Is this any way to retain nurses? - page 4

Soooo..... We've been unionized with our state nurses assoc since 1983, with significant monetary and professional standard contract gains ever since, and once again are in negotiations with the... Read More

  1. by   ainz
    This line of postings is intense!! Rightly so, these are important issues to all involved. I hope you know that I am for the advancement of nursing, particularly our place in the healthcare system. It simply will not work without us. During my years as a staff nurse I realized the only real power I/we had as nurses was the power to quit and go somehwere else. To me, that is not real power. After job-hopping until I had worked at every hospital in my area I thought there has to be a better way. This is certainly an adversarial situation. Since healthcare has been my interest since I was a child and I do not want to do anything else and don't know how to do anything else I became determined to find a way to begin to make a difference. So I studied "administration." What makes these people tick? Why do they come up with these idiotic policies and demands of nurses. How can I learn to understand this and speak their language so that I can argue things with them in an intelligent way that they will understand and listen to. So I became an administrator.

    I am saying there has got to be a better way than to strike, bring in a union, form a union of your own of nurses, by nurses, and for nurses, whatever the case may be. There has got to be a better way than to threaten to quit and simply job-hop or become an agency nurse and so on. As with most things, conditions in American hospitals didn't get this way overnight and it will not change quickly, that is a fact. But we must consider the lasting effects of the strategies for change we are undertaking now. So what if we have a union and we get better benefits, better hours, no mandatory OT, better orientation, and so on. It may be a relatively quick fix but where does that leave us in the longer term? It leaves us remaining as hourly employees, viewed as a cost center, viewed as a common hourly labor force that has to be "managed." It still does not bring us our rightful place in the healthcare system. Nursing is the backbone. We are to be valued and respected as professionals. How do we get this? We demonstrate that we are professionals, we behave as professionals, we become politically active to purse laws that give us professional status, that allow us to be autonomous and self-regulating (as much as can be these days in our society!). We, as a profession, agree on what the definition of a nurse is, what does it take to be a nurse, what are the educational requirements. We unite and put aside all of our internal bickering (collectively as a profession). We do not have multiple avenues to become a nurse. We do not have LPNs, diploma nurses, associate degree nurses, BSNs, MSNs, PhD nurses, we have one avenue to become a nurse. We clearly define what we do.

    We support, encourage, and ask nurses to gain the education and training to become "administrators" so that nurses are in positions of decision-makers where it matters. Not accepting some token positions where we feel like we have some authority, but nurses sitting in the chairs of the decision-makers. We learn to understand the finances and politics of our healthcare system. Not to simply have the attitude of "corporate jerks who want nothing but more money' (even though that is truly the case, we must have some savvy about how we communicate and deal with such).

    I simply advocate that we cast aside the mentality of the hourly employee who is being run over by the greedy and powerful corporations and come to understand the power we as nurses truly have and to use that power to make lasting change rather than shorter term gains in the form of better benefits, etc. There is so much more for us to gain.

    Consider this. What if a group of nurses got together and either bought or built our own hospital. We could then demonstrate to others (and to ourselves) the kind of hospital nurses would run. If we are no better than what is here now or if we fail, then we shut up and quit griping about corporations and administrators. If we really can make a difference in patient care and working conditions, then we have built a model for others to follow that will bring REAL CHANGE. Not every nurse would be interested in getting in the thick of it because it requires financial and business skills. Most nurses get into nursing because they want to do clinical things, not business things. However, I am sure there are enough nurses out there interested in doing this, such as myself, that have the skills and could put it together. Doctors do it, business people do it. How do you think they get the money? The old fashioned way--they borrow it and find venture capitalists who will invest!!

    Sorry for the length of this post, but, let's either put up or shut up. If we don't like the system then change it. If we can't do any better then be quiet. I happen to think a hospital company formed by nurses, run by nurses, with the proper perspective on delivering good patient care would revolutionize our system.

    Do you think we would fall prey to the greed and become "bottom liners" ourselves. Would be an interesting study in human nature if nothing else.
  2. by   roxannekkb
    I am saying there has got to be a better way than to strike, bring in a union, form a union of your own of nurses, by nurses, and for nurses, whatever the case may be. There has got to be a better way than to threaten to quit and simply job-hop or become an agency nurse and so on


    Uh, so what do you suggest? And please, some real suggestions, not a bunch of rhetoric about how we are all nurses and the backbone of the healthcare system, yadda yadda. Nurses need real solutions right now, such as the case that jt is describing. What would you suggest that she and her fellow nurses do? It seems that they have exhausted all avenues.

