Nursing strikes - and the Stricken

[NRSKarenRN, BSN, RN]

By Roberta B. Abrams, RNC, MA, LCCE, for HealthLeaders.com, July 23, 2001

http://www.healthleaders.com/news/feature1.php?contentid=26316

They've had it! Up to here! Nurses are saying they can no longer deal with a critical lack of professional nursing staff, mandatory overtime, unprepared, undisciplined and unlicensed assistive personnel, critically ill patients, unsafe working conditions, abusive managers, caustic physicians - the gamut of ills that exist in healthcare today.

The professional nursing staff is tired of excuses and promises that are never fulfilled. As a result, they're doing what many of them would have considered unthinkable - certainly undoable - a decade ago: They're going out on strike.

For many nurses, walking out on their patients is an anathema to their professional existence. Yet these professional nurses have reached the point where they are unable to see other options - and they cannot, and will not, continue to work in environments that they consider unsafe for their patients, for their careers, for their licenses.

Those of us who assiduously follow healthcare news, read almost daily stories of nurses who are on strike. Let's look at the ramifications of these events from A Nurse's Viewpoint.

What happens during a strike

We have long established that there is one reason, and only one reason, to ever admit a patient to the hospital: the need for 24-hour nursing care. The patient is deemed to be physiologically - or psychologically - so unstable that lack of constant care is dangerous to that patient's health and well being.

In a nurses' strike, that necessary work force is diminished. The quantity and quality of nurses necessary to provide safe and appropriate care are absent from the bedside. Most hospitals attempt to deal with nurses' strikes by bringing in replacement staff - either from local staffing companies or from "traveling nurse" agencies that provide nurses from around the country and/or around the world.

Temporary staff is a far-from-ideal solution. Licensed, willing, and able, they lack knowledge of the facility, of the medical and other staff, and of the structure, culture (and sometimes language) of the hospital. This lack of familiarity with the facility decreases the nurses' efficiency, and increases the probability of errors. The first group to be stricken by a nurses' strike, therefore, are the patients.

The hospital staff collectively comprises the next group stricken by a nurses' walkout. In any work setting, one main aspect of quality performance is the relationships among the staff. In an atmosphere where the staff has worked together over time, there is a mutual trust and understanding of the roles of each member. This give and take decreases the need for elaborate discussions and explanations, thereby making work processes more efficient.

This synchronicity is nowhere more easily demonstrated than in the nurse/physician relationship. Overtime, the rapport that develops between these care partners resembles a chamber music group - each knows the others' preferences, strengths, and soft points. Nurse Sally remembers that she should remind Dr. Jim to write referrals to the discharge planning coordinator for his newly diagnosed diabetics. Jim knows that when Nancy is on nights, any calls he receives will be important ones; Nancy's expertise is one reason Jim likes his patients on that unit. When the usual staff is missing from the clinical unit, that smooth collaboration disappears.

The hospital's administration is sorely stricken by a walkout of nursing staff. According to an article in The Plain Dealer in Cleveland, one replacement agency's staff nurses work 12 hours a day, "... five to six days per week, and earn $3,000 per week." Now, the contract hospital does not pay benefits to these nurses, but they often do pay for lodging and travel. It doesn't take very long, or very many nurses, for that to sink down to the budget base as a sea of red ink.

In addition, the administrative leaders must deal with their failure to meet the expectations of patients and staff, as well as the community in which they live. The mutual loss of trust, the breach in the dynamic relationship between staff and administration, is inexorably - sometimes permanently - altered. The reputation of the facility is diminished, and, in far too many cases, harm to patients leads to litigation.

The nurses are the final group to be stricken by their strike. The professional nurse, driven to this extreme action, must still try to make peace with the fact that she has, in the final analysis, abandoned her patients. That is a very bitter pill to swallow. Even when the community of healthcare providers and healthcare recipients express understanding of her actions, her professional conscience is distressed.

Options to the crisis

There are options. In those healthcare facilities where real leadership prevails, the response to the current crisis in nursing is to proactively convene a consortium of community leaders. Members of the consortium should include an assortment of nurses - those with clinical, those with administrative, and those with educational expertise. Physicians, therapists, support staff in the hospital, and, of course, patients have different kinds of knowledge that will help in framing potential solutions to the healthcare crisis.

