Michigan Nurses

-jt · Aug 31, 2001

ANA/UAN nurses continue to testify at federal Senate hearings and also their local state legislatures on the condition of nursing today and to offer solutions. Here are texts of testimonies of nurses from the Michigan Nurses Association/UAN

Pamela Chapman, BSN, RN

TESTIMONY

For the Subcommitte on Approripate Supply and Utilization of Michigan's Health Care Workforce of the Standing Committee on HEALTH POLICY

Monday, July 2, 2001

My name is Pamela Chapman, I have been in the field of nursing for nearly thirty (30) years. I began my nursing career as a licensed practical nurse in 1971. I have been a registered nurse since 1986. Presently, I work at Borgess Medical Center in Kalamazoo, and serve as the current president of Michigan Nurses Association Chapter Five (5).

There are many issues that face nursing today. The most pressing is the nursing shortage. When I talk with my peers and colleagues about the nursing shortage, they believe there is a shortage. They believe there is a shortage, in part, due to poor working conditions, inadequate pay, less than appropriate benefits, and a general lack of respect by administration and management. Coupled with the declining image of nursing, it's enough to challenge

one's decision to become a nurse or, for some, to continue in the practice of nursing.

I believe that nursing is still a worthy and noble profession, one of service and devotion to humankind. But, we are the walking wounded. I have watched the optimism and idealism of many nurses shatter into a thousand pieces of pessimism and cynicism, as they stood helpless in a pool of isolation; a pool that I too have waded in more than once.

When did our optimism turn to pessimism? I am sure we cannot know exactly when it happened. It could have happened because we were tired from working so many mandatory overtime shifts or working short staffed. Or, when we vehemently advocated for our patient's right for self-determination. Or, when we held a dying child in our arms and wondered how we were ever going to comfort the mother. Or, did it happen when we stood helplessly by and witnessed

death and the tearful farewell of a spouse, a mother, a father, a sister, a brother, a child, or a friend? Perhaps, it happened as we witnessed the grief and sorrow of one family turn to hope and joy for another, as we worked diligently to preserve the precious life of the organs of a teenager killed in a tragic car crash.

This is real, this is what nurses do. We look in the face of life and death, joy and sorrow everyday. We do it because we want to and most of us would walk the same path if we had it to do over. I love being a nurse; it is what I am and what I have been my whole life; it is all I know.

I believe that nursing has the power and creativity to solve many of its own issues. But, we have to be trusted with the responsibility. We have to be invited to the decision-making table. We have to be allowed to bring forth issues, concerns, and problems without fear of administrative retaliation. We must be present at all levels when nursing policy is set, not after it is set. We have to be allowed to embrace our own nursing values, and be allowed

to challenge the organizational values that do not encompass nursing's principles and ethics. When this happens, nursing will regain the respect and virtue that the profession so richly deserves.

I am grateful for the generosity of this committee to hear my humble opinions.

Submitted by Pamela Chapman, BSN, RN

http://www.minurses.org

-jt · Aug 31, 2001

Brenda Maynard, RN

ORAL TESTIMONY

For the Subcommittee on Appropriate Supply and Utilization of Michigan's Health Care Workforce of the Standing Committee on HEALTH POLICY

Monday, August 27, 2001

Re: Safe staffing -

Attacked & almost killed by a pt

Submitted by Brenda Maynard

(posted in Workplace Violence Thread) For story, see https://allnurses.com/forums/showthread.php?threadid=9334

-jt · Aug 31, 2001

Marylee Pakieser, MSN, RN, CS

TESTIMONY

For the Subcommittee on Appropriate Supply and Utilization of Michigan's Health Care Workforce of the Standing Committee on HEALTH POLICY

Saturday, July 21, 2001

Good morning. My name is Marylee Pakieser. I have been a registered nurse for 29 years and I am also the president of the Michigan Nurses Association.

I recently returned from Washington, D.C., where I listened to nurses from around the country tell their frustrations and concerns about the nursing professions. During the House of Delegate meetings for the American Nurses Association and its labor arm, the United American Nurses, I heard stories shared from military nurses, private sector nurses, staff nurses, public health nurses - the list goes on and on.

