Monthly Archives: March 2015
Inviting Patients To Help Decide Their Own Treatment
SAN FRANCISCO — Rose Gutierrez has a big decision to make.
Gutierrez, who was diagnosed with breast cancer last spring, had surgery and 10 weeks of chemotherapy. But the cancer is still there. Now Dr. Jasmine Wong, a surgeon at UC San Francisco, is explaining the choices – Gutierrez can either have another lumpectomy followed by radiation, or she can get a total mastectomy.
“I think both options are reasonable,” Wong said. “It’s just a matter of how you feel personally about preserving your breast, how you feel about having radiation therapy.”
“I’m kind of scared about that,” said Gutierrez, 52, sitting on an exam table with her daughter on a chair beside her.
“Well if you made it through chemo, radiation is going to be a lot easier,” Wong told Gutierrez, who is from Merced, Calif.
In many hospitals and clinics around the country, oncologists and surgeons simply tell cancer patients what treatments they should have, or at least give them strong recommendations. But here, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care.
It might seem like common sense: Each patient has different priorities and preferences; what’s right for one patient may be wrong for another. Of course patients should weigh in. But many aren’t accustomed to speaking up. Even the most engaged or educated patients may defer to their doctors because they are scared, they don’t want to be seen as difficult or they think the doctor knows best.
For their part, not all doctors want to cede control to patients who have far less medical knowledge or who may be relying on information they got from friends and the Internet. Also, many physicians don’t have the time for long discussions and the health care system isn’t set up to pay for them.
Even so, hospitals and clinics in several other states, including Massachusetts, Minnesota and Washington, have created collaborative programs to ensure that information and concerns flow back and forth between patient and doctor. UCSF’s approach, in particular, has been a model for other programs around the nation.
The concept of shared decision making has been around for years, but it is gaining new traction with the nation’s health law, which specifically encourages its use.
“Patients and families need to be in the driver’s seat with their doctors, making decisions that are the right choice for them for their unique circumstances,” said UCSF associate professor Jeff Belkora, who runs the shared decision-making program also known as the Patient Support Corps.
That way, he said, patients avoid “a rocky, bumpy ride” of either too much or too little treatment.
At UC San Francisco, patients receive DVDs, pamphlets or links approved by the physicians that explain available options for treatment. During appointments, the doctors not only explain carefully the benefits and the risks of those options but also ask about patients’ priorities and goals.
Patients are paired with college students or recent graduates who help them make a list of questions for the doctor beforehand. These young people also record the visit and type notes for the patients, who then leave with a definitive account of what was said.
That’s important because patients are nervous and emotional after a cancer diagnosis and often freeze up, said premed student Edward Wang. Wang said his presence helps put them at ease. “You’re just making a question list and you’re just taking notes,” he said. “But these simple things really do matter to the patient and to the doctor as well.”
Shared decision making has been used for patients with breast and prostate cancer, heart disease, back pain and other conditions for which there are multiple treatment options that offer similar results.
“It’s a massive cultural change,” said Glyn Elwyn, who researches shared decision making at The Dartmouth Institute for Health Policy and Clinical Practice. “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”
Elwyn and other researchers have found that patients are more satisfied with their care when they have a say in it. Also, it may save money. Some research shows that patients who are involved in their treatment decisions are more likely to be conservative, opting against costly procedures or surgeries.
That doesn’t mean the decisions are easy – even for knowledgeable patients.
Ilene Katz, a UCSF nurse who often works with cancer patients, was recently diagnosed with breast cancer and became a patient herself.
At first, she wanted a mastectomy. “My knee jerk reaction, which probably a lot of women have … is there is cancer in my body, cut it out, cut all of it out,” she said.
But on this February day, she came out of the exam room feeling different. A long conversation with the surgeon and the oncologist helped her decide that, for her, there was no real benefit to having a mastectomy over a lumpectomy.
Katz said she was relieved someone was there taking notes so she could go over it later. “I don’t remember everything,” Katz said, her eyes red from crying. “It’s all a black cloud.”
Katz’s doctor, Laura Esserman, said some patients want her to make choices for them. But Esserman, head of the UCSF breast care center, sees herself more as a coach, often asking questions to make sure patients don’t act out of fear or lack of knowledge: What’s the most important thing to you? How do you feel about your body image? What complications are you worried about?
