Earlier this month a medication error was reported at Cedars-Sinai Hospital. The television show “TMZ” (The Thirty Mile Zone) first broke the news of this error, since it involved the children of a celebrity. The error, as it was reported, involved the unintentional overdosing of three infants (though other sources have reported that the incident may have involved up to 13 infants) with a Heparin overdose. Two of the infants that were affected by this medication error are the twin infants of Dennis Quaid and wife Kimberly Buffington.
As of today, Nov. 25, 2007, there seems to be several conflicting stories, so I’ll start with the initial report. TMZ broke the news with the following general information; three infants received inadvertent overdoses of Heparin, used to flush IV lines. They reported that two separate doses of 10,000 u were administered: the first was on Saturday and the second 10,000 u was on Sunday; and that the error was caught when the nurses noticed that the infants were beginning to “bleed-out”. The drug Protamine, the anti-dote to the Heparin overdose, was administered and the children were in Neonatal intensive care (NICU). Cedars later issued a press release that characterized the incident as an error that occurred due to a technician inadvertently placing the high concentration 10,000 u vial of Heparin (usually used in adults only) in the unit’s pharmacy stock, the nurse accustomed to only one dosage type (the lower concentration vial of 10 u) being available grabbed the high concentration vial and administered the incorrect amount, the nurses realized an error had occurred, ran the test to confirm their suspicions and then administered the anti-dote, Protamine. The hospital admitted that the error occurred in part because the nurse did not follow hospital protocols and procedures and that the State of California Department of Health and Human Services was investigating the incident. It has also been reported that the infants were in stable condition and had suffered no ill effects.
In my opinion the most interesting coverage about this unfortunate, but preventable, error came courtesy of the Los Angeles Times. Their coverage appears to me to be an almost “kid glove” handling of this very serious medication error and breech of nursing practice. Let’s not forget that Cedars is suppose to be a “Best of the Best Hospital” and a Magnet Hospital and the list of so-called “excellent” hospital awards goes on, so for such a medication error to occur should have news agencies asking the tough questions. Instead, news agencies seem to be happy to regurgitate the Cedars press release and to “downplay” the incident by spinning it as medications errors in hospitals are not uncommon. When a similar incident occurred at the now defunct King/Drew Medical Center several years ago the LA Times, rightly so, reported heavily on the hospital’s failure to safeguard their patients from medication errors; but they seem unwilling to use the same journalistic scrutiny on Cedars during this incident. The first Los Angeles Times’ article, which ran the day after the story broke on TMZ seemed to be mostly a regurgitation of the information provided by the Quaid/Buffington family, TMZ and the Cedars-Sinai Hospital authorized press release with no real new information provided. The second story, which ran the next day, in the Los Angeles Times tried to convince its readers that hospital drug errors were not uncommon; and if we believe this then we should be very concerned about the state of nursing and medicine in our Nation’s hospitals. What the Los Angeles Times failed to mention or question was how could such a medication error and failure of basic nursing practice occur in a hospital that proudly displays its US News America’s Best Hospital 2007 award and that it has been awarded the American Nurses Credentialing Center’s (ANCC) Magnet Excellence in Nursing status. Cedars even proudly displays this statement from the ANCC on its website “The ANCC found that Cedars-Sinai's nursing services "represent the highest standards in the nation and internationally." I would have to say that the recent Heparin overdose incident puts this label into question. But then again most RNs think that both Joint Commission and Magnet status are “jokes” and more often representative of how well hospitals prepare and present their documentation and how they “play” to their surveyors then an actual representation as to the quality of care and the nursing staff.
As a RN with over 35 year of experience at both the bedside and in nursing management and education I find the nursing error at Cedars frightening, but not completely surprising. Why, because I am very familiar with this particular hospital and the caliber of its nursing staff. And though there are many good nurses at Cedars, I also know that the nursing staff as a whole has not always been at the peak of their game (also using many registry and traveler RNs). The past several years have seen at least two, ugly, but failed unionization attempts of the nursing staff. These attempts have taken their toll on the staff and have left many nurses feeling angry and betrayed by one or the other side. I know that at least one unit, which once had a very stable staff, has experienced a great deal of turn-over recently, and this turn-over has left the remaining staff feeling unsupported by nursing management, and in many cases feeling demoralized and burnt-out.
As recently as four weeks ago, a neighbor and nurse, was admitted at Cedars for surgery and when she returned she spoke of a very poorly run nursing staff and a care-environment that was anything but caring. What gave her great concern was the lack of English exhibited by the nurses in the clinical setting. She said during her entire stay that she very seldom heard a word of English spoken in her presence (she is an English speaker) and she was concerned that if their English was so poor that they had to communicate to one another in their common “native” language then how well did they comprehend orders that were given in both verbally and in writing in English.
However, as a RN, what concerns me greatly is the failure of the nurse to follow the most basic of nursing protocols and that is to always check the medication (and that means reading the label). We work in a field that is not only high-stress but prone to human error and it is for this reason we are taught to rely on our eyes to verify such things as: is it the right medication, the right dosage, etc. The excuse given that “the nurse was unaccustomed to more than one type of heparin vial” is a poor one.
This past April I covered the issue of medication errors for my column From the Floor, which is published every three weeks in Working Nurse Magazine. My article can be found by following this link http://www.solutionsoutsidethebox.net/articles___studies. In this article I spoke of a medication error that cost a young mother her life and left her newborn an orphan and how medication errors occur and what nursing and hospitals can do to minimize and reduce situations that give rise to errors of this magnitude. There is a current trend in nursing and medicine to practice what has been labeled “blameless medication errors” the premise of this method is that if we do not “blame the nurse” for a error then the nurse will be more forthcoming when an error occurs thus allowing the error to be addressed and a correction plan implemented. However, the downside to “blameless medication error” reporting is that there may very well be an incident in which protocols and practices have been violated in such a way that blame should be assigned, as in the case of outright negligence.
What concerns me about the Heparin incident at Cedars is that 1.) This is not the first time this type of error has occurred, 2.) There was an FDA warning issued about the possibilities of such incidents, 3.) No one double-checked the vial to ensure it was the right medication or dose, 4.) The conflicting reports that first there were two overdoses versus just the one, 5.) First reports provided different facts as to how the overdose was caught, 6.) Reports seem to vary greatly as to how many infants were actually given the Heparin overdose and 7.) The report that there have been no ill-affects, when any NICU nurse or physician knows that it could be weeks to months before we learn if the children who received the overdoses will suffer from any negative sequelae.
Yes, this was indeed a culmination of a series of human errors, however as nurses one of our jobs is to serve as the patient advocate, which sometimes translates into the last line of defense. In the end there should have been two nurses whose job it was to ensure that the patient received the correct medication and dosage. The nurse whose job was to administer the medication should have had another nurse check the order, the vial for appropriate drug and dosage (it was never stated if another nurse had check the dosage and drug). This failure to practice what is a most basic of nursing skills has caused several infant lives to be endangered, families to be traumatized; and for the nurses and the staff involved this may very well be a career ending event. Let’s hope that this time we learn the lesson so that no other infant is placed in this type of preventable medical jeopardy – again!
Sunday, November 25, 2007
Wednesday, October 31, 2007
STRIKE!
The nurses at Pomona Valley Hospital, who are represented by Service Employee International Union (SEIU) staged a brief strike recently; they struck on the pretext that they were striking for patient safety, first and foremost. Meanwhile, the nurses in Northern California held a two-day strike earlier in October also echoed this same sentiment. However, as often occurs when individuals feel the need to draw the proverbial line in the sand, the loftiest of intentions can have unplanned consequences and sometimes those consequences can be negative. For example shortly after the nursing strike at Pomona Valley Hospital I received calls from RNs expressing their concern at some of the behavior they had observed exhibited by the individuals (purported nurses) on the picket line. What they described was an action that the picketing individuals made by pointing their finger at their eye and then pointing that same finger at nurses that had made the decision to report to work, and of course “cross the picket-line”. The nurses with whom I spoke with interpreted this gesture to mean, “we are watching you and we know who you are!” – an overt act of hostility.
Shortly after the Pomona Valley Hospital strike made headlines, the California Nurses Association, C.N.A., gave notice of the intent of nurses at numerous Sutter Hospitals to stage a two-day strike. On the first day of the strike the Contra Costa Times newspaper reported at least two incidences, which gave me cause for concern. The first was the action of some of the picketers that caused the road in front of one of the Sutter hospitals to become blocked thus making it difficult for patients, visitors and employees alike to access the hospital; and the second was a 911 call to the local police that a member of a group of 30 picketers had shined a spotlight in the eyes of a bus driver, temporarily blinding the driver as he tried to drive a busload of replacement nurses into the hospital parking lot.
Of course a reasonable person might correctly conclude that such incidents, as described above, are in all likelihood the exception rather then the rule during a strike – or are they?
Strikes can and do evoke very strong feelings among the strikers and their supporters and the non-strikers and their supporters. It is precisely because both sides have felt that they have been “backed into a corner” that these feelings and emotions can and often do erupt in such a way as to cause someone who might normally never engage in unacceptable, dangerous or violent behavior to do so, and under the auspice of a strike some individuals feel as though they have been given “permission” by society to act out in ways that they might not normally engage in – a mob mentality so to speak. However, it is just this perceived license that can make for a situation that leaves behind feelings of betrayal among nursing cohorts, hospital employees and even members of the community.
Strikes are not something that nurses salivate over in anticipation of holding, in reality strikes are an activity that many pro-union nurses see as a kind of “final solution” to what they often perceive as an impasse in negotiations, usually over contract terms, and rarely occur outside the parameters of these negotiations. There are formalized rules and protocols that surround calling a strike vote, and usually include providing a strike notice thus allowing the targeted hospital time to plan and prepare to have adequate replacement nurse staffing. Nurses and the public-at-large are unaccustomed to nursing strikes but when they do occur hospitals and nurses both take a hunker down and see it through attitude. The past several months have seen at least two separate nursing unions call a strike, each lasting only a couple of days and thus placing minimal strain on the services the hospitals can provide to the communities they serve. Over twenty years ago the nurses at a local Los Angeles-area hospital went on strike and besides the hospital having to reduce its beds by half, they also lost significant dollars a day for the duration of the strike. Strikes, if held long enough can and do cause extensive economic harm, and it is no different when nurses or other first responders strike, except there can also be unintended harm done to the community they serve. As a one visitor to a Sutter Health hospital during the recent strike was quoted as saying in the Contra Costa Times after their access to the hospital was temporarily blocked by one of the picketers who walked out in the middle of the road and tried to stop them from entering. “They lost some sympathy from us."
Strikes also can cause a rift to develop between those who chose to strike and those who chose not to strike, especially when those who cross the picket line are union nurses, or when a unit is ethically divided over the strike thus leaving some walking the line while others cross it. It’s easy in these circumstances to feel the desire to demonize the ones who crossed the picket line to report to work, and they are often pelted with catcalls, invectives, and name calling such as scab, by the picketers. Those who are pro-union are often supportive of such behavior, and from their perspective it makes sense. They are taking an extreme position, holding the strike; and in order for the strike to have a full effect the “line must hold”. So for every staff and replacement RN that crosses the line and reports to work it either weakens or appears to weaken this hard line stance and the fear of the strike failing can become a reality. The other argument that is used to support the strikers is that when the union succeeds and its contract conditions are met in whole or part then all the RNs benefit, including those who didn’t walk the picket line. This behavior often leaves the RNs that honored and walked the picket line feeling “betrayed” that they didn’t receive the full support of their fellow RNs, many of whom they may view as friends not just co-workers. Of course these feelings are very much within the norm and should come to no surprise to anyone with even a modicum of understanding of human behavior.
