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Hard Facts? Whose Facts?

Once again John Grula has published yet another attack (“Hard Facts” – against Huntington Memorial Hospital (HMH), and argues that somehow a nursing union (in this case the California Nurses Association – CNA) is the panacea for all the ills that he lays at the doors of HMH. His source for his damning accusations of poor quality of care is the September 2013 issue of Consumer Reports article – “Your safer-surgery survival guide.” which in his article he cites as “the gold standard when it comes to providing trustworthy evaluations of consumer products and services.” Such reports might serve you well for a dishwasher, vacuum cleaner, car and so on, but maybe not so much for a hospital. Perhaps he and others may believe that Consumer Reports is the “gold standard”, but this nurse and health care professional prefers to rely on reports from sources such as the Joint Commission – and the Centers for Medicare and Medicaid Services (CMS) –, State and County Department of Health Services ratings when it comes to accessing the overall “quality” of a hospital.

I also had a good laugh at his reference to the recent Leapfrog scores where HMH received a grade of “C”. He made a great deal out of HMH’s C-grade while extolling Kaiser (a unionized hospital chain), but fails to point out that UCLA Medical Center (a unionized hospital) also received a “C” from Leapfrog. Grula also goes on to rave about how of the four hospitals designated by the CDC to provide care for Ebola patients were all in Northern California – oh and unionized. However, Grula should be well aware that in all likelihood these hospitals were selected more for meeting specific qualities and criteria that the CDC setup more than anything else. But then again Grula’s facts seem somewhat weak on this issue, because in his article he makes the following claim “A hospital really has to have its act together to be designated an Ebola treatment center by the CDC, and in the case of California, the four hospitals that achieved this mark of excellence are all in the northern part of the state.   Those four hospitals are:  Kaiser Oakland Medical Center, Kaiser South Sacramento Medical Center, the UC Davis Medical Center and the UC San Francisco Medical Center. No hospital in Southern California, including HMH, made the grade with the CDC.” However, a quick glance at this CDC page –, and you’ll see all 55 hospitals with Ebola treatment centers including the four Southern California area hospitals overlooked by Grula that hold this designation. I guess Grula and the Pasadena Weekly editors need to be more thorough with their fact checking – but perhaps the facts don’t matter for Grula and the Pasadena Weekly when it comes to their campaign to denigrate HMH. And for the curious among you this CDC link details the process for being designated an Ebola treatment center –

Grula, even went so far as to pull a quote from one of my blog posts “Myth of the Magnet Hospital”, but was unable to even correctly spell my name or include my credentials, where I state that I believe the Magnet designation is a dubious one. I stand by this statement primarily because unlike receiving Joint Commission accreditation that can be pulled by the Joint Commission. A “Magnet” hospital rarely if ever stands to loose its Magnet designation when their nursing staff truly fails. A Magnet hospital might not be able to renew their status, but to my knowledge UC Davis (it has since regained its Magnet designation) is the only Magnet hospital to lose its Magnet status ironically due to all the nursing conflict created by their nursing union. No other Magnet hospital has had it Magnet designation, not even Cedars lost their Magnet designation when their NICU nurses nearly killed several infants due to heparin overdosing due to nurses failing to read the vial and to follow the procedure to double-check the medication. So my philosophy is that the Magnet designation can serve a purpose to help distinguish excellence in nursing, but only if the organization behind that designation is willing to remove or place a hospital in a probationary status when the nursing team makes an egregious error. Just as the Joint Commission will come back to re-inspect a hospital when problems arise and if necessary remove their seal of approval until corrections are made, so too should the ANCC for the Magnet designation.

Grula is so enamored with Leapfrog and his conclusion that unionized hospitals provide the best of care he still hasn’t explained why Antelope Valley (a CNA-represented hospital) was the only hospital in LA County to receive a F from Leapfrog. Could he be engaging in the practice of ignoring information that might unfavorably skew his results? Just asking?

