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

Several days ago, Sherry Bebitch-Jeffe was quoted in an AP release.  Her quote was in reference to the ongoing push and pull between the Whitman Campaign and the California Nurses Association (C.N.A.).  She posited the following,  “While it’s common for Republican candidates to attack public employee unions, she said the public generally has goodwill toward nurses and does not equate their union with “big labor.” She went on to state “I would not have singled out the nurses association, even if they were making fun of me”.   Of course this is the same Bebitch-Jeffe that was adamant that the recall of Gray Davis would fail, so sure was she of her prediction that she made a bet with me that this would be the outcome and the loser would buy the winner dinner.  I’m still waiting on her to make good on her debt.

As a nurse I admire Whitman for defending her campaign and herself from the C.N.A.’s baseless attacks.  Unlike the C.N.A. nurses Whitman has been the professional while C.N.A. nurses have acted like spoiled children throwing tantrums.  The “march on the Whitman’s private home in Atherton” being the most recent tantrum.  I’m all for the freedom to demonstrate but we also need to respect certain social boundaries and one of these boundaries has been an individuals’ home.  Of course this seems to mean nothing to members of the C.N.A.  If they wanted to demonstrate they could’ve chosen the Whitman campaign headquarters or event; instead they chose to disrupt the serenity of an entire community, violating not only Whitman’s peace and tranquility but also that of all her neighbors in her Atherton community.  One would think nurses who take an oath to advocate for some of our communities most vulnerable and fragile members would at least respect some personal boundaries, but not the C.N.A. they have now joined the ranks of such disreputable groups as the Phelps/Westboro Baptist Church and if you don’t know who these folks are just head over to Wikipedia (http://en.wikipedia.org/wiki/Westboro_Baptist_Church).

I think Bebitch-Jeffe is dead wrong to think and publically state that Whitman should do nothing when groups try to bully her.  The C.N.A. threw the first salvo, long before Whitman was even the Republican candidate for Governor.  They did this not so much because of Whitman’s stance, but because their candidate of choice stands a very good chance of losing to Whitman in the General Election; which is why they tried to influence the Republican Primary in hopes that Poizner would win the nomination and failing that the C.N.A. has decided to pull out all the stops.  This strategy could very well back fire on the members of the C.N.A. because even though nurses are held in high regards by the public at large this is due mainly to the public’s vision that nurses behave in a more “ethical” behavior than many of us regular folks.  There are limits to what kind of “bad” behavior the public will tolerate even from nurses.  To date Whitman has appeared to have taken the high road, while the C.N.A. and many of its members have chosen to take the low road.

Nursing unions are quick to praise RNs when they vote to bring in a union and often characterize these nurses and their actions to join a union as brave or groundbreaking. However when RNs chose to deny a union foothold into their ranks suddenly these same RNs are now somehow victims of intimidation by the “evil” hospital administration, or somehow too weak to resist the management propaganda and thus hoodwinked into voting against unionization.

Case in point, the recent failure of the C.N.A. to organize the RNs at St. Agnes Medical Center in Fresno, California. The S.E.I.U. put out a “call for union unity” and used this recent loss (452 voted no while 327 voted yes with a margin of 125), which was the second failed attempt to unionize the St. Agnes RNs by the C.N.A. In the S.E.I.U. press release they clearly argued that the RNs were somehow manipulated by the hospital management and thus somehow incapable of making a decision of their own volition. Meanwhile, the S.E.I.U. conveniently failed to acknowledge the St. Agnes coalition of RNs “Our Voice-Our Choice” that lead an independent grassroots efforts to provide the “other-side” of the discussion to the RNs. This action was completely independent and to my knowledge unfunded by the management or administration of St. Agnes. So I find it rather ironic that a union that claims it’s all about empowering RNs to speak up for themselves would fail to acknowledge that these RNs did just that – oh I know it must not count if it’s not a union-led effort.

Too bad that nursing unions often show themselves to be no better than the hospital management that they label unresponsive to RNs wants and desires. In the case of St. Agnes the no vote appears rather decisive, but instead of giving kudos to the RNs for expressing themselves and exercising their collective will the C.N.A. has decided to fight the outcome of the vote and the S.E.I.U. chooses to characterize St. Agnes RNs as some kind of dupe to the hospital administration. In my opinion if the nursing unions were all about empowering the nurses, they should be celebrating that the St. Agnes nurses came together and that they made their will so clearly known, but then again it only counts when RNs chose to unionize versus affiliate as professionals. Why else do you think 85% of all RNs in the USA continue to choose to eschew the nursing unions, and over the past several decades or so nursing unions have basically been playing a zero sum game when it comes to membership?

In short, if we are expected to celebrate when RNs chose to vote in a union, we should equally celebrate when they chose to “self-represent” and be union-free. Otherwise, if we are to believe the union propaganda that RNs are somehow so feeble-minded that they fall under the “mind-control” of hospital administration or allow themselves to be so easily frightened and intimidated then you have to ask yourself do you want such a weak and feeble-minded RN caring for your loved-one, caring for your patient, or working on your team. For far too long nursing unions have denigrated RNs that resist their siren lure; it’s time that they show the same respect for RNs that chose to remain union-free as those who chose union membership.