The current compilation of problems confronting the healthcare delivery system is put on the table for discussion. Nursing has a prominent place at the table. Nursing did not create the current crisis, and nursing alone cannot ameliorate it. However, nursing must accept its share of ownership for the solution. Consultation with outside leaders, such as staff and leadership of facilities who have achieved "Magnet Hospital" credentials, may help in providing some direction.

Every facet of the healthcare delivery system is subject to review. What parts of the system can be streamlined to improve efficiency? How can technology be used to improve care delivery? A focus on outcomes, and on evidence-based practices, may result in the elimination of "traditional care elements" that no longer serve either patient or provider.

How can the facility - and the community around it - enhance the recruitment and retention of caregivers? Professional nurses seek - and deserve- a place at the table where decisions are made. It has been my experience as a nursing administrator that the staff has the knowledge and ability to resolve most of the issues that beset them. What they require is the trust and support of the administrative staff to implement the solutions.

Nursing salaries require review to acknowledge the nurses' expertise and contributions. "One size fits all" benefit practices need to be abandoned in favor of a cafeteria menu of benefits that acknowledges disparate needs - not just for nurses, but also for all healthcare providers.

Many of the benefits that were recently sacrificed on the altar of fiscal expediency should be restored. Continuing education (including tuition reimbursement for collegiate education) is a "perk" that attracts and retains nurses and other professional staff. It also facilitates care enhancement for the patients and improved delivery systems for the institution. Administrators need to focus on long-term gains for their facility, as opposed to knee-jerk responses to evanescent changes.

We need to work with our community educators to provide our youth with awareness of the benefits of healthcare careers. We need to help our elected representatives on the local, state, and national levels to cease tampering with processes for which they lack comprehensive understanding, and to instead empower those with that skill and knowledge to improve the health of our populace.

The hour is late - the risks are many. We do indeed have "promises to keep and miles to go before we sleep." Our healthcare delivery system is stricken. It must be made whole.

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Roberta B. Abrams, a regular columnist for HealthLeaders.com, uses her education and experience to help further the evolution of healthcare delivery systems through her consulting group, RBA Consults, in Farmington Hills, Mich. She also is on the adjunct nursing faculty at Madonna University.

[-jt]

>

The American Nurses Association (ANA), the New York State Nurses Association (NYSNA) and other professional nurses associations across the country disagree with that assertion. The author of that article should see the ANA's own website on collective bargaining for RNs at http://www.ana.org/dlwa/barg/index.htm

and review the ANA's new Bill of Rights for Registered Nurses.

In addition, I would suggest that she treat herself to a lovely, informative, enlightening gift & purchase the book "Honoring Our Past, Building Our Future", available from the New York State Nurses Association (http://www.NYSNA.org). She would see that not only did nurses indeed have to strike a decade ago, they had been doing so for decades before that. This is nothing new to us.

I would tell the author that nurses who strike do not at all feel that they are "abandoning" their patients. They believe they are fighting for their patients. It's the administration that would like to shake us up and deflate a strike threat by trying to make us feel guilty and in an effort to weaken our strength of unity, would like us to feel we are "abandoning" our patients.

But we do not feel we are abandoning our patients at all. Any nurses who have been on strike will tell you that.

In a strike situation, the hospital is given a 10 day warning notice. And theyve known for months before that notice that this is coming. In that 10 days time, the hospital can choose to negotiate fairly and post-pone a strike, reaching towards a fair settlement, thus averting a strike all together. Or it can choose to move its patients to other facilities for their care. The ball is in their court. Hopefully, they will see the light and work to avoid the strike before it starts, but if not, it is then their responsibility to make arrangements for those patients to be cared for elsewhere. No patient is abandoned and nurses will no longer be manipulated by that guilt complex managers try to push on them.

Nurses do not "walk out on their patients". Strikes only happen as a last resort, when there is nothing else left to do because the hospital itself walked out on the nurses first, refusing to come to the table and negotiate further, in effect going on strike against the nurses itself. Nurses are standing up for themselves and their patients. Striking nurses are not abandoning their patients. If that were true, the community, the patients families, and the elected officials would be condemming the nurses, not supporting them and walking their strike line with them.

