INCREDIBLE CNA/NNOC victory in Houston.

[Chico David]

I'm posting this fast, and don't yet have all the details, but here is what I do know:

CNA just won a representation election for the RNs at Cypress Fairbanks Hospital, a part of the Tenet chain in Houston Texas.

Other than a small number of RNs employed by the federal government, this represents the first unionized nurses in the entire state a very tough organizing environment. It is the first major fruits of a three year statewide campaign.

The election was run under an organizing agreement won at the bargaining table by Tenet nurses in California.

Don't yet have numbers or other details, will make a second post when I do. I've met some of these Texas nurses and they are just the greatest. This is only the first of many organizing victories to come in this state.

[vlynnieg]

Not all nurses believe as you do, and we are not 'blind' with our 'heads in the sand' if we do not agree with you. The reference to slavery was a nice touch: let's evoke strong emotional responses to gain some sort of advantage. Nurses are not oppressed slaves. Far from it. If that were the case, I don't think I would be providing nearly the life I am as a single mom to my kids.

The nursing shortage isn't due to lack of unionization, either. Rather, look back to the educational institutions and how they have to budget their finances to accomodate more students. Let's face it: if you can pay one nursing professor's salary and accomodate 40 nursing students, vs. let's say a math professor, and fill an auditorium for the same dollar value, OF COURSE the college is going to opt for more math professors and less nursing professors. Not to mention that for clinicals, you can only have 10 students per clinical instructor to have a safe and educational clinical experience. Therefore, there is a natural limit to how many nursing students per year an institution can accomodate. The union fairy isn't going to be able to wave some magic wand and make nurses appear out of nowhere. That being said, let's discuss something else.....

[RN4MERCY]

almost all of our staffing ratios were as good or better than the ones they negotiated in ca, and the ones that weren't were only one patient more than their ratio.... unions do not protect anyone from corporate greed... thank god for texas being a right to work state!

vlynnieg, "almost" just isn't good enough and having "only one patient more" places patients at significant risk of harm from preventable complications and even death! i think that's immoral. and, let's face it, the "evidence" just isn't on your side.

your statement is blatantly false with respect to the ratio law, because it was and is, in fact, a union of professional direct care rns, cna/nnoc, who sponsored california's first-in-the-nation rn to patient ratio law that protects patients from unrestrained and otherwise unopposed corporate greed.

in 2002 dr. linda aiken and her colleagues published their landmark study in jama, a widely respected, peer-reviewed journal which contributed to its credibility and acceptance by medical and nursing professionals. (unlike your anecdotal assertions posted here on allnurses, which falls a little short of actual empirical research, imho.)

the aiken study estimated the probability of death and “failure to rescue” for each patient under various patient to nurse ratios. the odds of patient mortality increased by 7% for every additional patient in the average nurse’s workload in the hospital; the difference from 4 to 6 patients per nurse and from 4 to 8 patients per nurse would be accompanied by 14% and 31% increases in mortality respectively.

dr.aiken and her colleagues noted that rns constitute an “around-the-clock” surveillance system in hospitals for early detection and prompt intervention when patients’ conditions deteriorate. “the effectiveness of nurse surveillance is influenced by the numbers of rns available to assess patients on an ongoing basis.”

just last month, dr. aiken and her colleagues published the results of a new study in the policy journal, health services research, implications of the california nurse staffing mandates for other states, comparing morbidity and mortality of patients in california with patients in two other states without the ratio law in place, pennsylvania and new jersey. the california rn to patient ratios are referred to as a "benchmark;" the researchers found: california nurses cared for two fewer patients on average than nurses in new jersey and 1.7 fewer than in pennsylvania. adding one patient to nurses' workloads increased patient's odds of dying by 10 percent in new jersey and 6 percent in pennsylvania

the researchers focused explicitly on rn staffing at the bedside and categorically stated, had new jersey hospitals and pennsylvania hospitals matched california’s 1:5 ratios in surgical units, they would have had 14% and 11% fewer patient deaths respectively. far fewer california rns miss changes in their patient’s conditions because of their workload ... california rns are more likely to stay at the bedside and less likely to report burnout or intent to leave the profession ... higher percentages of hospital nurses in california reported their workloads were reasonable, that they received substantial support in doing their jobs, that there were enough nurses to get their work done and provide high quality care, and that 30 minute breaks were part of their typical workday. and, the researchers reported a 35% increase in the number of relief nurses to cover those breaks in california.

frankly, i think the people living in texas: patients, their families, friends, and loved ones, will be more likely to seek out and choose to be cared for by nurses who voted to unionize with cna/nnoc when they realize that safe staffing ratios can be protected by law and their nurse's right to advocate in their exclusive interest is protected by a contract. i think they'll be thanking god for the nurses who stood up and asserted their collective right to protect them from a prolongued length of stay, pain, suffering, and even death from preventable complications.

