Sutter Santa Rosa Nurses Vote to Approve Possible Strike

With a large turnout Thursday, registered nurses at Sutter Santa Rosa Regional Hospital voted by 98 percent to authorize their nurse negotiators to call a strike, if needed, to protest the hospital’s refusal to act on their concerns for improved patient care staffing and management demands for significant cuts in health coverage for the nurses and their families.

Santa Rosa is the latest Sutter hospital in the past few weeks where RNs have voted to approve possible strikes with nearly unanimous votes.

Strike authorization has already occurred at Sutter Roseville Medical Center, a 96 percent strike vote, Sutter Auburn Faith, a 94 percent margin, Sutter Tracy, a 94 percent vote, and Mills-Peninsula Health Services, with facilities in Burlingame and San Mateo, a 97 percent margin. Together the five medical centers have nearly 2,600 RNs, represented by the California Nurses Association/National Nurses United. No date has been set for a possible strike.   

“Sutter is trying to force nurses to pay enormous out of pocket costs for healthcare, up to $10,000 per year for services, outside of monthly premium costs,” said Sutter Santa Rosa RN Nancy Anderson. “This employer is offering health care plans to the public that are better than what they are offering their own nurses. We need adequate health care for ourselves and our families and we need safe staffing that allows us to, minimally, take meals and breaks.”   

At each facility the RNs are fighting similar Sutter demands for cuts that nurses say will erode patient safety by a chain with a notorious history in recent years of cutting patient services while rolling up huge profits – nearly $3.5 billion the past five years.

“This vote shows that we are prepared to fight Sutter’s slash-and-burn agenda,” said Mills Peninsula RN Chris Picard. “As a nurse negotiator I am proud to stand with my fellow Mills-Peninsula RNs today: united, determined, and strong.”

“Many Sutter Tracy nurses came out to vote yes to a strike because they see power in solidarity. Over the last month, nurses have been collectively advocating for safe staffing by voicing their concerns and filling out ADOs (Assignment Despite Objection forms, which nurses provide to management documenting what they believe to be an unsafe patient assignment). Nurses are seeing what it really means to stand united,” said Sutter Tracy RN Victoria Lat, RN.

At Roseville, where the RNs held a picket earlier this month, the nurses cite budget cuts and a resulting lack of beds that have meant patients are being admitted with no hospital beds available. The patients are then housed in the ER, limiting the ability of ER nurses to safely care for other patients needing emergency care while they have to also monitor and provide care for patients who should be in an inpatient hospital bed. It also results in RNs from other hospital units having to leave their patient assignments to work in the ER. 

“We’re fighting for patient safety, we’re fighting against unsafe staffing,” says Roseville RN Jennifer Barker Andrea Seils, RN. She notes staffing cuts in the labor and delivery unit where she works are being carried out under the guise of  “efficiency” that nurses say is actually about cost cutting at the expense of care. According to Seils, “They’re trying to restructure our unit to eliminate positions and combine care. It’s unsafe for mothers and babies in our community.”

Additionally, Roseville nurses say Sutter is demanding more than 30 reductions in the RNs’ existing health coverage, including big increases in out of pocket costs for nurses, all of which are paid to Sutter under Sutter Health’s self-insured plan. These costs exceed what county and school district employees covered by Sutter’s HMO pay to Sutter Health.

 “There’s no economic or operations justification for any of their proposals,” says Seils. “The strike vote will send a strong message to Sutter Health that RNs are serious about fighting for patient care.” 

In Auburn, the overwhelming strike vote was intended, said Sutter Auburn Faith RN Sandy Ralston, “to serve as a very strong signal to the employer that nurses are not willing to accept the significant health care cost increases being proposed by Sutter. It also sends an unmistakable message about staffing safely by acuity and that we are united in our commitment to a fair and just contract. ”  

CNA/NNU nurses are also engaged in a similar battle for a fair contract at Sutter’s California Pacific Medical Center-Pacific campus in San Francisco, Sutter Lakeside, Sutter Santa Cruz (a visiting nurses home health service), and Sutter Solano in Vallejo.

Conversations with Kay, Part 1


      It would not be an understatement to say that the very existence of National Nurses United, and the modern bedside nurses movement it represents, would not be possible today without the leadership of Kay McVay, RN.

      McVay, a longtime Kaiser Permanente intensive care unit nurse from California, just celebrated her 80th birthday in January. In her career, she has seen nursing practice change from a time when RNs were not even allowed to draw blood to when they are routinely performing life-saving interventions, using the most sophisticated equipment, and assessing the sickest and most fragile of patients.

      And though the practice of nursing has evolved at a breakneck pace over the last 50 years, the working standards and salaries of nurses have not – a failure largely attributable to the extremely classist culture of the country’s state nursing associations and its parent organization, the American Nurses Association.

      It might sound odd to NNU members today who are used to their organization championing bread-and-butter nursing issues such as safe RN-to-patient staffing ratios and fair contracts, but, as late as the 1990s, the vast majority of the state nursing associations did not prioritize the concerns of the bedside nurse. They were controlled mainly by nursing executives and nursing academia types who actually thought that if you were a nurse who still valued or (gasp!) enjoyed providing hands-on patient care at the bedside, that you must be not very smart, not very ambitious, not very worthy, or all of the above.

      Kay McVay helped change all of this.  

      Starting in 1992, McVay, a handful of other RN leaders, and dedicated staff, including now-NNU Executive Director RoseAnn DeMoro, successfully worked to win back control of their state nursing organization, the California Nurses Association, for bedside nurses. CNA’s “staff nurse rebellion” spurred its secession from the American Nurses Association in 1995 and paved the way for many more states to follow suit, including Massachusetts, Maine, Minnesota, Michigan, and New York. Many of these states are the founding members of National Nurses United, now the vanguard organization for registered nurses across the country.