The challenge for a nursing strike, especially when the premise is that of patient safety, quality of care or other similar concerns is that the action of the nurses on strike can become an issue of ethics and a reality check as to the underlying “real” cause of the strike. This is not to say that when patient health and safety or quality of care is an issue then it might be reasonable that a union after feeling that it has exhausted all other avenues to remedy the issue may present a case to their RN members that a strike is the “wake up call” that is needed. However, this can create a scenario where the RNs create an environment that puts the very patients they are advocating for in jeopardy, thus rendering their reason for striking moot. Let me present the following example: many years ago a local nursing union called a strike at a nearby Los Angeles-area hospital, their nursing membership agreed with the call for a strike and then planned a five-day strike in order to bring attention to numerous issues, but two issues were singled out. They were patient safety and short staffing. I was doing a research project at this hospital prior to the strike vote and when approached with the opportunity to work during the strike I thought that this would provide me with the proverbial bird’s eye view of what a strike environment was like in a hospital. I had never worked a strike before, and this was the only strike I ever worked but it opened my eyes to the fact that some RNs exhibit the same take no prisoner attitude that strikers of other ilk have been known to exhibit. The most memorable experience was showing up to work the first day of the strike to discover that many of the RNs that had ended the shift before and were now walking the picket line with signs espousing the need for patient safety and quality of care had locked the replacement and staff nurses out of many of the monitors required to perform much needed tests on the critically ill patients in the NICU and had hidden the manuals to many of the other equipment. So it would appear to me that some RNs thought nothing of placing patients lives at risk in order to prove their point of the need for patient safety. I guess my greatest disappointment was learning that no-one from the nursing union seemed to be concerned that patients’ lives were put at risk, not because of a lack of nursing care or even incompetent nursing care but that a few overly zealous RNs thought that by making the replacement RNs lives ”difficult” they could advance their issues. Sad but true.
Does this mean I believe that RNs shouldn’t be allowed to strike? No, it is their right under our law, however on a personal level I would never strike. What saddens me is that RNs, especially when there are extreme feelings on both sides (both pro and con) about unions that this sometimes leads these individuals to engage in unprofessional and just plain bad behavior. When RN’s strike and that strike becomes “angry” with all the negative emotional baggage that comes with such a strike then situations occur that can cause irrevocable harm to the hospital, to the patients, to the community and to the RNs themselves. A RN strike is not like a grocery worker or entertainment industry strike. When the grocery workers strike you can choose to change your shopping patterns, as many of us did during the last one; and in a protracted strike lasting many months that may cause for a shortage of some food items you may loose a little weight as you consume fewer calories. During an entertainment strike you may not see any new movies or have a leaner selection of TV shows but you can always watch re-runs, DVDs or even shift activities to compensate for a lack of TV/movie programming. However, during a nursing strike, especially when the strike may take place at the one hospital in the community it may have the unintended consequence of placing a community at risk.
Things to remember when you’ve drawn that line in the sand:
➢ Remember that as a nurse we take an oath to advocate and care for our patients, don’t let your actions put them in
jeopardy,
➢ Remember to follow the rules and codes of conduct of the hospital if you decide to cross the picket line and report
for duty,
➢ Remember to follow the rules and codes of conduct set by your union for the strike action,
➢ Remember to avoid the temptation to make “your point” through vandalism, malicious action, etc.,
➢ Remember just as your reasons for striking are valid and should be respected, so are the reasons for those RNs
who chose, for whatever reason, not to strike,
➢ Even though the purpose of the strike is to “make the hospital aware”, try not to engage in activities or behavior
that intentionally creates the very problems related to safety you say you are striking about,
➢ Since it bears repeating, remember if you can feel so passionate about your position that you walk the picket line
to express your devotion to your patients, those RNs who chose to cross the picket line are also expressing their
passion and commitment to their patients by staying at the bedside,
➢ Remember it’s suppose to be about the patients,
➢ And finally, remember every strike has consequences – good and bad.
What I ask that pro-union RNs to consider when undertaking a strike is that they comport themselves in such a way as not to endanger their patients, their patients’ families and friends or even the replacement RNs that have been called in to provide care. Keep in mind that when the issues that brings you to the final solution of calling and holding a strike is patient centered then you should not create an environment that jeopardizes the health and well-being of the very patients’ whose safety you have gone on strike to protect. As professionals we must never lower our level of care and concern for the wellbeing of our patients and by extension our community by engaging in unprofessional behavior that places those patients at an even greater risk.
Shortly after the Pomona Valley Hospital strike made headlines, the California Nurses Association, C.N.A., gave notice of the intent of nurses at numerous Sutter Hospitals to stage a two-day strike. On the first day of the strike the Contra Costa Times newspaper reported at least two incidences, which gave me cause for concern. The first was the action of some of the picketers that caused the road in front of one of the Sutter hospitals to become blocked thus making it difficult for patients, visitors and employees alike to access the hospital; and the second was a 911 call to the local police that a member of a group of 30 picketers had shined a spotlight in the eyes of a bus driver, temporarily blinding the driver as he tried to drive a busload of replacement nurses into the hospital parking lot.
Of course a reasonable person might correctly conclude that such incidents, as described above, are in all likelihood the exception rather then the rule during a strike – or are they?
Strikes can and do evoke very strong feelings among the strikers and their supporters and the non-strikers and their supporters. It is precisely because both sides have felt that they have been “backed into a corner” that these feelings and emotions can and often do erupt in such a way as to cause someone who might normally never engage in unacceptable, dangerous or violent behavior to do so, and under the auspice of a strike some individuals feel as though they have been given “permission” by society to act out in ways that they might not normally engage in – a mob mentality so to speak. However, it is just this perceived license that can make for a situation that leaves behind feelings of betrayal among nursing cohorts, hospital employees and even members of the community.
Strikes are not something that nurses salivate over in anticipation of holding, in reality strikes are an activity that many pro-union nurses see as a kind of “final solution” to what they often perceive as an impasse in negotiations, usually over contract terms, and rarely occur outside the parameters of these negotiations. There are formalized rules and protocols that surround calling a strike vote, and usually include providing a strike notice thus allowing the targeted hospital time to plan and prepare to have adequate replacement nurse staffing. Nurses and the public-at-large are unaccustomed to nursing strikes but when they do occur hospitals and nurses both take a hunker down and see it through attitude. The past several months have seen at least two separate nursing unions call a strike, each lasting only a couple of days and thus placing minimal strain on the services the hospitals can provide to the communities they serve. Over twenty years ago the nurses at a local Los Angeles-area hospital went on strike and besides the hospital having to reduce its beds by half, they also lost significant dollars a day for the duration of the strike. Strikes, if held long enough can and do cause extensive economic harm, and it is no different when nurses or other first responders strike, except there can also be unintended harm done to the community they serve. As a one visitor to a Sutter Health hospital during the recent strike was quoted as saying in the Contra Costa Times after their access to the hospital was temporarily blocked by one of the picketers who walked out in the middle of the road and tried to stop them from entering. “They lost some sympathy from us."
Strikes also can cause a rift to develop between those who chose to strike and those who chose not to strike, especially when those who cross the picket line are union nurses, or when a unit is ethically divided over the strike thus leaving some walking the line while others cross it. It’s easy in these circumstances to feel the desire to demonize the ones who crossed the picket line to report to work, and they are often pelted with catcalls, invectives, and name calling such as scab, by the picketers. Those who are pro-union are often supportive of such behavior, and from their perspective it makes sense. They are taking an extreme position, holding the strike; and in order for the strike to have a full effect the “line must hold”. So for every staff and replacement RN that crosses the line and reports to work it either weakens or appears to weaken this hard line stance and the fear of the strike failing can become a reality. The other argument that is used to support the strikers is that when the union succeeds and its contract conditions are met in whole or part then all the RNs benefit, including those who didn’t walk the picket line. This behavior often leaves the RNs that honored and walked the picket line feeling “betrayed” that they didn’t receive the full support of their fellow RNs, many of whom they may view as friends not just co-workers. Of course these feelings are very much within the norm and should come to no surprise to anyone with even a modicum of understanding of human behavior.
The challenge for a nursing strike, especially when the premise is that of patient safety, quality of care or other similar concerns is that the action of the nurses on strike can become an issue of ethics and a reality check as to the underlying “real” cause of the strike. This is not to say that when patient health and safety or quality of care is an issue then it might be reasonable that a union after feeling that it has exhausted all other avenues to remedy the issue may present a case to their RN members that a strike is the “wake up call” that is needed. However, this can create a scenario where the RNs create an environment that puts the very patients they are advocating for in jeopardy, thus rendering their reason for striking moot. Let me present the following example: many years ago a local nursing union called a strike at a nearby Los Angeles-area hospital, their nursing membership agreed with the call for a strike and then planned a five-day strike in order to bring attention to numerous issues, but two issues were singled out. They were patient safety and short staffing. I was doing a research project at this hospital prior to the strike vote and when approached with the opportunity to work during the strike I thought that this would provide me with the proverbial bird’s eye view of what a strike environment was like in a hospital. I had never worked a strike before, and this was the only strike I ever worked but it opened my eyes to the fact that some RNs exhibit the same take no prisoner attitude that strikers of other ilk have been known to exhibit. The most memorable experience was showing up to work the first day of the strike to discover that many of the RNs that had ended the shift before and were now walking the picket line with signs espousing the need for patient safety and quality of care had locked the replacement and staff nurses out of many of the monitors required to perform much needed tests on the critically ill patients in the NICU and had hidden the manuals to many of the other equipment. So it would appear to me that some RNs thought nothing of placing patients lives at risk in order to prove their point of the need for patient safety. I guess my greatest disappointment was learning that no-one from the nursing union seemed to be concerned that patients’ lives were put at risk, not because of a lack of nursing care or even incompetent nursing care but that a few overly zealous RNs thought that by making the replacement RNs lives ”difficult” they could advance their issues. Sad but true.
Does this mean I believe that RNs shouldn’t be allowed to strike? No, it is their right under our law, however on a personal level I would never strike. What saddens me is that RNs, especially when there are extreme feelings on both sides (both pro and con) about unions that this sometimes leads these individuals to engage in unprofessional and just plain bad behavior. When RN’s strike and that strike becomes “angry” with all the negative emotional baggage that comes with such a strike then situations occur that can cause irrevocable harm to the hospital, to the patients, to the community and to the RNs themselves. A RN strike is not like a grocery worker or entertainment industry strike. When the grocery workers strike you can choose to change your shopping patterns, as many of us did during the last one; and in a protracted strike lasting many months that may cause for a shortage of some food items you may loose a little weight as you consume fewer calories. During an entertainment strike you may not see any new movies or have a leaner selection of TV shows but you can always watch re-runs, DVDs or even shift activities to compensate for a lack of TV/movie programming. However, during a nursing strike, especially when the strike may take place at the one hospital in the community it may have the unintended consequence of placing a community at risk.
