The Nurse Unchained
One nurse’s unabashed opinion on all things nursing.

Nurses throughout California either have already received or will be receiving a flyer from the C.N.A. that, in this RN’s opinion, as usual has more misstatements and lies than truth.  Today, I received a copy of their flyer “Why is CEO Meg Whitman at War with California Nurses?”  Of course, in true C.N.A. style this statement is more fiction than truth, since Whitman is not at war with California nurses, but the C.N.A., which represents less than 80,000 of California’s nearly 400,000 RNs threw the first punch and is peeved because Whitman refuses to kowtow to them.  Instead she’s chosen to engage all of California’s RNs in an open and free manner letting the RN decide for herself/himself.

Which brings me to the other misrepresentations and lies that the leadership of C.N.A., has decided to hurl at me, simply because I refuse to allow the C.N.A. to speak for me and because I make it clear at every opportunity that the C.N.A. can only speak for their members and not for every nurse in California.  So in return the leadership of C.N.A. placed my picture on their recent attack piece.  Of course this vile practice is commonplace when it comes to the leadership of C.N.A., but their false statements will not silence me, and as I’ve done before I will address their attack piece with the facts.

First, they state that I’m Whitman’s “Nurse Advisor”, handpicked by Whitman.  Well this is news to me, since though I’ve been happy to answer questions from members of the Whitman team as well as make suggestions this is something I’m happy to do for any person, candidate, politician, nurse, citizen, etc.  Based on the leadership of the C.N.A.’s logic this would make me Senator Dianne Feinstein’s “nurse advisor” as well since I often meet with her staff or her when I travel to DC to participate in our wonderful democracy.

Second, yes I’m a former Director of Nursing, as I’m a former nurse educator, head nurse and more importantly a former NICU/PICU nurse.  But of course the leadership of the C.N.A. loves to stir the pot and prefers to diminish my qualifications as a bedside nurse because as we all know management is inherently evil – I wonder if Deborah Burger and her co-presidents of the C.N.A./N.N.U. know that they are also members of this elite group, since they are after all part of management as is Rose Ann DeMoro.

Third, I never endorsed Schwarzenegger’s bid to “rollback” the ratio law since he never asked the ratio law to be rolled back, simple to delay the implementation of phase two.  What I advocated, which was the same message the Schwarzenegger attempted to communicate, was that California should hold off implementing the Phase II of the ratio until we had studied the impact of Phase I.  Considering that we had one side claiming gloom and doom because of the ratio and the other side claiming that all of nursing ills had somehow been cured because of the ratio I thought it made sense to see what the studies bore out.  And as we were to learn most of the studies have shown mixed results, and don’t even get me started on Aiken’s apples vs. oranges study that was published claiming that if only New Jersey and New York had the same ratio law a percentage of patients would have survived.  I wonder why she didn’t simply compare a set of California hospitals pre and post ratio law?  I think those results would have been much more interesting and a better indicator on the impact of the law.

Fourth, I never campaigned against nurses, just because the leadership of the C.N.A. didn’t like the fact that there were nurses that didn’t cleave to their party line doesn’t mean we campaigned against nurses.  It simply means we were exercising our constitutional guaranteed rights, just as the C.N.A.

Fifth, worked as a consultant for the hospital industry on restructuring and downsizing, yes and I also worked with the hospital industry on such things as developing acuity systems, recruitment and retention of nurses and other hospital/nursing issues.  Restructuring and downsizing aren’t always bad things, if restructuring allows the nursing department and its team to become better managers so that they are more responsive and supportive of the nursing team –this is a good thing, and I would hardly call downsizing the registry pool to zero and replacing those slots with all permanent staff nurses a bad thing since every hospital’s goal should be to have little to no reliance of registry/travel nurses.

Sixth, not sure why the C.N.A. thinks I’ve travelled around the U.S. fighting RN ratios because I haven’t, I ‘ve exercised my right of freedom of speech to write letters to the editor when the issue of nurse/patient ratios have come up.  Of course when I’ve been physically up to travelling to DC I’m sure I’ve shared with my elected officials my opinions on the cookie-cutter ratio versus the acuity system.

