Ethics and Collective Bargaining: Calls to Action

Chico David, BSN, RN · Apr 7, 2008

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 · Apr 8, 2008

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. :uhoh3: 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! :down:

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........ :yeah:

FedUpWithIgnorance · Apr 24, 2008

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!:redbeathe

Chico David, BSN, RN · Apr 24, 2008

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!:redbeathe

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 · May 4, 2008

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. :up:

nanacarol · Jan 19, 2011

Alright, I give. I can't continue silently while we nurses inadvertently promote what we do as being qualified as being a nurse merely because we have recently been "butt wipers". There is so much more to being a nurse than the "down in the trenches tasks" we do. Butt wiping can be outsourced and doen not or should not garner a $25+ hourly wage. Lets be real, we need all of the experiences and education the individual nurse brings to the table. I learned the skill associated with the task of butt wiper and I can perform that skill with the best of them but I have honed my critical thinking skills tat enable me to merely visualize a patient or patient family member and develop a set of queries that will allow me to ask the questions that will be significant in developing a treatment plan that addresses the needs of my patient and his family. This does not take me an inordinate amount of time so the saying all of the paper work takes away from my ability to care for my patient is not valuable. If I am focused on completing the lastest template so I can get to the next room you may have some legitimate concerns. We are nurses, what we do, what we really do can not be duplicated by any other discipline unless we relegate ourselves and out offering to the role of "butt wipers and such".

Who do you think advocated for the nurse patient ratio to be decreased? Those non butt wiping nurses who sat in the various board rooms, participated as Union representatives, the nurse lobbyist, they are the voice of nursing. I am not intending to minimize the work or importance of the bedside nurse, nor am I purporting that major loads are placed on theses nurses everyday in practically every hospital, I am suggesting that it may be time for us to review how we speak respect for who we are and what we do and provide. It begins with a change in our "speak" As a man/woman speaks so is he/she. We are nurses, all of us! nanacarol

Chico David, BSN, RN · Jan 20, 2011

Alright, I give. I can't continue silently while we nurses inadvertently promote what we do as being qualified as being a nurse merely because we have recently been "butt wipers". There is so much more to being a nurse than the "down in the trenches tasks" we do. Butt wiping can be outsourced and doen not or should not garner a $25+ hourly wage. Lets be real, we need all of the experiences and education the individual nurse brings to the table. I learned the skill associated with the task of butt wiper and I can perform that skill with the best of them but I have honed my critical thinking skills tat enable me to merely visualize a patient or patient family member and develop a set of queries that will allow me to ask the questions that will be significant in developing a treatment plan that addresses the needs of my patient and his family. This does not take me an inordinate amount of time so the saying all of the paper work takes away from my ability to care for my patient is not valuable. If I am focused on completing the lastest template so I can get to the next room you may have some legitimate concerns. We are nurses, what we do, what we really do can not be duplicated by any other discipline unless we relegate ourselves and out offering to the role of "butt wipers and such".
Who do you think advocated for the nurse patient ratio to be decreased? Those non butt wiping nurses who sat in the various board rooms, participated as Union representatives, the nurse lobbyist, they are the voice of nursing. I am not intending to minimize the work or importance of the bedside nurse, nor am I purporting that major loads are placed on theses nurses everyday in practically every hospital, I am suggesting that it may be time for us to review how we speak respect for who we are and what we do and provide. It begins with a change in our "speak" As a man/woman speaks so is he/she. We are nurses, all of us! nanacarol

I think you may be putting a bit to literal an interpretation on a couple of the comments here. The real point is that we see an awful lot of people who hold nursing degrees and licenses, but have not cared for a patient in 10, 20 or more years purporting to speak for the nursing profession. More importantly, many of those are people who specifically make their living by oppressing and degrading bedside nurses. Their interests align with the big hospital corporations, the insurance companies, the drug companies, etc. It's a travesty for people like that to be in the position of representing the nursing profession. Yes, nurse managers and academic nurses are a valuable part of the profession, but only as long as they retain nursing values. Values like putting the need of the patient ahead of maximizing the corporate bottom line.