Things to remember when you’ve drawn that line in the sand:
➢ Remember that as a nurse we take an oath to advocate and care for our patients, don’t let your actions put them in
jeopardy,
➢ Remember to follow the rules and codes of conduct of the hospital if you decide to cross the picket line and report
for duty,
➢ Remember to follow the rules and codes of conduct set by your union for the strike action,
➢ Remember to avoid the temptation to make “your point” through vandalism, malicious action, etc.,
➢ Remember just as your reasons for striking are valid and should be respected, so are the reasons for those RNs
who chose, for whatever reason, not to strike,
➢ Even though the purpose of the strike is to “make the hospital aware”, try not to engage in activities or behavior
that intentionally creates the very problems related to safety you say you are striking about,
➢ Since it bears repeating, remember if you can feel so passionate about your position that you walk the picket line
to express your devotion to your patients, those RNs who chose to cross the picket line are also expressing their
passion and commitment to their patients by staying at the bedside,
➢ Remember it’s suppose to be about the patients,
➢ And finally, remember every strike has consequences – good and bad.
What I ask that pro-union RNs to consider when undertaking a strike is that they comport themselves in such a way as not to endanger their patients, their patients’ families and friends or even the replacement RNs that have been called in to provide care. Keep in mind that when the issues that brings you to the final solution of calling and holding a strike is patient centered then you should not create an environment that jeopardizes the health and well-being of the very patients’ whose safety you have gone on strike to protect. As professionals we must never lower our level of care and concern for the wellbeing of our patients and by extension our community by engaging in unprofessional behavior that places those patients at an even greater risk.
Sunday, October 14, 2007
When newspapers fail, are they even aware of it?
In mid-September I opened my copy of the Los Angeles Times and as I read through the various sections my roving eye stopped at an article picked up from the San Diego Union-Tribune entitled “Outsourcing education”. The article heralds a bold new idea that the California Labor and Workforce Development Agency had worked out to “solve” California’s persistent nursing shortage. The solution they would send upwards to 40 students who had completed their pre-nursing education to attend nursing school at a college in Guadalajara, Mexico. The twist to this brainchild the team at the California Labor and Workforce Development Agency is that the students would have to be English/Spanish bilingual and willing to spend upwards to two years working in a “needy” hospital. It appears this program will cost somewhere in the neighborhood of $20,000 US dollars, not to mention the cost of the team that will be organized to support these students to ensure they acclimate to the new system, and cultural environment.
I attended the California Board of Registered Nursing (BRN) when this notion was presented. What was suppose to be a simple 10 – 15 minute presentation turned out to be nearly an one hour+ dog and pony show, complete with The Honorable Rosario Marin, Secretary of California’s State and Consumer Services Agency and a honcho from the university in Guadalajara. When the members of the BRN expressed concern at what appeared to be an quick start time, they presented the plan with the intent to kick-off the program in January, the members of the BRN were presented with a “your approval is not necessary, since they will be educated outside the US and will enter the California system as a foreign-educated nurse”. When I expressed my concerns at the meeting Stacy Leach form the California Labor and Workforce Development Agency approached me and announced that she had been meaning to contact me, and as of the writing of this post I’m still waiting to hear from her, but then again I’m not surprised at another bureaucrat making empty promises.
Now I’m no investigative journalist but I can tell when something doesn’t seem like it make sense and this entire plan reeks of old fashion patronization. Questions like why will this program cost nearly $20,000 which is the cost of a community college nursing program (hint the current currency conversion rate is 1 USD to 10 Mexican Pesos), why is the program only available to Spanish/English speakers and does this violate equal access laws especially since it appears that the program will be receiving taxpayer dollars, if we can do this why aren’t we investing these dollars in our local community college nursing programs, and if this program is so much on the “up and up” why sneak it through the back door – they presented the program as a fait accompli, etc. One would think that the San Diego Union-Tribune reporters would be the ones asking these questions, but they appeared to be more concerned about regurgitating the press release then asking the really hard questions. And the newspaper owners, editorial boards, reporters, etc., wonder why they continue to lose subscribers.
So when I read the article I sent the following letter to the editor, and since it appears they chose not to run it I am taking this opportunity to post it on my blog.
In closing I fervently believe that we need to muster all resources and ideas to alleviate our nursing shortage (both in the educational and work pipeline). However, first and foremost we need to look at ways of supporting home-grown solutions, as these are the only ones that will have the most long-term and long-reaching affect and effect.
==
September 19, 2007
Letters to the Editor
San Diego Union-Tribune
PO Box 120191
San Diego, CA 92112-0191
Re: “Outsourcing education”
Dear Editor:
As a RN with over 35 years of experience I can’t begin to say how this plan gives me a great deal of concern. What are they thinking?
The plan to pay for almost 40 Spanish/English speaking Californians to attend nursing school in Guadalajara, I believe it is short-sighted and poorly thought out.
First, would such a program if being supported through taxpayer dollars violate our provision of equal access? This could be a problem since the program is not, contrary to the article open to bilingual nursing school students, its only available those who speak Spanish and English.
Second, will the courses in Guadalajara be in English, or will they be conducted in Spanish; and if the later will those graduates be required to take the required English proficiency exams required of nurses educated in foreign countries?
Third, the cost of the program seems high even by California standards. If memory serves the amount quoted in the paper is at the high end of our A.D.N. program so why does this program appear to cost the same dollar to peso?
Four, why not invest these dollars into our local community and community college economy. Why do we continually not blink an eye to outsource when for nearly the same investment we can begin to grow our own nursing pipeline?
In short this is an idea whose time has not come.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
I attended the California Board of Registered Nursing (BRN) when this notion was presented. What was suppose to be a simple 10 – 15 minute presentation turned out to be nearly an one hour+ dog and pony show, complete with The Honorable Rosario Marin, Secretary of California’s State and Consumer Services Agency and a honcho from the university in Guadalajara. When the members of the BRN expressed concern at what appeared to be an quick start time, they presented the plan with the intent to kick-off the program in January, the members of the BRN were presented with a “your approval is not necessary, since they will be educated outside the US and will enter the California system as a foreign-educated nurse”. When I expressed my concerns at the meeting Stacy Leach form the California Labor and Workforce Development Agency approached me and announced that she had been meaning to contact me, and as of the writing of this post I’m still waiting to hear from her, but then again I’m not surprised at another bureaucrat making empty promises.
Now I’m no investigative journalist but I can tell when something doesn’t seem like it make sense and this entire plan reeks of old fashion patronization. Questions like why will this program cost nearly $20,000 which is the cost of a community college nursing program (hint the current currency conversion rate is 1 USD to 10 Mexican Pesos), why is the program only available to Spanish/English speakers and does this violate equal access laws especially since it appears that the program will be receiving taxpayer dollars, if we can do this why aren’t we investing these dollars in our local community college nursing programs, and if this program is so much on the “up and up” why sneak it through the back door – they presented the program as a fait accompli, etc. One would think that the San Diego Union-Tribune reporters would be the ones asking these questions, but they appeared to be more concerned about regurgitating the press release then asking the really hard questions. And the newspaper owners, editorial boards, reporters, etc., wonder why they continue to lose subscribers.
So when I read the article I sent the following letter to the editor, and since it appears they chose not to run it I am taking this opportunity to post it on my blog.
In closing I fervently believe that we need to muster all resources and ideas to alleviate our nursing shortage (both in the educational and work pipeline). However, first and foremost we need to look at ways of supporting home-grown solutions, as these are the only ones that will have the most long-term and long-reaching affect and effect.
==
September 19, 2007
Letters to the Editor
San Diego Union-Tribune
PO Box 120191
San Diego, CA 92112-0191
Re: “Outsourcing education”
Dear Editor:
As a RN with over 35 years of experience I can’t begin to say how this plan gives me a great deal of concern. What are they thinking?
The plan to pay for almost 40 Spanish/English speaking Californians to attend nursing school in Guadalajara, I believe it is short-sighted and poorly thought out.
First, would such a program if being supported through taxpayer dollars violate our provision of equal access? This could be a problem since the program is not, contrary to the article open to bilingual nursing school students, its only available those who speak Spanish and English.
Second, will the courses in Guadalajara be in English, or will they be conducted in Spanish; and if the later will those graduates be required to take the required English proficiency exams required of nurses educated in foreign countries?
Third, the cost of the program seems high even by California standards. If memory serves the amount quoted in the paper is at the high end of our A.D.N. program so why does this program appear to cost the same dollar to peso?
Four, why not invest these dollars into our local community and community college economy. Why do we continually not blink an eye to outsource when for nearly the same investment we can begin to grow our own nursing pipeline?
In short this is an idea whose time has not come.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
Monday, September 10, 2007
SEIU cries "foul" over outsing by nurses
The nurses of St. John's Mercy Medical Center were offered a choice, stick with their union, the SEIU, join a different union, the UFCW, or dump them both and become free of union representation. A total of 1.036 nurses voted for neither, 685 voted to stay with the SEIU and two voted to join the UFWC. With a vote spread of nearly 349 between those wanting to seperate from the union versus to remain with the union -- the union cries "unfair practices".
A reasonable person could understand if the vote to decertify was close, but when the majority says no then shoudn't the union respect what the workers' want, isn't that what the union purport to support -- what workers' want? This nurse says respect what these professionals want, respect their opinon and more importantly respect their vote!
Below is a copy of the letter to the editor which I submitted in response to the article the ran on the SEIU's sour grapes attitude. The link to the original article can be found at the end of the letter.
(SUBMITTED BUT NOT PRINTED)
August 23, 2007
Letters to the Editor
St. Louis Post-Dispatch
900 North Tucker Blvd.
St. Louis, MO 63101
Re: “Union says hospital used access to influence nurses”
Dear Editor:
Can we say “sour grapes”? After losing the “decertification vote” by 349 the union cries “undue influence”, why? Because in their myopic view of the world no one in their right mind would reject the benevolent protection of the union power structure, and nurses surely could not think they could – speak with their own voice. As to Wright’s complaint about the letter from the Sister’s of Mercy to vote with the hospital, how is this any different from the full page newspaper ads this same union is taking out in my home town beseeching the community to “stand by the nurses” in their attempt to unionize at a local hospital. Oh, I know the difference these full page ads are paid for by union dues and displaying the signatures of local, state and federal politicians and powerbrokers are meant to influence the community into browbeating those opposing joining a union into joining one. Also, it should have been apparent to the union that they were most likely on the losing side of this vote when only 1/5 of the nurses chose to join them under the open shop agreement – this was not a resounding endorsement, or maybe the St. John’s nurses were aware of the SEIU’s role in the King/Harbor Hospital debacle and didn’t think they wanted that “type” of representation.
Whatever, the reason, this nurse says kudos to the nurses of St. John’s for making their voices heard. I think what every one should take notice in this vote is the turnout and the disparity between the ayes and nays, because contrary to the unions plaintive assertions this speaks volumes about what the nurses wanted!
Geneviève M. Clavreul, RN, Ph.D.
The link to the original article can be found here: http://www.stltoday.com/stltoday/business/stories.nsf/healthcare/story/C98F115679922E458625733F00092A0A?OpenDocument
A reasonable person could understand if the vote to decertify was close, but when the majority says no then shoudn't the union respect what the workers' want, isn't that what the union purport to support -- what workers' want? This nurse says respect what these professionals want, respect their opinon and more importantly respect their vote!
Below is a copy of the letter to the editor which I submitted in response to the article the ran on the SEIU's sour grapes attitude. The link to the original article can be found at the end of the letter.