My trips around Michigan, from the UP to Detroit to the southwestern areas, mirror that experience. Though the degrees of the problem differ, they all point to the same thing: we are facing a nursing shortage of epic proportions. And we are just seeing the tip of the iceberg.

You've no doubt heard horror stories from California about the nursing shortage such as patients calling 911 because no one would answer their call bells. We don't have the extreme situation that Californians face, but don't be fooled into thinking that Michigan doesn't face a nursing shortage. You would be surprised to find out how large some of the vacancy situations are in Michigan. In early 2001, Battle Creek Health System reported a 9.6% vacancy

rate.1 Last fall, Sparrow Hospital had 40 open positions and Ingham was not much better with 1/10th of their RN staff positions open.2 Even the Petoskey area reported a 5% general nursing vacancy.3

Far more alarming, however, are the anecdotal accounts coming from the Detroit area. MNA has been told of times recently when the Detroit Medical Center had 154 open positions and the University of Michigan was looking for RNs to fill approximately 200 open positions.

Why the "shortage"? Do you know the actual average earnings of a full-time nurse in the United States? $46,782. If you adjust that figure to match the purchasing power of the dollar, it's $23,369. Even more incredible, based on the dollar's worth, the salary for an RN has only increased $203 between 1992 and 2000. That's a $ 25.37 raise per year for a job that requires analytical and critical thinking skills while

performing physical labor at the same time. It's certainly something to think about.

You've no doubt heard testimony about the working conditions nurses face today in hospitals, especially mandatory overtime. Don't be fooled by this term, either. Sometimes it's called "extra assigned shifts" or "hospital requested shifts" or any variety of terms. Mandatory overtime is oftentimes used by hospitals as a staffing solution when there are not enough nurses to handle the patient load. But think this through........

The hospital is putting nurses back on floors that have already worked their scheduled shift and oftentimes are exhausted. Think about the last time you put in a full day in Lansing and then had to drive home to your district. Were you at your best? Should you have been driving? What if there had been a heart patient, newly back from open heart surgery, relying on you to be the one to save them if their monitor went off?

A 12-hour shift is very common for nurses. Now think about 4 hours added on to that. 6 hours. 8 hours. Very little time off your feet and a bag of chips for your meal. It's not a good thought, is it? It's reality, though, for a lot of nurses.

The American Nurses Credentialing Center surveys hospitals seeking recognition for having excellence in nursing practice and work environments friendly to nursing. These selected hospitals, which petition the ANCC, are granted the status of being a Magnet Hospital. Sad to say, there are no Magnet Hospitals currently in Michigan. We need to have one or more Magnet Hospitals in our state to use as models for nursing excellence.

I've read that these Magnet Hospitals don't experience problems with the nursing shortage and mandatory overtime. Could it be a coincidence that where nurses are treated as professional caregivers, the problems that many hospitals face don't exist? Something to think about!

We are the backbone of the healthcare system and we know that a future without nursing will truly be a disaster.

. We usually solve our own problems, but this one is too big for us alone. As Dr. Peter Buerhaus, a well-known nurse researcher of the shortage, has stated, this is a social problem as well. We need assistance from our government, our communities, our educators.

We need you to work with us before we face a world without nurses.

Did you know that the average age of a nursing instructor is 56.5? We cannot educate new nurses if we have a shortage of adequately prepared instructors. To teach the analytical skills needed for good nursing requires educators who can matriculate at a university level, and these are in short supply. Consequently, we need more scholarship money for masters and doctorate programs.

We want the best and the brightest recruits to enter and to stay in nursing. But to do that, respect for our profession has to skyrocket. We are a separate and independent profession from medicine and the other health care disciplines. You can't just lump us into the "not doctors" category and expect us to be here down the road. The tide has to turn now.

We need our work environments to be conducive to quality patient care. Our profession must begin receiving the respect it deserves. You've had doctors stand before sub-committee members in the past two months and tell you that they're worried about the nursing shortage. If the doctors are worried and the nurses are worried, then it's time for the legislators to get worried and stay worried until together we can figure out some practical answers to

meeting this crisis.