      As the new CNA’s first president, Kay McVay has been a key leader every step of the way in building this new nurses movement. Beginning in this issue, we will be regularly sharing interviews we are conducting with McVay about all that she has witnessed over her 80 years. We hope that through her stories of life, of her nursing career, of her involvement with the California Nurses Association and National Nurses United, you will better understand how far registered nurses have come, and how far we still have to go.

      In this column, Kay gives us a glimpse of what it used to be like as a staff, bedside nurse to deal with the old California Nurses Association, pre-1993.


Kay, you always refer to the old California Nurses Association as headed by “the ladies auxiliary.” What do you mean by that expression?

It refers to a type of society group that was popular back then for women, especially the wives of men who were in some kind of association, to belong to. They would typically concern themselves with hosting charity events and social functions that would make them look good and confer them a certain social status, but that were ultimately just superficial and never addressed any real problems.   


So it’s the 1980s, you had a work problem, and you called the Ladies Auxiliary. What was your problem and how did they respond?

Well, we were being told to stay and work overtime or come in and work whether you had obligations at home or not. And if you didn’t stay or come in, you could be fired. I would be called in at two in the morning, and I would go. We needed to work these types of problems out, and nobody was willing to do anything, to say anything, or to give you any insight into what to do or how to possibly talk about it with your superiors. So I remember calling the person who was in charge of nursing practice because I wanted some help in how to handle this problem, and the person told me that I had a union and I had to take my problem to the union, that I couldn’t possibly get any help from her.


So for the Ladies Auxiliary, the union was this completely separate thing that had nothing to do with nursing?

Right. And back then, it really was a separate department, the Economic and General Welfare division. There was no understanding that your working conditions and standards were absolutely related to nursing practice and the care you could provide as a nurse.


Who were these Ladies Auxiliary members and where did they come from?

They were academics and managers for different hospital chains, including Kaiser.


It sounds like they were really disconnected from actual nursing.

Their attitude was that if you remain at the bedside, you must not know very much. To me, that was the only reason why I became a nurse was to be at the bedside. I didn’t want to be anything else.


Check back next issue to find out what Kay McVay did next.

RN Delegation Lobbies, Protests in Sacramento to Stop TPP, Fast Track

Dozens of nurses and supporters gathered Tuesday in Sacramento, to protest what they say is the REAL “trade” being faced by the U.S. and 11 other countries, under an impending, secretive trade agreement called the Trans-Pacific Partnership (TPP): Public health in exchange for corporate profits.

“The TPP is going to cause a lot of harm to people in this country,” emphasized Kaiser Oakland RN Kathy Donahue, during a rally at the Sacramento offices of PhRMA, the lobbying arm of the pharmaceutical industry. RNs are particularly concerned about the major risks the TPP poses to public health as a result of numerous provisions written by corporate lobbyists—including inflating drug costs, threatening food safety, and nullifying environmental protections.

“Senior citizens are not going to be able to buy their drugs at the rate they have been in the past,” said Donahue, citing a 12-year monopoly drug pricing that would be given to global healthcare corporations. “HIV and AIDS patients may no longer be able to afford medication. Families may no longer be able to afford medications for their child.

Earlier in the day, Donahue joined RNs Diane McClure (South Sacramento Kaiser) and Dolores Trujillo (Kaiser Roseville) for a meeting at the offices of Congressman Ami Bera, to lobby against “Fast Track” authority, which would allow the TPP to slide through Congress unchallenged.

“We expect congressman Bera to be a champion on this issue. The TPP undermines health protections for our community,” says Trujillo. I

Nurses are visiting several members of Congress – including Congress members Scott Peters and Susan Davis in San Diego, and Norma Torres in Ontario –

Congresswoman Barbara Lee recently said, “I join the vast majority of Americans, from both parties, in opposing Fast Track for the Trans-Pacific Partnership. If the U.S. is going to pursue a free trade agreement in the Pacific, Congress needs to have public debates and hearings so the deal is fair and the American people know what’s in it”—a sentiment RNs say they hope for from all congress members they are visiting this week.

After the Bera visit, the nurses reconvened at PhRMA’s offices, now dozens strong, along with supporters from the Sacramento Central Labor Council, to demand a stop to Fast Track and the TPP. Chanting, “Stop TPP now!” the group marched down K street, then into the lobby, demanding to speak with a PhRMA rep. The gigantic pharmaceutical corporation responded by locking down the elevators and stairs.

“We’re here to let PhRMA know we are against fast track and the TPP!” Donahue said, in a raucous rally the group held in the lobby, in lieu of being allowed onto PhRMA’s floors. “We’re giving a loud message: Stop TPP now!”

Supporters from the Sacramento Central Labor Council also voiced solidarity with the California Nurses Association/National Nurses United, in the nurses’ fight against TPP.

“What you’re doing is working,” said Robert Longer, Legislative-Political Director of the Communications Workers of America. “If we can stop Fast Track, we can stop the TPP. We can protect your patients—our health, our safety. Keep up the good work; we are all fighting the same fight, and we are going to win this thing!”

Holding a giant prescription pill bottle breaking down the inflated costs of medicine under the TPP, and a banner warning “TPP, Fast Track Puts Our Health in Danger!” the nurses and supporters managed to disrupt the morning at PhRMA’s otherwise quiet offices. And at the end of their spirited rally, they left behind, in the spacious lobby, the echo of their final chanted words: “We’ll be back! We’ll be back!”

For more information on Fast Track/TPP:

Better Safe than Sorry

“You know the sound a bowling ball makes, when it strikes the pins? That crash happened inside my head.”

Maureen Holder is describing the July 13, 2012 punch by a patient that, 20 years into her career as an ER nurse, changed her entire life. While waiting for a CT scan, Holder’s patient, a professional boxer with possible head trauma, needed a urinal. Radiology staff was delayed, security was busy handling a different patient, and her facility, St. Francis Memorial Hospital in San Francisco, had made staffing cuts the previous year, leaving her alone without the tech who might otherwise have been by her side.