(SUBMITTED BUT NOT PRINTED)
August 23, 2007
Letters to the Editor
St. Louis Post-Dispatch
900 North Tucker Blvd.
St. Louis, MO 63101
Re: “Union says hospital used access to influence nurses”
Dear Editor:
Can we say “sour grapes”? After losing the “decertification vote” by 349 the union cries “undue influence”, why? Because in their myopic view of the world no one in their right mind would reject the benevolent protection of the union power structure, and nurses surely could not think they could – speak with their own voice. As to Wright’s complaint about the letter from the Sister’s of Mercy to vote with the hospital, how is this any different from the full page newspaper ads this same union is taking out in my home town beseeching the community to “stand by the nurses” in their attempt to unionize at a local hospital. Oh, I know the difference these full page ads are paid for by union dues and displaying the signatures of local, state and federal politicians and powerbrokers are meant to influence the community into browbeating those opposing joining a union into joining one. Also, it should have been apparent to the union that they were most likely on the losing side of this vote when only 1/5 of the nurses chose to join them under the open shop agreement – this was not a resounding endorsement, or maybe the St. John’s nurses were aware of the SEIU’s role in the King/Harbor Hospital debacle and didn’t think they wanted that “type” of representation.
Whatever, the reason, this nurse says kudos to the nurses of St. John’s for making their voices heard. I think what every one should take notice in this vote is the turnout and the disparity between the ayes and nays, because contrary to the unions plaintive assertions this speaks volumes about what the nurses wanted!
Geneviève M. Clavreul, RN, Ph.D.
The link to the original article can be found here: http://www.stltoday.com/stltoday/business/stories.nsf/healthcare/story/C98F115679922E458625733F00092A0A?OpenDocument
Monday, August 20, 2007
For whom the bell tolls, it tolls for thee – King/Harbor Hospital
By now the closure of King/Harbor Hospital’s Emergency Room after the failed “make or break” CMS inspection has made the rounds of the newspapers, radio talk shows and various news outlets. I was one of the many King/Drew Medical Center supporters who both fought for and knew that the hospital could be “fixed” if the correct steps were taken. However, as the months passed and endless reports were issued I quickly concluded that under the current “save the hospital” plan being implemented that failure was the only possible scenario.
My knowledge and expertise was based on over 35 years as a nurse at the bedside, in nursing/hospital management and as a nursing educator. The County hired two different consulting firms, one that was billed as a consulting firm (The Camden Group) with nursing expertise and the other (Navigant) billed as being skilled at hospital turn-arounds. A little due diligence and research on my part provided me with information that contradicted the PR being spewed by Dr. Garthwaite, (head of Department of Health Services at the time). However, the Board didn’t have to rely on my word or even my proof, they only had to read the reports from the CMS and even the local paper to discern that the so-called nursing consultants were not making the grade. Under Camden’s watch we had the stunning failure of surgical instruments not being counted at the end of surgeries. Not long afterwards CMS issued their now infamous memo, which forced the County to enter into an agreement to pay for a management firm to oversee the day-to-day hospital operations. This MOU gave us Navigant Consulting and their 1000+ problems of KDMC report. It was about this same time that Garthwaite made his recommendation to close the trauma center, explaining that this would help “decompress” the hospital’s other service areas and thereby assuring a greater chance to pass the much needed CMS inspection. No one should forget that the Los Angeles County District Attorney found that the Board of Supervisors had violated the Brown Act by holding a closed-door session prior to announcing the decision to close the Trauma Center; however he never released the tapes of that session and I believe that this is still being litigated.
Navigant took over the day-to-day operations with a guarantee of a full time staff and promises that they were the “right” folks to do the job. And it was long afterward that we discovered that full time attention meant something more like Tuesday through Thursday; and forget have a Chief Nursing Officer (CNO) on 24 hour call since their CNO flew back to spend her weekends in her home in one of the Carolinas. She was later replaced with a CNO who lived much closer only requiring her to travel to New Mexico for her weekends. After at least one contract extension and a couple of financial augmentations Navigant finally concluded their overhaul of King/Drew with the placement of Ms. Antoinette Epps-Smith as the hospital’s Chief Executive Officer. There was a small opportunity for the County to rid itself of Navigant and replace them with another firm. Supervisor Antonovich managed to get the Board to consider FTI Cambio, unfortunately Ms. Epps sang the praises of Navigant (I wonder why) and we continued on with a firm that had been with us through several failed JCAHO and CMS inspections.
When CMS came for its next inspection the failure was so great as to caused the County to promise to down size and reorganize the hospital, placing it under the “umbrella”
of its sister hospital Harbor-UCLA. In the real world Ms. Epps would have tender her resignation or the DHS would have asked for her resignation, but of course this is Los Angeles County where people get promotions, praises, and raises when they fail. So Ms. Epps received a standing ovation from the community she failed and praises from the Board of Supervisors. It was about this point in time when Chernof and Epps became successful in clamping an almost complete lockdown on information about all things King/Harbor. Employees (nurses, physicians and staff alike) seemed fearful of sharing any information with anyone – but that didn’t stop the failures from occurring.
The most notable was the death of Ms. Rodriguez, a woman who had sought help from the hospital instead found an unresponsive and uncaring staff. Even after being left to writhe on the ER floor for 45 minutes, and it has been reported that numerous staff, including at least one RN, ignored her cries of pain that is until the hospital safety police came to arrest her, her boyfriend agreed when an officer informed him that she would get care at the County USC jail ward – imagine his desperation that allowing her to be arrested on the promise that it could possibly get her the medical care that King/Harbor personnel were unwilling or unable to give her. Unfortunately this intervention came too late. As she was being wheeled out to the patrol car she collapsed and all attempts to rescuitate her failed.
Shortly afterwards the State of California Department of Health and Human Services issued a notice that the state planned to revoke the hospital’s license. And this was followed by the failure of King/Harbor to pass the last critical CMS inspection and the loss of 200 million dollars in crucial federal dollars. The County immediately closed the ER and is in the process of closing the hospital leaving an urgent care clinic in the footprint of this once 200+-bed hospital.
Do the citizens of South Central need a hospital with an Emergency Room, without a doubt! Do I believe King/Drew Medical Center could have been brought up to minimum national standards, you betcha! There are those who blame the Board and indeed they deserve their share of blame for the failure – these failures occurred at several critical junctures and in my opinion they were:
1. Not firing the Camden Group when it was apparent they were being unsuccessful and once they “completed the job” and it was discovered that the work product appeared less than exemplar the County never sought legal remedy.
2. Not firing Dr. Garthwaite for his gross misunderstanding of the problem, which led to the mandated MOU agreement with CMS, which of course saddled us with Navigant.
3. Not replacing Navigant with Cambio or another firm when the opportunity presented itself.
4. The hiring of Ms. Epps, who was advertised as having presented an excellent resume did not appear to have ever been solely responsible for such a momentous task.
5. Not firing Ms. Epps when King/Drew failed its first “make or break” CMS inspection, which then caused for the drastic downsizing and reorganization of King/Drew and it being renamed King/Harbor.
You may wonder why such measures, because the failures that we saw at King/Harbor were never new ones but the repetition of many of the same ones that caused the original jeopardy. The consultants and DHS staff alleged that much of the King/Harbor staff appeared unwilling to accept change and there were even vague allegations of “sabotage” such as employees being given new policy to adhere to only to pretend that they had never received such policies. But most importantly the incident involving Ms. Rodriguez illustrates a staff so demoralized and demotivated that they were unable to respond to someone writhing in pain on the floor right before their eyes. When a staff reaches this point there is little that can be done to reinvigorate it and often the only remedy is closure.
So what does the future hold for beleaguered King/Harbor Hospital? Well, if we are to believe the Board of Supervisors they plan to find a private firm that will assume the operations of the hospital. It won’t be an easy task to find a private firm to assume the operations of this hospital, if we are fortunate enough to find such a firm then, I believe, to ensure the greatest possibility of success the County will, no must, relinquish a great deal of authority thus allowing the private firm a wide latitude of autonomy to make the necessary changes that will not only restore the hospital’s federal funding, but also stave off the loss of the hospital’s licensure to the State. And it’s not just the County that has to be willing to give up some control, all stakeholders are going to have to give up some of their “interests” (something that never really happened the last time around) and allow the firm to do what must be done. This of course is all dependent on the premise that the private firm is competent in its function and that they have a strong commitment to providing service to the community of South Central and by extension all of Los Angeles.
Just for added background on August 2, 2004 I submitted a civilian complaint to the Los Angeles County Civil Grand Jury, vis a vis the board of Supervisors lack of appropriate knowledge to oversee the health care of Los Angeles County and ask that they recommend a health care authority. The civil grand jury investigated and recommended the creation of a health authority. It would appear that, as usual, the Supervisors decided to let things be as is and now we know where that course has led. See grand civil 2004 findings and recommendations.
And for those who believe that CMS was overly harsh in its critique or evaluation of King/Harbor I encourage you to read the complete CMS report, which can be found at http://bos.co.la.ca.us/Categories/Agenda/cms1_071137.htm and select CMS Report, or you can download the report directly at http://lacounty.info/bos/sop/supdocs/34095.pdf. Read the report and then draw you own conclusions . . .
My knowledge and expertise was based on over 35 years as a nurse at the bedside, in nursing/hospital management and as a nursing educator. The County hired two different consulting firms, one that was billed as a consulting firm (The Camden Group) with nursing expertise and the other (Navigant) billed as being skilled at hospital turn-arounds. A little due diligence and research on my part provided me with information that contradicted the PR being spewed by Dr. Garthwaite, (head of Department of Health Services at the time). However, the Board didn’t have to rely on my word or even my proof, they only had to read the reports from the CMS and even the local paper to discern that the so-called nursing consultants were not making the grade. Under Camden’s watch we had the stunning failure of surgical instruments not being counted at the end of surgeries. Not long afterwards CMS issued their now infamous memo, which forced the County to enter into an agreement to pay for a management firm to oversee the day-to-day hospital operations. This MOU gave us Navigant Consulting and their 1000+ problems of KDMC report. It was about this same time that Garthwaite made his recommendation to close the trauma center, explaining that this would help “decompress” the hospital’s other service areas and thereby assuring a greater chance to pass the much needed CMS inspection. No one should forget that the Los Angeles County District Attorney found that the Board of Supervisors had violated the Brown Act by holding a closed-door session prior to announcing the decision to close the Trauma Center; however he never released the tapes of that session and I believe that this is still being litigated.
Navigant took over the day-to-day operations with a guarantee of a full time staff and promises that they were the “right” folks to do the job. And it was long afterward that we discovered that full time attention meant something more like Tuesday through Thursday; and forget have a Chief Nursing Officer (CNO) on 24 hour call since their CNO flew back to spend her weekends in her home in one of the Carolinas. She was later replaced with a CNO who lived much closer only requiring her to travel to New Mexico for her weekends. After at least one contract extension and a couple of financial augmentations Navigant finally concluded their overhaul of King/Drew with the placement of Ms. Antoinette Epps-Smith as the hospital’s Chief Executive Officer. There was a small opportunity for the County to rid itself of Navigant and replace them with another firm. Supervisor Antonovich managed to get the Board to consider FTI Cambio, unfortunately Ms. Epps sang the praises of Navigant (I wonder why) and we continued on with a firm that had been with us through several failed JCAHO and CMS inspections.
When CMS came for its next inspection the failure was so great as to caused the County to promise to down size and reorganize the hospital, placing it under the “umbrella”
of its sister hospital Harbor-UCLA. In the real world Ms. Epps would have tender her resignation or the DHS would have asked for her resignation, but of course this is Los Angeles County where people get promotions, praises, and raises when they fail. So Ms. Epps received a standing ovation from the community she failed and praises from the Board of Supervisors. It was about this point in time when Chernof and Epps became successful in clamping an almost complete lockdown on information about all things King/Harbor. Employees (nurses, physicians and staff alike) seemed fearful of sharing any information with anyone – but that didn’t stop the failures from occurring.
