamed Obama and they seemed to understand.Not kidding….I really blamed him and it felt righteous.

    That is awfully negative.  I’m accused of being dark!

    As soon as bundled payment for services hits, just wait and see the ish hit the proverbial fan.  One payment for all outcomes and all lengths of stay, provided you provide the government-approved plan of care!  Healthcare of the future!

    Speaking of which, I received a missive about the “Transformative Healthcare of the Future” at work today.  Dear Leader promised transformation.  Here it is.

    • #24
  25. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Front Seat Cat:But there is still power in the collective voice – using social media, a march on Washington, letting the public know what is going on. While everyone is trying to do their jobs and make ends meet, the powers-that-be are changing the rules under our noses. Freedom and joy in work has been replaced by worry and stress, rules and more rules. Thank you nurses and all who serve – you make a difference! Read story on Ben Carson by Max Ledoux, July 8th!

    The collective voice meaning unions?  I mean unions in lowercase u, much like I enjoy libertarianism but am not a Libertarian.  Coming together as a union, as a collection of smaller unions perhaps is the way.  Coming together in an association of individuals without political agenda or platform, unions should serve to better their hospitals and their patients lives.

    Separately, whistleblowers can and will be punished, even at non-profit hospitals.  Ultimately, the patients will suffer as our system comes closer to the single-payer utopia imagined by our Euro-centric, Nanny-state loving, socialist compadres.

    And nursing, as a calling, will go the way of the white rhino.

    • #25
  26. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    Most of our professional organizations are very lefty. I’m afraid a union (local or not) would just follow their lead

    Yes, they are, and yes, they would be just as lefty.

    A few thoughts from the people’s republic of IL:

    1) Ratios mandated by the state give rise to exactly what has been complained of in this post. The support staff (think deliver trays, empty the garbage/ sharps, respiratory care, etc.) are eliminated to make room in the budget for nurses. Period. You are better off at a hospital with good administration than with a patient ratio mandated by the government. Once the mandate is in place, administration hands are tied. It has not come to IL yet, and I would fight to prevent it.

    2) I am not convinced that there isn’t more room for support staff than currently exists. Why can’t high school trained people give shots? The should not be reviewing orders or expected to think critically about the medication, but it’s a pretty simple procedure. A monkey could do it. Thinking about whether this is the right shot, etc. is another story.

    • #26
  27. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    Con’t

    3) The right metrics either don’t exist, are inadequately tested, or are politically unpopular. I hate patient satisfaction most of the time. But there is a place in which this metric is necessary. If patients are treated like chattel, then those scores will reflect this problem. It is important that patients are treated with dignity and respect, even when we’re telling them that their personal choices are killing them. The real issue is that the difference between the 70th and 90th percentile is now about 2% more “excellent” ratings than “very good” ratings. It’s significant from a metric standpoint, but not practically significant at all.

    • #27
  28. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    civil westman:RNs have been turned into data entry clerks. The more data the gov’t, JCAHO, and other regulators possess, the more rules they can make. Their incentive, in the name of care improvement, is actually to justify their own existence. This vicious cycle must be broken. Nurses are simply called upon to perform too many tasks per unit time and until they are freed from useless data entry, they can never be the nurses they wish to be and actually be able to care. In my opinion, this is the reason many nurses are doing jobs other then nursing. The very ones who care are the first to leave, since they can’t stand being in a constant double-bind: enter data or be human.

    I doubt unions will help much. What is needed is to remove the government and the regulators.

    True to some extent but over-simplified. The state of electronic medical records is truly atrocious. However, with increasingly complex patients, EMRs provide an unparalleled opportunity to capitalize on data to find alarming trends before they cause harm. But yes, much is just to satisfy well-intentioned but practically meaningless regulatory mandates.

    • #28
  29. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    TheRightNurse:Instugator, you are correct.But what are unions at their truest foundation than a group of people working together to prevent abuses and safety hazards?I’m not talking about AFL-CIO type unions (I believe CNA is under that umbrella).I am talking about the root of what inspired people to ensure the safety of others.I am not talking about fair wages or that nonsense. I am talking about making sure nurses, aides, and patients are safe.

    The wish list, I assure you,is much, much longer.

    This is not what really happens, though. It’s the same thing that teacher’s unions say – that it’s about making sure student’s will learn. Really, it’s about a cushy job with an early pension. I have no interest in a union limiting my workforce mobility. I will succeed on my own merits, and agitate for change without a massive, meddling, leftist organization on my back.

    I have lots of experience in this. It is not personally comfortable, but it is remarkably effective if your skin is thick enough.

    • #29
  30. Super Nurse Inactive
    Super Nurse
    @SuperNurse

    TheRightNurse:

    The collective voice meaning unions? I mean unions in lowercase u, much like I enjoy libertarianism but am not a Libertarian. Coming together as a union, as a collection of smaller unions perhaps is the way.

    Separately, whistleblowers can and will be punished, even at non-profit hospitals. Ultimately, the patients will suffer as our system comes closer to the single-payer utopia imagined by our Euro-centric, Nanny-state loving, socialist compadres.

    Again, unions will be usurped by the ANA or similar leftist organization, and the dream will become the nightmare, no question. History really provides no counter-examples. Unless you think this would be an exception, you can just bet on the outcome in advance.

    Sure, whistleblowers will be punished. How significant are the abuses? What do your ethics mean to you? Can you gain skills that will allow you to challenge skillfully and politically with acceptable self-risk? I have asked an answered these questions over the years, and found that in my practice (no mandated ratios) I am more effective within the system that outside, and that it is possible to drive change from within. And that most administrators are equally between a rock and a hard place, and need our help to place the proper priorities.

    • #30
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