[NRSKarenRN]

FRom: Online Journal of Issues in Nursing
Article published July 23, 2004


Ethics and Collective Bargaining: Calls to Action

Kathleen O. Williams, PhD, RN

Keywords: collective bargaining, nursing, leadership, ethics, labor

The 2001 American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (referred hereafter as the Code) articulates clear values and goals of nursing practice. The directives outline our duties to care, advocate and be faithful to those who entrust their health care to us. The duty of the nurse to the patient and the patient’s environment are probably the best known to both nurses and the public.

As the industry of health care continues its transformation and evolution, we may need to emphasize other elements of our ethical code. The ANA Code (2001) also identifies, for example, the obligation of the nurse to work with other health professions, citizens and communities to promote the public’s health on both a local and national level "through individual and collective action" (p. 20).

In this column, the past triumphs gained by collective bargaining and the erosions of those triumphs are discussed. This is followed by a historical look at changes in the health industry’s power based on economic changes. Then leadership opportunities that are grounded in ethics are discussed. Last, four calls to action are made that are based on Provisions six through nine of the Code.

[Chico David RN]

The referenced article is an interesting read, but mostly as an example of how far the academic nursing mindset is divorced from the reality of the world as nurses live it at the bedside. A systematic response is beyond what I feel up to tackling at the moment, but a few thoughts.

The author is a fan of interest based bargaining. This is a style of non-traditional collective bargaining that has seen some success, mainly in public schools and in other areas of public employment. There would be at least one huge barrier to transposing it to healthcare - transparency. In the public emploement arena, sources of income, salaries at all levels and pretty much all spending is a matter of public record. That transparency is an essential pre-requisite for interest based bargaining. My hospital is a community based non-profit that carefully guards all its financial information for as long as it possibly can and uses every possible extension to delay the reports it must file. We can find out what the CEO made 2 years ago, but not currently. Fees paid to consultants are buried in various acounts to avoid public disclosure of them. Etc. I suspect virtually all hospitals do the same. It would require a major change in management culture to accept the kind of financial openness required for interest based bargaining.

The author also states something to the effect that healthcare management also live by ethical codes and are "not the enemy". Unfortunately, in a business based healthcare system, the logic of business draws even the non-profit hospitals into business thinking, in which the overriding goal, the be-all and end-all is the bottom line and patient welfare or ethical considerations are freely sacrificed. In that environment, the best role of the ethical nurse is to band together with other nurses to fight that bottom line ethic and represent the interest of the caregiver and the patient. A collaborative or partnership model, in which the nurses or their representatives allign themselves with the interest of management, inevitably results in the sacrifice of patient care in the name of financial success.
And the very highest role that nurses can play is to work for systemic change - creating a system in which the incentives built into the system are no longer in conflict with the interests of the patient.

[lamazeteacher]

Originally Posted by Chico David RN

The referenced article is an interesting read, but mostly as an example of how far the academic nursing mindset is divorced from the reality of the world as nurses live it at the bedside. A systematic response is beyond what I feel up to tackling at the moment, but a few thoughts.

The author is a fan of interest based bargaining. This is a style of non-traditional collective bargaining that has seen some success, mainly in public schools and in other areas of public employment. There would be at least one huge barrier to transposing it to healthcare - transparency. In the public emploement arena, sources of income, salaries at all levels and pretty much all spending is a matter of public record. That transparency is an essential pre-requisite for interest based bargaining. My hospital is a community based non-profit that carefully guards all its financial information for as long as it possibly can and uses every possible extension to delay the reports it must file. We can find out what the CEO made 2 years ago, but not currently. Fees paid to consultants are buried in various acounts to avoid public disclosure of them. Etc. I suspect virtually all hospitals do the same. It would require a major change in management culture to accept the kind of financial openness required for interest based bargaining.

The author also states something to the effect that healthcare management also live by ethical codes and are "not the enemy". Unfortunately, in a business based healthcare system, the logic of business draws even the non-profit hospitals into business thinking, in which the overriding goal, the be-all and end-all is the bottom line and patient welfare or ethical considerations are freely sacrificed. In that environment, the best role of the ethical nurse is to band together with other nurses to fight that bottom line ethic and represent the interest of the caregiver and the patient. A collaborative or partnership model, in which the nurses or their representatives allign themselves with the interest of management, inevitably results in the sacrifice of patient care in the name of financial success.
And the very highest role that nurses can play is to work for systemic change - creating a system in which the incentives built into the system are no longer in conflict with the interests of the patient.