Concerned with making her patient more comfortable, she quickly ran across the hall for the urinal. When she returned, her patient was off the gurney, with his back turned, falling. Holder reached out to help catch him, and with all the force of a pro boxer, he turned around and swung.

“I thought I had ruptured my eyeball,” she said. Holder turned out to have an orbital floor fracture underneath her eye, a nasal fracture, fractures in her cheek, a concussion, and a traumatic brain injury, all of which required two eye surgeries, one nose surgery, physical therapy, and chiropractic treatments. And the psychological wounds ran deep.

“I had counseling for about two years. I didn’t want to leave my house,” says Holder. Acupuncture and weekly cognitive behavioral therapy worked to curb residual trauma, but Holder still had lingering double vision, ringing in her ears, difficulty lifting, and post-traumatic stress disorder. She was unable to return to ER nursing. Her workers’ comp payments, a fraction of her original salary, eventually ran out, and she was essentially forced, for lack of funds, to move to Florida to live with one of her daughters and her family. Now, still experiencing vision and hearing issues as well as “a significant number of headaches every week,” she has returned to school at age 59 in an attempt to qualify for an office job.

“I am keeping a positive attitude and refuse to allow this to define me going forward,” said Holder. “But this has been life-changing, and I feel let down by the system.”

No job comes without some degree of risk. But for registered nurses, the dangers of being hurt by workplace violence while doing their jobs have not only reached unprecedentedly high levels, but are also now much more frequent. The U.S. Bureau of Labor Statistics reports that violence against hospital workers is almost five times greater than the average worker in all other industries combined, and the rates appear to be rising.

For too long, nurses have simply put up with the violence. Or, worse yet, they actually assimilated and normalized the violence as a routine part of their jobs.

Hospitals must be held accountable for having violence prevention plans and for practices, such as unsafe staffing levels, that directly contribute to the inability to stave off violent incidents, say RNs. They must also be prepared to deal with increasingly mentally unstable patients, and even their family members, due to the abandonment of psychological services across both the public and private health sectors. The healthcare industry’s plans to maximize profits by shifting the burden of care onto the patient’s family members at home may also be putting undue stress on both patients and relatives. By having a plan to prevent violence, employers will not only be protecting RN and other healthcare staff, but also other patients, families, and visitors.

Across the country, RNs are now demanding that hospitals and clinics take responsibility for creating and maintaining safe work environments – as employers across all sectors are required to do. Nurses in California in 2014 passed a law directing their state Occupational Health and Safety Administration to draft tougher workplace violence rules for hospitals and spell out what is required of them. Nurses in Minnesota, Florida, Texas, and Massachusetts are also trying to pass legislation requiring similar safeguards.

Holder said RNs understand that with the confusion and fear brought on by illness, medication, old age, and mental illness, there is some amount of risk that a patient will occasionally become agitated or lash out. She’s been bitten, hit, and scratched by “little old ladies,” but the scenarios RNs face now are wholly different. Today, nurses are constantly put in risky situations that should have been avoided in the first place had the hospital had better protections and policies in place. No staff should have been left alone with a boxer suspected to suffer from a head injury.

“We feel like we’re putting our life on the line for no reason,” said Holder. “Now I have a permanent injury. As far as having any kind of light at the end of the tunnel after all this, or [the hospital saying], ‘Here, we’re going to make up for your lost wages.’ There have been no phone calls [from administration], no card. They forget about you.”


* * * * *


Ask a convention hall packed full of thousands of registered nurses, “Who has suffered violence at work?” and almost all will raise their hands. Violence comes in many forms, whether physical, verbal, or psychological, and can be committed by patients, their friends and family members, and even doctors, hospital management, and administrators.

“We’ve always considered workplace violence a critical issue,” said Karen Higgins, a Massachusetts RN and a copresident of National Nurses United. “Now, the concern is that the violence seems to be escalating.”

According to the Bureau of Labor statistics, violence against healthcare workers is, indeed, on the rise. In 2013, thirteen percent of the injuries and illnesses requiring health care and social assistance workers to miss workdays were the result of violence. That’s an increase, for the second year in a row, of 16.2 cases per 10,000 workers, up from 15.1 in 2012, according to the BLS. Again, these rates are almost five times greater than typical workers.

And those are just the recorded figures. According to the U.S. Department of Justice, Federal Bureau of Investigation, actual statistics regarding violence committed against healthcare workers may be even higher, due to a “likely under-reporting of violence and a persistent perception within the healthcare industry that assaults are part of the job. Under-reporting may reflect a lack of institutional reporting policies, employee beliefs that reporting will not benefit them, or employee fears that employers may deem assaults the result of employee negligence or poor job performance.”

In her 40 years as a nurse, Kathy Britten, RN, of Sanford Thief River Falls Medical Center, in Thief River Falls, Minn., has seen violence go unreported, due, she believes, to factors such as worries about getting fired and not wanting to be reprimanded. “I keep telling my younger coworkers, you need to fill things out,” she said, stressing that it’s critical to report and document violence in order to establish patterns and hold management accountable.

In the face of escalating workplace violence, possibly even more widespread than the reported numbers, nurses have been mobilizing to call for greater protections. The California Nurses Association, for example, shepherded passage of the 2014 Healthcare Workplace Violence Prevention Act. This landmark bill requires California hospitals to adopt comprehensive workplace violence prevention plans and also forces hospitals to document and report incidents of violence to the California Occupational Safety and Health Association (Cal/OSHA).

At a National Nurses Organizing Committee conference in January, around 100 RNs from Florida, Texas, Missouri, Kansas, and Nevada, echoed California’s call for stepped-up action to reduce hospital violence. They gathered in Tampa for a rally piggybacking on proposed Florida legislation geared, much like California’s, to standardizing and formalizing workplace violence prevention.