The most notable was the death of Ms. Rodriguez, a woman who had sought help from the hospital instead found an unresponsive and uncaring staff. Even after being left to writhe on the ER floor for 45 minutes, and it has been reported that numerous staff, including at least one RN, ignored her cries of pain that is until the hospital safety police came to arrest her, her boyfriend agreed when an officer informed him that she would get care at the County USC jail ward – imagine his desperation that allowing her to be arrested on the promise that it could possibly get her the medical care that King/Harbor personnel were unwilling or unable to give her. Unfortunately this intervention came too late. As she was being wheeled out to the patrol car she collapsed and all attempts to rescuitate her failed.
Shortly afterwards the State of California Department of Health and Human Services issued a notice that the state planned to revoke the hospital’s license. And this was followed by the failure of King/Harbor to pass the last critical CMS inspection and the loss of 200 million dollars in crucial federal dollars. The County immediately closed the ER and is in the process of closing the hospital leaving an urgent care clinic in the footprint of this once 200+-bed hospital.
Do the citizens of South Central need a hospital with an Emergency Room, without a doubt! Do I believe King/Drew Medical Center could have been brought up to minimum national standards, you betcha! There are those who blame the Board and indeed they deserve their share of blame for the failure – these failures occurred at several critical junctures and in my opinion they were:
1. Not firing the Camden Group when it was apparent they were being unsuccessful and once they “completed the job” and it was discovered that the work product appeared less than exemplar the County never sought legal remedy.
2. Not firing Dr. Garthwaite for his gross misunderstanding of the problem, which led to the mandated MOU agreement with CMS, which of course saddled us with Navigant.
3. Not replacing Navigant with Cambio or another firm when the opportunity presented itself.
4. The hiring of Ms. Epps, who was advertised as having presented an excellent resume did not appear to have ever been solely responsible for such a momentous task.
5. Not firing Ms. Epps when King/Drew failed its first “make or break” CMS inspection, which then caused for the drastic downsizing and reorganization of King/Drew and it being renamed King/Harbor.
You may wonder why such measures, because the failures that we saw at King/Harbor were never new ones but the repetition of many of the same ones that caused the original jeopardy. The consultants and DHS staff alleged that much of the King/Harbor staff appeared unwilling to accept change and there were even vague allegations of “sabotage” such as employees being given new policy to adhere to only to pretend that they had never received such policies. But most importantly the incident involving Ms. Rodriguez illustrates a staff so demoralized and demotivated that they were unable to respond to someone writhing in pain on the floor right before their eyes. When a staff reaches this point there is little that can be done to reinvigorate it and often the only remedy is closure.
So what does the future hold for beleaguered King/Harbor Hospital? Well, if we are to believe the Board of Supervisors they plan to find a private firm that will assume the operations of the hospital. It won’t be an easy task to find a private firm to assume the operations of this hospital, if we are fortunate enough to find such a firm then, I believe, to ensure the greatest possibility of success the County will, no must, relinquish a great deal of authority thus allowing the private firm a wide latitude of autonomy to make the necessary changes that will not only restore the hospital’s federal funding, but also stave off the loss of the hospital’s licensure to the State. And it’s not just the County that has to be willing to give up some control, all stakeholders are going to have to give up some of their “interests” (something that never really happened the last time around) and allow the firm to do what must be done. This of course is all dependent on the premise that the private firm is competent in its function and that they have a strong commitment to providing service to the community of South Central and by extension all of Los Angeles.
Just for added background on August 2, 2004 I submitted a civilian complaint to the Los Angeles County Civil Grand Jury, vis a vis the board of Supervisors lack of appropriate knowledge to oversee the health care of Los Angeles County and ask that they recommend a health care authority. The civil grand jury investigated and recommended the creation of a health authority. It would appear that, as usual, the Supervisors decided to let things be as is and now we know where that course has led. See grand civil 2004 findings and recommendations.
And for those who believe that CMS was overly harsh in its critique or evaluation of King/Harbor I encourage you to read the complete CMS report, which can be found at http://bos.co.la.ca.us/Categories/Agenda/cms1_071137.htm and select CMS Report, or you can download the report directly at http://lacounty.info/bos/sop/supdocs/34095.pdf. Read the report and then draw you own conclusions . . .
Thursday, August 9, 2007
Mt. Sinai nurses soundly reject the C.N.A./N.N.O.C unionization attempt
For those who may not have heard the news, and don’t be surprised if you haven’t since the California Nurses Association (C.N.A.) is not likely to advertise their loss of the certification vote at Mt. Sinai Hospital in Chicago. Why, because when you loss by a vote of 152 in favor and 293 opposed (that’s a 141 vote difference) and only 11 challenges you don’t go issuing any press releases!
Many of nurses, both non-union and union, have been following the machinations of the C.N.A. and their national organizing arm N.N.O.C. Nurses have watched as the C.N.A. was accused of raiding another nursing union, the take over of the Hawaii Nursing Association and the attempt to undermine the Louisiana Nursing Association during their Hurricane Katrina Recovery period and wondered when nurses would say enough. It looks as though this may have just occurred in Chicago with the Mt. Sinai nurses overwhelmingly voting to remain free to speak with their own voices.
All too often nurses become so “war weary” of the join a union/don’t join a union pushme pullme circus that when the certification election is held more stay home failing to cast their vote, leaving the margin of victory for either side so slim that which ever side looses can easily launch a challenge. Not so in the case of Mt. Sinai Hospital with only 11 challenges and a 141 vote difference the victory in this matters lies clearly with nurses choosing to exercise their “advocacy muscles” for themselves and their cohorts.
You can read the official announcement here.
Many of nurses, both non-union and union, have been following the machinations of the C.N.A. and their national organizing arm N.N.O.C. Nurses have watched as the C.N.A. was accused of raiding another nursing union, the take over of the Hawaii Nursing Association and the attempt to undermine the Louisiana Nursing Association during their Hurricane Katrina Recovery period and wondered when nurses would say enough. It looks as though this may have just occurred in Chicago with the Mt. Sinai nurses overwhelmingly voting to remain free to speak with their own voices.
All too often nurses become so “war weary” of the join a union/don’t join a union pushme pullme circus that when the certification election is held more stay home failing to cast their vote, leaving the margin of victory for either side so slim that which ever side looses can easily launch a challenge. Not so in the case of Mt. Sinai Hospital with only 11 challenges and a 141 vote difference the victory in this matters lies clearly with nurses choosing to exercise their “advocacy muscles” for themselves and their cohorts.
You can read the official announcement here.
Thursday, June 28, 2007
Nurses, an Oppressed Group?
The Unions’ power structure and their supporters have been hard at lobbying both local and federal legislators -- their latest project convincing our elected officials that it is less intimidating to have union organizers speak to prospective members one on one and convince them to sign a card signifying their desire to unionize rather than holding the secret ballot system that is now most commonly used. I think that for the average American it is a no-brainer, one-on-one lobbying vs. secret ballot -- the secret ballot allows for an individual to freely express their true desires. However, the Unions are quite accomplished at convincing legislators that their members are not adept at representing themselves so Unions are needed to do this. Don't believe me, just read AB 1201, which is now in suspense in the California Legislature. Also below you can read my two cents on the issue.
Nurses, an Oppressed Group? -- NOT!
A couple of weeks ago I was speaking with a nursing colleague from the East Coast. We had connected over a mutual interest in the National Labor Relations Board decision concerning charge nurse and their role in management (or not). During our conversation she shared with me her concerns that she had recently learned that the local nurse’s union was promoting the notion that RNs were an oppressed group and therefore in need of “special protection” that can only be wrought through legislature intervention. The words “oppressed group” rolled around in my head for a few days, and with each passing day I grew concerned at what effect these words might have on our profession. Then several weeks later I received one of the many nursing magazines that I subscribe to and imagine my surprise as I perused the table of contents the phrase “oppressed group” popped up. I read the study with great interest and some concern, puzzled at what the outcomes might be and low and behold the author of the study concluded that nurses met the criteria of an “oppressed group”. So both the conversation and the article gave me great food for thought and it motivated me to speak up (as if this is a problem for me) about what I think on this subject.
My first response to hearing this terminology used to describe us, concerned me and the more I ruminated over it the more concerned I have become. Why, because I see this label, and that is precisely what it is, as a tool to advance some group’s agenda, and that agenda is in all likelihood probably not shared by the majority of Registered Nurses in this country. This doesn’t mean that the profession doesn’t have problems, but nurses “oppressed” – I think not! Our profession shares a lot in common with other first responder professions, I wonder if legislators feel that they are “oppressed” as well, or is it because our profession is still viewed as a predominately a “woman’s” occupation thus requiring the need to be “taken care of”?
Labeling RNs as “oppressed” may seem to be a convenient way for some so-called nursing leaders to get their point across, but I think it sets a very bad precedence. Somehow I don’t think Jane Arminda Delano, Dorothea Dix, Clara Louise Maass, Mary Eliza Mahoney, Florence Nightingale, Mabel Keaton Staupers, Adah Belle Samuel Thoms, Susie Walking Bear Yellowtail, to name a few, would be very happy with being labeled as an “oppressed group”.
So what can possibly be gained by getting legislators, opinion leaders and even the RNs themselves to accept the label of “oppressed” group? Well, for starters there are those that ascribe to the school of thought that by getting people, especially legislators, to accept such a label as fact that this then lays the ground work for the passage a whole host of laws that are “billed” as protection for the “oppressed” group. There are also those who desire to keep the “oppressed” group in a subordinate role, and by getting all parties involved to accept the label it allows for the group to remain in that role, being “looked” out for by their benevolent supporters. This brings me to the topic of AB 1201, a bill pending in the California Legislature that purports to be looking out for the “interest” of the direct care nurse. The language is such that one can almost be lead to believe that without this bill the “evil” hospital and healthcare organizations will run roughshod over the nursing staff thus leaving the patients with out anyone to look out for them; it even goes so far as having language that implies that nurses are in such a weak state that only through unions can they effectively advocate for their patients. Just in case you think I am exaggerating let me share with you some of the testimony provided by the sponsor of AB 1201. The AB 1201 sponsor used the example of the Tenet hospital in Redding, California where numerous cardiac surgeries were performed, later many of these surgeries were found to be unnecessary. The bill sponsor stated emphatically that if only a union had represented these Redding nurses then none of this would have happened, further commenting that it was the lack of “union protection” that kept the nurses silent. As I sat in stunned silence, I wondered, then what was the explanation for the silence of the nurses at both UC Irvine and St. Vincent, both hospitals’ transplant programs racked by recent scandals, since nursing unions (in fact by the bill’s sponsor) represents the nurses at both these hospitals. It is precisely this behavior that allows “nursing” leaders to rationalize distorting facts on the backs of the very nurses they say they are out to protect. However, as my mother was fond of saying when she heard outlandish statements – “better to hear that, then to be deaf”.
Do I think that nurses conspired at any of these hospitals to place their patients in harms way, hardly. However, I don’t think that offering the vague promises that only if there had been a union then the nurses would have come forward, just as they failed to come forward at hospitals with union representation. As with almost any similar situations, individuals with mal-intent or with corruption on their minds or just plain weak-willed found a way to use and abuse the system. In turn they recruited like-minded individuals into their scheme and presto a formula where their scheme flourished until it was rooted out. It is easy to lay the blame on the big, “evil” hospital, especially in these times when groups are looking to scapegoat someone and hospitals have a big target painted on them.
