Introduction

Our nation's health care delivery system is in turmoil. Because Congress has not passed rational health care reform, the "market" is making changes on its own. Some of the changes hold promise; others are alarming. It is clear that the goals and priorities of the market are not necessarily in line with good public policy or quality health care for consumers.

Restructuring is putting great pressures on health care facilities, be they acute or chronic, public or private. No hospital or health facility is immune from these changes. As health providers are pressured into joining networks or establishing affiliations, the ability of hospitals or institutions to be free standing is coming to an end.

Much of the burden for change is being felt by nurses, the hands-on providers of day-to-day health care. Patient care quality is being compromised, and the nursing profession itself is under attack. But UNA/AFSCME is not standing by. On behalf of the more than 40,000 RNs, RNPs, LPNs and LVNs we represent, our union has launched a number of initiatives to ensure that nurses have a say in the future direction of our nation's health care delivery system.

In May 1995, over 300 nurses from across the country met at the United Nurses of America's fifth national nurses congress in Washington, D.C. to discuss the changes taking place in that system and their impact on nursing professionals, devise an action plan to preserve the integrity of the nurse profession, and work towards the establishment of guidelines to protect the quality of care in America's hospitals and institutions.

To assist the nurses participating in that seminal event, UNA/AFSCME assigned staff experts in public policy, research, and public affairs. Speakers testified to the severity of the changes taking place, and nurse participants themselves related the experiences they felt at their respective facilities. Never before had any organization devoted such a vast array of resources toward providing nurses with a vehicle for debating the changes taking place in the health care industry, and for formulating strategies for minimizing the impact those changes would have on their profession and on the quality of patient care.

UNA/AFSCME nurses truly are the voice for quality care in our country. This manual incorporates their input from the May 1995 conference and beyond. We hope you find it a useful tool as you confront restructuring where you work.

Gerald W. McEntee
International President

William Lucy
International Secretary-Treasurer