Typically, Esserman said, she tells patients, “I need to know more about your thought process … and how you are going to feel a year from now.”
Candace Walls, 41, appreciates having some control over her care. Diagnosed with cancer six years ago in Stockton, Walls said the doctor recommended a mastectomy and then did the surgery.
“I didn’t have lots to choose from,” Walls said. “It was just kind of like, ‘This is what I think you should do.’”
Since coming to UCSF a year ago, however, she has been very involved with her decisions about breast reconstruction, even asking the doctor to redo part of the surgery when she didn’t like how it turned out. At a February appointment, Dr. Wong answered her questions one by one. “It is a very good feeling to know you can say what you want to your doctor,” Walls said afterward.
That same day, Gutierrez, the patient from Merced, sat nervously in Wong’s exam room as the doctor explained more about her surgery choices.
“With the partial mastectomy we just need to take a little bit more tissue out … and then we would have to do radiation,” Wong said, as a note taker sat typing quickly. “With the [total] mastectomy, you probably wouldn’t need radiation but obviously it’s a bigger operation.”
Gutierrez said that as a single woman in her 50s, she wasn’t too concerned about keeping her breast. But she was worried about how her body would react to radiation. Most important, she wanted to be sure doctors got rid of the cancer.
“I have 12 grandbabies,” she said. “I want to be here for them.”
Still, Gutierrez told the doctors she was leaning toward the lumpectomy, saying she felt nervous about the pain. “I’m a big sissy,” she said.
“No, you are doing great,” Wong said. She encouraged Gutierrez to take the time she needed to talk over the choices with her family and to call if she needed to talk more. “I don’t want you to feel like you are pressured to make a decision.”
A few days later, Gutierrez decided on a mastectomy, mostly to avoid the radiation and the worry about cancer’s return. She had surgery in early March.
Reached by telephone the next day, Gutierrez said she felt good about her decision – and how she made it with her doctors. “It makes us seem like we are a team,” she said.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
FAQ: Could Congress Be Ready To Fix Medicare Pay For Doctors?
With a deadline fast approaching, bipartisan negotiations are heating up in the House to find a permanent replacement for Medicare’s physician payment formula. But the tentative package being hammered out behind closed doors contains some key provisions that are likely to raise objections from both Republicans and Democrats.
Unless Congress takes action by the end of this month, doctors who treat Medicare patients will see a 21 percent payment cut.
For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by the 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times.
The current proposal for a permanent fix may not include full financing for repealing the payment formula, according to congressional aides and industry lobbyists who have been briefed on the talks but spoke on the condition of not being named because of the sensitivity of the discussions. That provision could run into concerns from many Republicans and some Democrats.
In addition, Senate Democrats are leery of another provision reportedly part of the negotiations – charging wealthier Medicare beneficiaries more for their coverage, according to top Senate aides who briefed reporters Sunday. They also noted that although Democrats are eager to attach to a deal an unrelated measure to extend the Children’s Health Insurance Program, they would like it to cover four years, not the two years that the House is reportedly considering.
Still, they said, with some changes in the package, Senate Democrats might be able to support the developing House package.
“Our members would like to get there,” one of the aides said.
Here are some answers to frequently asked questions about the congressional ritual known as the doc fix.
Q: How did this become an issue?
Today’s problem is a result of efforts years ago to control federal spending – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth, known as the “sustainable growth rate” (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors were furious when they came in for a 4.8 percent pay cut. Every year since, Congress has staved off the scheduled cuts. But each deferral just increased the size of the fix needed the next time.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress, says the SGR is “fundamentally flawed” and has called for its repeal. The SGR provides “no incentive for providers to restrain volume,” the agency said.
Q. Why don’t lawmakers simply eliminate the formula?
Money is the biggest problem. An earlier bipartisan, bicameral SGR overhaul plan produced jointly by three key congressional committees would cost $175 billion over the next decade, according to the Congressional Budget Office. While that’s far less than previous estimates for an SGR repeal, it is difficult to find consensus on how to finance a fix.
For physicians, the prospect of facing big payment cuts is a source of mounting frustration. Some say the uncertainty has led them to quit the program, while others are threatening to do so. Still, defections have not been significant to date, according to MedPAC.