“Such a large percentage of us are assaulted at work,” said rally attendee Kim Scott, an intensive care unit RN at Oakhill Hospital in Brooksville, Fla. Her own violent experiences range from verbal assaults, to watching a coworker get kicked “hard in the chest.” She joined RNs holding signs that read “Assaulted” and “Physically Assaulted,” while Bonnie Castillo, RN and director of National Nurses United’s Registered Nurse Response Network, read statistics from the Journal of Emergency Nursing citing that 76 percent of nurses with at least 10 years of experience had experienced some form of workplace assault in 2013.


* * * * *


There are a multitude of reasons why violence against healthcare workers is on the rise. But in discussion with registered nurses across the country, several key factors attributable to the hospitals and healthcare industry’s prioritization of profits over its staff and patients are most prominent.

One main way hospitals can prevent workplace violence, agreed nurses, is to simply increase staffing. More staff means more sets of eyes on the patients, more hands and bodies to step in if a patient or family member acts out. Better care also means patients and families are less likely to become agitated. This applies across all levels to not just registered nurses, but techs, aids, and sitters to watch potentially volatile patients. California’s recent legislation, for example, involves safe staffing protocols written into its standards for healthcare facilities.

Holder points out that not being left alone may have prevented the patient from slugging her. “The hospital is always trying to save money, downsizing, making staff cuts,” she said. “We used to have a person on every shift who would help nurses with transporting, drawing blood, getting people undressed or helping us with agitated patients. They cut those positions, so we didn’t have help at all. It really made a difference.”

A second is that patients today tend to be sicker and more likely to present with emotional and psychological volatility – if not outright untreated mental illnesses. Millions of people lost their jobs and, subsequently, their health insurance during the Great Recession and have had to go long periods without primary healthcare, therapy, or needed prescription medication. Private and public services for patients suffering from mental health issues have been cut, cut, cut.

According to a 2014 report by the National Association on Mental Illness (NAMI), the lack of acute inpatient or crisis stabilization services for patients who are experiencing psychiatric emergencies has “contributed to the problems with ‘psychiatric boarding’ in emergency rooms.”

“There’s a serious problem throughout the country with ERs housing psych patients because there aren’t enough psych beds,” said Judy Lerma, an RN of the Center for Healthcare Services (CHS) Crisis Care Center in San Antonio, Texas and an active member of NNOC-Texas. Lerma’s facility assesses adult patients having a psychiatric emergency, and accomplishes a 48-hour crisis observation in order to keep these patients “out of jail — or the hospital.”

“The idea is that [our facility] will stabilize them, and they won’t need to end up sitting in the ER, waiting in a bed there.” But many psychiatric patients across the country still wind up in the emergency room, nonetheless.

Last, nurses point to changes in hospital visitor policies intended to maximize hospital profits that result in many more people besides just patients and hospital personnel to be present on a unit.

When Scott became an ICU nurse 27 years ago, RNs had to buzz visitors in. Today, she said, there is minimal security and few rules about who and when someone can be on the unit.

Hospitals will never admit it, but they actually need and want patients’ families and friends to stay and do the work – helping patients to the toilet, feeding them, refilling their water – that was once performed by paid staff they’ve now eliminated.

As the industry has continued to commodify healthcare as a “product” and pushed the concept of patients and their families as “customers,” hospitals have further relaxed visitor policies for family members who, understandably, would like unrestricted access to be with their loved ones. Some nurses reported that they felt visitor policies were geared more toward encouraging higher scores on patient satisfaction surveys, rather than facilitating care. Sadly, payments to hospitals today are tied to patient satisfaction scores and reward the patient’s perception of care instead of the reality of care they receive. “The hospital cares more about patient and family satisfaction because it impacts their bottom line,” said Scott.

The two drivers are, in fact, interrelated. Instead of spending money on increased hospital staffing and services, which would naturally improve actual patient care, outcomes, and satisfaction, the hospitals have a calculated strategy to shift the burden, cost, and responsibility for care onto unpaid family members. If relatives and friends were not available to step in to fill that void, that would surely lead to greater suffering and upset by patients. Hence the current situation where many more people are on the unit, introducing potentially violent variables into the work equation.

Scott understands the calming effect friends and family can have on patients and always encourages them to ask questions and advocate for the best care for their loved ones. But she noted that RNs sometimes have to perform job duties or procedures where, even under the most ideal circumstances, it would be best if visitors were not present. For example, when an RN asks a post-operative patient to turn and cough, the patient will likely feel pain – something that worried relatives don’t understand and could further upset them. “Families will be angry at us, yelling at us,” said Gwynn Pepin, an RN at St. John’s Hospital in Maplewood, Minn., where a brutal Nov. 2, 2014 attack by a patient stunned the country. “There are times we don’t even think about it as verbal harassment, and we just try to deal with it, to do our best.”

Even living on the edge of violence, via verbal threats, can take its toll. A recent study by the Manitoba Nurses Union, on the prevalence of PTSD among nurses, revealed that nurses who did not sustain any injuries, but just “anticipated some sort of violence at work, reported higher levels of stress than nurses with minor injuries.”

And when an RN’s best isn’t enough to deescalate visitors, with hospital policies barring nurses from controlling which “customers” are on their unit, the threat of violence looms.


* * * * *


This attack had no prelude. Through security camera footage, you can see nurses calmly working and charting at their nurses’ station; one RN even had her hands relaxed and folded behind her head. Seconds later, around 2 a.m., RNs at St. John’s Hospital in Maplewood, Minn. were blindsided when 68-year-old patient Charles Logan rushed into the med-surg station, wielding a metal bar he had stripped from his bed, and began striking nurses.

Surveillance video of the assault exploded across both mainstream and social media. Reports focused on the shocking footage and subsequent injuries to four nurses (including a collapsed lung and a fractured wrist), and also on Logan’s apprehension by police, several blocks from the hospital, where he collapsed while resisting arrest and ultimately died.

