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.

In this nurse’s opinion the California Nurses Association (C.N.A.) membership hit an all time low this afternoon in Atherton, California.  You may wonder what could be worse than threatening opposition nurses, their children, and pets, or stalking opposition nurses, showing up at their relatives homes and calling family members at all hours of the night and day under the pretext of “convincing” the recalcitrant nurse that the C.N.A. is a great organization to join is low  — you weren’t in Atherton.  Today, low behavior was when hundreds of C.N.A. members and supporters descended on this quiet neighborhood so they could hold a demonstration at the private residence of California gubernatorial candidate, Meg Whitman.

Of course this demonstration was accompanied by all the usual hyperbole and misrepresentations that are part of the C.N.A.’s usual arsenal.  But to come to a person’s private home is truly above the pale. I’m sure Ms. DeMoro, Nurse Burger and company wouldn’t appreciate say the S.E.I.U. coming to their private homes and demonstrating to illustrate how the C.N.A. has engaged in raiding their nursing unions.  But common decency, and socially appropriate behavior seems to be lacking in the C.N.A. leadership DNA.

But what this nurse liked best was that in the C.N.A.’s attempt to garner media attention a nurse delivered a letter to Ms. Whitman by placing said letter in Whitman’s residential mailbox. In doing so this nurse may have engaged in a federal offense.  What federal offense, why the law that states only authorized letter carriers may insert mail into a residential mailbox.  Oh my!  The rule making and rule toting C.N.A. broke a rule themselves – color me surprised! …. More to come.

For those who may not have heard the news, and don’t be surprised if you haven’t since the California Nurses Association (C.N.A.) is not likely to advertise their loss of the certification vote at Mt. Sinai Hospital in Chicago. Why, because when you loss by a vote of 152 in favor and 293 opposed (that’s a 141 vote difference) and only 11 challenges you don’t go issuing any press releases!

Many of nurses, both non-union and union, have been following the machinations of the C.N.A. and their national organizing arm N.N.O.C. Nurses have watched as the C.N.A. was accused of raiding another nursing union, the take over of the Hawaii Nursing Association and the attempt to undermine the Louisiana Nursing Association during their Hurricane Katrina Recovery period and wondered when nurses would say enough. It looks as though this may have just occurred in Chicago with the Mt. Sinai nurses overwhelmingly voting to remain free to speak with their own voices.

All too often nurses become so “war weary” of the join a union/don’t join a union pushme pullme circus that when the certification election is held more stay home failing to cast their vote, leaving the margin of victory for either side so slim that which ever side looses can easily launch a challenge. Not so in the case of Mt. Sinai Hospital with only 11 challenges and a 141 vote difference the victory in this matters lies clearly with nurses choosing to exercise their “advocacy muscles” for themselves and their cohorts.

You can read the official announcement here.

The Unions’ power structure and their supporters have been hard at lobbying both local and federal legislators — their latest project convincing our elected officials that it is less intimidating to have union organizers speak to prospective members one on one and convince them to sign a card signifying their desire to unionize rather than holding the secret ballot system that is now most commonly used. I think that for the average American it is a no-brainer, one-on-one lobbying vs. secret ballot — the secret ballot allows for an individual to freely express their true desires. However, the Unions are quite accomplished at convincing legislators that their members are not adept at representing themselves so Unions are needed to do this. Don’t believe me, just read AB 1201, which is now in suspense in the California Legislature. Also below you can read my two cents on the issue.

Nurses, an Oppressed Group? — NOT!