In a March 2014 report, the panel stated that beneficiaries’ access to physician services is “stable and similar to (or better than) access among privately insured individuals ages 50 to 64.” Those findings could change, however, if the full force of SGR cuts were ever implemented.
Q: What are the options that Congress is looking at?
A: The bipartisan negotiations among key House leadership and staff from committees with jurisdiction over the SGR have been behind closed doors, and the offices of both House Speaker John Boehner, D-Ohio, and House Minority Leader Nancy Pelosi, D-Calif., declined to comment on the negotiations. But some details are emerging.
Late Friday, the bipartisan leadership of the House Ways and Means and Energy and Commerce committees – the two House panels with jurisdiction over the SGR – said in a statement that “we are now engaging in active discussions on a bipartisan basis – following up on the work done by leadership – to try to achieve an effective permanent resolution to the SGR problem, strengthen Medicare for our seniors, and extend the popular Children’s Health Insurance Program.”
Last year’s proposal from the House Energy and Commerce and Ways and Means committees and the Senate Finance Committee is reportedly the basis of the current SGR talks, according to the lobbyists and aides, in part because it enjoyed bipartisan support and would encourage better care coordination and chronic care management, ideas that experts have said are needed in the Medicare program.
That proposal would have scrapped the SGR and given doctors an 0.5 percent bump for each of the next five years as Medicare transitions to a payment system designed to reward physicians based on the quality of care provided, rather than the quantity of procedures performed, as the current payment formula does.
Tacking on a package of other health measures – known as extenders – that Congress renews each year during the SGR debate would push the cost even higher. They include additional funding for therapy services, ambulance services and rural hospitals, as well as continuing a program that allows low-income people to keep their Medicaid coverage as they transition into employment and earn more money.
As part of the proposal, the House members are also talking about adding two years of funding for the Children’s Health Insurance Program, a federal-state program that provides insurance for low-income children whose families earned too much money to qualify for Medicaid, according to the lobbyists. While the health law continues CHIP authorization through 2019, funding for the program has not been extended beyond the end of September.
The length of the extension could cause strains with Senate Democrats. Last month, the Senate Democratic caucus signed on to legislation from Sen. Sherrod Brown, D-Ohio, calling for a four-year extension of the current CHIP program, according to senior Senate Democratic aides. Democrats want that CHIP language in the SGR deal because “this may be the only health care vehicle moving,” said one of the Senate aides.
Just two years of additional CHIP funding is non-starter for Democrats. “We need to make sure that Children’s Health Insurance Program is on a sustainable path,” the aide said.
Q: How would Congress pay for all of that?
A: It might not. That would be a major departure from the GOP’s mantra that all legislation must be financed. Tired of the yearly SGR battle, veteran members in both chambers may be willing to repeal the SGR on the basis that it’s a budget gimmick – the cuts are never made – and therefore financing is unnecessary.
But that strategy could run into stiff opposition from Republican lawmakers and some Democrats. Most lawmakers are expected to feel the need to find financing for the Medicare extenders, the CHIP extension and any increase in physician payments over the current pay schedule. Those items would account for about $60 billion of financing in an approximately $200 billion package.
Conservative groups are urging Republicans to fully pay for any SGR repeal.
“Americans didn’t hand Republicans a historic House majority to engage in more deficit spending and budget gimmickry,” Dan Holler, communications director for Heritage Action for America, said in a statement. “Any deal that offsets a fraction of the cost, like the one currently being discussed behind closed doors and leaked to the press, is a non-starter for conservatives.”
But physicians and other analysts make the point that Congress has already paid out billions on temporary patches that don’t fix the problem.
“Congress has spent a staggering $170 billion on 17 patches in a 12-year period, the cost of which has far exceeded the cost of eliminating the SGR altogether,” American Medical Association President Robert M. Wah wrote last month. “This continuous cycle of putting a Band-Aid on the real problem, creates an unpredictable environment that makes it difficult for physicians to budget and plan for practice innovations that could improve quality and reduce costs.”
Q. Will seniors and Medicare providers have to help pay for the plan?
According to the lobbyists and aides, the potential financing options being looked at by House negotiators include charging wealthier Medicare beneficiaries – who already pay a higher premium – even more and introducing a surcharge on the popular “first-dollar” supplemental Medicare insurance known as “Medigap.” Experts contend that the “first-dollar” plans, which cover nearly all deductibles and co-payments, keep beneficiaries from being judicious when making medical decisions. The change could convince them to reduce opt against treatment they don’t need, thus saving Medicare money. President Barack Obama’s fiscal 2016 budget plan includes similar provisions.