    Consider this. What if a group of nurses got together and either bought or built our own hospital. We could then demonstrate to others (and to ourselves) the kind of hospital nurses would run. If we are no better than what is here now or if we fail, then we shut up and quit griping about corporations and administrators.


    Well that's all nice and good, and a great suggestion for a long term goal. But what most nurses need right now is to create a working environment that they can tolerate. What needs to be done are short and long term goals. That's a great long term goal, for nurses to run a facility. But we need goals for and solutions for the short term, for right now. Many nurses may stand to lost overtime pay, and be mandated to work overtime. What are you suggestions for that? Yes, it's an hourly worker mentality, but it is the reality right now.

    As with most things, conditions in American hospitals didn't get this way overnight and it will not change quickly, that is a fact.
    No, they didn't get this way overnight. You should read up on nursing history. Up until the 1930s, hospitals were staffed by slave labor--nursing students. Nurses also used to do all of the housekeeping as well. Major housekeeping chores continued into well into the 1950s-early 60s, and even nurses today are still pulling trash and cleaning up floors because of cutbacks.

    Working schedules used to be horrendous, and nurses fought hard for an 8 hour day and a decent pay. Times have changed, but the history of hospital nursing is not one of extreme benevolence. Considering the situation 50 years ago, nurses are a lot better off today.

    So I agree, it will not change quickly. The situation seems to be rapidly back-pedaling to what it was in those good old days.

    I think you have some good ideas, but you do seem to miss the point that nurses working now need to do something.
  3. by   ainz
    Thanks roxannekkb, you have made some good points.

    First of all, I do not engage in "a bunch of rhetoric. . . yadda, yadda." I absolutely and completely despise rhetoric and BS. That is one reason I left staff nursing and a promise I made to myself years ago that I would not become an administrator full of hot air and rhetoric manipulating the staff to try and get them to do things so my numbers would come out right. And besides, we see right through that.

    This situation sounds pretty bad and I agree with previous comments--why would anyone want to work there. Not rhetoric but truth--in our free market society people have choices. Businesses, including hospitals, have employees and customers. If either side becomes disatisfied with the business it fails.

    This situation sounds like a bad marriage and indeed the same dynamics and principles apply. The couple fights and argues, things are said that create ill will and can't be retracted, actions are taken that inflict hurt on the other, agreement on things disappears, and the relationship deteriorates to the point that the slightest difference in opinion is elevated to a fight. The relationship spirals downward and effective communication disappears, thus the need for an arbitrator of some kind. There comes a time when it is appropriate to admit it isn't working and end the relationship. Sounds like that is where this one may be. But I guess people have many motivators that drive them to stay in something like that. So let's work with that, the decision has been made to stay and try to work through all of this mess.

    First thing I would do is get a new set of people to negotiate for the nurses. Different faces, different voices, different personalities. It is an effective technique when at an impasse. Proof of this is in the automobile sales industry. A salesman works with a customer and they are $1000 apart from a sale. The customer says no, I will not pay another penny. The salesman say I will not take a penny less. Frustration and irritation with the other set in and they are at a stalemate. Then the salesman gets another salesman or a manger to come in and the atmosphere changes. Same car, same deal, same numbers, same customers, different negotiator. And the deal is made. Not always but statistically enough that the car sales industry has adopted this technique nationwide. The T/O or turnover. With some different people negotiating on behalf of the nurses the atmosphere and tone of the talks changes.

    Next I would present data that links employee satisfaction with customer satisfaction and customer satisfaction with improved financial performance. The administration already knows that customer satisfaction = better profits, that is why they brought it up. However, the conditions in which they brought it to the table and the way they want to implement it have doomed it to failure. They left out the part about employee satisfaction. The Quint Studer organization has hard data that shows, in a quantitative way, when employee satisfaction increases, margins and profits increase. A nurse's attitude about their employer comes through to the patient and the doctors. When employees are satisfied with their working conditions then their performance improves, it is human nature and well documented. When employee performance improves then business improves. A gentleman named Gary Golden and his company also have data to support this, I can't recall his company's name but I have it in my office.