However, the biggest misstatement/lie of the leadership of the C.N.A. comes near the end of their presentation.  They present the following, labeling it “in her own words”.  “Forced overtime is one way for hospitals to work around staffing shortfalls”. – Working Nurse magazine, Feb. 5, 2007.  What they fail to do, which is yet another example of how the leadership of the C.N.A. chooses to spread it misinformation and lies about those they see as threats to their mission, is to provide to the reader/recipient the whole sentence, let alone the whole quote from my Feb. 5, 2007 column entitled “Mandatory Overtime?” (the whole article can be found at http://www.solutionsoutsidethebox.net/2007-From-the-Floor-Archive.php).  The actual and whole quote is as follows “Forced overtime is one way for hospitals to work around shortfalls, which probably happens all too often.  The constant use of overtime may be symptomatic of substandard management.  An extremely capable Chief Nursing Officer (CNO), Director of Nursing (DON), and even charge nurse does not need to rely upon a continuous use of overtime because where there is good and solid nursing management, you’ll find happy nurses, and as a rule, a complete nursing staff.  Therefore, there will be less reliance on registry and overtime to compensate for the staffing shortfalls.” Of course providing the sentence in its entirety or the full quote wouldn’t have served the leadership of the C.N.A.’s purpose, which was of course to paint me as some kind of hospital’s hatchet woman, but as those who know me can attest I’m no man’s (woman’s) hatchet person – which is why I think the C.N.A. leadership fears me as they do.

And finally my letter to the editor to the Boston Globe which I wrote in response to an editorial by Suzanne Gordon (which can be found here http://www.solutionsoutsidethebox.net/Nursing.php).  In my letter, which the Globe titled “California’s experience raises questions”, I shared my first hand experience and concerns about California’s nurse/patient ratio law.  I did so because as a NICU/PICU nurse I never treated my patients with cookie-cutter nursing care and I don’t believe that the nurse/patient ratio law’s cookie-cutter approach is in the best interest of our patients or of the nursing team.  Many RNs and I support the acuity system, which allows the nursing team to assess the patient, the illness, its severity and complexity of treatment and then match that with a nurse’s skill sets.  I prefer this because I firmly believe that as nurses we treat patients not numbers.

Of course its my personal belief that the main reason the leadership of the C.N.A. attacked Whitman, even before she received the Republican nomination was because they had already decided to support Jerry Brown and the fight for the Governor’s office would go much easier if Brown had to face Steve Poizner, so they pulled out all the stops to help defeat Whitman in the primary – but things didn’t go their way and so like petulant children they’ve decided to throw mud and vile accusations at nurses who dare support Whitman.  But I won’t support Brown because I haven’t forgotten Project Iatrogenesis also known as SB 666.  For my readers who may not remember, or don’t know what SB 666 entailed (attached is some background).  But to make a long story short, Project Iatrogenesis which was a key component of SB 666 and the brainchild of then Gov. Brown and carried by then State Senator Watson, would’ve allowed for a nurses aides to accumulate a number of hours at the bedside and with no additional educational requirements take a test and if passed become a LVN, a LVN could accumulate a number of hours at the bedside and with no additional educational requirements take a test and if passed become a RN, and so forth following this same path a RN could even become a physician.  The leadership of the C.N.A. may have forgotten about this little episode under then Governor Brown, but this RN hasn’t.

The leadership of the C.N.A. appears happy to provide its nursing membership, the media and public at large with information that at best are twisted to fit a message, ask yourself this if this nursing organization is willing to provide false and misleading information to the public in order to advance its cause, what stops one of its RN members from doing the same to a patient’s medical record or during report?  There’s a French proverb “qui vole un œuf vole un bœuf”, loosely translated it means, “if one can steal and egg, one can steal a cow”.

SB 666

They’re at it again, those prevaricating leaders of the ANA, misrepresenting their membership numbers and of course the media that seems more concerned with regurgitating a press release then actually fact checking what the ANA spoon feeds them and then writing their own story instead they are complicit in perpetuating the ANA’s lie.  If not for the media aiding and abetting the ANA in their fabrication, the ANA would have long ago stopped their prevaricating ways (or at least some of them) and not pretend that they represent the interest of nurses that aren’t even members of their organization.

President Obama (a man, I think, that’s never met a misstatement that he hasn’t liked) stands before the American people and tells us that his “plan” for health care reform which is not even his own (the plan actually belongs to Congress and in particular the Democratic-controlled Congress) has the backing of the nurses, as if all 2.9 million of us have held a convention and come to an agreement on his “vision” and we’re unanimous about our support of his “plan” when we are far from an agreement on his or any other plan being floated out there.  What he means to say is that the ANA, a nursing organization that reportedly represents somewhere between 180,000 to 190,000 thousand RNs out of the almost 3 million RNs that are active in this country, is behind him when the reality is that just a little over 15% (and that’s assuming that all of the ANA’s members agree) of America’s RNs are behind him and his efforts when he refers to the support of the nurses and the ANA.