Congress could also extend the automatic 2 percent Medicare cuts in place as part of budget sequestration, but those cuts would face stiff opposition from Medicare providers and the groups they serve.
Senate aides said Democrats there are likely to take issue with the provisions to reduce reimbursements to Medicare providers and to require seniors to pay more.
Medicare beneficiaries already pay 25 percent of all Part B costs (physician services are included in Medicare Part B), so an increase in Medicare reimbursements to physicians would increase what seniors in the traditional Medicare program pay for premiums, deductibles and co-insurance, according to an analysis from the Kaiser Family Foundation. According to the report, half of all people on Medicare live on incomes of about $23,500 or less, and seniors spend three times more than younger households on health care as a share of their household budgets. (KHN is an editorially independent program of the foundation.)
Asking seniors to pay more for their Medicare in exchange for higher Medicare payments to physicians “doesn’t seem like a very fair thing to do for seniors,” a senior Senate Democratic aide said. Using payment cuts to other Medicare providers, like hospitals, may be problematic as well because such steps “always sort of generate opposition and heartburn for both sides of the aisle,” the aide said.
Q. How quickly could Congress act?
Legislation to repeal the SGR could move in the House as early as the week of March 16, the lobbyists said.
The Senate Democratic aides said that they expected Democrats and Republicans in that chamber will want to offer amendments to the emerging House package, making it extremely difficult to pass any overhaul before the Senate’s two-week break scheduled to begin starting March 30.
If the SGR issue can’t be resolved by March 31, expect Congress to pass a temporary patch as negotiations continue.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
Standing On Our Own Shoulders
“Change does not roll in on the wheels of inevitability, but comes through continuous struggle.” – Dr. Martin Luther King, Jr.
“We believe that it is going to be the nurses, the RNs, who will lead the change in healthcare.” – Kay McVay, RN, President Emeritus, California Nurses Association
Year 15 of the new millennium opened with a most momentous achievement for registered nurses and patients – a precedent-setting agreement in the largest RN contract in the nation, for 18,000 Kaiser Permanente RNs and NPs that will likely raise the bar for nurses from coast to coast.
The new pact could not have been realized without the unified determination of Kaiser nurses, with the broad support of other RNs and our unparalleled organization, to defend the role of nurses and their professional expertise as patient advocates.
Their unity and devotion to assuring the highest level of quality care for patients as well as protections for the nurses who deliver that care produced a historic agreement that will result in hundreds of additional RNs providing care for patients, not just in the clinics and home, but in the hospitals as well with a significant impact on the quality of care.
It means an agreement that features landmark new security for nurses on the job, with supplemental insurance, for RNs exposed to workplace violence, deadly infectious diseases such as Ebola, and needle-stick injuries. And it includes a significant, well-earned, pay increase, stricter limits on travelers, and maintenance of the critical pension plan for nurses to look forward to be able to retire with dignity and in health.
Yet, the new pact cannot be understood just in the months of rallies, marches, and struggles by Kaiser RNs. It is also a reminder of the traditions and efforts of Kaiser RNs like Kay McVay and CNA over many years, and a historical memory lodged in the offices of Kaiser and other hospital executives as well as our nurses.
“If you want to understand today, you have to search yesterday,” wrote Pearl Buck, or, in the words of Oscar Wilde, “Memory is the diary we all carry about with us.”
Kaiser RNs have long been in the forefront of standing up for their patients and themselves, setting a benchmark that others have followed.
To understand the victory of Kaiser nurses today, a good place to start is the 14-month fight with a more entrenched Kaiser management of the 1990s that sought to push through multiple contract reduction demands and refused to respond to RN concerns about patient care standards.
The Kaiser RNs well understood that their response would rebound through other hospitals. As Kaiser RN Zenei Cortez, now a CNA-co-president, noted later, “We needed to fight not only for all the Kaiser nurses, but for all the RNs in the United States.”
And fight they did, with six short-term, unified, strikes, with a vision that the nurses and their organization would not allow the role of the registered nurse to be compromised.