    When you have data with financial information that is presented in a professional way, well organized, and in a way where the accountants and MBAs can clearly see the increases in revenue and profit and the decreases in operating expenses, it will be effective. It must be presented in a spirit of a genuine intention to be of help and not a way to prove the nurses' point that they are getting screwed and administration is a bunch of greedy idiots. It can't be presented in a way that nursing is beating administration over the head with it. On the other hand, it must be presented firmly and with true conviction that this is the way to solve these issues.

    I KNOW for a fact that administration is always interested in ways to improve their margins. There are not many absolutes in this world but that is one of them. There are many hospitals around the country that have resolved employee issues and improved their financial performance by implementing a sound program aimed at employee satisfaction. There are organizations out there that will come to your hospital and help get it off the ground or teach your administration and nursing leadership how to do it themselves. The Studer program is one.

    I know these programs work because we did it at our hospital. It is not really a program, that sounds too phony and manipulative. What it really is is a philosophy of running a business. It calls for changes in the basic views of people. The principle is that in order for the administration to be successful, the staff must be successful. And if the administration is successful then the staff will succeed. The end result is a quality product and organization that people want to use and be a part of. Administration and nursing working together to help each other succeed in their jobs. Imagine that.

    We presented our idea to "turn our hospital around" to our corporate leadership and they went for it. I work for a for-profit company and these guys are as bottom line oriented as it gets. In a way, you can manipulate their desire for more profit for your own benefit. That is exactly what we did and we clearly demonstrated the increased revenue, decreased operating expenses, and the resulting increase in profits. The nursing union should think about that and come up with ways to play on it. It is manipulative but something needs to be done.

    Sound like rhetoric? Perhaps, but it will work and has worked in many hospitals. It will call for commitment and agreement on both sides. Everybody can win. Administration gets the financial performance they want and nursing gets the working conditions and compensation they want. And the patient receives much better care.
  4. by   roxannekkb
    Ainz, I can't speak for jt, but other than bring in new nurse negotiators, it sounds like they have done everything you suggested and more.

    You wrote that it "It will call for commitment and agreement on both sides." Well, that's the problem. It doesn't seem like management is interested in anything the nurses have to say. It sounds like they have their own agenda, and if the nurses don't agree, they will bring in foreign staff. So much for everyone having a win-win situation.

    Yes, much of what you wrote sounds like rhetoric because it just doesn't work in many situations. It sounds all nice and optimistic on paper, or on a BB as the case may be, but I've been there, and hospitals are notoriously short-sited. Save money today, that's all that counts. We've all seen this, and while you give a good talk, it just doesn't work much of the time.

    So back to my original question. Jt and her colleagues appear to have reached the end of the line. What should they do? Not strike? Give in to what the hospital wants? What should their solution be? Should they all quit and go work elsewhere? It appears that these are their only choices left open.
  5. by   -jt
    <I happen to think a hospital company formed by nurses, run by nurses, with the proper perspective on delivering good patient care would revolutionize our system. >

    In a Canadian experiment, nurses in Alberta (I think it was Alberta) did just that & proved nurses do it better. I wonder why it didnt become a permanent thing.
  6. by   -jt
    <It seems that they have exhausted all avenues.>

    nahhhhh not yet. We'll be hammering this out for months. The nurses are already saying they want a strike vote, but a strike is the LAST RESORT when all else fails and we're not at that point yet. You cant just call a strike when your still negotiating. And we've only had a couple of meetings so far. The process has only just started. At the meeting the other day, I was telling the HR director that we considered his proposals reflective of administration's negative tone towards nurses - and we found them to be insulting as well as unrealistic. His response, believe it or not, was to actually admit that they had no intention of getting what they were demanding -"its just the language and we all know damn well we're not getting that language" - its just the game of negotiations. We told him we're not here to play games. These are serious issues and we're here to address them seriously, so give us a real proposal and lets get down to business.