A couple of weeks ago I was speaking with a nursing colleague from the East Coast. We had connected over a mutual interest in the National Labor Relations Board decision concerning charge nurse and their role in management (or not). During our conversation she shared with me her concerns that she had recently learned that the local nurse’s union was promoting the notion that RNs were an oppressed group and therefore in need of “special protection” that can only be wrought through legislature intervention. The words “oppressed group” rolled around in my head for a few days, and with each passing day I grew concerned at what effect these words might have on our profession. Then several weeks later I received one of the many nursing magazines that I subscribe to and imagine my surprise as I perused the table of contents the phrase “oppressed group” popped up. I read the study with great interest and some concern, puzzled at what the outcomes might be and low and behold the author of the study concluded that nurses met the criteria of an “oppressed group”. So both the conversation and the article gave me great food for thought and it motivated me to speak up (as if this is a problem for me) about what I think on this subject.

My first response to hearing this terminology used to describe us, concerned me and the more I ruminated over it the more concerned I have become. Why, because I see this label, and that is precisely what it is, as a tool to advance some group’s agenda, and that agenda is in all likelihood probably not shared by the majority of Registered Nurses in this country. This doesn’t mean that the profession doesn’t have problems, but nurses “oppressed” – I think not! Our profession shares a lot in common with other first responder professions, I wonder if legislators feel that they are “oppressed” as well, or is it because our profession is still viewed as a predominately a “woman’s” occupation thus requiring the need to be “taken care of”?
Labeling RNs as “oppressed” may seem to be a convenient way for some so-called nursing leaders to get their point across, but I think it sets a very bad precedence. Somehow I don’t think Jane Arminda Delano, Dorothea Dix, Clara Louise Maass, Mary Eliza Mahoney, Florence Nightingale, Mabel Keaton Staupers, Adah Belle Samuel Thoms, Susie Walking Bear Yellowtail, to name a few, would be very happy with being labeled as an “oppressed group”.

So what can possibly be gained by getting legislators, opinion leaders and even the RNs themselves to accept the label of “oppressed” group? Well, for starters there are those that ascribe to the school of thought that by getting people, especially legislators, to accept such a label as fact that this then lays the ground work for the passage a whole host of laws that are “billed” as protection for the “oppressed” group. There are also those who desire to keep the “oppressed” group in a subordinate role, and by getting all parties involved to accept the label it allows for the group to remain in that role, being “looked” out for by their benevolent supporters. This brings me to the topic of AB 1201, a bill pending in the California Legislature that purports to be looking out for the “interest” of the direct care nurse. The language is such that one can almost be lead to believe that without this bill the “evil” hospital and healthcare organizations will run roughshod over the nursing staff thus leaving the patients with out anyone to look out for them; it even goes so far as having language that implies that nurses are in such a weak state that only through unions can they effectively advocate for their patients. Just in case you think I am exaggerating let me share with you some of the testimony provided by the sponsor of AB 1201. The AB 1201 sponsor used the example of the Tenet hospital in Redding, California where numerous cardiac surgeries were performed, later many of these surgeries were found to be unnecessary. The bill sponsor stated emphatically that if only a union had represented these Redding nurses then none of this would have happened, further commenting that it was the lack of “union protection” that kept the nurses silent. As I sat in stunned silence, I wondered, then what was the explanation for the silence of the nurses at both UC Irvine and St. Vincent, both hospitals’ transplant programs racked by recent scandals, since nursing unions (in fact by the bill’s sponsor) represents the nurses at both these hospitals. It is precisely this behavior that allows “nursing” leaders to rationalize distorting facts on the backs of the very nurses they say they are out to protect. However, as my mother was fond of saying when she heard outlandish statements – “better to hear that, then to be deaf”.

Do I think that nurses conspired at any of these hospitals to place their patients in harms way, hardly. However, I don’t think that offering the vague promises that only if there had been a union then the nurses would have come forward, just as they failed to come forward at hospitals with union representation. As with almost any similar situations, individuals with mal-intent or with corruption on their minds or just plain weak-willed found a way to use and abuse the system. In turn they recruited like-minded individuals into their scheme and presto a formula where their scheme flourished until it was rooted out. It is easy to lay the blame on the big, “evil” hospital, especially in these times when groups are looking to scapegoat someone and hospitals have a big target painted on them.

