I’ve changed multiple details in this article to protect the identity of the nurse I interviewed. I offered to pay her for her time, but she refused, so I made a donation to the American Nurses Foundation Coronavirus Response Fund in her honor. The fund, Coronavirus Response Fund for Nurses, focuses on:
Providing direct financial assistance to nurses
Supporting the mental health of nurses – today and in the future
Ensuring nurses everywhere have access to the latest science-based information to protect themselves, prevent infection, and care for those in need
Driving the national advocacy focused on nurses and patients
Sandy is an ER nurse in a hospital with only 10 cases since the Covid-19 outbreak began. Her state is in the first phases of re-opening and the number of cases has doubled in the last week. I first talked to her over three weeks ago, so a few days I checked in. She told me, “not much has changed. They are setting unrealistic metrics, the census is increasing, the staff is increasingly compromised…believe it or not, it’s worse…but we’re hanging in there for the vote.”
And by “vote” she means a vote to unionize, which could happen in the next few weeks.
Unions are a controversial topic in the U.S., and it can be tough to find unbiased information. I remember when I was a new nurse back in 2006, I was told that if you even said the word “union” you could be fired. This was in North Carolina, where I had been taught “Unions are illegal.” I discovered it is illegal to dismiss an employee for trying to organize or join a union, but it can be hard to prove that someone was fired for those reasons.
The US Bureau of Labor Statistics states that approximately 13% of Americans belong to a union (down from 20% in 1983). But, 18% of RNs belong to unions. A union is an organization of workers formed to protect and advocate for the member's interests. Nurses don’t have a single labor union. Some of the most active include National Nurses United and The American Federation of Labor and Congress of Industrial Organizations. Twenty-eight states are “right to work” and twenty-two states have mandatory union participation, including California, New York and Illinois. It is important to note that most unions are not organized or led by nurses. Dues can be as much as $90 each month, but nurses in unions are paid 20% higher than nurses in non-union facilities.
Pros to Nursing Unions
Job security, better working conditions, guaranteed wages and pay increases, seniority advantages, education reimbursement, better benefits, a guaranteed process for grievances, ability to strike, legal representation. Research has shown that hospitals with successful unionization have improved patient outcomes and better employee satisfaction.
Cons to Nursing Unions
These are cons to unions, like bad eggs -- it’s very hard to fire someone who isn’t doing a good job. In health care, with lives on the line, this can be a frightening concept. Many nurses are against the idea that an incompetent nurse can keep her job if she’s in a union. Though some sources say unions favor seniority over performance, Sandy says in the union she’s pushing for, pay raises are merit-based. Mandatory striking is another issue. If you are a member of the union, it is possible you’ll have to strike, though striking is a last resort and only occurs if the majority of the nurses decide if the strike takes place. Sandy says, “It’s a one-day strike maximum in this union.” Another issue is that union negotiations have the potential to create adversarial relationships between employees and employers. Other complaints are about union dues.
Why a Union?
When I asked Sandy about the Covid-19 situation at her hospital she said, “I feel very unsafe at work, but it’s not at all related to PPE. It has everything to do with staffing. We agreed on a 3:1 ratio with nursing administration in our high acuity pod, but now it’s crept back to 4:1.”
“An elderly patient came in for a kidney stone with a 98.7 temp. Then the temp started to spike, the pressure started to drop. She developed slurred speech and her mentation declined. She started shivering and spiked 103. We were trying to get a blood draw before she could go to pre-op, but her blood was clotting like crazy. Phlebotomy is no longer coming to the most critical pod in the ER so labs take 2 hours to come back. So you might think 14 patients in the ER seems manageable with 5 or 6 nurses, but it blows up with traumas coming in, people getting stabbed, people who are emergent. You can’t predict what will happen and we need to have staff available.”
“There’s no one on call. There are no float nurses. How am I supposed to respond effectively and safely to 4 patients when I’ve got a status epilepticus needing intubation, a septic patient, a patient who needs intubation, and a fourth one who is waiting for a urinary stent and pulling out his IV?”
“People are quitting, and our ER is full of new graduates. One primed some antibiotics and didn’t do it correctly. Just stupid stuff. The ED is down to who can survive it. The PRN folks have been cut loose – furloughed and encouraged to take travel assignments. There is no one to cover FMLA. We’ve lost 30 nurses in 3 months due to a combination of firing and quitting.”
“Our director mandated we won’t get lunch breaks because we have low productivity in the ER. So, we don’t get paid for the 30 minutes of lunch. All the pictures you see of nurses getting free food for being heroes. Those pictures are with managers, educators and supervisors.
At the end of March, Sandy said she was working every other day. She was distressed because she said, “We lost another good nurse. She gave her two weeks’ notice and they told her not to come back.” She went on to say, “I’ve been flexed a few times at 70% of my base pay. We have to use PTO to cover the other 30%. When workers have had positive exposures, there’s been no quarantine, no nothing. If someone is a PUI, and they’ve tested positive, there’s a sheet with all the names of those who have provided bedside care, but they are not told – you’d be more likely to find out in the newspaper that you were exposed, than from hospital administration."
“In the ER, we always have plenty of surgical masks, N95 not as much. We didn’t see any N95s for a while, but on March 24th they suddenly came out of hiding. That’s when the education on PPE, how to use it, scenarios, etc… really started.”
People of Interest
“When we get people with symptoms who don’t need to be hospitalized, we are sending them home and not testing. Someone is supposed to be checking on them to see if they are compromised. How would you even know if you are desatting, if you are desatting? Who has a pulse-oximeter at home? A patient went home on self-quarantine, she couldn’t breathe and by the time EMS arrived, she had died. This is not okay. We have to change what we are doing, how we are responding.”
Covid-19 is Just Reinforcing What We Already Knew About Our Hospital
Sandy says, “The need for a union is so dire. Our focus needs to be on supporting each other and taking care of our staff, but sometimes I get so angry, I want to jump ship. We have to focus on getting people to believe there is strength in numbers. You may be fine in your nursing job, you may have adequate staffing and bathroom breaks, but you have to stop thinking about yourself and think about the bigger picture.”
Would you like to be interviewed?
I'm going to continue to interview nurses on the frontlines. If you'd like to be interviewed or you have a particular area of nursing you are interested in, let me know. I've already got a few other interviews out there for you as well:
At the Bedside with Covid-19 - Stories from the Frontlines
At the Bedside with Covid-19 - Part 2: John
Methadone Clinics and Covid-19: More Stories from Nurse on the Frontlines