Commentary
Nurses' strike is one symptom of a deeper problem
by Will Nicholson, M.D.Members of the Minnesota Nurses Association walked picket lines outside of my workplace yesterday as a result of gridlock in their contract negotiations with Twin Cities area hospitals. But the one-day strike by Twin Cities nurses was a lot more than a disagreement between labor and management in our local hospitals.
It's a sign that our health care safety net is being stretched dangerously thin.
Although other sectors of health care -- especially those not involved with direct patient care -- continue to rake in profits even during a stagnant economy, the part of the health care system that actually takes care of us when we are sick is at a critical point financially. Faced with an economic downturn along with national and state government reimbursement schemes that continue to shortchange basic, primary-care medical care services, our local hospitals are having a hard time making ends meet without either laying off critical workforce or slashing their benefits.
I work for a nonprofit community hospital that, in spite of cutthroat corporate competition and a cumbersome and counterproductive health insurance system, still finds a way to provide first-rate, cost-effective, patient-centered care for our local community. Time and again, studies have shown that community-based, primary-care-driven medicine like the kind we provide at my hospital is the best investment for any health care dollar. Yet time and again the money in health care has found its way into the pockets of the insurance executives, the patent holders and the lobbying firms first.
So while our local news has been covering the strike as a classic battle between labor and management, I urge everyone to consider the strike a symptom of a greater problem.
And this problem will persist until we decide to protect the core medical services we all depend on. When times get tough, we should ask the nonessential medical services, the insurance tycoons, the designer drug makers, and the lobbyist armies to tighten their belts. At least enough so that your nurse can stay at your bedside, instead of rallying in the street.
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Will Nicholson, M.D., practices family medicine in Maplewood and blogs at triagepolitics.com.
Comments (15)
I wrote an article on my blog that related to this article. I pointed out that when our local hospitals were run by non-profit organizations that quality health care was provided to all at affordable prices. When these hospitals were bought by private corporations everything changed. It is interesting that the number one rated hospital by consumers in Minnesota is run by a non-profit religeous organization. I refrain from naming it to avoid flooding them with patients, they are that good.
I appreciate Dr Nicholson's comments. As a striking Minnesota nurse, I can tell you we did not go into nursing with the goal of walking a picket line. But something is terribly wrong when all the players in the Medical Industrial Complex can eat up so many precious healthcare dollars and then tell sick people and their caregivers to fight over the crumbs. Something is very wrong when a Not-For-Profit system allows hospitals to spend millions of dollars on nonessential amenities like expensive remodeling and landscaping then tell nurses that there is just not enough money for safe staffing or for keeping their promise for hard earned pensions. Something is terribly wrong and will not change until the public demands it. Now would be a very good time to do so!
Society should take a long hard look at the health-care system in order to fix its problems. We should be studying the way providers operate, the way HMO's and the government reimburse, and the way employers fund healthcare. In the meantime however, the issues at hand are with the facilities themselves. Non-profit hospitals don't have to return profits to private investors, they are supposed to use their profit to improve the facility and to enhance patient care. Studies have shown that the higher the quality of care and the more safely it is delivered, the lower the costs are. Putting two and two together, lower nurse to patient ratios would allow higher quality and safer conditions. Hospital management should be doing the math. Physicians should also be doing their part to help the hospitals lower costs. Time and again, I witness patients sitting in hospital beds that should have been dischareged. Every day a patient stays in the hospital = extra cost. Also, I have witnessed physicians ordering unnecessary treatments. Overtreatment is a big contributor to runaway healthcare costs, but that's a whole other ball of wax. The bottom line is, the area hospitals are making ends meet. Every one of the striking hospitals made millions of dollars in revenue last year. Why aren't the profits being funneled back into the hospital system as they should be? Hospitals should be staffing their facilities better and until they realize this, nurses will continue to rally in the streets!
I am also a striking MN nurse. I went back to work yesterday and am grateful for all the support I received from my patients. I am putting my job and therefore the economic life of my family at risk to stand up for what I believe in. In the end, it might cost me my job. If it does, then nursing is no longer the profession I loved.
A lot of people where I work lost their jobs. Every one for about 18 months have been on a wage freeze. During the same period the company did not have any profit sharing contribution. Our medical insurance went up with higher deductables, we are under staffed and for about 7 months our hours were cut back to 32 a week. These were all sacrifices that we all had to make for our company to survive. I think if you want public support they would like to know how you have suffered. Perhaps MPR could create run an article giving the Nurses and opportunity to tell their side of the story.
As an advanced practice nurse with 26 years in primary care, I have the utmost respect and concern for the nurses working with hospitalized patients. Seeing the newspaper headlines and susequent article discuss nurse patient ratios was a wellcomed, longer over due attention to the real issues in this labor dispute! Patients who are hospitalized now are much sicker with a greater acuity index requiring more intensive assessment skills from registered nurses. The hospital management and the media failed to understand that a patient's life, death, and longterm health outcomes depend, now more than ever, on the watchful eye of their primary nurse!