In that vein, I'd like to share this shocking advertisement. I read an industry (healthcare insurance) "rag" today that was impressive and reflects the pressure on employers by the healthcare insurance companies, to minimize their costs by finding out what the health histories (?and ages) new employees have. An ad showed a woman with a price tag of $58,002. tied around her wrist.

The blurb was "Ordinary people are costing your company millions. Applicant fraud isn't caused by hardened criminals. Average, ordinary friends, neighbors and relatives make omissions on your health applications and you pay for it.............. Research shows that 12 out of 1,000 individual policies standard or better should have been declined. An additional 31 of those policies should have been rated up or ridered."
That was placed by MIB solutions, an investigational agency. Dirty business!

Not only does Federal law prohibit the disclosure of age (there were 4 places in my paperwork as a new employee where I was required to write my birth year), and when I worked as an employee health nurse in CA, I was told that health histories and physicals by employers are not allowed now........

[FedUpWithIgnorance]

We care for patients, not for a hospitals "bottom line" - if i have to stand with my fellow rn's to ENSURE that my patients will get what they need then, let the collective bargaining begin!!! Ask yourself, when was the last time you wiped butt? If it has been awhile, then maybe you need to get back to the basics, what nursing is all about - taking care of people!

[Chico David RN]

Originally Posted by FedUpWithIgnorance

We care for patients, not for a hospitals "bottom line" - if i have to stand with my fellow rn's to ENSURE that my patients will get what they need then, let the collective bargaining begin!!! Ask yourself, when was the last time you wiped butt? If it has been awhile, then maybe you need to get back to the basics, what nursing is all about - taking care of people!

One of my good nursing buddies has a standard test for who's really a nurse: If you haven't seen a bare butt at work in the last week, you're a paper pusher, not a nurse. Maybe just a little overstated, but I sympathize with the thought

[RN4MERCY]

Originally Posted by Chico David RN

One of my good nursing buddies has a standard test for who's really a nurse: If you haven't seen a bare butt at work in the last week, you're a paper pusher, not a nurse. Maybe just a little overstated, but I sympathize with the thought

No doubt, out of frustration with the "champions of change," "change agents", and "partnership councils of the church of the holy redesign." Sorry, but these schemes are often the products of non-nurses, and they're not just pushing paper any more. Information technology and virtual reality, in a parallel universe of computer simulation-it's like an even more frightening sequel to The Matrix, once it comes to a hospital or a so-called nursing education program. Is it any wonder that critical thinking and the art and practice of nursing/caring science has been devalued by the "pumps and pearls" matrons who haven't seen the business end of a bedpan in many years? In their rush to embrace change, they've forgotten that not all change benefits humankind.

I fear that the art and science of nursing is being replaced by Artificial Intelligence, that will enslave nurses for years, like patterns of ones and zeroes repeated in streams of computer code. "Do not worry," say the champion of change. "We are creating a better society, a just society. You will serve us in this grand goal. There is no reason to resist."

Big PhRMA, IT Companies, Industrial redesign consultants, Health Insurance Companies and hospital corporations get richer, as more money is diverted away from putting more direct care nurses at the bedside.

In many of CNA/NNOC's model contracts, we fight to get good language to protect the ability of RNs to exercise their duty and their right to advocate in the exclusive interests of their patients. We reserve the right to review all new technology and computer programs to insure that they are assistive to the RN, but do not override the independent, professional clinical judgement of the RN.

[mo_07]

A have a question that NO ONE has been able to answer! Can some one help

[lamazeteacher]

Originally Posted by mo_07

A have a question that NO ONE has been able to answer! Can some one help

Uh, and that question is.............?

[earle58]

Originally Posted by mo_07

A have a question that NO ONE has been able to answer! Can some one help

is this about your thread in the gen'l nsg forum...
your hiv patient?

leslie