What’s not obvious in the video, according to Pepin, is that even in the midst of panic, there was also strategy. The pattern of movement, on the part of RNs, purposely led Logan away from other patients. RNs also pressed a panic button that notified a trained team of respondents, including hospital security. In the aftermath, RNs were provided with workers’ comp and ongoing counseling, all as part of the facility’s workplace violence plan, dubbed “Code Green.”

Every hospital must have a plan, say NNU nurses, not only for how to prevent workplace violence but how to handle any incidents that arise on any unit and the subsequent trauma.

Any workplace violence prevention training RNs have received has traditionally focused on ER nurses in emergency and psychiatric departments, since they were often dealing with patients in crisis. However, Higgins points out that these units cannot be the only areas of the hospital prepared for violence. All units, she said, in all communities, also need access to a plan.

“You don’t know where violence is going to show up,” she emphasizes. “It has spread through all areas of the hospital. You can never assume just because RNs are in a certain area of the hospital or in a sleepy community, that they’re safe. We should always make sure we have training in place — everywhere.”

Public health nurse Laarni San Juan, RN, of California’s San Mateo County takes the call for training a step further, advocating for plans extending beyond the hospital walls, into the community.

“Public health nurses go out and visit the most vulnerable and marginalized patients, the most unlikely to have health insurance,” said San Juan. “We are aware of the inherent risk, but that’s why we chose this work: to help those who are vulnerable.”

In her 17 years with the county, San Juan has been in homes with evidence of abuse, had a drug dealer jump in her car, and navigated a number of situations where her facility’s basic guidelines, such as “lock your car door” or “trust your gut,” did not feel sufficient.

“I cannot even recall the last training we’ve had,” San Juan said. “It’s one thing to have a general guideline, but what’s missing is: If I were to get into a situation where law enforcement was involved and I needed medical attention, I don’t know what the protocols are. There’s nothing in place. It’s scary to think an [institution] that employs nurses who are at most risk, going in their cars into the community, does not have that in place.” 

Jon Tollefson, who handles governmental affairs for the Minnesota Nurses Association, explained that an upcoming Minnesota bill seeks to guarantee hospital staff is fully trained for violent scenarios.

“Not just training for RNs in ER or psych,” Tollefson said, “but for all healthcare workers employed or contracted. We have some hospitals where they have a contractor, and who knows what kind of training they get? They have to get the same as in-house staff.”

RNs want change. Last year, before moving to Florida, Holder lobbied for passage of California’s Healthcare Workplace Violence Prevention Act. She was encouraged to do so by her friend Nicole van Stijgeren, an ER nurse at San Mateo Medical Center, in San Mateo, Calif., who also participated.

“I asked her to go because I thought it would be cathartic. She was a powerful speaker; she had such a powerful personal story,” said van Stijgeren, who was “devastated” to witness the impact of workplace violence on Holder. In fact, while van Stijgeren had encountered violence in her own career, it was seeing her friend in so much physical and emotional pain that motivated van Stijgeren to take collective action through her union.

“This turned me into an activist for the violence that I was seeing and experiencing myself. It really made me want to speak out,” said van Stijgeren. And she is not alone in her activism; nurses across the country are increasingly rallying, lobbying, and saying they have had enough of hospital workplace violence. The unions of National Nurses United are providing nurses an avenue by which to fight to protect workers and communities.

“Maureen’s experience gave me a voice and [so did] meeting my CNA rep, who is an activist,” said van Stijgeren. “It inspired me to fight to better protect nurses.”

In a system where violence is both normalized and on the rise, Holder’s story and others like it are fueling a movement to ensure that no more RNs will feel that their lives and careers are considered expendable before the hospital industry is held accountable for change.

Nurses sound a CODE BLUE in D.C. on Fast Track and TPP

Watch the Press Conference

With the White House and some of the biggest multinational corporations lobbying Congress to “fast track” the Trans-Pacific Partnership, a massive trade deal between the United States and 11 other countries, National Nurses United today converged on the nation’s capital to explain that what’s good for investors’ balance sheets is not necessarily good for patients.

“Nurses are patient advocates—and by extension advocates of our patients’ families and our communities—and we are here to sound a Code Blue on fast track,” said RN Deborah Burger, a member of the NNU’s Council of Presidents. “While there are many good reasons to reject fast track, the nation’s registered nurses are particularly concerned about these trade agreements’ threats to public health and safety.”

She points to pharmaceutical corporations that would be given years more of monopoly pricing practices on patents for high-priced, brand-name drugs to block distribution of competitive, cheaper, lifesaving generic medications. “That is especially critical for people suffering from cancer, HIV/AIDS, hepatitis, and other illnesses in developing countries as well as in the United States,” she said.

Burger was one of dozens of nurses to attend a press conference today with Rep. Rosa DeLauro (D-Connecticut) urging lawmakers to reject fast track legislation for the TPP. Described by former U.S. Labor Secretary Robert Reich as “NAFTA on steroids,” the TPP is largely being negotiated in secret. The Obama administration and Republican lawmakers want Congress to approve fast-track authority, which would require Congress to ratify the treaty but relinquish its Constitutional authority to amend the trade pact in any way.

That cannot happen.

“We say no to any provision in any trade deal that threatens to raise the price of drugs in the name of profits for big pharma. The middle class simply cannot afford it,” DeLauro said.

RN and NNU Co-president Jean Ross says this all does not bode well. And while the public has no access to the negotiations between U.S. trade officials, business executives, and their foreign counterparts, leaked documents and NAFTA provide us a glimpse of what the future might look like under the TPP.

“So no matter what the will of the people in any particular locale, state and nation, these trade agreements can supercede statutes that protect the people’s health and safety. Currently, for example, Lone Pine Resources, Inc., a Calgary-based oil and gas company, is suing the province of Quebec under NAFTA because the provincial government has imposed a moratorium on fracking,” Ross said.