Let me close by just offering a few suggestions:

We need one or more Magnet hospitals in Michigan;

I mentioned earlier in my testimony the needs for Masters and doctorate scholarship money to provide for more nurse educators;

We need your support for legislation that benefits nurses, including banning the use of mandatory overtime as a means of staffing.

I encourage you to turn to MNA for expert advice on the issues facing nurses. We have nurses in every area of nursing practice - researchers, clinicians, educators, administrators - that can accurately provide information to help you in your legislative efforts. We know that to make significant change, nurses and legislators must communicate and join forces. We are committed to making that happen.

On a personal level, there is one thing that you could do immediately. I've heard it said, time and again, "You're so smart, why aren't you a doctor instead of settling for being a nurse?" Not only does this hurt the nurse who receives this back-handed compliment, but it hurts the nursing profession. I urge you to look inside your own perception of nurses. If you share this view, even a little, I encourage you to spend some time with nurses. Go to where they work. Talk to them about their education. Find out what they do on a daily basis. Understand their needs. If you'll do that, you'll play an integral part in the social solution for correcting the nursing shortage.

I appreciate your time and your interest. Thank you.

Submitted by Marylee Pakieser, MSN, RN, CS

http://www.minurses.org

-jt · Aug 31, 2001

From Michigan NA:

"As more than 400 nurses and nursing students gathered on Tuesday, March 27, in Lansing for Nurses Impact, Tom Renkes, RN, Michigan Nurses Associations CEO, was spending his time between the Radisson and the House Office Building. Renkes was testifying before the House Subcommittee on Appropriate Supply and Utilization of Michigan Health Care Workforce of the Standing Committee on Health Policy. Representatives Scranton, Vander Veen and Schauer and an attentive audience listened with interest as Renkes read his testimony (shown below) and answered a multitude of questions.............

To: Subcommittee on Appropriate Supply and Utilization of Michigan's Health Care Workforce of the Standing Committee on Health Policy

FROM: Tom Renkes, RN, CEO, Michigan Nurses Association

DATE: March 27, 2001

RE: Nurses in Michigan

For nearly 100 years, the Michigan Nurses Association has worked to put the concerns of the Registered Nurse at the forefront of the health care environment. For years, those concerns were heard but often times ignored for other more pressing health care agendas. Now we have the fallout from those "other more pressing health care agendas" - no nurses.

Nurses have not been able to attract full advanced practice status or prescriptive authority - so some leave. Nurses have been given little say in the scheduling of their time and needs related to patient acuity - so some leave. Nurses have been told their jobs are expendable, and we only need non-professional caretakers, so some leave. Nurses have been given poor pay raises and virtually no retirement benefits - so some leave. Nurses have been told that because we made some mistakes in how we spent our money on health care and the health care environment, that they must work mandatory overtime - so some leave.

The American Nurses Association, the Michigan Nurses Association, the Detroit News, Free Press, Chicago Tribune, and several other journals and newspapers have completed and published surveys or articles emphasizing issues surrounding nurses and the workplace. There have also been 11 strikes by unionized nurses over the last year related to the same issues which are:

More respect in the workplace;

Improved pay and benefits for retention;

Assistance in rebuilding a battered image;

Provide more data about the profession so future directions can be plotted.

We at the Michigan Nurses Association have changed the way we do business in response to these issues. We have a full marketing and media campaign for the image and growth of nursing through the Association. Several groups are meeting to establish recruitment methods, and we are working with DCIS and the Michigan Health Council to establish a career link web site. We are also being much more aggressive by taking member requests and turning them into action priorities such as mandatory overtime. But we need your help.

Respect in the workplace equates to an engaged ear listening to what really happens when life on a health care unit gets busy. The nurses must have a voice in scheduling and staffing. Where it happens through collective bargaining, nurses press on. Where it doesn't, nurses leave. Legislatively, staffing ratios may not be the best answer, but we need something that brings all parties to the staffing table for decisions based on acuity and not some

budgetary whim.

Oppose mandatory overtime as a scheduling choice. Health care facilities need to respond to normal market pressures and pay staff that does the work. This would increase pay and benefits to nurses who now want primary pay and benefits. The secondary income demographic is long gone. Guess what, it is about the money.

We need legislation that gives highly educated and experienced nurse practitioners, midwives and anesthetists the ability to practice independently for improved access to all patients at far less cost to the consumer. Even the Journal of the American Medical Association spoke positively to this.