Throughout the battle, nurses had to withstand a unified healthcare industry, their union partners who signed the infamous labor-management partnership on the day of the first strike, and an often-hostile press.
But we had a significant ally, as Kaiser RN, now CNA and NNU co-president Deborah Burger noted afterward. “The strikes galvanized not only the nurses, but the public and the patients. Each time we came back, there was even more support.”
Through that long fight, Kaiser and the hospital industry as a whole learned a valuable lesson. The Kaiser RNs, and the leadership and staff of the organization, would not break.
It ended with a stellar attainment, as the New York Times noted in a national article headlined, “Nurses Get New Role in Patient Protection. Pact with Biggest H.M.O. Allows Care Givers to Guard Standards.”
A key component was the establishment of an unprecedented provision in which Kaiser agreed to the establishment of 18 quality liaisons, selected by the nurses themselves, to meet with management to address and resolve patient care concerns, as well as protection of the RNs’ contract standards achieved over years of effort.
As Robert Kuttner wrote in the Boston Globe at the time, “Unions do best, not just as self-interested workers with their hands out but as a broader social conscience on behalf of vulnerable people. Indeed, if labor fails to play this role, it is just another interest group, and it loses public support.”
That is the legacy that is a foundation of our latest achievement with Kaiser and our continued success in fighting for all nurses, patients, and the public interest. It is a legacy, and model, our organization will never forget.
Find Hiking and Biking Trails Near Your Travel Nurse Assignment
Find hiking and biking trails near your Travel Nurse assignment and make the most of spring!
So you just landed in a wonderful new location and spring is about to be SPRUNG.
Whether you’re a serious hiker or biker, or you’re just out for a casual stroll, you want to get outdoors and take advantage of the natural beauty surrounding your latest Travel Nursing location. But as someone who’s unfamiliar with the area, it can be challenging to know where to find the best locales and opportunities that fall in line with your specific preferences.
With that in mind, here are a few resources that will help you find hiking and biking trails near your Travel Nurse assignment:
In my opinion, this is one of the best resources for Travelers looking to find hiking and biking trails near them. All Trails’ website has great search functions that let you narrow in on exactly what you want to find. It breaks trails down into hiking, biking, and running, and also includes helpful user photos and reviews as well as info on how pet friendly a particular trail is. This site also offers the 411 on local networking events, which is perfect for Travel Nurses looking to find new friends through organized events! You can also keep a Trail Journal here, which lets you save trails you’ve completed and the trails you hope to do in the future.
This is a great guide to national trails, with a state by state breakdown. American Trails also provides other helpful regional links and information related to outdoors activities of all kinds by state and area. The site also boasts an outdoors advocacy bent and is full of resources on trail design and guidelines, to help pave (or un-pave?) the way for future trails and greenways.
Are you traveling with your furry best friend? Bring Fido is a great resource for finding pet-friendly trails near your assignment. This site also helps you find pet friendly accommodations, travel options, events, restaurants, and more, as well as a handy guide to pet services wherever in the world you are.
I hope these resources will help you find hiking and biking trails near your Travel Nurse assignment. Happy spring to all!
Ask a Travel Nurse: How picky can I be when choosing a Travel Nursing assignment?
Ask a Travel Nurse: How picky can I be when choosing a Travel Nursing assignment?
Ask a Travel Nurse Question:
Hi David, I kind of have two questions. First, I’ve been told that when looking for a Travel Nurse assignment, you should go through a couple different agencies. True or false?
Well, I did that, and just accepted an exciting job in Washington. When I told my other recruiter that I got a job, she wasn’t too happy with me. And when she was working with me she seemed to want me to take the first hospital that called me for an interview. So, my second question is how picky can I be when choosing a Travel Nursing assignment? Don’t I have the right to go through a couple agencies and find the best job? I’m not sure if the recruiter I was working with is really good or just really pushy and wants to land a contract for her company. Plus, she wanted to me to go to Yuma, Arizona for my first assignment, which I haven’t heard the best things about. What do you think? Thanks!
Ask a Travel Nurse Answer:
Using multiple agencies? True, this is the best practice. I’m not sure I know of any seasoned travelers who do not use more than one agency. I hit two decades of travel this year and I am on file with about six or seven agencies to meet my needs.