[RN4MERCY]

not all nurses believe as you do, and we are not 'blind' with our 'heads in the sand' if we do not agree with you. . the union fairy isn't going to be able to wave some magic wand and make nurses appear out of nowhere. that being said, let's discuss something else.....

please, not so fast. let's talk about the ratio law instead of union fairies and magic wands. have you ever heard of the adage, "if you build it, they will come?" i'm not saying the nurses "appeared out of nowhere" but, at least check out the facts regarding the california ratio law's impact on the so-called nursing shortage. rn to patient ratio standards have improved the working conditions so much nurses feel they can provide the kind of care they were educated to provide, and, the care their patients deserve. they experience less burnout and are more likely to remain employed as nurses.

[vlynnieg]

vlynnieg, "almost" just isn't good enough and having "only one patient more" places patients at significant risk of harm from preventable complications and even death! I think that's immoral. And, let's face it, the "evidence" just isn't on your side.

Your statement is blatantly false with respect to the ratio law, because it was and is, in fact, a union of professional direct care RNs, CNA/NNOC, who sponsored California's first-in-the-nation RN to patient ratio law that protects patients from unrestrained and otherwise unopposed corporate greed.

In 2002 Dr. Linda Aiken and her colleagues published their landmark study in JAMA, a widely respected, peer-reviewed journal which contributed to its credibility and acceptance by medical and nursing professionals. (unlike your anecdotal assertions posted here on allnurses, which falls a little short of actual empirical research, IMHO.)

Just last month, Dr. Aiken and her colleagues published the results of a new study in the policy journal, Health Services Research, Implications of the California Nurse Staffing Mandates for Other States, comparing morbidity and mortality of patients in California with patients in two other states without the ratio law in place, Pennsylvania and New Jersey. The California RN to patient ratios are referred to as a "benchmark;" The researchers found: California nurses cared for two fewer patients on average than nurses in New Jersey and 1.7 fewer than in Pennsylvania. Adding one patient to nurses' workloads increased patient's odds of dying by 10 percent in New Jersey and 6 percent in Pennsylvania

Frankly, I think the people living in Texas: patients, their families, friends, and loved ones, will be more likely to seek out and choose to be cared for by nurses who voted to unionize with CNA/NNOC when they realize that safe staffing ratios can be protected by law and their nurse's right to advocate in their exclusive interest is protected by a contract. I think they'll be thanking God for the nurses who stood up and asserted their collective right to protect them from a prolongued length of stay, pain, suffering, and even death from preventable complications.

The ratio in my specific care area is better than the one they were offering, as were some other areas in my hospital. There were only perhaps two care areas that the ratio varied from theirs by one patient. On my unit, the ratios are evidence-based best practice and our nurse educator is constantly pouring over the research to stay on top of the latest. With that being said, I feel that we are proactive in protecting our patients' safety.

[RN4MERCY]

the ratio in my specific care area is better than the one they were offering, as were some other areas in my hospital. there were only perhaps two care areas that the ratio varied from theirs by one patient. on my unit, the ratios are evidence-based best practice and our nurse educator is constantly pouring over the research to stay on top of the latest. with that being said, i feel that we are proactive in protecting our patients' safety.

here's what florence nightingale had to say about "feelings": "i think one's feelings waste themselves in words; they ought all to be distilled into actions which bring results."

it seems to me that you have a grasp of the concept regarding specific numerical minimums, but perhaps you don't fully understand and appreciate the ratio law in its entirety. what the hospital giveth, the hospital can take away. that kind of power corrupts and is often coercive and abusive rather than authentic. it has been used throughout the ages to keep nurses in a submissive and subordinate role in health care. the collective power of nurses acting in unity to control their professional practice and the delivery of healthcare is aligned exclusively with the interests, needs, and wishes of patients. authentic power is derived from the social contract inherent between the public and the profession of nursing and it is the moral and ethical imperative of our union, as both a professional and a labor organzation.