However, it concerns me a great deal that those who say they have only the best interest of nurses in mind are using such examples to further an agenda that I believe may have unforeseen consequences for nurses, especially those who remain at the bedside. I encourage everyone reading my column that has access to the Internet to bookmark the following page, http://www.legislature.ca.gov/port-bilinfo.html. Once on the search page you can simply select search by bill number, type in 1201 and it will take you to the page that has all the information on the bill, including the text of the bill, all its revisions, history and status. Read it, formulate your own opinion and then if you are so inclined call the bill author, Assemblyman Mark Leno in Sacramento at (916) 319-2013 and provide his office with feedback. You can also send him an email by directing you browser to the following address http://democrats.assembly.ca.gov/members/a13/capitol.htm and then select “email Assemblyman Leno” or by mailing or faxing him a letter at: State Capitol, P.O. Box 942849, Sacramento, CA 94249-0013 or (916) 319-2113 respectively. If you do send a letter or email, I would encourage you to forward a copy to me as well. While you are at it be sure to send a copy to the Assemblyperson and State Senator that represents you, because it would help if they knew your opinion and feelings about this and other bills that affect nursing. If you don’t know who they are you can access that information on the Internet at http://www.legislature.ca.gov/legislators_and_districts/legislators/your_legislator.html. Select “search by zip code for your legislator” and follow the directions. You can also find the information in the blue pages of your local telephone book.
My opposition to this bill doesn’t mean I think that working in today’s hospital environment is a perfect work environment for nurses; on the contrary anyone who has read any of my columns should be well aware of how I feel that poor nursing and hospital management is a primary reason why so many nurses burnout or leave nursing. I am just unwilling to lay all the blame at the feet of hospitals; some of the blame can and should be laid at the feet of nurses and nursing unions. Before everyone feigns righteous indignation, we all know that sometimes nurses are our own worst enemy. We see it with the cliques that become so tight knit that they are quick to bring attention to non-clique member’s errors or misbehavior all the while protecting their own members from being reported when they commit errors or exhibit unacceptable behavior. Nurses, nursing associations, nursing unions and nursing advocates often bemoan the lack of proactive and responsive nursing leadership in hospitals. However, I have also seen experienced nurses failing to support their nursing administration when that administrator comes under fire for defending nurses and patients by bean counters and poor hospital administration.
It could be said that hospitals and healthcare administration encourages this environment, a form of chaos that keeps the “underlings” undercutting one another for the benefit of the “powers that be”. However this argument is not entirely valid since physicians, for example, have long shown themselves immune to this strategy. It is well known within the healthcare profession that physicians are extraordinarily supportive of the “doctor’s club”, and that they equally defend one another regardless of gender, race and class in most circumstances – so why not nurses?
Call me optimistic but I know that this is not and does not have to be the nursing environment of the future. We, as nursing professionals, can change this milieu. The question is are we willing to put in the effort and emotional investment that it will take to make this change in our own unit, within our own nursing team, hospital, and ultimately within the structure of our nursing schools? This change is not for the faint of heart as it can be and often is painful since the status quo does not exactly respond positively to change. However, if we allow those at the table to succeed in placing the label of “oppressed” on our profession and ultimately on us then our attempts to make change can become encumbered by the very people who profess to support and champion us and our goals. As an individual, who is proud that she chose to become a RN, I am greatly concerned that as our profession struggles to define itself we might fall victim to the whims of some who would have us seen as though we are weak and incapable of advocating for ourselves let alone our patients thus describing us to legislators and those in “power” as somehow oppressed. The question we must all ask ourselves is this, are we willing to accept this label? Because once we accept this label, even in the guise of advancing it for our protection or getting much needed change then changing this perception at a later date could very well be impossible. I for one am not willing to accept the label of “oppressed”. To those who believe that by seeking out these special protections is a kindness or a way to achieve a positive result: I would remind them of the old adage. “The road to Hell is often paved with good intentions.”
Nurses, an Oppressed Group? -- NOT!
A couple of weeks ago I was speaking with a nursing colleague from the East Coast. We had connected over a mutual interest in the National Labor Relations Board decision concerning charge nurse and their role in management (or not). During our conversation she shared with me her concerns that she had recently learned that the local nurse’s union was promoting the notion that RNs were an oppressed group and therefore in need of “special protection” that can only be wrought through legislature intervention. The words “oppressed group” rolled around in my head for a few days, and with each passing day I grew concerned at what effect these words might have on our profession. Then several weeks later I received one of the many nursing magazines that I subscribe to and imagine my surprise as I perused the table of contents the phrase “oppressed group” popped up. I read the study with great interest and some concern, puzzled at what the outcomes might be and low and behold the author of the study concluded that nurses met the criteria of an “oppressed group”. So both the conversation and the article gave me great food for thought and it motivated me to speak up (as if this is a problem for me) about what I think on this subject.
My first response to hearing this terminology used to describe us, concerned me and the more I ruminated over it the more concerned I have become. Why, because I see this label, and that is precisely what it is, as a tool to advance some group’s agenda, and that agenda is in all likelihood probably not shared by the majority of Registered Nurses in this country. This doesn’t mean that the profession doesn’t have problems, but nurses “oppressed” – I think not! Our profession shares a lot in common with other first responder professions, I wonder if legislators feel that they are “oppressed” as well, or is it because our profession is still viewed as a predominately a “woman’s” occupation thus requiring the need to be “taken care of”?
Labeling RNs as “oppressed” may seem to be a convenient way for some so-called nursing leaders to get their point across, but I think it sets a very bad precedence. Somehow I don’t think Jane Arminda Delano, Dorothea Dix, Clara Louise Maass, Mary Eliza Mahoney, Florence Nightingale, Mabel Keaton Staupers, Adah Belle Samuel Thoms, Susie Walking Bear Yellowtail, to name a few, would be very happy with being labeled as an “oppressed group”.
So what can possibly be gained by getting legislators, opinion leaders and even the RNs themselves to accept the label of “oppressed” group? Well, for starters there are those that ascribe to the school of thought that by getting people, especially legislators, to accept such a label as fact that this then lays the ground work for the passage a whole host of laws that are “billed” as protection for the “oppressed” group. There are also those who desire to keep the “oppressed” group in a subordinate role, and by getting all parties involved to accept the label it allows for the group to remain in that role, being “looked” out for by their benevolent supporters. This brings me to the topic of AB 1201, a bill pending in the California Legislature that purports to be looking out for the “interest” of the direct care nurse. The language is such that one can almost be lead to believe that without this bill the “evil” hospital and healthcare organizations will run roughshod over the nursing staff thus leaving the patients with out anyone to look out for them; it even goes so far as having language that implies that nurses are in such a weak state that only through unions can they effectively advocate for their patients. Just in case you think I am exaggerating let me share with you some of the testimony provided by the sponsor of AB 1201. The AB 1201 sponsor used the example of the Tenet hospital in Redding, California where numerous cardiac surgeries were performed, later many of these surgeries were found to be unnecessary. The bill sponsor stated emphatically that if only a union had represented these Redding nurses then none of this would have happened, further commenting that it was the lack of “union protection” that kept the nurses silent. As I sat in stunned silence, I wondered, then what was the explanation for the silence of the nurses at both UC Irvine and St. Vincent, both hospitals’ transplant programs racked by recent scandals, since nursing unions (in fact by the bill’s sponsor) represents the nurses at both these hospitals. It is precisely this behavior that allows “nursing” leaders to rationalize distorting facts on the backs of the very nurses they say they are out to protect. However, as my mother was fond of saying when she heard outlandish statements – “better to hear that, then to be deaf”.
Do I think that nurses conspired at any of these hospitals to place their patients in harms way, hardly. However, I don’t think that offering the vague promises that only if there had been a union then the nurses would have come forward, just as they failed to come forward at hospitals with union representation. As with almost any similar situations, individuals with mal-intent or with corruption on their minds or just plain weak-willed found a way to use and abuse the system. In turn they recruited like-minded individuals into their scheme and presto a formula where their scheme flourished until it was rooted out. It is easy to lay the blame on the big, “evil” hospital, especially in these times when groups are looking to scapegoat someone and hospitals have a big target painted on them.
However, it concerns me a great deal that those who say they have only the best interest of nurses in mind are using such examples to further an agenda that I believe may have unforeseen consequences for nurses, especially those who remain at the bedside. I encourage everyone reading my column that has access to the Internet to bookmark the following page, http://www.legislature.ca.gov/port-bilinfo.html. Once on the search page you can simply select search by bill number, type in 1201 and it will take you to the page that has all the information on the bill, including the text of the bill, all its revisions, history and status. Read it, formulate your own opinion and then if you are so inclined call the bill author, Assemblyman Mark Leno in Sacramento at (916) 319-2013 and provide his office with feedback. You can also send him an email by directing you browser to the following address http://democrats.assembly.ca.gov/members/a13/capitol.htm and then select “email Assemblyman Leno” or by mailing or faxing him a letter at: State Capitol, P.O. Box 942849, Sacramento, CA 94249-0013 or (916) 319-2113 respectively. If you do send a letter or email, I would encourage you to forward a copy to me as well. While you are at it be sure to send a copy to the Assemblyperson and State Senator that represents you, because it would help if they knew your opinion and feelings about this and other bills that affect nursing. If you don’t know who they are you can access that information on the Internet at http://www.legislature.ca.gov/legislators_and_districts/legislators/your_legislator.html. Select “search by zip code for your legislator” and follow the directions. You can also find the information in the blue pages of your local telephone book.
My opposition to this bill doesn’t mean I think that working in today’s hospital environment is a perfect work environment for nurses; on the contrary anyone who has read any of my columns should be well aware of how I feel that poor nursing and hospital management is a primary reason why so many nurses burnout or leave nursing. I am just unwilling to lay all the blame at the feet of hospitals; some of the blame can and should be laid at the feet of nurses and nursing unions. Before everyone feigns righteous indignation, we all know that sometimes nurses are our own worst enemy. We see it with the cliques that become so tight knit that they are quick to bring attention to non-clique member’s errors or misbehavior all the while protecting their own members from being reported when they commit errors or exhibit unacceptable behavior. Nurses, nursing associations, nursing unions and nursing advocates often bemoan the lack of proactive and responsive nursing leadership in hospitals. However, I have also seen experienced nurses failing to support their nursing administration when that administrator comes under fire for defending nurses and patients by bean counters and poor hospital administration.
It could be said that hospitals and healthcare administration encourages this environment, a form of chaos that keeps the “underlings” undercutting one another for the benefit of the “powers that be”. However this argument is not entirely valid since physicians, for example, have long shown themselves immune to this strategy. It is well known within the healthcare profession that physicians are extraordinarily supportive of the “doctor’s club”, and that they equally defend one another regardless of gender, race and class in most circumstances – so why not nurses?
Call me optimistic but I know that this is not and does not have to be the nursing environment of the future. We, as nursing professionals, can change this milieu. The question is are we willing to put in the effort and emotional investment that it will take to make this change in our own unit, within our own nursing team, hospital, and ultimately within the structure of our nursing schools? This change is not for the faint of heart as it can be and often is painful since the status quo does not exactly respond positively to change. However, if we allow those at the table to succeed in placing the label of “oppressed” on our profession and ultimately on us then our attempts to make change can become encumbered by the very people who profess to support and champion us and our goals. As an individual, who is proud that she chose to become a RN, I am greatly concerned that as our profession struggles to define itself we might fall victim to the whims of some who would have us seen as though we are weak and incapable of advocating for ourselves let alone our patients thus describing us to legislators and those in “power” as somehow oppressed. The question we must all ask ourselves is this, are we willing to accept this label? Because once we accept this label, even in the guise of advancing it for our protection or getting much needed change then changing this perception at a later date could very well be impossible. I for one am not willing to accept the label of “oppressed”. To those who believe that by seeking out these special protections is a kindness or a way to achieve a positive result: I would remind them of the old adage. “The road to Hell is often paved with good intentions.”