When the hospital says you WILL be responsible for 14 pts & you WILL work 16 hrs and if you dont like that you can leave, what are we supposed to do? Accept that? We dont accept that as the final word. The author is right on many points but we cant wait for employers to get the message and start behaving reasonably on their own. They havent. They arent.

Wouldnt it be wonderful if nurse's backs were not pushed to the wall by their employers to the point where the nurses had to take a job action in order for their concerns to be heard? If the nurse's didnt strike when the hospital refused to address serious issues effectively or negotiate fairly (if at all), the RNs would just have to accept intolerable, unacceptable conditions as a way of life (like our Southern colleagues do) and our union would be broken. Our voice silenced and our right and ability to be a part of the decision-making that affects us, our working environment, and our practice would be eliminated. Wouldnt it be wonderful if the employers, while saying they "value and respect" their RNs, actually backed up those empty words with some honest actions to support what they say? Until that happens nurses will continue to be forced to strike.

As a long-time direct-care RN working in an ICU, a collective bargaining member of the NYSNA, and a member of the ANA, I know that the only way we ever had any power to control our own workplace situations is through organization with our professional association. If we had to wait for administration to pay attention to what we know and what we say, we'd be waiting forever.... and we, as well as our patients, would be at risk. Waiting for an administrator to recognize us is not the answer. We demand it. I, for one, am not willing to relinquish my voice in my workplace by giving up my union or by working in a non-union facility. I expect many other nurses will feel the same way.

As we work in a facility where the RNs are represented for collective bargaining by their professional state association, and as we take part in the decision-making that affects us at our workplace, negotiate contracts, and function as a labor bargaining unit, as well as professionals, we also work with our community educators and our elected officials to have them "on the local, state, and national levels cease tampering with processes for which they lack comprehensive understanding, and to instead empower those with that skill and knowledge to improve the health of our populace." We have written legislation that would protect nurses, healthcare workers, patients, and would improve quality of care. (http://www.nysna.org/PROGRAMS/LEG/points/solutions.htm).

We did not have to give up our rights to collective bargaining or our right to strike when forced to, in order to do it.

Finally, isnt it ironic that in this day of world-wide beside nurse shortage, employers of bedside nurses still RESIST making the workplace one that will bring nurses back to the bedside. How hypocritical to say "we value our nurses", and then intentionally force them out on the street in an effort to avoid meeting their professional concerns. One might almost think the employer has no inclination to alleviate the bedside nurse shortage at all and will even do anything to exacerbate the problem. Maybe without nurses, the employer will have an excuse to alter the healthcare delivery system to one that is provided by less costly personnel . Maybe it's to the employer's benefit to not be able to "find" nurses.

Food for thought.

[NRSKarenRN, BSN, RN]

JT:

I think you should copy your post and place as a rebutal at the healthleaders.com site...they do encourage replys.

It is true that RN's don't want to strike and DON't want to leave their patients/facilities. They only do that as the very last resort after all attempts to bargain over working conditions have failed.

It is the failure of many hospital administrations to have nursing staff (who are the largest group of employees in a facility) have a vote at the conference table regarding the management of the facility. Who is more involved 24/7 than nursing staff regaring patient concerns, and how to finagle the system to get thier clients need fulfilled?? Nurses are the first to realize when a system process or department is not functioning as well as it should....when concerns are addressed, does management listen or are they brushed aside??

Nurses do not abandon patients during a strike.

Abandoment occurs ONLY after a patient assignment is accepted AND the nurse leaves the assigment area prior to another nurse assuming reponsibility.

Most of Roberta's points re what leads up to a strike are right on the mark.

[lsmo]

jt you are awesome. I vote for you for president!

[-jt]

nahhhhhhhhh not awesome. Just been in this business to damn long. : )

But thanks.

I agree with a lot of what Roberta has to say & spoke with her today. After I sent her that letter. My point was that shes right. I think she was talking more to the administrators with that article. We should be treated the way she said we should be but administrators on a whole have never done that without us having to fight tooth & nail for it. And they still arent. Sitting there waiting for them to see the light is not going to help us. If they were going to put pt care before profits on their own, out of the goodness of their hearts, we wouldnt be out on the strike line. I think she underestimates the nurses who are striking. I have never met a striking nurse who was upset because she felt she felt she abandoned her pts. We just dont think that way because it isnt true.