ultimately, under the circumstances you've described, you'd have to admit that your hospital has retained supreme flexibility and holds firmly onto the reins of controlling the staffing. you'd have to admit that such a system, whereby the hospital/management retains such exclusive control is a bit paternalistic. it deprives rns, individually and collectively, of professional autonomy; the right to control the provision of care and the environment of care.

what recourse do the nurses have when the hospital decides to eliminate educator positions, or when the staffing is unsafe because an rn is floated to an area where he/she lacks a lot of experience or competencies specific to that unit/patient population; or, if the nurse is a new grad just off orientation and on the night shift, or if the nurses' aide or unit secretary positions are eliminated, thereby increasing the workload?

what happens when the rn (who's being expected to take an assignment given to them by management), believes they lack the experience or the resources necessary to provide the safe, therapeutic, and effective care the patients deserve? what happens when that rn speaks up and declares that fact to management? are they told, "do the best you can" or, "you need to work on time management", or "there's no money in the budget for additional staff", or "we just can't get anyone else to come in", or, "the last nurse managed, why are you complaining, at least you have a job, you're not being cost efficient"? who's held accountable and blamed when harm befalls a patient under such a system?

hopefully, you will come to understand that the ratio law in california and the ratio law that's been introduced by senator barbara boxer, s 1031, the national nursing shortage and patient protection act is evidence-based. the staffing must be enriched based on the patient's severity of illness, dependency, need for sophisticated technology, complexity of care and the level of experience of the staff. it must also be enriched based on the fact that additional time is needed and/or required to carry out indirect care activities, such as data collection and entry, and whether or not a student or orientee is also assigned to work with the rn. the law also codifies the direct care rn's right and duty to control their practice and provide care in the exclusive interests of their patients; it's not subject to the whims of the employer. and, the law protects the rn whistleblower so the rn advocate no longer has to fear retaliation for speaking up against arbitrary and capricious hospital management practices that create unsafe working conditions and unsafe conditions for patients.

so, rather than undermining the work of union nurses who are organizing, you should support their efforts. your educator is to be commended for "pouring over the research" but ultimately, there's no such thing as an army of one; meaning, you can have all the knowledge in the world, but it's what you do or are able to do with it that counts. when it comes to being proactive, most nurses have come to the "evidence-based" conclusion that we need stronger laws to protect our duties, rights, patients and practice. and, in order to have the power to monitor and enforce those laws at the bedside, we need to support and become active members of a strong national professional and labor organization!

[forrester]

Not all nurses believe as you do, and we are not 'blind' with our 'heads in the sand' if we do not agree with you. The reference to slavery was a nice touch: let's evoke strong emotional responses to gain some sort of advantage. Nurses are not oppressed slaves. Far from it. If that were the case, I don't think I would be providing nearly the life I am as a single mom to my kids.

The nursing shortage isn't due to lack of unionization, either. Rather, look back to the educational institutions and how they have to budget their finances to accomodate more students. Let's face it: if you can pay one nursing professor's salary and accomodate 40 nursing students, vs. let's say a math professor, and fill an auditorium for the same dollar value, OF COURSE the college is going to opt for more math professors and less nursing professors. Not to mention that for clinicals, you can only have 10 students per clinical instructor to have a safe and educational clinical experience. Therefore, there is a natural limit to how many nursing students per year an institution can accomodate. The union fairy isn't going to be able to wave some magic wand and make nurses appear out of nowhere. That being said, let's discuss something else.....

There are so many issues here.

No one said the nursing shortage was a result of a lack of unionization. In fact, many nurses are leaving bedside practice as a result of the abusive ratios in many facilities and on many floors. This has been the result in many, many nursing surveys over the years, but is particularly evident since the late 1980's up to the present.

The nursing shortage is also a result of a lack of nursing faculty. Why should nurses pursue advanced degrees when the facilities they work in don't care one way or the other. I made the same as an ER nurse with an ADN as I did with a Master's. NO ONE CARES what degree I have, at least not when it comes to paying more for it. In fact, I've been told by several administrators that getting the MBA was much more important than getting an MSN.

NUrsing education is labor intensive to be sure.

As to the slavery analogy, it stands. Being the house slave vs a field slave is hardly a selling feature.

Finally, nurses don't have their heads in the sand because they don't agree with me. They have their heads in the sand because they refure to do anything about it. We have the power if we want to use it. Problem is, we have no leadership to get us there. The ANA is a collective joke, and the AONE is an insult. These facilities are compromising patient safety in the name of profits, they are destroying the concept of nursing as a patient advocate, and are eagerly anticipating the day when they can replace us at the bedside.