Lone Pine Resources claimed the Quebec government was infringing on its profits and that either that law must be overturned or the people of Quebec must pay compensation to the corporation.

“Will the state of New York, which recently also banned fracking, be forced to compensate oil and gas companies because the state government stood up to protect the drinking water of New Yorkers?” she asked.

Similarly under NAFTA, Canada was forced to lift a ban on a gasoline additive called MTBE banned in the United States as a suspected carcinogen, after a corporate challenge. MTBE is associated with human neuro-toxicological effects, such as dizziness, nausea and headaches and found to be an animal carcinogen with the potential to cause human cancer.

Moreover, said Beverly Van Buren, a St. Louis RN, the TPP “would effectively outsource domestic food inspection to other countries.”

“The TPP would require us to allow food imports if the exporting country claims that its health and safety laws are ‘equivalent’ to our own, even if they violate the key principles of our food safety laws,” said Van Buren.

That’s problematic, she said, because U.S. food safety regulations currently need to be strengthened, not weakened.

“The U.S. Food and Drug Administration currently checks just 2 percent of imports for contaminants (including drug residues, microbes and heavy metals), according to one study, compared to 20 to 50 percent in Europe, 18 percent in Japan and up to 15 percent in Canada,” Van Buren said. “And when the FDA does inspect seafood imports, it looks for residues from only 13 drugs. In contrast, Europe tests for 34 drugs. That means overseas fish farms can be using a range of drugs for which the U.S. doesn’t even screen.”

Several TPP signatory countries are significant seafood exporters and some have had serious problems with contamination.

DeLauro joined the nurses in exhorting lawmakers to reject fast track, and also offered a personal note of thanks to NNU and nurses across the nation.

“I could not have survived ovarian cancer without great nurses 30 years ago. . . the nurses who could look in my face and tell if it was a good day or if it was a bad day,” she said.

The True Price of Gas in Torrance

RNs join USW refinery workers on picket line in Martinez, Calif.

A plume of smoke blanketed the city of Torrance Wednesday, Feb. 18 after the ExxonMobil refinery explosion jolted local residents. It shook homes and schools, ripped through the city like an earthquake, injured workers, and rained ash that covered sidewalks with black soot. When nurses arrived to see the damage, the toxic air caused them nausea and choking that persisted through the day. Local authorities issued “shelter in place” warnings and asked nearby schools to stay indoors due to the health risks to children.

United Steel Workers oil workers saw this coming. They have been on strike for over twenty days at eleven refineries across the country, including the nearby Tesoro oil refinery in Carson, CA. They have been warning of the dangerous working conditions from being short-staffed and overworked. In a statement that USW released, USW International President Leo W. Gerard noted, “While employers have reaped billions of dollars in profits over the past several years, they have done little to improve conditions for workers and surrounding communities.” According to the LA Times, which quoted Cal/OSHA records, the refinery has had over $100,000 in penalties for equipment and safety violations over five years of continuous inspections.

Maria Vazquez being interviewed by NBC reporter in front of the site where the blast occurred

Long Beach nurses treated four workers injured from the refinery blast later that morning, but luckily those worker’s injuries were minor. Unfortunately the adverse health effects on workers and surrounding communities breathing in these fumes are still to come. “Days later I can still smell the fumes,” said a concerned Maria Vazquez, an RN at Providence Little Company of Mary Medical Center Torrance. “I imagine we are going to get an increase in patients admitted this weekend from those who can no longer avoid being outdoors.”

“As nurses, we are very concerned about the health and safety of our community. Its members are our patients,” continued Vazquez. “We see respiratory, cardio-vascular issues brought by these refineries on a daily basis.” Chemicals produced by refineries are linked to cancers, reproductive issues, and lung and heart health. These gases are also linked to global warming.

The refinery in Torrance produces 155,000 barrels of crude oil a day and communities have been paying too high a price in lost health. This is the second explosion already this year, following one in Lima, Ohio. “We cannot afford preventable explosions,” said Vazquez. “Nurses are demanding better safety and health standards for the workers. There’s an alternative to our dependence on oil and gas. Green technology, green jobs should be the way to go.”

Trade Deals Should Come With Their Own Warnings for Public Health

 Second in a series

Last September, the small West African nation Togo launched a public health campaign about the hazards of smoking. First they put warning labels in three languages on cigarette packages. Since Togo is one of the poorest countries in the world with a high illiteracy rate, they then added graphic images, such as smokers’ diseased lungs, similar to a model used by Australia.

That’s when the roof fell in. As the brilliant comic John Oliver chronicled on his HBO show “Last Week Tonight” February 15, the government of Togo received a letter from Phillip Morris International (PMI), which owns seven of the top 15 best selling cigarette brands, threatening “an incalculable amount of international trade litigation.”

Noting that Phillip Morris’ $80 billion in annual revenues dwarfs Togo’s gross domestic product of $4.3 billion, Oliver explained that Togo, “justifiably terrified by the threat of billion dollar settlements, backed down from a public health law that many people wanted.”

Togo was not alone. PMI and other tobacco giants also cited global trade pacts to overturn packaging laws for tobacco in Australia (which ultimately won a court fight with PMI), Uruguay, Namibia and the Solomon Islands. “That’s right,” intoned Oliver, “a company was able to sue a country over a public health measure through an international court.”

Thus the problem with so many of the international trade deals signed at the behest of transnational corporations the past three decades. National sovereignty is overridden by the inexorable push for higher corporate profits, with public health frequently a first target.

President Obama and leaders of Congress are presently pushing the next set of trade deals, including the Trans-Pacific Partnership, and seeking fast track authority that would bar critics of the handouts to corporate interests from amending the deals and even limiting debate.

If there’s one sign of whose ox is likely to be gored, just note that much of the language was written by Wall Street lobbyists and that corporate executives have had an advance look at the language of the proposed deals that are still being kept secret from not only the public but even many members of Congress.