Wednesday, June 20, 2007
AB 1201 remains in "suspense" -- and this is a good thing!
Question: What can one person or a small group accomplish? Answer: A lot, if they are committed, determined and perseverant.
Defeat of AB 1201 - Related to Collective Bargaining, is or should I say was a bill in the California Legislature (you can find text of the amended bill here:
http://www.nrnpa.org/legislation). Today, May 31, 2007 at 16:26, I learned that AB 1201 was left held in the Suspense File, which means that it is for all intents and purposes inactive for the remainder of this legislative session. This is welcomed news since the bill, in my opinion, characterized nurses as so weak as to require legislative intervention in order to perform their responsibilities. I know several nurses that shared my concerns and that I encouraged them to contact AB 1201's author (Assemblyman Leno) and their Assemblyperson. I know that Suzanne Geimer, RN, not only wrote to Assemblyman Leno but that she also took the time to contact her elected Assemblyman and meet with one of his field representatives to share with him her opinion and experiences (I joined her in this meeting as per her invitation). To all those who took the time to contact their elected representatives I want to say THANK YOU. The NRNPA is all about getting information both professional and legislative that affects and effects our chosen profession and then encouraging them to inform and educate their elected officials about how they feel this will impact them.
You can read a copy of my letter of opposition that I emailed to Assemblyman Leno, and my elected representatives at the end of this post. The attachment that is referred to in the letter can be emailed upon request (it is in PDF and easily attached to this blog entry). In the meantime, until AB 1201 is withdrawn, not passed or vetoed it can be resurrected in the next or future legislative session so it will be important to be vigilant.
May 29, 2007
The Honorable Mark Leno
13th Assembly District
State of California
P.O. Box 942849
Sacramento, CA 94249-0013
Re: Opposition to AB 1201
Dear Assemblyman Leno:
I have long been an outspoken advocate on issues that affect and effect nursing and a nurse's ability to deliver quality of care. It is this concern that has spurred me to make my opposition to AB 1201 clear. AB 1201 is not a bill that enhances a nurse's ability to deliver quality of care to their patients, contrary to the statements of its sponsor even though I believe they think it does. The language used in AB 1201 denigrates nurses and our profession; its chauvinistic language makes nurses out to be so weak as to be unable to stand up for their rights let alone the rights of their patients. In truth if a nurse is this weak I would not want this person caring for me or a loved one.
Below are some of the key points made in AB 1201 that I believe are erroneous and incorrect assumptions made by the bill's sponsor:
1) Only nurses in unions can effectively advocate for safe patient care -- NOT:
a) In your testimony before the Assembly Labor and Employment committee you testified that California is facing a critical nursing shortage. However you must ask AB 1201's sponsor why then did their representatives when interviewed by the Pasadena Star News editorial board on April 5, 2004 say that there is not a shortage? They asserted that the nursing shortage was manufactured and was now no longer a major issue. (See attached). Also, the bill's sponsor testified at this same committee meeting that if the nurses' at the Tenet run hospital in Redding had only been unionized that somehow the scandal involving unnecessary cardiac surgery would not have occurred. However more recently at two Southland hospitals there have been transplant scandals where no nurse came forward to blow the whistle, and yet the sponsors of AB 1201 represent both of these hospital's nurses.
2) The card check protects the nurse -- NOT:
a) AB 1201 also attempts to establish a card-check or petition system over the secret balloting system now in place. I find this very concerning since during unionization or decertification attempts "feelings" from both sides can be very volatile and a secret balloting system permits the individual at least the security of being the only one who knows how they chose to vote. I would like to share with you several examples of what can only be described as efforts to intimidate that I personally know of having occurred.
i) After a failed attempt by the C.N.A. to organize at a local southland hospital, a particularly outspoken anti-union nurse had all their employment records, including time cards, as well as all the patients' records (of patients that the nurse had cared for) subpoenaed. The C.N.A. only relented after that nurse engaged a private attorney to fight the release of the records.
ii) A nurse had her picture prominently displayed on a flyer, along with a picture of her husband who was running for elective office. The flyer tried to characterize her husband as being less than honest. One wonders what his campaign had to do with the union's attempt to unionize a hospital, especially since the candidate was not at all involved in healthcare except for being married to a nurse.
iii) Two other nurses received numerous telephone calls that threatened the two dogs that the one owned and the daughters of the other. The threats though vague (we know where you and your daughters live) were worded in such a way that a reasonable person could interpret them as being of a threatening nature.
b) All the examples provided above can be found in the public records. These are clear examples that unions can at times be found to play fast and loose with the rules. I think you must ask yourself this, if hospitals were the ones pushing for the legislation of a card check/petition system rather than the secret balloting system would you be as quick to support them in this legislative endeavor.
3) The NLRB was wrong -- NOT:
a) Lastly, the sponsor of AB 1201 argues that the recent NLRB decision somehow diminishes the charge nurses ability to effectively advocate for nurses and patients. Personally, as an RN with over thirty years at both the bedside and in nursing management I believe that the NLRB decision was a sound decision based on good management principles. One of the main complaint nurses cite for their dissatisfaction and for leaving the profession is often poor nursing management. If we are ever going to address this issue our profession must develop strong and competent pathways into nursing management and the charge nurse is the entry level into this pathway. The NLRB decision made it clear that its ruling applied only to the full time charge nurse and not the rotating charge nurse position, and thus making it clear that the rotating charge nurse is not in a position of management. It is important to remember that in California the highest nursing position in a hospital, often referred to as the Chief Nursing Officer, is required by law to hold an active California RN license. The reason for this is to make it clear that even at the highest level of nursing management the individual is still a nurse first and therefore bound by our nursing rules, regulations and oath and remains first and foremost a patient advocate. It is my personal and professional belief that AB 1201 undermines this since its language clearly defines the nurse as being incapable of fulfilling this requirement without legislative intervention. In my 30 years I have never felt that my ability to properly advocate for my patients has ever been prevented by "administration".
I hold licenses in three states and the District of Columbia and I have practiced as a nurse (either as a LVN or RN) in Kansas, Texas, Georgia, South Dakota and of course California - so you can see my experience is vast. Perhaps my success is in knowing and understanding the nursing regulations as well as I do, which is one of the reasons that I share my skills and talents with the almost 200,000 RNs in Southern California and Arizona who read my monthly column, "From the Floor".
In closing I ask that you place my letter and name in firm opposition to AB 1201 in the official record.
Respectfully submitted,
Geneviève M. Clavreul, RN, Ph.D.
Cc: State Senator J. Scott
Assemblyman A. Portantino
For a copy of the attachment referenced in the letter email me at clavreul@nrnpa.org
Defeat of AB 1201 - Related to Collective Bargaining, is or should I say was a bill in the California Legislature (you can find text of the amended bill here:
http://www.nrnpa.org/legislation). Today, May 31, 2007 at 16:26, I learned that AB 1201 was left held in the Suspense File, which means that it is for all intents and purposes inactive for the remainder of this legislative session. This is welcomed news since the bill, in my opinion, characterized nurses as so weak as to require legislative intervention in order to perform their responsibilities. I know several nurses that shared my concerns and that I encouraged them to contact AB 1201's author (Assemblyman Leno) and their Assemblyperson. I know that Suzanne Geimer, RN, not only wrote to Assemblyman Leno but that she also took the time to contact her elected Assemblyman and meet with one of his field representatives to share with him her opinion and experiences (I joined her in this meeting as per her invitation). To all those who took the time to contact their elected representatives I want to say THANK YOU. The NRNPA is all about getting information both professional and legislative that affects and effects our chosen profession and then encouraging them to inform and educate their elected officials about how they feel this will impact them.
You can read a copy of my letter of opposition that I emailed to Assemblyman Leno, and my elected representatives at the end of this post. The attachment that is referred to in the letter can be emailed upon request (it is in PDF and easily attached to this blog entry). In the meantime, until AB 1201 is withdrawn, not passed or vetoed it can be resurrected in the next or future legislative session so it will be important to be vigilant.
May 29, 2007
The Honorable Mark Leno
13th Assembly District
State of California
P.O. Box 942849
Sacramento, CA 94249-0013
Re: Opposition to AB 1201
Dear Assemblyman Leno:
I have long been an outspoken advocate on issues that affect and effect nursing and a nurse's ability to deliver quality of care. It is this concern that has spurred me to make my opposition to AB 1201 clear. AB 1201 is not a bill that enhances a nurse's ability to deliver quality of care to their patients, contrary to the statements of its sponsor even though I believe they think it does. The language used in AB 1201 denigrates nurses and our profession; its chauvinistic language makes nurses out to be so weak as to be unable to stand up for their rights let alone the rights of their patients. In truth if a nurse is this weak I would not want this person caring for me or a loved one.
Below are some of the key points made in AB 1201 that I believe are erroneous and incorrect assumptions made by the bill's sponsor:
1) Only nurses in unions can effectively advocate for safe patient care -- NOT:
a) In your testimony before the Assembly Labor and Employment committee you testified that California is facing a critical nursing shortage. However you must ask AB 1201's sponsor why then did their representatives when interviewed by the Pasadena Star News editorial board on April 5, 2004 say that there is not a shortage? They asserted that the nursing shortage was manufactured and was now no longer a major issue. (See attached). Also, the bill's sponsor testified at this same committee meeting that if the nurses' at the Tenet run hospital in Redding had only been unionized that somehow the scandal involving unnecessary cardiac surgery would not have occurred. However more recently at two Southland hospitals there have been transplant scandals where no nurse came forward to blow the whistle, and yet the sponsors of AB 1201 represent both of these hospital's nurses.
2) The card check protects the nurse -- NOT:
a) AB 1201 also attempts to establish a card-check or petition system over the secret balloting system now in place. I find this very concerning since during unionization or decertification attempts "feelings" from both sides can be very volatile and a secret balloting system permits the individual at least the security of being the only one who knows how they chose to vote. I would like to share with you several examples of what can only be described as efforts to intimidate that I personally know of having occurred.
i) After a failed attempt by the C.N.A. to organize at a local southland hospital, a particularly outspoken anti-union nurse had all their employment records, including time cards, as well as all the patients' records (of patients that the nurse had cared for) subpoenaed. The C.N.A. only relented after that nurse engaged a private attorney to fight the release of the records.
ii) A nurse had her picture prominently displayed on a flyer, along with a picture of her husband who was running for elective office. The flyer tried to characterize her husband as being less than honest. One wonders what his campaign had to do with the union's attempt to unionize a hospital, especially since the candidate was not at all involved in healthcare except for being married to a nurse.
iii) Two other nurses received numerous telephone calls that threatened the two dogs that the one owned and the daughters of the other. The threats though vague (we know where you and your daughters live) were worded in such a way that a reasonable person could interpret them as being of a threatening nature.
b) All the examples provided above can be found in the public records. These are clear examples that unions can at times be found to play fast and loose with the rules. I think you must ask yourself this, if hospitals were the ones pushing for the legislation of a card check/petition system rather than the secret balloting system would you be as quick to support them in this legislative endeavor.
