union pro or con

RN4MERCY · Mar 27, 2009

Thanks.
Speculative correlation, but not necessarily causation.
Kind of what I was thinking...just wanted to clarify.
Would it be fair to say that it's not sufficient to actually promote unions for clinical reasons? Possibly a Class III modality? (ACLS-speak).

In terms of the ACLS-speak analogy, union pro or con, I believe organizing and affiliating with California Nurses Association/NNOC is definitely a Class I treatment modality. Therapeutic and effective as demonstrated by the powerful action agenda of collective patient and professional advocacy. Passage, implementation, and ongoing facility-based enforcement of the RN to patient Ratio Law in California is evidence of their effectiveness.

There's a critical problem with our health care system. I would say that we have a duty to act, once we've recognized that there is a problem. Nursing is an action profession; we have to go back in the room. And sometimes, as social advocates, we have to take our advocacy from the bedside to the halls of justice and the legislature. The so-called nursing shortage has been described as a self-inflicted wound brought on by the industry--as hospitals introduced a "lean and mean" industrial model of restructuring care. Nurses were laid off, their work was fragmented and intensified and many left the profession because of the onerous working conditions that made hospitalization for patients more hazardous and less safe.

What's been described as burnout, is better described by the term "moral distress." Individual RNs, although well-intentioned and most sincere, have been targeted and "picked off" by industry, when they've tried to control their practice and the ability to exercise independent judgement in the planning, implementation, and evaluation of nursing care that's in the best interests of patients against the corporate agenda of bottom line self interest. Moral distress has been described as the physical or emotional suffering that is experienced when constraints (internal or external) prevent one from following the course of action that one believes is right. With more responsibility than authority, nurses often lack the autonomy to do what they feel should be done.

Time and time again, throughout history, the cure for overcoming these constraints, (which are most often abusive and collusive employer practices), is self organization by workers; in other words, they form unions. I think the time for sitting around and just talking about what to do is over.

I like the analogy of the disabled plane; for the purposes of this forum the plane represents the bedside practice of nursing and our health care system; it's going down, dropping like a dead bird from the sky, and you're going with it. Do you put on a parachute, jump, and pull the cord and hope that the chute will deploy? One group of passengers says, "yeah we need to do that, put on the parachutes and take action or we're all going to die".

Another passenger looks up from reading Sky Mall, and says, "Where's the evidence that parachutes save lives? There haven't been any double-blind controlled clinical trials to show that parachutes save lives. If you have some evidence, summarize it for me so I won't be accused of bias. What we need to do is form a parachute safety committee...and, by the way, parachutes are expensive; maybe there's another way to make crashing planes safer so we don't need parachutes." What will be the cause of death of the passengers? Care to speculate? Are parachutes, possibly, only a class III modality, in ACLS speak?

As a direct care RN and as a patient advocate, I feel it's imperative that RNs belong to a union, like CNA/NNOC, that supports the RN's duty and right to advocate in the exclusive interests of patients. I've seen how hospitals may try to cut corners by pushing for early discharge or transfer of patients who still need nursing care based on medical need. Having competent RNs present and available in sufficient numbers to care for patients is a Class 1 modality for sure. A matter of life and death. No speculation, just facts.

http://www.calnurses.org/assets/pdf/ratios/ratios_patient_safety.pdf

http://www.calnurses.org/assets/pdf/ratios/rations_solve_rn_shortage.pdf

momatwork · Apr 6, 2009

I worked in a union facility and now a non-union hospital. The union hospital took my money, and allowed incompetent nurses to continue to practice. It was practically impossible to have them removed, as they used the union to back them. Senior nurses would request off annually on prime holidays, and received them off based on seniority, not what was fair. Pay raises were based on union rates, not merit. The nurse who called out like clockwork every 90 days to avoid a write up, and never changed her schedule, and gave mediocre care received the same raise as we who advocated, educated, and remained flexible. Unions breed mediocrity. I was so tired of hearing "I'm going to grieve," boo-hoo, that I left for a non-union hospital.

RN4MERCY · Apr 6, 2009

I worked in a union facility and now a non-union hospital. The union hospital took my money, and allowed incompetent nurses to continue to practice. It was practically impossible to have them removed, as they used the union to back them. Senior nurses would request off annually on prime holidays, and received them off based on seniority, not what was fair. Pay raises were based on union rates, not merit. The nurse who called out like clockwork every 90 days to avoid a write up, and never changed her schedule, and gave mediocre care received the same raise as we who advocated, educated, and remained flexible. Unions breed mediocrity. I was so tired of hearing "I'm going to grieve," boo-hoo, that I left for a non-union hospital.