It would appear his love for Kaiser knows no bounds, because as he extolls Kaiser’s virtues he fails to acknowledge the recent 28 million, that’s right 28 million, dollar judgment against Kaiser for their failure to promptly MRI a patient, costing that patient the loss of her leg, and fines imposed against Kaiser for their failure to provide appropriate mental health services to their patients, this is the second year where they still have deficiencies and not made all the corrections required. This is a common willful blindness problem on the part of the rabid pro-union advocates. They pick apart organizations and individuals that they perceive as opposing their unions and views at the expense of some obvious truths. Many years ago the CNA tried to get the California legislature to pass a card-check law for nurses. If passed this law would simply require a union gather enough qualified signatures from nurses at a particular hospital and that hospital’s nursing staff would automatically be represented by a union, no election, no opportunity to present any other side of the discussion. I attended one of the hearings in Sacramento where unionized nurses presented their tale of woe to the committee. They argued that without a nursing union nurses couldn’t stand up to hospital administrators and appropriately advocate for the patient. Their tales were vivid and pulled at your heartstrings they even invoked the example of a Tenet hospital in Redding, CA that was accused, at that time, of excessive cardiac surgery. Their claim was simple, if only those nurses had been in a union they would’ve felt safe to speak up; the only problem with their argument was that it was the nurses, the non-union nurses that blew the whistle on this practice. As I listened to their rationale, I wondered where were all the union nurses blowing the whistle on the IVF scandal at UC Irvine so many years ago? And because I had my ducks in a row and all the evidence, I like to think it was this last minute effort by a handful of nurses and myself that helped get the bill pulled by its sponsor and it eventually died. If there’s one-thing legislators don’t like, its being lied to and made a fool.

And while we’re at it if unions are so great for nurses why are the CNA and another nursing union, UNAC/AFSCME embroiled in a fight at Kaiser – Los Angeles Medical Center to hold an election so the nurses can leave UNAC for the CNA. Ironically, the CNA has also accused UNAC and Kaiser of engaging in practices that are blocking the nurses from this vote. Here’s a copy of an Open Letter to UNAC members_Sigs2 sent to UNAC members sent by CNA-supporting nurses regarding this very matter. In their letter they plead that people should call “UNAC at 800-762-5874 and tell them to withdraw all blocking charges, charges that are preventing your nurse colleagues at LAMC from a fair and democratic election that will finally allow us to choose our union”. Sounds familiar doesn’t it, I guess “evil” hospitals aren’t the only ones that seem to cause the CNA problems, unionized nurses cause the CNA problems as well – how ironic!

So Grula I call your September 2013 issue of Consumer Reports article and raise you my 2014- 2015 US News & World Report Best Regional Hospitals (

In Grula’s opinion piece “Huntington Hospital is Ill” that ran in the November 6, 2014 edition of the Pasadena Weekly, he attempted to paint Huntington Hospital as some kind of sub-par hospital and it’s administration (calling out its CEO Steve Ralphs) as somehow cruel and uncaring of their nursing staff – all this, in my opinion, at the beck and call of the California Nurses Association (CNA).

Why? You may ask, because the CNA has been trying unsuccessfully, to date, to unionize the 1,100 RN workforce that ply their craft at Huntington Hospital. As expected, the CNA was up to its usual shenanigans, they held a rally where they claimed hundreds of supporters attended lining the length of Pasadena Avenue, when in reality somewhere about 80 – 100 people showed up, of which only a handful were actual Huntington RNs. Their theme for the rally, “restore quality patient care”.  As a RN and Pasadena resident it really irked me that the pro-CNA nurses at Huntington would allow the CNA to spread such a despicable message, because to restore something implies that something, in this case quality patient care, is missing which isn’t the case with Huntington Hospital. However, the CNA isn’t one to let the facts get in their way and neither it appears is Grula or the editors at the Pasadena Weekly.

I make this bold statement, because in Grula’s piece he tries to convince his readers that somehow it makes sense to allow the Huntington nurses to unionize because 60% of California nurses already belong to unions. He bases these numbers on two statistics both provided by, you guessed it, the CNA. The first statistic he provides is that there are 200,000 RNs in California and that 120,000 are in unions. So when you use these figures its easy to see how one might conclude that about 60% of all California RNs are in unions, but there’s one small problem. What, pray tell, might that be? All it takes is a quick telephone call to the California Board of Registered Nursing (BRN) to learn that there are currently 398,134 actively licensed California RNs with another 16,025 holding an inactive license for a total of 414,159 California RNs. It’s that quick and easy. Not sure you can look it up on line at or for the most up to date figures you can call the BRN at (916) 574-7699. So with more accurate figures the 60% of all nurses belonging to unions becomes more like 30% with the majority of California nurses (about 70%) choosing to remain union-free.