    41 RN vacancies that they cant fill and they have time to play games -- and have the nerve to admit it. Thats the same as admitting that theyre just pushing us to see how far they can get. Sometimes it feels like your banging your head against the wall. I could maybe see them having this kind of "sellers" attitude if there were lots of nurses and not so many jobs to be had, but for them to be acting like this in a "buyers" market, when they have to compete for a limited supply of RNs, well, it just defies logic.
  7. by   -jt
    <We are to be valued and respected as professionals. How do we get this? We demonstrate that we are professionals, we behave as professionals, we become politically active to purse laws that give us professional status, that allow us to be autonomous and self-regulating>

    Absolutely. But laws are going to take a while to get into place. It took California 10 years to pass their staffing law. In the meantime, we still have to work. We cant have them wreaking havoc on us while we wait for laws to be passed. So while Im doing all that you mention up at the state capitol, Im still working at the bedside too and I want a legally binding say in the conditions of my workplace and employment. (a contract)

    Just because we have that doesnt mean we cant also be politically active or demonstrate professionalism. In fact, most of our contract is about addressing our professional issues. Salary clauses take up just 2 pages of the 50 page contract.

    Why do some sound like having a contract is something undesireable? The hospital CEO has one -- and he got to decide on & agree to what went into it. The DON does too. Everybody accepts that you work out a contract when you buy a car or hire a lawyer or enter into any other kind of deal for services. That contract details the terms of the deal. And you and the provider of the service both iron out those terms, decide on them and agree to them together. And its legally binding for both sides. Why should staff nurses providing a service to the hospital not be entitled to the same?
    Last edit by -jt on Jul 15, '03
  8. by   -jt
    To just quit & go someplace else doesnt do any good because in most cases, most places will do only as much as the next place is doing and call it being competitive. Why should any other place do any better if a facility in their area is getting away with doing less? You dont improve the standard in an area if you just keep quitting and letting them perpetuate their unsafe policies & inadequate compensations. And by quitting, arent you abandoning those pts who will be left in those unsafe conditions like short staffing and exhausted nurses working too many hours. Those pts deserve and need someone to advocate for them and stand up & say NO MORE.


    If we just keep quitting and letting them continue getting away with abusing nurses, nothing will ever change and then who is going to be there and what kind of care will there be when WE are the ones in that hospital bed?
    Last edit by -jt on Jul 15, '03
  9. by   ainz
    Sorry to hear that. If that is the situation I would quit and go somewhere else. Let them sink. Again, all businesses need satisfied customers and satisfied employees. If either becomes disatisfied, the business will fail eventually.

    As I said in another thread--administration has 2 primary focuses. 1) Build volume and bring in more business to increase revenue and profit. 2) Manage costs by reducing or at least containing them.

    If your proposals are not structured to address at least one of these two issues then you are dead in the water. With some thought and homework, and a little help from a finance person, you can tie most any proposal to one of these two issues. Most nurses don't know how to do this or even think to do this, because they are not taught this and usually don't have a tremendous interest in providing the detail that administrative types want and need to see. As you probably are aware, any activity in a hospital will either generate revenue or cause the hospital in incur cost.

    To get administration's attention you must quantify your proposal and have a professional finance person put the numbers together for you in a spreadsheet or other similar professional format and then be able to explain the numbers in detail.

    You are probably right when you say it is a tactic to force the experienced, expensive RNs out so they can be replaced with cheaper labor sources. It is sad.

    I would simply quit and launch a media campaign to expose what these people are doing. They are deliberate and evil!!!! I am not kidding!!!! If they are that calculating, there are probably other things they are doing that are immoral, unethical, and probably illegal. They should be investigated. No kidding.
  10. by   ainz
    Perhaps you should seriously consider "bringing in" new negotiators or getting new ones from you staff. Again, new face, new voice, new attitude, etc., it really does have the chance of changing the tone a bit. That is why I would say someone new from the outside. From the way this sounds, what do you have to lose?!?!
  11. by   -jt
    <bring in new nurse negotiators,>

    We dont "bring in" negotiators. The staff RNs nominated and voted for the colleagues they want representing them at the table. The staff RNs are the ones who say who negotiates for them. And besides, we dont change the team midway thru.

    If managements hostile, obstructionist attitude continues, THEY will be the ones who will have to change their negotiating team. We've had to have the corporation remove someone from their team once before. And we had the Board take control of negotiations once too. Hopefully it wont get that far this time. Im not worried about negotiations. We're giving them the benefit of the doubt and recognizing that most of what theyre doing is just putting on a show. Theyll settle down soon enough and seriously get to work. We'll see.