The union hospital "took your money"? and "allowed incompetent nurses to continue to practice"? "Unions breed mediocrity? I don't think so. That just doesn't make sense to me. Why would the hospital take your money? Dues are paid by members to their association, for member representation, contract negotiation and enforcement, arbitration, legal and administrative staff, professional headquarters, publications, member education and all kinds of benefits.

Why would any hospital allow incompetent nurses to practice? That would be unsafe and a they would be legally liable for any harm to patients. As for seniority and holidays, in my experience these are rotated, by agreement; no nurse gets the same holiday rotation every year, so that everyone gets a turn.

Unions don't breed mediocracy, far from it. Many excellent nurses from direct care nurses to clinical educators, to nurse practitioners belong to an all RN union, as a professional association and labor organization. They earn excellence in caring awards and achievement awards from their employers and the respect of their colleagues. They are proud and certain of their ability to act as true patient advocates, to speak out against unsafe practice, without fear of retailiation.

If a union nurse sees unsafe practice they have a duty, as patient advocates, to try to stop it, or to follow through with a report to management, who has the responsibility to take corrective action and counsel the employee. As a union nurse I believe it's not in anyone's interest to keep an incompetent person in the clinical area; hospitals are responsible for annual validation of current clinical competency, and most Boards of Nursing hold each nurse accountable for determining whether or not they are competent to accept a patient care assignment in the first place. I will say that every union member is entitled to due process and fairness in grievance proceedings and to have a union representative present during a disciplinary hearing or investigatory meeting.

jadey1 · Apr 7, 2009

There're more nurses than nursing jobs? That's a generalization, if I ever heard one.

In my area, a lowly LPN, such as myself, has NO options as to where to work. The 4 major hospitals just merged. You have to be an RN, in order to be hired, unless you're going to nursing school. The LPN's, that are already on staff at the hospitals, have been given a 2 year ultimatum; go back to school to be an RN, or you'll be demoted to custodial work...with the same pay and title of LPN. Private Dr.'s offices have very little turnover. Home Health pays well, but your hours aren't guaranteed, therefore neither are your benefits, if you go below full-time. Plus, being in a semi-rural area, individual home health jobs can be affected by weather/road conditions and the ability to squeeze in as many jobs as possible, even in good weather, just due to distance between jobs.

There's been a buzz that LPN's are being phased out. The buzz seems to be coming to fruition. I know that MY facility has replaced a Unit Manager, who was an LPN, with an RN. I was re-routed to floor nurse, from Unit Desk Nurse, because I was replaced by an RN, which, by the way I had to train to replace me, which was a total slap in the face. She's only going to be as good as I train her to be. Things are looking pretty bleak, for our area.

I'd WELCOME a union, just for some continuity and a voice.

RN4MERCY · Apr 7, 2009

There're more nurses than nursing jobs? That's a generalization, if I ever heard one.
In my area, a lowly LPN, such as myself, has NO options as to where to work. The 4 major hospitals just merged. You have to be an RN, in order to be hired, unless you're going to nursing school. The LPN's, that are already on staff at the hospitals, have been given a 2 year ultimatum; go back to school to be an RN, or you'll be demoted to custodial work...with the same pay and title of LPN. Private Dr.'s offices have very little turnover. Home Health pays well, but your hours aren't guaranteed, therefore neither are your benefits, if you go below full-time. Plus, being in a semi-rural area, individual home health jobs can be affected by weather/road conditions and the ability to squeeze in as many jobs as possible, even in good weather, just due to distance between jobs.
There's been a buzz that LPN's are being phased out. The buzz seems to be coming to fruition. I know that MY facility has replaced a Unit Manager, who was an LPN, with an RN. I was re-routed to floor nurse, from Unit Desk Nurse, because I was replaced by an RN, which, by the way I had to train to replace me, which was a total slap in the face. She's only going to be as good as I train her to be. Things are looking pretty bleak, for our area.
I'd WELCOME a union, just for some continuity and a voice.

You sound like you have a lot of experience and it's unfortunate that so many employers don't respect their workers. Belonging to a union helps protect workers from unfair labor practices, and collectively, there is strength in numbers when it comes to negotiating for better wages, hours, and working conditions.