Additionally, my recruiters know that I use multiple agencies. I have even had one recruiter tell me that she would honestly go with another company for an upcoming assignment. This was due to the fact that her company could not match the stipend ($400/month more) that another company was offering on the exact same assignment (same location, same hospital, even same unit!!).
However, this type of dialog is only possible when you have great recruiters that know that even if you do not take an assignment with them today, you may very well take one with them in the future.
All recruiters want to put you to work and even mine have pushed a time or two when exploring assignment options. The difference is, when I stated my position clearly, they acquiesced and didn’t get mad, didn’t pout, and often played it off with an “Alright, I understand” in a dejected, but pleasant tone.
You are in charge and as I have written many times before, it is not so much the company that you work for that is the integral part of a good travel experience, but rather, the Travel Nurse recruiter with whom you are working.
Plus, at this time of year, if your recruiter can’t get you to Phoenix (a much nicer assignment location than Yuma), then that agency may not have all the assignment options you should have available.
I keep toying with the notion of consulting and putting together a one day education program for the travel companies where I go to their offices and teach their recruiters what they should know about travel … from a Travel Nurse’s perspective!! Every time I receive an email like yours, I truly see there is a need for it. J
I hope this helps and answers all your questions.
David
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.
Proposal protects healthcare workers from workplace violence
MNA members testify in favor of a proposal by Sen. Chuck Wiger to reduce workplace violence against healthcare workers on March 11
By Mathew Keller, RN JD, MNA Nurse Policy Specialist
As a result of the assault against staff at St. John’s Hospital last November, the hospital removed bedside poles that could be used as weapons. While this action may prevent future violence, it’s too late to help the nurses who were attacked that day.
Meanwhile, there’s a bill in the Minnesota Legislature that could lead to better prevention and preparation for healthcare workers caught with a violent patient. HF 1087 and SF 1071 are bipartisan bills aimed at preventing violence against health care workers, require that hospitals:
- Develop preparedness and incident response action plans in collaboration with health care workers;
- Provide adequate security staff;
- Allow healthcare workers to request additional staff due to concerns over possible violence;
- Provide training to all health care workers on safety guidelines, the incident response plan, how to properly de-escalate situations and request additional staff, and the worker’s rights regarding acts of violence.
In addition, HF 1087/SF 1071 prohibit hospitals from interfering with a healthcare worker’s right to contact law enforcement or the Minnesota Department of Health regarding an act of violence, and establishes an electronic violence prevention database, which will allow the state to track trends in violence against healthcare workers at a hospital level.
The violence against healthcare workers bill could go a long way toward preventing potentially violent or abusive situations we have all experienced as bedside nurses. Furthermore, it will prohibit hospitals from preventing or discouraging nurses from reporting abuse from patients or visitors, which we know is a common problem.
Unfortunately, the Minnesota Hospital Association would rather enact harsher punishments on perpetrators of such violence rather than prevent the violence in the first place.
MHA claims that nurses can already report safety lapses to the Office of Health Facilities Complaints, but this argument displays little understanding of how healthcare workers can interact with state agencies. Both MDH and its commissioner tell MNA that OHFC investigates only complaints against facilities that are violating current law; when a patient assaults a worker, the facility has not violated current law, and therefore a complaint against the facility would fall outside the jurisdiction of OHFC.
The hospital association also claims that the violence prevention bill is a ploy to enable nurses to report safety issues to the Minnesota Department of Health; but as MHA itself stated in a letter dated August 13, 2014, to MNA President Linda Hamilton, they view nurses as statutorily obligated to report unsafe staffing to the Department of Health and state that “allowing hospitals, the Board of Nursing, or the Office of Health Facility Complaints to actually address any legitimate concerns” is of paramount importance. Thus, on one hand MHA views the violence prevention bill as a ploy to enable nurse reporting to MDH, but on the other hand views such reporting as mandatory and of paramount importance.
MHA needs to take a hard look in the mirror and accept some responsibility for a flawed system, which does little to nothing to prevent violence in the healthcare setting, ignores nurses who ask for resources to help prevent a brewing problem from exploding, and discourages nurses from reporting violent or abusive situations to the relevant authorities. Instead of punishing sick and delusional patients even more for their abhorrent actions, let’s prevent them in the first place. Let’s remove the pole before it is used as a weapon.
Call for Public Comment on Draft Nursing: Scope and Standards of Practice, Third Edition
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.