But based on past experience – and what leaks have emerged – it is evident that the deals pose a significant threat to public health, consumer protections, and the environment. As well as to the democratic rights of any nation’s people to enact laws that will not be overturned by legal action or multi-billion dollar bullying by corporations that, like Phillip Morris, are wealthier than many nations.

The TPP, for example, would grant much greater leverage to block access to lower priced life saving medications, as chronicled in the first part of this series.

Public Citizen has warned that the TPP would require the U.S. to allow food imports that fail to meet U.S. safety guidelines, and that any food safety rules on use of pesticides, additives, or labeling requirements could be challenged as a barrier to trade.

Another proposed trade agreement, the Trans Atlantic Trade and Investment Partnership, would provide further license for healthcare corporations to undermine national health systems.

Yet a third trade deal in the works, the equally secretive Trade in Services Agreement, would promote privatization of health services.

According to a leaked document analyzed by Public Services International, the TISA negotiators are salivating over a “huge untapped potential for the globalization of healthcare services” mainly because “health care services (are) funded and provided by state or welfare organizations and (with) virtually no interest for foreign competitors due to lack of market-orientated scope for activity.”

In addition to providing the legal recourse for corporations to use international courts to overturn national or local laws they don’t like, all three of the current draft agreements contain an “investor-state dispute settlements” provision, which establishes separate “corporate courts” to adjudicate complaints, because of supposed infringement on their marketing.

NAFTA, the North American Free Trade Agreement (NAFTA), has provided many examples of the land mines for the public interest.

Citing NAFTA, drug giant Eli Lilly sued the Canadian government after Canadian courts invalidated the company’s monopoly patents and a group of private investors led by an Arizona entrepreneur challenged Canadian restrictions on for-profit surgery centers.

In another prominent case, Lone Pine Resources, a big oil and gas company is suing the Canadian province Quebec, under the rules of NAFTA, over a moratorium on the environmentally dangerous process of hydraulic fracturing or fracking.  

Stewart Trew of the Council of Canadians in Ottawa has warned of more lawsuits if the TPP and similar trade deals are approved as they are likely to include investor protection provisions similar to NAFTA’s.

Enloe Medical Center RN’s Vote Strongly in Favor of New Contract

Registered Nurses at Enloe Medical Center
Vote Overwhelmingly to Ratify New Pact 

CHICO—Registered nurses at Enloe Medical Center in Chico have overwhelmingly approved a new three year contract covering 860 RNs affiliated with the California Nurses Association.
RNs welcome the new agreement which provides more time for nurses to address patient care concerns, as well as economic gains that promote the retention of experienced nurses.

At a time some hospitals are demanding reductions in nurses’ workplace and economic standards and patient care protections, the new contract retains the protections Enloe RNs have won over a number of years.
“The new contract is fair and reasonable and this supports the retention of experienced nurses, which in turn promotes the standard of high quality patient care held at Enloe,” said Pamela Stowe, RN, a 13-veteran at the hospital. 

Contract highlights include:

  • More paid time for Professional Performance Committee to address patient care issues. This committee of nurses meets with management to advocate for patients, such as safe staffing and other patient care issues.​
  • Improved wages. A 1.5 percent bonus for all RNs upon ratification of the agreement, additional across the board increases of 3.75 percent over the next two years, and additional increases for the most long term RNs and those who work night shifts which nurses say will help the hospital retain experienced nurses for Chico area residents.
  • New successor protections. In the event of an ownership change, contract provisions will stay intact, ensuring RN retention and continuity of care to the community.

​The agreement runs through January, 2018. 

The Same Fight

The same fight

Nurses support the United Steelworkers on their strike lines

Members of the United Steelworkers union on strike from their jobs at the Tesoro Golden Eagle Refinery in Martinez, Calif. got a major boost today from registered nurses around the Bay Area who joined their picket line to show support and share stories about why it’s critical for workers to have a say in their work in order to protect the health and safety of themselves and their communities.

“Nurses are here today because so many of the conditions the steelworkers are facing are the same the nurses are facing,” said Katy Roemer, an RN at Kaiser Permanente Oakland Medical Center. “They need the ability to shut down production when they identify health and safety risks.”

The refinery workers reported that they are often forced to work mandatory overtime; required to work consecutive days for weeks without a day off; constantly asked to speed up the throughput of the refinery while at the same time pushed to cut corners; and ignored by management when they put in requests for equipment to be repaired or maintained.

Nope! Steelworkers and Nurses turn back oil trucks.

When the refinery has accidents and gas flares, toxic substances and particulates are often released into the air. Pamela Luiz, an RN who works in the emergency room at Kaiser Antioch and also lives in Antioch, has resided downwind of the Golden Eagle refinery for 20 years. She said that asthmas rates in her community are alarming and every time there’s a refinery release, the nurses observe many more people flooding the ER. She’s constantly worried for her granddaughter, who lives with her and suffers from asthma.

“Before, you’d see more asthma cases with the spring and fall weather changes,” said Luiz. “Now it’s gotten to the point where it’s year round.”

Steelworker Rafael Zabat works on the “alki unit,” a nickname for the “alkylation plant,” where workers operate sophisticated equipment that takes waste gases from the refining process and, using sulphuric acid as a catalyst, converts them into a liquid that is used to blend high-octane gasoline. It’s a complicated process that requires many different chemicals and materials to be held in balance and strict attention to various pressures, levels, and temperatures in order to run within safe parameters.

Rafael Zabat says his company was reluctant to maintain equipment because of lost productivity.

Zabat and his coworkers said that, for years, company has been pushing the operators who control the “board” (kind of the master dashboard of all the equipment readings) to run much higher rates of throughput than the operators believed the system could handle. Sulphuric acid is also expensive, so at the same time, the company had been pushing workers to cut the amount of acid that they were using. Both practices are much harder and more corrosive on the equipment, and workers had over the years submitted multiple requests to management for the pipes to be fixed, cleaned, and maintained. But the company, reluctant to shut down the unit because any stoppage means loss of profits, either fixed equipment very slowly or not at all.