One group, this CNA/NNOC, is showing us a way. Yes, we actually have to do something, we have to support them however we can. It may actually cost $30 per year! Now, we can sit around waiting for the day when the industry sees the error in their ways and staffs their units based on some actual acuity system instead of profits, or we can get proactive and make them do it.

Yes, we can trust the healthcare industry to look out for our best interests and our patients best intersts, but to paraphrase James Madison- Nurses have learned the need for ancillary precautions.

[Ludlow]

More unions = more strikes = more money for those of us who work strike hospitals.

More unions = safer working conditions and safer patients.

The Massey mine disaster and the BP oil vulcano-spewing-oil-into-the-Gulf-of-Mexico disaster (both needlessly killing workers) are the results of fewer workers having the power that a union would have given them to keep their work environments as safe as possible. Deregulation and union busting paved the way to such disasters.

Union RNs would all much rather that the hospital move to keep patients safe like for instance by staffing to acuity within the framework of the California ratios AT ALL TIMES on their own or even when we are sitting at the bargaining table, but if we have to strike to so move them we will.

[Ludlow]

The ratio in my specific care area is better than the one they were offering, as were some other areas in my hospital. There were only perhaps two care areas that the ratio varied from theirs by one patient. On my unit, the ratios are evidence-based best practice and our nurse educator is constantly pouring over the research to stay on top of the latest. With that being said, I feel that we are proactive in protecting our patients' safety.

Nothing in the California ratios is meant to limit it to the specified number, richer staffing is meant to happen if the patient's care needs dictate it.

Now, say, if in the ICU the ratios varied by one patient, that would be a big deal. And a big problem.

[txdude35]

The union got voted into my facility a few weeks ago. Most people I spoke with hadn't done any homework at all- they ate up everything the union was shoveling without hesitation. Of course, the union reps made everything look fantastic and most people didn't take the time to do some fact checking of their own.

I did. When confronted with specific examples of union misconduct, financial irregularities, and questions that required an answer that went beyond the script reps tended to raise their voices and dance around the questions as quickly as possible. When I asked about why 47% of the Cypress/Fairbanks staff wanted them gone one of the reps said "it doesn't matter what they think- this is a democracy and we won."

Arrogance such as this is offensive to me. The night before the vote a RN from Cyfair was at the facility and told me what a great contract they had negotiated. Soooo..... do they have a contract or not? Healthy debate is one thing, flat out lieing to me is quite another.

The hospitals here in TX are in a very strong bargaining position because of the right to work status- they know many people don't support the union or won't pay dues. I expect a protracted contract negotiation that may or may not benefit the staff. Like it or not, they're here and we have to deal with them.

[vlynnieg]

txdude35, there is a particular organizer's face that pops into my mind as I'm reading your contribution. She reacted the same way when another nurse and I asked her similar questions when she interrupted our break. It's weird seeing a third party say 'we won' when they are referring to a facility--kinda like the Mongol horde invasion. It's my understanding that there still is not a contract for Cypress Fairbanks--unless it has happened in the last 1 week.

[vlynnieg]

Nothing in the California ratios is meant to limit it to the specified number, richer staffing is meant to happen if the patient's care needs dictate it.

Ludlow, it may not be meant that way, but when numbers are mandated in such a manner, often enough those same mandated numbers wind up actually being limiting when patient acuity dictates that the ratio be lower than the mandated one.

[Ludlow]

Nothing in the California ratios is meant to limit it to the specified number, richer staffing is meant to happen if the patient's care needs dictate it.

Ludlow, it may not be meant that way, but when numbers are mandated in such a manner, often enough those same mandated numbers wind up actually being limiting when patient acuity dictates that the ratio be lower than the mandated one.

In the ICU we've had the mandated ratios of at least 2 patients:1nurse since the 1970s in California. Yet I have often just had one patient and at times I have cared for one patient who needed 2 nurses. Ratios are the floor and we staff richer if patients need it. But this is our fight as nurses. Administrations will want the fewest nurses possible. We have to advocate for our patients and tell administration--hey these patients require more time to get the care they deserve so let's get another nurse in here!

Before the union it was "Do the best you can" or "Last shift's nurses did it, why can't you?" and all manner of like things. With the union we have ways of pushing back and getting extra nurses.