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Recently, 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