3) The NLRB was wrong -- NOT:
a) Lastly, the sponsor of AB 1201 argues that the recent NLRB decision somehow diminishes the charge nurses ability to effectively advocate for nurses and patients. Personally, as an RN with over thirty years at both the bedside and in nursing management I believe that the NLRB decision was a sound decision based on good management principles. One of the main complaint nurses cite for their dissatisfaction and for leaving the profession is often poor nursing management. If we are ever going to address this issue our profession must develop strong and competent pathways into nursing management and the charge nurse is the entry level into this pathway. The NLRB decision made it clear that its ruling applied only to the full time charge nurse and not the rotating charge nurse position, and thus making it clear that the rotating charge nurse is not in a position of management. It is important to remember that in California the highest nursing position in a hospital, often referred to as the Chief Nursing Officer, is required by law to hold an active California RN license. The reason for this is to make it clear that even at the highest level of nursing management the individual is still a nurse first and therefore bound by our nursing rules, regulations and oath and remains first and foremost a patient advocate. It is my personal and professional belief that AB 1201 undermines this since its language clearly defines the nurse as being incapable of fulfilling this requirement without legislative intervention. In my 30 years I have never felt that my ability to properly advocate for my patients has ever been prevented by "administration".
I hold licenses in three states and the District of Columbia and I have practiced as a nurse (either as a LVN or RN) in Kansas, Texas, Georgia, South Dakota and of course California - so you can see my experience is vast. Perhaps my success is in knowing and understanding the nursing regulations as well as I do, which is one of the reasons that I share my skills and talents with the almost 200,000 RNs in Southern California and Arizona who read my monthly column, "From the Floor".
In closing I ask that you place my letter and name in firm opposition to AB 1201 in the official record.
Respectfully submitted,
Geneviève M. Clavreul, RN, Ph.D.
Cc: State Senator J. Scott
Assemblyman A. Portantino
For a copy of the attachment referenced in the letter email me at clavreul@nrnpa.org
Question: When is a news story not a news story? Answer: When it's a planted story.
Well here we go again, many readers in Texas were subjected to a lengthy, though already rather worn, tale of the triumph of the C.N.A over to evil hospital corporations/ However for those of us, many who are RNs, this story was yet another pubic relations tall tale about the C.N.A. and its non-nurse executive director DeMoro. Early this month the San Francisco Chronicle tried to portray DeMoro as some kind of modern day Florence Nightingale and now the Texas Observer would want us to believe that she is a modern day Wonder Woman. The problem with both analogies is that they are incorrect. First, as so many of us know DeMoro is not nor has she ever been a licensed RN and her actions and behavior would shame the woman credited with founding modern nursing. As for being a Wonder Woman, those of us who grew up with Wonder Woman recognize that the reference to the nurse members of the C.N.A. as her (DeMoro's) nurses is an insult to the Wonder Woman myth. Wonder Woman would have never tolerate anyone referring to people as "hers" as if they are owned by DeMoro.
So when I read this what I can only characterize as a publicity stunt I responded with a letter to the Texas Observer, and a follow up phone call. Again no response except the request to resend the email to another individual at the Texas Observer, which I did. Still no response so up on the "Nurse Unchained" it goes. Below you will find my letter and the link to the article it is in response.
Enjoy.
May 18, 2007
Letters to the Editor
The Texas Observer
Austin, TX 78701
Re: An Ounce of Dissension
Dear Editor:
When I read the above article I was struck with a strong sense of déjà vu? Why, because I had read a strikingly similar article a week earlier in a local California newspaper. There is a term in journalism for this kind of reporting and its called planting a story. I wasn't surprised to discover the California newspaper had engaged in such a practice - it's common in a state that makes its business in the marketing of illusions - but to see it being excepted in the Texas press is very saddening.
As for the Texas nurses taking a stand for nurses and patients rights I say kudos, though I'm not sure the NNOC is the way to go. I find Sharp's reference to nurses as "her (DeMoro's) nurses" tacky - since they are not her nurses! As a nurse who has worked at the bedside in many states, including Texas (Bexar County Hospital) and now lives in California I can proudly state that I am no nurse of DeMoro; and I am one of the more than 250,000 active California RNs that have said no to the antics of the C.N.A. and DeMoro. I also find it intriguing that no mention was made of Deborah Burger, who is a RN, and the president of the organization. But what should I expect of an organization that pays its executive director (who is not a RN) almost three times what they pay their president (who is a RN). Sounds to me like DeMoro has more in common with the hospital/healthcare corporations she so adamantly denounces than she knows.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
The link to the article is here: http://www.texasobserver.org/article.php?aid=2495
So when I read this what I can only characterize as a publicity stunt I responded with a letter to the Texas Observer, and a follow up phone call. Again no response except the request to resend the email to another individual at the Texas Observer, which I did. Still no response so up on the "Nurse Unchained" it goes. Below you will find my letter and the link to the article it is in response.
Enjoy.
May 18, 2007
Letters to the Editor
The Texas Observer
Austin, TX 78701
Re: An Ounce of Dissension
Dear Editor:
When I read the above article I was struck with a strong sense of déjà vu? Why, because I had read a strikingly similar article a week earlier in a local California newspaper. There is a term in journalism for this kind of reporting and its called planting a story. I wasn't surprised to discover the California newspaper had engaged in such a practice - it's common in a state that makes its business in the marketing of illusions - but to see it being excepted in the Texas press is very saddening.
As for the Texas nurses taking a stand for nurses and patients rights I say kudos, though I'm not sure the NNOC is the way to go. I find Sharp's reference to nurses as "her (DeMoro's) nurses" tacky - since they are not her nurses! As a nurse who has worked at the bedside in many states, including Texas (Bexar County Hospital) and now lives in California I can proudly state that I am no nurse of DeMoro; and I am one of the more than 250,000 active California RNs that have said no to the antics of the C.N.A. and DeMoro. I also find it intriguing that no mention was made of Deborah Burger, who is a RN, and the president of the organization. But what should I expect of an organization that pays its executive director (who is not a RN) almost three times what they pay their president (who is a RN). Sounds to me like DeMoro has more in common with the hospital/healthcare corporations she so adamantly denounces than she knows.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
The link to the article is here: http://www.texasobserver.org/article.php?aid=2495
Is the San Francisco Chronicle providing free PR for the C.N.A.?
Freedom of the press is critical to the foundations of our democracy, however accuracy of the press is also equally important! For when the press reports erroneous information or moves from reporting the news to acting as a "public relations" agent for a person, group, organization, etc then the press fails to keep its promise to the people it purports to serve.
Recently the California Nurses Association (a nursing union) has garnered some press for their antics and outspoken "activism". This is all well and good since we do live in a free society, however it is imperative that when the press covers actions of the C.N.A. that they do so with accuracy. It is my opinion that this was not the case in a recent San Francisco Chronicle article, "The Rabble-Rouser" published on May 6, 2007 and written by Kathleen Sharp. After reading the article, I felt compelled to respond, since I felt it was more a free public relations article then news article; and that there were numerous inaccuracies and mischaracterizations that needed to be addressed. You will find my response to the article as well as the article archived here.
Why, you may ask, have I posted this letter as well as copies of the letter and article to the NRNPA website? Since it would seem that the San Francisco Chronicle editorial staff has chosen not to run my letter nor answer three separate phone calls, I persevered and tried a fourth time and on May 7th I spoke with Ms. Greene. At her request I e-mailed a copy of my letter directly to her, she was kind enough to acknowledge the receipt of my email and informed me to whom she had forwarded copies of my email. Meanwhile I waited and surmised the SF Chronicle would not print my letter since I strongly believe that they had an unadvertised "support" for unions and the C.N.A., in particular. So I am not completely surprised that they have yet to run my response, though I had hoped they would have presented another viewpoint.
And this is why I have decided to run it. I encourage you to read both my letter and the article to which it is in response to and to formulate your own opinion and if you feel so incline share it with me at clavreul@nrnpa.org.
May 10, 2007
Letters to the Editor
San Francisco Chronicle
901 Mission Street
San Francisco, CA 94103
Re: The Rabble-rouser
Dear Editor:
I read the above article, or should I say PR piece, with interest and concern. Your reporter made several errors in the article; according to the C.N.A.'s own website they have approx. 75,000 members not the 80,000 your reporter cited and Ms. DeMoro is no modern day Florence Nightingale - in fact she is no RN and her actions are an insult to the memory of Florence Nightingale!
Finally, RNs across this country (both in unions and not) have not exactly jumped on the C.N.A.'s bandwagon. Nurses represented by other nursing unions have decried DeMoro and the C.N.A.'s tactics since they often play fast and loose with the facts in order to push their agenda; they have received at least one written warning from the Calif. Board of Registered Nursing for violating the Continuing Education program - all which often runs counter to the oaths we as nurses take when we become licensed. And finally before you paint them as though they represent a large portion of RNs in this country please remember that we are almost 3 million RNs compared to 75,000 RNs in the C.N.A.
For the record I am one of the 290,000 California RNs that has chosen not to let the C.N.A represent nor speak for me and who despises the deceptive tactics that their organization employs.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
The link to the article is here: http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/05/06/CMGJIP6QD41.DTL
Recently the California Nurses Association (a nursing union) has garnered some press for their antics and outspoken "activism". This is all well and good since we do live in a free society, however it is imperative that when the press covers actions of the C.N.A. that they do so with accuracy. It is my opinion that this was not the case in a recent San Francisco Chronicle article, "The Rabble-Rouser" published on May 6, 2007 and written by Kathleen Sharp. After reading the article, I felt compelled to respond, since I felt it was more a free public relations article then news article; and that there were numerous inaccuracies and mischaracterizations that needed to be addressed. You will find my response to the article as well as the article archived here.
Why, you may ask, have I posted this letter as well as copies of the letter and article to the NRNPA website? Since it would seem that the San Francisco Chronicle editorial staff has chosen not to run my letter nor answer three separate phone calls, I persevered and tried a fourth time and on May 7th I spoke with Ms. Greene. At her request I e-mailed a copy of my letter directly to her, she was kind enough to acknowledge the receipt of my email and informed me to whom she had forwarded copies of my email. Meanwhile I waited and surmised the SF Chronicle would not print my letter since I strongly believe that they had an unadvertised "support" for unions and the C.N.A., in particular. So I am not completely surprised that they have yet to run my response, though I had hoped they would have presented another viewpoint.
And this is why I have decided to run it. I encourage you to read both my letter and the article to which it is in response to and to formulate your own opinion and if you feel so incline share it with me at clavreul@nrnpa.org.
May 10, 2007
Letters to the Editor
San Francisco Chronicle
901 Mission Street
San Francisco, CA 94103
Re: The Rabble-rouser
Dear Editor:
I read the above article, or should I say PR piece, with interest and concern. Your reporter made several errors in the article; according to the C.N.A.'s own website they have approx. 75,000 members not the 80,000 your reporter cited and Ms. DeMoro is no modern day Florence Nightingale - in fact she is no RN and her actions are an insult to the memory of Florence Nightingale!
Finally, RNs across this country (both in unions and not) have not exactly jumped on the C.N.A.'s bandwagon. Nurses represented by other nursing unions have decried DeMoro and the C.N.A.'s tactics since they often play fast and loose with the facts in order to push their agenda; they have received at least one written warning from the Calif. Board of Registered Nursing for violating the Continuing Education program - all which often runs counter to the oaths we as nurses take when we become licensed. And finally before you paint them as though they represent a large portion of RNs in this country please remember that we are almost 3 million RNs compared to 75,000 RNs in the C.N.A.
For the record I am one of the 290,000 California RNs that has chosen not to let the C.N.A represent nor speak for me and who despises the deceptive tactics that their organization employs.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
The link to the article is here: http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/05/06/CMGJIP6QD41.DTL
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