Improving the image and workplace conditions will take some time, but time is not on our side. The average age of the RN is approximately 45 years, and enrollments at universities are down in comparison to past years of surplus. People continue to trust nurses far beyond other professionals, and according to a recent front-page story in the Detroit Free Press, patients continue to pick hospitals by the care received. To keep the trust of the public

in our health care system, we can't let the people who care for patients 24 hours a day lose faith in that same health care system. But at this point, that's exactly what we have.

We need your commitment and efforts to assist us in this retrenching. We cannot expect legislative efforts to be the means to a perfect end, but as colleagues we can all work toward the goal of increased nurses available in the work force."

http://www.minurses.org

-jt · Aug 31, 2001

RN Speaks Out for Her Profession

The following testimony was delivered Friday, July 2, 2001 to the House Subcommittee on Apropriate Supply and Utilization of Michigan's Health Care Workforce of the Standing Committee on Health Policy

Elaine Van Doren, Ph.D., RN

Coordinator & Instructor

Kalamazoo Area, RN Studies Program

University of Michigan, School of Nursing

Testimony regarding nursing shortage

I have been a practicing nurse for over 30 years in this State. During this time, I had come to believe that I had seen it all as far as nursing shortages and the ways in which people respond to them. However, the past several years have surprised even me. I am increasingly concerned about the health and safety of both those who are seeking care from our health care organizations and the staff providing that care. Today, I would like to talk with you about those concerns, based on my own direct observations and from the many conversations I have had with students.

First, let me tell you that my students come from all over West Michigan; from as far away as Benton Harbor, Albion, Grand Rapids and Sturgis and all points in between. These men and women are already RNs, they have Associate Degrees in nursing from a variety of community colleges. They come to the RN Studies Program so that they may meet the requirements for a BSN, the Bachelor of Science degree in Nursing. Nurses obtain their BSNs to develop greater skill in applying the nursing process for their clients and/or to expand their career opportunities.

The majority of my students are also employed full time and provide direct service to clients as staff nurses in acute care, outpatient and long term facilities. Most are married and have children; some are single parents. Given all these characteristics, it should not be surprising for me to tell you that I find my students to be some of the most dedicated, hard working professionals I have ever met. Unfortunately, over the last several years, I also find them to be increasingly more discouraged and frustrated. Like other American nurses, they are very dissatisfied with their work settings.

There are 3 issues I would like to address:

The routine use of mandatory overtime is a major problem in too many acute care settings. One Tuesday night a student called me in tears to tell me she couldn't attend class the next day because she had been mandated to stay at work for 4 more hours after working her usual 12 hour shift. She still would have come to class, but was also told that she had to work the 7 am to 7 pm shift that next day due to a opening in the schedule. Please note that the nurse had approximately 7 hours in between shifts and the last day was the 3rd day in a row she had worked 12 hours. Extending a shift, rapid turnaround for shifts and last minute changes in scheduling are common occurrences.

Ethical conflicts are increasing for today's staff nurse as a result of such scheduling and staffing problems. Each year as part of a course, my students complete an ethical analysis. Five years ago, most of the situations presented related to clinical issues such as assisted suicide and stopping treatment. In the last several years, the students' present conflicts such as being threatened with patient abandonment if they refuse to work, ill prepared

nursing assistants, lack of control over nursing personnel and inadequate staffing issues.

In general, nursing is hard work with limited monetary rewards. Nursing salaries have not kept pace with the rate of inflation, potential salary growth is limited, and retirement benefits are usually inadequate. Additionally, health care employers after laying off nurses in the 80's, cut benefits in the 90's. Ten years ago, many students had full tuition coverage, now most are significantly limited either by hours or total dollars.

I have tried to provide just a few examples of the issues faced by staff nurses in our area. As you and I know, these situations are the result of complex factors within the health care system. While the causes may be complex, the results are becoming more understandable. In a major study by Needleman and Buerhaus from Harvard, consistent relationships were found between nurse staffing variables and negative patient outcomes.

Nurses and the Public need your support and commitment in:

Increasing funding for education at the associate degree and baccalaureate level.

