Care Delivery Models and the Union

[elizabethjk]

So I have (unfortunately) been subjected to a situation in which admin hired some "consultants" in order to implement one of those fancy "models" which is just a grid to determine how many nurses and unlicensed patient care providers are on at a given time.

Our facility is union and the union is appropriately disgusted with the lack of consideration of acuity on the floor in relationship to the shift ratios, the jerking around of flex and float nurses and a boatload of other things I am sure you can imagine.

I used to LOVE my job. Not to toot my own horn, but I know I am a dedicated patient advocate, passionate about what I do, probably annoying to physicians about my adamant means of communication.

I now feel like I have my hands tied and risk being reprimanded for staying late to provide essential care that can not be overlooked (adhering to protocols, DOCUMENTATION, providing needed psychosocial support etc).

The union is trying to approach this problem, but I feel as though it could be more aggressive in communicating to my fellow nurses WHAT WE NEED TO DO TO MAKE CHANGE.

Has anyone else encountered this problem? Coworkers being poorly informed that the union is supported by the members, and change won't happen without action....?

I need some hope after frustrating shifts where I can't take a lunch because I have a complicated chemo protocol and multiple blood products and no one to cover me safely... ACK.

[smoke over fire]

What state are you in?

[elizabethjk]

MA.....

[Chico David, BSN, RN]

I can offer a number of thoughts as a union steward at my hospital.

If there is anything that is fundamental to being a professional, it is setting the standards of what is acceptable practice - and not allowing our employer to set them for us or to degrade our practice in the name of profit or economy.

I'm a big believer in unions, and a union can do a lot, but it's important to remember the basic lesson that "the union" is not something other than you - the nurses at your hospital ARE "the union" and the most powerful and effective actions are actions taken by the nurses as a group. What the union staff should provide is leadership, ideas, support and backup to help you take action to fix it.

So when a group of nurses from a floor approach me as a union leader and want me to wave a magic wand and fix the problem for them, my first instinct is to teach them how to fix it themselves.

So if I were dealing with your situation, I would say to you: "Get together a small group of nurses from your floor to meet with me and let's plan how to fix this".

I'd then sit down with that small group and listen while they defined the problem. Once we had a sense of the problem I would work with them to map out a plan to fix it.

Laying out the whole plan here would be too long, but here are some thoughts:

During speed-ups like this, a standard management tactic is to try to bully nurses into not claiming their overtime - they say to you "everyone else gets their work done on time - why can't you?" Of course they are lying and are saying the same thing to all the other nurses. So the first step is to get the nurses on a unit to agree to certain things and promise each other to stick to them - like claiming all of your overtime. If everyone is doing it, they can't single people out for it. But you have to stand together and not be bullied into working unpaid overtime. Some nurses foolishly think that working unpaid overtime is "professional". What it actually is is devaluing your work, your profession and your own value and letting down your patients, your profession and your co-workers.

With the protection of a union behind you, you can take an escalating series of actions that might include: going as a group to meet with higher level managers, doing petition drives among your fellow nurses, documenting instances when understaffing causes "near-misses" in patient care, filing complaints with state regulatory agencies, writing letters to your local paper, or talking to a reporter, and finally holding a press conference outside the hospital to announce that conditions inside are unsafe.

That's by no means a complete road map for a plan, but it might give you some ideas. I've been involved with pretty much all of those actions at one time or another at my hospital - and they do work but they also do require the unity and active participation of the nurses - union staff can't wave a wand and make it better, but they should provide leadership and ideas.

[mdfog10]

Unless the nurses/union have the contractual right to negotiate all staffing issues with the hospital----the hospital can make changes to staffing levels at any time. This is a major part of our job and we need to fight to get the right to negotiate staffing levels in the contract.

[elizabethjk]

I totally agree with all you are saying, and I guess my primary frustration is getting the UNITY. If I could do it all myself I would be out there, but that's not how this works.

[elizabethjk]

Hey guys, I got a guilt trip for filling out an unsafe staffing form from my nurse manager and the next day when I saw her she approached me in a condescending manner when typically we get along very well.

This should be fun, I'm not backing down.

[herring_RN, ASN, BSN]

he Maine State Nurses Association has an ADO form on the web - http://www.calnurses.org/nnoc/maine/assets/pdf/maine_ado_form.pdf

Here are links to information about why it is good to document unsafe staffing, floating when not competent for the assigned patients, or lack of working equipment.

It is your proof that you notified a manager or supervisor of the situation. You then do your best and in the event of an adverse event the facility, not you, is responsible.

http://www.calnurses.org/nursing-practice/assets/pdf/prtotect_your-licensemar2309.pdf

http://www.calnurses.org/nursing-practice/assets/pdf/ado_explained.pdf

[mdfog10]

I would try to find one or two others to join you in filling out the ADO. You don't want to let them single you out. It is about standing up for the work we do, get others comfortable with filling out the form, and using it to force management to deal with the problems. You can do it!!

[elizabethjk]

I typically get all of, or most of the nurses on a given shift to sign on as well.

I started an email group with the nurses on my floor to try to establish a sense on unity in a private manner...

Next I am going to contact my union and tell them we need to be more forthright and aggressive. They push me I'm going to push back twice as hard... for the sake of patient safety.

[mdfog10]

Absolutely!!! That is a main point I make to nurses why we need to fill out the ADO: we are held to delivering 100% of the standards of care of our hospital for our unit. If we cannot deliver what is expected we need to document it and why. For me , it is because they are moving us and patients sooo fast. There is no time allowed for patient teaching or any psychological care, interventions with families and case managers, etc. Much less the *******' computer!!!

[elizabethjk]

teaching? psychosocial care? what are those....?

OH THOSE ARE REASONS I SPEND AN EXTRA HOUR AT WORK BECAUSE I REFUSE TO GIVE THEM UP.

....that and the !@#$%^' computer. ugh.