As an advanced practice nurse with 26 years in primary care, I have the utmost respect and concern for the nurses working with hospitalized patients. Seeing the newspaper headlines and susequent article discuss nurse patient ratios was a wellcomed, longer over due attention to the real issues in this labor dispute! Patients who are hospitalized now are much sicker with a greater acuity index requiring more intensive assessment skills from registered nurses. The hospital management and the media failed to understand that a patient's life, death, and longterm health outcomes depend, now more than ever, on the watchful eye of their primary nurse!
Society should be taking a long hard look at the healthcare system in order to fix its problems. We should be studying the way providers operate, the way HMO's and the government reimburse, and the way employers fund healthcare. In the meantime however, the issue at hand is with the facilities themselves. I too work at a non-profit community hospital. Non-profit hospitals don't have to return profits to private investors. They are supposed to use their profit to improve the facility and to enhance patient care. Studies have shown that the higher the quality of care and the more safely it is delivered, the lower the costs are. Putting two and two together, lower nurse to patient ratios would allow higher quality and safer conditions. Hospital administrators should be doing the math! Physicians should also be doing their part to lower costs. Time and again, patients sit in hospital beds that should have been discharged. Every day a patient stays in the hospital = a cost. Also, overtreatment is a big contributor to runaway healthcare costs, but that's a whole other ball of wax. The bottom line is, the area hospitals are making ends meat. Every one of the striking hospitals made millions of dollars in revenue last year. So why aren't the profits being funneled back into the hospital system as they should be? Hospitals should be staffing their facilities better and until they realize this, nurses will continue to rally in the streets!
This strike has nothing to do with patient care and improved nurse / patient ratio. This is about nurses demanding more money at the cost of patient care!! When you striked hundreds of patients were transfered to other hospitals who had to pick up your slack and care for these patients. These patient's primarily were transferred to trauma centers which then limited the beds available for trauma patients. GREAT JOB NURSES, YOU PUT HUNDREDS A RISK FOR A FEW DOLLARS. You are already overpaid. You have nurses aids, techs, assistants...what exactly does the nurse do anymore anyway...besides "document" all day. And to that person that puts blame on physicians for not discharging patient in a timely manner...you are ridiculous!!! Nurses don't deserve more money until the economy improves....just like most people who are not getting raises and still working. Wait out the hard economic times and then ask for more money.....BUT IT IS ALL ABOUT PATIENT CARE - RIGHT!!
So, then, it's OK for patients to do more with less, as well, right? Go for it, nurses! How can one be expected to provide expert, safe care when probably less than one hour of actual hands-on time is allotted to each one of my patients on a regular basis? It's all wrong!
Perhaps you need less breaks and less gossip time in order to spend time with your patients!! Then you will have more than an hour for each one. You don't need a donut and cup of coffee every time you sit down to document. document in the patient's room and then move on to the next patient. Unions have made it so inefficient nurses get paid well and there is no incentive for productivity in the nursing profession
To the Medicine Doctor of St. Paul ,you are misinformed. I am a striking nurse who works at a non profit hospital on a very busy OB unit. The team of nurses and physicians I work with take pride in the excellent care we provide. I work 12 hour shifts and I am lucky to get one 15 minute break a day much less "eating donuts" as I document. We are not asking for a large pay raise but rather we want the hospitals to include the RNs in making decisions about staffing to keep patients safe. The average patient has more health issues than 10 years ago and they expect more during their stay at the hospital (Hilton). While attending to these needs we are also expected to exceed on patient satisfaction surveys and do it without overtime and make no mistakes. Healthcare in Minnesota is known throughout the nation for being top-notch
let us continue to provide this care in a manner that is safe.
To Medicine Doctor: Wow! Are you sadly mistaken! I'm a critical care nurse. On average we have two patients, sometimes one. We have no techs, aids, or assistants doing ANY work for us. Every day we are given more responsibilities and more paperwork to complete. We are the eyes and ears for physicians. We have to be able to make life saving decisions when a doc doesn't call us back in a timely manner. We are expected to follow up on the MDs to make sure the orders they write are correct and thorough. You should put yourself in our shoes. Just for one shift. You stand at the bedside after someone else has told the family that the patient is going to die and then left the room. You stand there and be berated because "Mom didn't get
chicken with her dinner." You turn and clean a 500+lb patient every two hours. You wonder if you can keep your patient alive. while working within your scope of practice, while waiting for a phycisian to get to the unit. Do this all with a smile on your face and no support from administration. Come on, step up to the plate and walk the walk. You wouldn't last two hours in a nurses's uniform! The public has got to realize that we have so many more demands placed on us these days. Patients are a lot sicker and the amount of changing information we have to be responsible for is endless. Stop bashing nurses and start supporting us.
The Medicine Doctor from St Paul well represents many of his peer that have no respect for nursing. Remember this he is not licensed as a nurse so therefore is unqualified to make nursing judgement. Medicine and Nursing at best is a partnership for better treatment and care of patients. In the case of the St Paul doctor it is obvious a partnership with him would be totally disfunctional. And of course the patient is the one that suffers
Work Harder, stop being lazy.
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