However, it concerns me a great deal that those who say they have only the best interest of nurses in mind are using such examples to further an agenda that I believe may have unforeseen consequences for nurses, especially those who remain at the bedside. I encourage everyone reading my column that has access to the Internet to bookmark the following page, http://www.legislature.ca.gov/port-bilinfo.html. Once on the search page you can simply select search by bill number, type in 1201 and it will take you to the page that has all the information on the bill, including the text of the bill, all its revisions, history and status. Read it, formulate your own opinion and then if you are so inclined call the bill author, Assemblyman Mark Leno in Sacramento at (916) 319-2013 and provide his office with feedback. You can also send him an email by directing you browser to the following address http://democrats.assembly.ca.gov/members/a13/capitol.htm and then select “email Assemblyman Leno” or by mailing or faxing him a letter at: State Capitol, P.O. Box 942849, Sacramento, CA 94249-0013 or (916) 319-2113 respectively. If you do send a letter or email, I would encourage you to forward a copy to me as well. While you are at it be sure to send a copy to the Assemblyperson and State Senator that represents you, because it would help if they knew your opinion and feelings about this and other bills that affect nursing. If you don’t know who they are you can access that information on the Internet at http://www.legislature.ca.gov/legislators_and_districts/legislators/your_legislator.html. Select “search by zip code for your legislator” and follow the directions. You can also find the information in the blue pages of your local telephone book.

My opposition to this bill doesn’t mean I think that working in today’s hospital environment is a perfect work environment for nurses; on the contrary anyone who has read any of my columns should be well aware of how I feel that poor nursing and hospital management is a primary reason why so many nurses burnout or leave nursing. I am just unwilling to lay all the blame at the feet of hospitals; some of the blame can and should be laid at the feet of nurses and nursing unions. Before everyone feigns righteous indignation, we all know that sometimes nurses are our own worst enemy. We see it with the cliques that become so tight knit that they are quick to bring attention to non-clique member’s errors or misbehavior all the while protecting their own members from being reported when they commit errors or exhibit unacceptable behavior. Nurses, nursing associations, nursing unions and nursing advocates often bemoan the lack of proactive and responsive nursing leadership in hospitals. However, I have also seen experienced nurses failing to support their nursing administration when that administrator comes under fire for defending nurses and patients by bean counters and poor hospital administration.
It could be said that hospitals and healthcare administration encourages this environment, a form of chaos that keeps the “underlings” undercutting one another for the benefit of the “powers that be”. However this argument is not entirely valid since physicians, for example, have long shown themselves immune to this strategy. It is well known within the healthcare profession that physicians are extraordinarily supportive of the “doctor’s club”, and that they equally defend one another regardless of gender, race and class in most circumstances – so why not nurses?

Call me optimistic but I know that this is not and does not have to be the nursing environment of the future. We, as nursing professionals, can change this milieu. The question is are we willing to put in the effort and emotional investment that it will take to make this change in our own unit, within our own nursing team, hospital, and ultimately within the structure of our nursing schools? This change is not for the faint of heart as it can be and often is painful since the status quo does not exactly respond positively to change. However, if we allow those at the table to succeed in placing the label of “oppressed” on our profession and ultimately on us then our attempts to make change can become encumbered by the very people who profess to support and champion us and our goals. As an individual, who is proud that she chose to become a RN, I am greatly concerned that as our profession struggles to define itself we might fall victim to the whims of some who would have us seen as though we are weak and incapable of advocating for ourselves let alone our patients thus describing us to legislators and those in “power” as somehow oppressed. The question we must all ask ourselves is this, are we willing to accept this label? Because once we accept this label, even in the guise of advancing it for our protection or getting much needed change then changing this perception at a later date could very well be impossible. I for one am not willing to accept the label of “oppressed”. To those who believe that by seeking out these special protections is a kindness or a way to achieve a positive result: I would remind them of the old adage. “The road to Hell is often paved with good intentions.”