Opposing mandatory overtime as a scheduling choice

Supporting salaries and benefits that not only will attract but retain nurses.

Encouraging the involvement of direct care nurses in staffing decisions.

Thank you

submitted by Elaine Van Doren, Ph.D., RN

http://www.minurses.org

-jt · Aug 31, 2001

From Tom Renkes RN, MS, CEO of the Michigan Nurses Association/UAN

To the House of Representatives Health Policy Committee

Subcommittee on Appropriate Supply and Utilization of Michigan's

Health Care Workforce

August 27, 2001

"I'm Tom Renkes RN, MS, CEO of the Michigan Nurses Association.

Thank you again for allowing me to present on yet another occasion. I presented several points at your first hearing, and I would like to take a minute to make Michigan NA's final comment on the shortage prior to your sessions beginning in September.

Four elements of the current conditions for nurses have been continually highlighted from visits across the state.

1. Mandatory overtime: while many times a chicken-and-the-egg argument, we have made some progress. The Michigan Board of Nursing unanimously passed a resolution to allow nurses the ability to refuse mandatory overtime and not jeopardize their license. This resolution became stronger with the recent attorney general's opinion falling directly in line.

However, nurses are still prone to discipline from their workplace for refusing to work the mandated shifts, and that continues to drive many nurses from the workforce. MANDATORY OVERTIME NEEDS TO STOP.

2. Increased whistleblower protection: more and more states are passing laws enabling all health professionals expanded protection for reporting unsafe conditions. Most recently Oregon, Ohio and New Jersey have agreed to give health care professionals a greater tool in combating difficulties in their practice settings that may create patient harm or disrupt care. You've just heard testimony from a nurse in a position to speak up. Most are not.

We cannot allow people to be fearful when safe patient care is paramount. EXPANDED WHISTLEBLOWER PROTECTION IS NEEDED NOW.

3. Expanded data collection: Michigan NA has worked with the Michigan Health and Safety Coalition and in collaboration with the Michigan Organization of Nurse Executives to engage in a nurse staffing initiative. This initiative collects staffing data related to patient safety indicators. We also encourage continued use of current licensing funds through DCIS for projects such as NurseCareer Link that will collect current workforce data. This

data will enable planning and a projection for future nursing needs taking a great deal of pressure off of DCIS staff and resources. PLEASE ASSIST US IN OUR CONTINUED DATA COLLECTION EFFORTS.

4. Return of adequate funding for health care: there is no secret the free market at work would raise salary, benefits and expand workplace recognition of nurses to engage more people into the workforce. We also believe as everyone else does that a review and reinvention of health care bureaucracy and regulation is necessary. However, some of this can't happen as long as revenue streams continue to not keep pace with demand of service by the public.

Government payments don't fully compensate hospitals and health care facilities for Medicare and Medicaid patients, nor do they fully recognize the rising costs of labor and technology. A reduction in payments from managed care has occurred over this same time period. A shortage of qualified nurses is a complex problem that cannot be solved by any one group alone. The problem demands a multi-tiered, collaborative approach by all stakeholders to develop effective strategies and solutions to meet the health care needs of tomorrow. PLEASE PROVIDE ADEQUATE FUNDING TO HEALTH CARE VENUES TO MEET PATIENT AND TECHNOLOGY DEMANDS.

We understand there are lots of wants and desires by people that usually end up costing government or taxpayers more money.

Ending mandatory overtime is no cost to government.

Expanding whistleblower protection can utilize current reporting streams already at DCIS.

Expanded data collection can utilize current licensing funds already at DCIS.

Return of adequate funding will return monies to health care facilities allowing them to hire adequate staff at competitive compensation and benefit rates. This also ends the spiral of dollars spent in other avenues just to recruit people into health care professional positions.

Whatever this Subcommittee and the Health Policy Committee decides, we need action now to bring an end to the current workforce shortage and the increasing shortage that looms on the horizon. Patients need the highest quality care at the best available access, and we at the Michigan Nurses Association believe assistance in the above areas could make that dream come true. Thanks for this opportunity, and as always, we are at your service for assistance as needed.

submitted by Tom Renkes RN, MS, CEO of the Michigan Nurses Association"

http://www.minurses.org