You didn't say what state you work in, but I hope I can add something here to help you rethink your frustration at being "replaced" by an RN. In nursing, very often it is the employer who blurs the lines of distinction between "role" and "accountability." I often find that "blurring" is for the benefit of the employer's bottom line. As professionals, we have to step up to the plate and demand accountability; laws are in place to protect the public, and it's often up to us to enforce them in the work place. That's why many RNs have joined with and formed all RN unions. Other healthcare workers belong to service-worker unions, and for good reason. Many "roles" in the hospital have legal and professional accountabilities attached to them; facilities are supposed to comply with the regulations as a condition of their licensure. Employers are organized, and as workers, we must take them on collectively and in unity, when employers engage in dangerous 'work-arounds' in an attempt to ignore or subvert the law.

As an RN, I have worked with many competent LVNs who contribute a great deal to the care, comfort, and safety of patients. I have always valued their contribution as team members and co-workers. RNs are expected to consider the observations of their team members when planning and evaluating the nursing care provided. The RN responsible for the patient may delegate certain tasks and aspects of care to other nursing personnel, if they are competent to perform the tasks, AND it is within the scope of practice of the worker to whom the task was delegated. RNs and LVNs have different accountability under the law for the provision of patient care.

Just having the ability to perform a task or the competency to carry out a function or role doesn't mean you have legal authority to do so. Conversely, licensure does not automatically insure competency. It may be that your hospital was cited by a regulatory agency for using LVNs to perform functions that were outside of the scope of practice for LVNs. Or, an alert nursing administrator became aware of this fact and had to replace the LVNs with RNs in order to get certification. The roles and the legal accountabilities are not interchangeable. So, it sounds to me as though the change in your work responsibility wasn't handled with respect, and you weren't given a good explanation of why it was necessary.

Also, as an advocate for fair treatment of all workers, I am concerned about your story from another perspective. And that has to do with how an unscrupulous employer has given you the defacto responsibility of doing the work of an RN but they only wanted to pay LVN wages. The other part of that is it puts your license at risk as well. It brings back the old glass ceiling and double standard; it's oppressive and abusive, not to mention unsafe. Employers like to call it "cost effective" however what they're doing is making and keeping the "profit" for themselves while they game the system and put patients at risk.

An RN's educational preparation, in comparison to the requirements for the LVN , are more extensive including a broad liberal arts education, together with substantial coursework in the physical and biological sciences. In most states, LVNs can be trained on the job, and can take a licensure test on their practical experience; some then take a medication class, and after employer verification of competency, they can pass certain kinds of meds. The LVN license is dependent, which means they must function under the direction of the RN accountable for the patient in a hospital; or, they function under the direct supervision of the physician who employs them in a clinic setting.

RNs, like LVNs grow in competency and experience as they move along the continuum from novice/beginner to expert. I heard your frustration, but I really must take exception to your comment about the RN who was hired to replace you:

She's only going to be as good as I train her to be.

I just don't see how that can be true. She has a professional education and my guess is that she wants to be a successful patient advocate and a good employee. I'm sure she welcomed your efforts to "orient" her to the work environment (insofar as you were able to overcome your resentment). Hopefully, she will continue to welcome your help in the provision of care to the patients, because you will have shown a willing heart that will help you both succeed, for the benefit of your patients. But, as I've pointed out, you have different accountabilities under the law. You should continue to share your observations and I hope you can do so collegially, and treat her as you'd like to be treated. Together you should make a great team and provide the patients you serve with excellent care.

Perhaps the blame for the frustration you feel could be placed on the rotten "for-profit" health care industry in this country. I hope you will turn it around and work with many of us who are working to build a grassroots movement toward a more just and fair system. For ideas and suggestions for taking action to make sure all patients are able to get the medically necessary care they deserve, check out the site, Health Care NOW. :up:

jadey1 · Apr 7, 2009

I posted another thread, describing my workplace and it's shortfalls. I forget what the title was, but if you search my posts, under my profile, you'll see it.

I'm in Northern KY and I work Skilled LTC/Rehab.

As for the RN, with the Master's Degree: She's already been terminated, r/t a huge med error, where an ENTIRE pre-filled syring of Byatta was injected and the patient went into cardiac arrest. She's, since, lost her license, altogether.