    Listen guys, you have some great ideas for the long run, but youre missing the point. This administration has no use for experienced RNs. Period. No matter what the data says, no matter what we prove - like the fact that they have spent so much on overtime that they could have created 55 new FTE RN positions with all that money - etc, for now they just continue their disrespect and devaluation of nurses and ignore all the news reports about whats caused this mass exodus of RNs from the bedside, ignore all the recent studies about how staffing and RN care directly impacts on pt outcomes, complications & deaths, and ignore the data proving that we are more cost effective in the long run, etc.

    But we're there for the duration to make them see the error of their ways. Discussions will continue. There is no impasse. There is no need for a strike vote yet. They will come around in the end cause they want to stay in business.

    Whats just so unbelievable is that they choose to go this tired-old route in this current climate of shortages and still think they will be able to fill their vacant positions. Most of what theyre doing is just posturing and, as the man inferred, playing the game of negotiations. Half of their proposals will probably be withdrawn since HR has already admitted they have no intention of actually getting them and werent serious about them when drafting them.

    So then why do they bother to present those kinds of proposals in the first place & go on the attack on nurses professional concerns (like staffing & floating to areas we are not qualified for), showing the nurses how little they think of them right from the beginning? Its not all about money. Why deliberately cause the nurses to get all riled up over how much they are being disrespected, demoralize them some more, and create more tensions between the RNs and administration? Because maybe then a lot of highly paid experienced nurses will get fed up enough to quit and the hospital can then fill their place with lower paid new grads who dont know any better yet. And nurses from over-seas who wont complain if they want to stay in this country.

    Dont you see? It doesnt matter what we argue. Theyre playing a game. They have an AGENDA. Retaining experienced (expensive) nurses is not it. And thats the point of this thread
    Last edit by -jt on Jul 15, '03
  12. by   -jt
    <Most nurses don't know how to do this or even think to do this, because they are not taught this and usually don't have a tremendous interest in providing the detail that administrative types want and need to see.>

    Thats why we have specialists from our professional RN union there assisting us. A labor lawyer and an RN who is also an RN labor specialist. They've already obtained cost-outs from the union pension board and the union health benefits administrator on the changes we need. We quantify everything in all our other proposals too because with each one the hospital asks whats it going to cost. And we have to be able to answer that. You cant just go in there & say I WANT. GIMME. (thats NY-ese for "Give Me"). You have to also recognize that the hospital doesnt have a bottomless pit of money. Some of our proposals will cost them nothing.

    Believe me, how to negotiate is not the problem. We know how. We've receive training, and workshops and CEU classes on it all once elected to the team. And we have the expertise of our professional state assoc union resources to help with the legal, financial and other advice & work that needs to be done. I really wasnt asking about what to do with these negotiations. I was just making a point about the hospital talking out of both sides of their face --- "we want to retain nurses - so we're going to make demands that will cause them to flee".

    The problem is not the contract or the negotiations. The problem is the fact that in this time of nurses bolting from the bedsides, here is yet another hospital administration that is trying to spit in their faces --- at the same time its saying its "doing everything" it can to attract them --- but its refusing to recognize how it is causing the loss of RNs by its own attitude.

    And their behavior at these negotiations sessions just proves the point of their contradiction.
    Last edit by -jt on Jul 15, '03
  13. by   gojack
    AINZ>>>>
    This story illustrates my point very well. If we (nursing) rely on labor unions or nursing unions or any kind of union, it only reinforces and perpetuates the notion that we are common hourly manual labor, a line item expense that must be controlled. We may need unions for the short term but that is not the answer.
    ---------------------------------------------------------------------------------
    REPLY to AINZ,
    I feel that the whole premise you have here is total nonsense. You are blaming unionized nurses for contributing to the reality that management treats nurses like "hourly manual labor"! That's too funny for words.

    In the state of Texas there is no nurses union. Surprise, but management treats nurse here like hourly manual labor. too. Worse than in California even!

    It never surprises me how many silly excuses some nurses have for siding with management that constantly kicks nurses in the teeth. Could it just be that these pro-company nurses subconsciously do it as a self-defense measure, hoping that the worst abuse gets thrown at all those nurses not ready to pledge allegiance to the company?

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