On Feb. 12, 2014, Zabat and another alki operator were putting a piece of equipment into service and checking how much sulphuric acid was still in the system. As they opened a valve, a pipe ruptured about five feet from where they were standing and sprayed both of their entire bodies with sulphuric acid. They immediately rushed to a safety shower and rinsed off as much as they could. They had been wearing personal protective equipment, but the outfit was designed more for flash fires, not chemical spills. “My face was burning,” remembered Zabat. “It got in my mouth, on my lips, face, ears, neck.”

Carson Steelworkers and Nurses picket Tesoro

The two were airlifted by helicopter to UC Davis Medical Center, where they were told they were lucky to have escaped with second-degree chemical burns. All the skin on Zabat’s face bubbled and blistered up; he had scars for another six to eight months. He spent six months off work recuperating, during which the company dismissed his burns as “minor injuries” and pushed him to return to work earlier than he was ready. At one point during his recovery, before various providers had his workers compensation policy number, he received a $42,000 bill for the airlift from the helicopter company. His family was traumatized by the entire incident, and he himself had to go through some counseling before he could go back to his position.

Zabat still works on the alki unit; he would be reluctant to transfer to another area because he is as close to his coworkers as family. He said that the company appeared to shape up after he was burned, but now has fallen into their old habits of deferring maintenance. “It would be nice to see them have a proactive approach to safety instead of a reactive approach,” said Zabat. “So this strike is for the safety of the workers and the communities around us.” — Lucia Hwang

Big Pharma and the Rush to the Latest Dangerous Trade Pact: Part 1 of 2

(First of two parts)


To get a glimpse of how corporate-oriented trade deals, such as the currently proposed Trans-Pacific Partnership, threaten both the public interest and national sovereignty, take a look at an innovative green energy initiative in Ontario, Canada.

In the years following the 2008 global economic crash, Ontario moved forward on a climate action plan billed the “most comprehensive renewable energy policy” in the world. It would provide premium rates for renewable energy for businesses, local governments, and first nations, and a lot of local jobs with a requirement that a minimum percentage of the labor force and materials be local to Ontario.

In “This Changes Everything,” her book on the climate crisis, Naomi Klein tells what happened next. Citing World Trade Organization rules, the European Union charged that the buy local provisions would discriminate against non-Ontario businesses. The WTO ruled the local laws were illegal, and the project, the improved local economy and contribution to climate action, were scuttled.

Skip ahead to the Trans-Pacific Partnership and the push to “fast track” the deal – meaning Congress could only vote the pact up or down, not amend it.

While final terms of the deal, being pushed by the Obama administration, many in Congress, the Chamber of Commerce, Wall Street, and other transnational corporations, remain a closely guarded secret, the history of similar trade deals provides ample reason for alarm. That’s probably why the deals remain secret to most legislators and the public, though its corporate backers apparently have an open book to the negotiations and its provisions.

From what information has been disclosed, it seems apparent that the TPP poses a significant threat to health, consumer safety regulations, and democracy – in each case subordinating a broad range of public protections, as well as local and even national laws to be overturned if they are ruled to interfere with corporate profits.

The gift to global pharmaceutical corporations may be the poster child for what is at stake with the TPP.


More profits for the drug giants, less access to lower cost medications 

In a January 30 commentary in the New York Times, Joseph Stiglitz, a Nobel economics laureate and leading critic of inequality, warned that the TPP would likely lead to less access to lower cost generic drugs, producing even greater profits for the already wealthy pharmaceutical industry. 

Equally problematic is the drug giants’ “second stategy,” wrote Stiglitz, “to undermine government regulation of drug prices.” Many nations, especially those with single payer or national health systems, make medications more accessible by negotiating bulk pricing agreements that mitigate the price gouging by the drug companies. 

Such bulk pricing power has been repeatedly blocked in the U.S. thanks to massive lobbying by the pharmaceutical industry and their many compliant legislators in Congress and states. But that is not enough for the profit-hungry drug giants. The result has been drug prices in the U.S. that are at times twice as expensive as in other countries with such prohibitively priced medications such as Gildead Science’s notorious $1,000 a pill hepatitis C drug Sovaldi.

Now the trade representative of the U.S., is pushing for the TPP to allow drug companies the right to overturn restrictions on the price gouging by other countries.

As the international relief agency Doctors Without Borders/Medicins Sans Frontieres (MSF) puts it, rules “proposed by U.S. negotiations” would “enhance patent and data protections for pharmaceutical companies, dismantle public health safeguards enshrined in international law, and obstruct price-lowering generic competition for medicines.”

MSF is especially alarmed about the impact on developing countries which already struggle to make affordable medications available to their people.

As Stiglitz concluded, passage of the TPP with this provision in particular, may result in “worse health and unnecessary death.”

Don’t think this latest present to big pharma will be easy to block, as symbolized by a Washington Post editorial February 4 defending the TPP and its concessions to the pharmaceutical industry.

“Medical innovation,” the Post contends “costs money – billions of dollars sometimes” and “drug prices must be high enough to encourage risk-taking.”

It’s a deceptive argument, at best.

Much of that vaunted research for innovation –55 percent alone for the five top selling drugs according to a National Institutes of Health internal document exposed by Public Citizen in 2001 – is actually funded by U.S. taxpayers.

And, U.S. drug companies hardly need any more help. In 2013 alone, the 25 wealthiest drug firms racked up more than $100 billion in profits while wildly inflating drug prices, all with the help of a compliant U.S. government that now wants to help them overturn protective laws in other countries.

The outrageous gift to the drug giants is by itself reason enough to oppose both the TPP and the “fast track” process to speed its passage. But there are plenty of other reasons as well. More in Part 2.

Chuck Idelson, Director of Communications for National Nurses United