I didn't mean that she was only going to be as good a NURSE as I was training her to be. I meant, she was only going to be as good a DESK NURSE as I trained her to be. Paperwork, Physicians' Orders, MD/Family communication, admissions....ANYONE can do those things. LPN or RN. I've only been doing LTC for 1.5 years. I've always worked in Dr.'s offices. Triage, med audit, PT/INR's. This is my first hands-on patient care position. I've moved up the ranks VERY quickly. I've been offered a Unit Manager position, on a non-skilled floor. Being mostly LPN's, at my facility, I don't find it fair that we have no say in anything, but a newb RN can come in an push us out of our jobs.

daniRN65 · Apr 11, 2009

I think unions can have their place, but I think they can have a negative effect as well. What about being paid for additional education? In my facility fair wage is in play and sometimes that is frustrating for those with Bachelor's degrees and/or specialty ceritfication. Those of who have worked at furthering their education beyond an asscociates degree are not able to be compensated for their efforts. Also, those who show up to work to "punch the clock" and just putting their time in, are getting the same percent of pay increase as those who are dedicated to providing their patients top notch care. And i don't care what any one says, you all can instantly identify those people. They are there. The bottom line should really be the patient and the care they receive. Also, thinking that with tighter, stricter guidelines set out by CMS, Joint Commission & a competitive market, hospitals are going to be forced to step up and provide better working conditions or they won't be able to meet guidelines and be forced to either loser reimbursment, accredidation and be forced to close.

For example, in my area , (midwest, mostly rural) within a 100 mile radius there are at least 14 Hospitals (off the top of my head), all ranging from small to a larger teaching university. Residents of this area of a large selection of where to go to receive their care. If my hospital wants to stay competitive they are going to have to be able to provide top quality care. With Press-Ganey surveys and now HCAPs which is reported publically, patients definitely have a choice.

If your working conditions are so terrible, you may need a union, but remember there will be downsides to it also.

RN4MERCY · Apr 11, 2009

I think unions can have their place, but I think they can have a negative effect as well. What about being paid for additional education? In my facility fair wage is in play and sometimes that is frustrating for those with Bachelor's degrees and/or specialty ceritfication. Those of who have worked at furthering their education beyond an asscociates degree are not able to be compensated for their efforts. Also, those who show up to work to "punch the clock" and just putting their time in, are getting the same percent of pay increase as those who are dedicated to providing their patients top notch care. And i don't care what any one says, you all can instantly identify those people. They are there. The bottom line should really be the patient and the care they receive. Also, thinking that with tighter, stricter guidelines set out by CMS, Joint Commission & a competitive market, hospitals are going to be forced to step up and provide better working conditions or they won't be able to meet guidelines and be forced to either loser reimbursment, accredidation and be forced to close.
For example, in my area , (midwest, mostly rural) within a 100 mile radius there are at least 14 Hospitals (off the top of my head), all ranging from small to a larger teaching university. Residents of this area of a large selection of where to go to receive their care. If my hospital wants to stay competitive they are going to have to be able to provide top quality care. With Press-Ganey surveys and now HCAPs which is reported publically, patients definitely have a choice.
If your working conditions are so terrible, you may need a union, but remember there will be downsides to it also.

I'm not sure I understand what you believe are the downsides to union membership. Unions represent workers for the purposes of collective bargaining. A team of union members negotiates with management to achieve a contract that sets forth wages, hours, and working conditions. If, for instance, the represented nurses at your facility want to negotiate a premium wage, or some kind of bonus pay for RNs who complete additional education, and enough members are willing to stick together and support that demand, then it will be submitted as a proposal during bargaining. My hospital used to offer that; I think it amounted to an extra $50 per month for having/achieving a BSN.

They kept that up for awhile, but then over time, they took away education pay, retirement contributions became sporadic, and they capped or eliminated raises, or gave raises based on very subjective criteria. Favoritism was rampant and in our experience, the management "yes" nurses got what raises there were, and those of us who spoke out and tried to change clinical practice to make it safer for patients were retaliated against. The "poor performers" you alluded to are most often the manager's pets in a non-union environment. Those of us who organized did so because we were fed up with such disrespectful and abusive work place practices.

It's management's responsibility to ensure competency and compliance with specific, measurable and achievable work place behaviors. The expectations should be the same, whether the facility has union representation or not. Union representation protects workers from management's whims. Union representation insures fairness in the disciplinary process. It eliminates "at-will" employment (the employer can terminate you for any reason, at any time). I think we can agree that everyone should be entitled to due process and "just cause" discipline. Without union representation, there's no recourse or protections for a nurse who's been unfairly targeted for trying to change unsafe working conditions or to challenge inequitable treatment. Without a contract, management can change the terms, benefits, and conditions of employment at any time. :specs:

The other part of your post had to do with patient satisfaction scores, access to care, improved patient outcomes, and choice of provider. Here's some food for thought: Is satisfaction about marketing a perception? Are patients really qualified by virtue of education, professional license, or experience to determine whether or not they've received therapeutic and appropriate care? A patient may believe they were "well treated" and yet, be discharged early and have a shortened length of stay based on their provider's bottom line, only to suffer from complications and readmission later down the road. Is choice of hospital really in the hands of the patient and their family, or is it at the discretion of their HMO, insurance company, or otherwise determined or mandated because their employer doesn't offer insurance, or they can't afford or qualify for insurance? What happens to public hospitals who don't have the funds to provide "concierge service" and luxurious hoted decor; should reimbursement really be tied to patient satisfaction? What is the relationship between customer service and therapeutic, safe care, and good health outcomes?