All the while they’re in their white lab coats and scrubs in neat little lines behind the President using the illusion of the organization’s large membership to provide him with credibility, just like the American Medical Association right before their membership blew the lid off of their charade of being the voice of the American doctor; and yet few have questioned the validity of the ANA’s claim of representing the interest of 2.9 million RNs.  What’s truly ironic is that a membership of nearly 200,000 is a respectable number by nearly any standard, especially for nurses who can be as hard as herding cats when it comes to getting them to join a group.  But no the nursing leadership of the ANA can’t help themselves and they have to pretend that they represent all of “nursingdom”, and I know I’m not the only one who’s grown tired of their lies and misrepresentations.

In their latest press release they have the gall to open their press release citing the statistic that nurses, once again, are ranked as one of our nation’s most trusted professions, and yet they think nothing of misrepresenting the facts when it comes to their membership and it’s a slippery slope because as the saying goes little lie, big lie.  The ANA doesn’t nor has it ever even come close to represent the interest of all of America’s RNs, they as a membership organization can only represent their members and unless you pay the ANA cold cash you’re not a member thus limiting their sphere of representation to those nurses who consent to be members of the ANA.  But the ANA like the AMA has long held an over inflated sense of self-worth and this has caused them to misrepresent their membership base just so they can have a seat at the table.  It’s time for the ANA to come clean and cite their actual membership numbers and leave the rest of the 2,710,000 of us alone because we didn’t appoint them our spokesperson or spokes organization.

I’ve got a pretty good track record in getting letters to the editor published – if I say so myself.  Every now and then I send a letter that I think is particularly important, especially when it is correcting misinformation, doesn’t seem to make the “cut”.  When this happens I sometimes decide to post it on my blog, and this is what I’ve done with a copy of the letter to the editor that I sent in response to an Pasadena Star News editorial piece they published on the nursing education and nursing shortage challenge.  Though overall the article made a valiant attempt to present solutions, I also found at least one glaring error and many of the same old-same old problems and solutions that the nursing talking heads have been nattering about for almost as long as I’ve been a registered nurse.  However, the Pasadena Star News paper letter to the editor person felt that my response was too long to print and after he suggested that I might want to consider editing it down and “tightening” it up I should resend it, which I did.  Alas, neither letter has been published to date.  So below you’ll find both versions of my letter to the editor the first is the original followed by the much revised and edited down version of the second submission.

September 22, 2008

As someone who has written extensively on the issue of the nursing shortage and an outspoken advocate for nursing I have called on a “Flexner-like” study of our nation’s nursing programs.  In the early 1900s our Nation’s medical schools and the very structure of medicine received an overhaul of sorts in the form of a nation-wide study that is often referred to as the Flexner-study.  This study provided a framework from which all medical schools now design their program around which has allowed for a maximization of available “seats” in medical schools, the facilitation of transfers within and outside school systems all the while maintaining a high level of quality.  I think nursing, too, could benefit from a similar review.  This does not necessarily mean that I think nursing should be forced to adopt the same study tool, but perhaps nursing could use a top to bottom review from a core group of experts that could then provide recommendations on everything from what the entry-level of nursing should be to how we should structure the complete nursing career ladder, to how to design our nursing programs to maximize the available and often limited seats and so forth.

October 3, 2008

Many external factors impact our nursing education pipeline, some of which you noted in your article.  However your editorial failed to address issues such as the low student to instructor ratio which is mandated (in some cases as low as 8:1) which often makes colleges and universities hesitant to launch, expand or maintain nursing programs.  Many of our nursing schools have a high attrition rate; contributing factors are due in great part to poorly prepared students specifically in areas of science, math and yes English-language skills.  Nursing programs are also plagued by a great deal of “individuality” which often makes transferring from one nursing program to another problematic.  Not to mention that the average nursing school educator can make more money as a staff nurse. These are just a few of the issues that place a strain on our nursing pipeline, and while these problems are partially addressed, all too often they’re being addressed piece-meal with very little county, state or nation-wide coordination.

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