Gurla also tried to make a point of Huntington’s CEO Ralphs’ salary, but failed to note how much money the CNA will make yearly off the backs of the RNs in the way of dues if they are successful in unionizing the Huntington RN workforce. Think the number one followed by six zeroes and then some. His entire piece supports solely the goal of the CNA and the Huntington RNs that support the CNA, but fails to mention that the greatest opposition comes from within the very Huntington RN family – from members who don’t want the union to represent them as they feel they don’t need an additional layer between them and management. Of course, if Grula even mentioned that opposition was coming from Huntington nurses, themselves, then the CNA’s and his argument that it’s the “evil” management that’s fighting the CNA — falls to pieces and blows the “we’re poor weak nurses who can’t speak for ourselves so we need the CNA to fight our battles for us” theory out of the water.

So when Grula’s piece was published, wrong statistics and all, I submitted a letter to the editor to both correct the erroneous statistics and to provide my two cents on what’s happening at Huntington, which is that the CNA is facing resistance, not from hospital management but from the very nurses they are attempting to organize. Some of the nurses who didn’t want a union reached out to me and asked for advice and guidance, which I was happy to give them. Something the CNA hates, because they like to portray themselves as the protector of the hard working nurse who is somehow so downtrodden by management that they can’t stand on their on two feet. So when the very nurses they want to represent, fight them and spurn the CNA overtures, the leadership of the CNA becomes practically apoplectic.

After emailing my letter to the editor I followed it up with a phone call to the editor, Kevin, and had a nice chat with him and received a promise that he’d run my letter in the November 20th edition. So when November 20th rolled around I picked a copy of the Pasadena Weekly and found that my letter to the editor hadn’t been printed as promised. I called Kevin and imagine my surprise when he informed me that he gave my letter to Grula so he could “respond”. Why? Because somehow the statistics I provided from the BRN were an “opinion”, or as he so quaintly put it “my contention”. I’d say that the Pasadena Weekly editorial staff has egg on its face for failing to fact check Grula’s stats and now their trying to find a way to save face and to dig themselves out of this fiasco of Grula’s and their making.

So, I say to the Pasadena Weekly do the math, show some journalistic integrity, make the correction, print the letter, and let your readers know that it isn’t the management resisting the CNA, but many of the Huntington nurses themselves.

You can read Grula’s “hit piece” on Huntington Hospital here

Adventures in Patient Land

My latest column is out —

What Makes a Great Nurse?

There’s more to nursing than experience alone

By Genevieve M. Clavreul, RN, Ph.D.

In recent years, there’s been a lot of talk in the nursing world about education: advanced degrees, certifications and training in the latest technologies. However, this nurse has long believed that all the certifications and degrees in the world are no substitute for good basic nursing skills, including attention to detail, listening and, most important of all, a deep and abiding compassion for all the patients under your care.

I recently received a dramatic reminder of this point when my eldest daughter Patricia was unexpectedly hospitalized. Her experience left me simultaneously impressed and frightened about the state of nursing in the Golden State. (Before I begin this tale, I should note that Patricia has given her consent to my sharing her story with my readers, but I’ve redacted the names and certain details to protect the innocent — and the guilty.)

Unexpected Surgery

Patricia’s hospital “adventure” began with an emergency trip to her primary care physician. Patricia had seen the doctor earlier in the week about a persistent rash and swelling in her feet. Blood tests revealed that her hemoglobin count had dropped to 8.0; since 12.0 to 15.5 is considered the normal range for women, such low levels were serious enough to merit immediate hospitalization.

After Patricia was admitted, her hemoglobin count continued to fall even after she received several full pints of blood. A CAT scan eventually revealed a large abscess that had displaced her right kidney from its normal position to the front of her abdomen. As if this weren’t bad news enough, the scan showed that the kidney was basically a shriveled mass and no longer functioning.

To make a long and painful story short, Patricia underwent a six-hour surgery to remove the abscess and the nonfunctional kidney, after which she was intubated for several days. She also ended up in isolation after a nasal swab came back positive for MRSA. As of this writing, she’s still in the hospital, but her white blood cell count is back to normal, most of the tubes have been removed and she is once again allowed solid food. She’s looking forward to going home.