In the extreme, consider the case of the hospitals where patients received heart surgery that wasn't medically indicated? In the year before the scandal broke, a news article was published that contained this quote: "Redding Medical Center was ranked by Healthgrades, a national healthcare quality solutions company, as the top-ranked hospital for cardiac care in far Northern California, and earned a five-star rating, putting RMC in the top five percent of hospitals nationwide for cardiac care. The hospital is fully accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency." The next time you see unionized nurses who are forced to picket the hospital where they work, or stage a protest in front of an insurance company, or as advocates in front of the legislature consider this: when nurses are on the outside, there's something wrong on the inside. The public has a right to know; it's our duty to inform them. The public trusts us to be their advocates.

The power of unions to represent the public interest is evidenced by their collective ability to support research and expose evidence of fraud and system-wide abuse that deprives the public of precious health care resources, and demand public accountability. An individual doesn't stand much of a change against wealthy corporations and their bought-off politicians. But collectively and in unity, RNs are a powerful force in advocating for change that benefits all of us.

The United American Nurses/National Nurses Organizing Committee, is the largest collective of unionized RNs in the country. We have a national vision and an action plan to achieve universal access to a single standard of excellent health care for everyone in this country. By expanding and improving Medicare to cover all of us, we address all those issues in a publicly supported, publicly accountable system of health care delivery. Legislation, HR 676 is currently before Congress, and we are at the forefront of seeking it's passage.

jadey1 · Apr 12, 2009

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daniRN65 · Apr 13, 2009

Thank you for sharing. I'm not against unions. I am aware of how contracts are reached, negotiations and the work involved, on both sides. But I disagree about the low-perfomers. I was not referring to "manager's pets" in non-union positions. I was in fact alluding to RN's in patient care areas doing the same work as I am. But they sit on their butts and get up only when they "have" to and do the bare minimum to get by. I don't care where you work, they are out there. And a nurse can follow the rules and "get by" and still be a low performer. It is a frustration that those nurses will recieve the same percent wage increase as those who are busting their butts. Wages should not be based on seniority only. Skill, knowledge and ability should also be considered in this process.

Regarding patient satisfaction scores. It doesn't matter if they should or shouldn't matter. The truth is if the patient is dissatisfied w/ their care, they don't have to come to my facility, and if patients stop coming to my facility, then what happens? More staff cuts, lay-offs? Of course. That's where that comes in to play.

I do not disagree w/ you. I think unions have paved many wonderful roads for our profession. I do believe there are facilities who are not for the nurse and for their own bottom line, cut wages, eliminate benefits. But to say there are NO downsides to unions is a far stretch. I know there are many great things yet to come from organized labor, but I am still frustrated that "Miss-flip-through-her- magazine and ignore lights is still getting the same wage increase" & I do agree it's managements responsibility to address these issues, but like I said you can follow the rules and still "just get by".

I really appreciate your repsonse. It has been very helpful and insightful.

MN BigJ · Apr 13, 2009

Unions have some benifits, however I too would like to see pay and raises based on performance and not on seniority. I agree with an earlier post that unions breed mediocracy (sp). Things that make a difference are union reps, management's willingness to work with the union and of course if the Union puts up with people just getting by. I don't believe the Union is there to support everyone like the claim is. It is there to support you if you have seniority but that's it. I was laid off because of the Unions rules. Not based on qualifications, but seniority, even though management tried to fight the union, but that's a whole nother story.

I do think the Unions help with working conditions and increasing compensation in general but you have to take the good with the bad, decide what means more to you and go with it.

momatwork · Jun 7, 2009

Unions are for profit and have agendas just as any organization. There are special clauses such as super seniority, which allow pro union employees to bump other nurses with more experience. Also vacations are based on seniority. I watched a union try to organize at my hospital. Union reps called nurses at all hours, and showed up at our doors unannounced. They conducted a very dirty campaign, using intimidation of peers. Thay tried to show us CEO salaries, but neglected to mention that many of the union administrators, such as its president make more than our CEO. I don't need to pay 1% of my gross salary to a union to speak for me...I can speak for myself. Our benefits were rival with the union hospitals in the information they presented us...why did we need to pay someone else! Over 90% of us voted........and it appears they are not welcome!