The whole spectrum


The quality of nursing care my daughter received throughout this ordeal ranged from superb to truly lousy. Here are just a few examples from both ends of the spectrum:

Good: One of the day nurses was consistently attentive and thoughtful, making a point of always speaking to Patricia each and every time he needed to perform any action that affected her, from taking her blood sugar (like me, Patricia is diabetic) to more invasive procedures like checking her two No. 19 BLAKE drains. It was a small gesture that made a big difference.

Extraordinary: When Patricia received her diagnosis and was told that her kidney needed to be removed, she was understandably overwhelmed and began to cry and fret. One of the nurses, aware of the situation, disappeared down the hallway for a moment and returned with a harpist who offered to play several songs for Patricia to help her relax.

Bad: After Patricia was moved from the ICU to a regular room, the nurse who received her made it clear that she considered Patricia a burden. When my daughter complained of feeling warm and flushed after starting a new, more powerful antibiotic, the nurse could barely find the time to answer a call light and refused to take my daughter’s temperature again until asked to do so by the charge nurse. Appallingly enough, the recalcitrant nurse was mentoring a student nurse at the time. So much for modeling good nursing practice!

Worse: Since Patricia has very fragile veins, her doctors decided she needed a peripherally inserted central catheter (PICC) line to continue her antibiotics. The nurse who was sent to insert the PICC line insisted that I leave the room during the procedure because she needed a sterile field, but seemed oblivious to the gnats flitting about her so-called “sterile field.”
To my dismay, she then proceeded to pick up items that had fallen on the floor and put them back on the top of her cart without cleaning them first. I finally ordered her out of the room and requested a different PICC nurse.

Some of the nurses were very nice, but seemed worryingly inept. For instance, when I asked one young nursing graduate what dosage of morphine she was about to give Patricia, the nurse had to leave the room and reread the order before she could answer — hardly a reassuring sign. So much for making sure you’re giving the patient the right meds!

Some of the nurses shaped up noticeably after they learned I was an RN myself and thus was keeping an extra-sharp eye on them. It was good to know they were paying attention, but it suggested that they had grown a little slack and lazy when they didn’t think they were being “graded.”

Even the best nurses on the hospital’s staff had their off moments. One RN, an excellent nurse by most standards, had the bad habit of picking up the trash can lid each time he disposed of something and then continuing with his patient care. This didn’t make him a bad nurse, but it was a bad habit that could have negative consequences for patients.

What really counts

It struck me during Patricia’s hospitalization that there wasn’t an obvious correlation between the nurses’ levels of experience and the quality of care they provided. There were seasoned nurses who acted like they were going through the motions and veterans who still behaved as if each patient was as unique and important as the first patients they cared for when they begun their careers 20 years ago. There were new nurses who seemed out of their depth, but some of the finest nurses we encountered had only been RNs for a few years.

There were also patient care assistants (PCA) who provided care as good as or better than the RNs they supported. One PCA was so attentive and conscientious that I was heartened to learn she had just received her RN license that night. It gave me hope for the future of nursing.

What made the difference was not so much each nurse’s experience or level of training, but his or her personal commitment to patients and determination to practice to the best of his or her ability. Simply put, some of the nurses cared for my daughter as if she were their own loved one and others did not. Speaking as both a nurse and as a worried mother, it wasn’t hard to tell the difference and it had a meaningful impact on my daughter’s experience.

upholding the principles

I know there’s no such thing as a perfect hospital and even the best healthcare professionals make mistakes or have bad days — we’re only human, after all. I also don’t wish to downplay the importance of education and the judgment that comes with experience. However, it’s important for us to remember that education and experience are not a panacea. Teachers and mentors can tell us over and over again about the importance of compassion and patient advocacy, but it’s up to us to uphold those principles at every stage of our careers.

We must never forget that we often see patients at their most vulnerable and those patients’ families and friends are counting on us to help restore their loved one to health. Our profession demands that we challenge ourselves to always provide the best care we can and not allow ourselves to compromise patient outcomes with bad habits or a poor attitude. When that happens, it tarnishes us all.