What Do Nurses Want?

Aretha Franklin may have said it best: R-E-S-P-E-C-T! As the nation faces a nursing shortage, hospitals are offering nurses signing bonuses and higher pay, but nurses aren’t lining up to apply.

By Susan Ellen Holleran

Gone are those mild-mannered doctors’ helpers of yesterday. Facing shortages of health care resources and staff, today’s nurses must be ready to battle for high-quality patient care. And, as they are learning, they must assert themselves before the power brokers of modern medicine will listen to them.

It has not been easy to unionize nurses. For years, those who sought union representation were labeled as selfish and unprofes-sional. Hospitals fiercely fought organizing attempts. Unions often won elections for a hospital’s entire staff except the registered nurses. Management would play divide-and-conquer games to convince them that they didn’t want to be in the same union as "nonprofessionals."

AFSCME has always had a sprinkling of nurse members — mostly public employees. As the union’s organizing efforts reached farther into health care, more nurses joined. Then, in 1989, the National Union of Hospital and Health Care Employees/Local 1199 affiliated with AFSCME — bringing in a large number of registered nurses (RNs) and licensed practical/vocational nurses (LPNs/LVNs).

AFSCME nurses convened in Washington, D.C., in March 1990 to launch United Nurses of America — an organization for nurses of all classifications.

A decade later, UNA members are still speaking out on health care issues facing nurses, including today’s headline-making shortage of them. AFSCME’s responsiveness to these concerns has attracted many nurses to the union. Today, the union represents about 50,000 nurses, and the numbers keep growing.

CAUGHT SHORT. After decades of ignoring nurses’ concerns and resisting their efforts to improve health care, employers have made a startling discovery: They don’t have enough nurses. In 1999, the average age for registered nurses in the United States was 41.9 years, and younger men and women are not entering the field. Enrollment in bachelor’s degree programs dropped 4.6 percent, according to the American Association of Colleges of Nursing.

The shortage has numerous causes: poor image of nursing in the media; inadequate salaries and benefits compared with other fields; lack of scheduling flexibility — including mandatory overtime; the fact that management does not value them.

Nurses will tell you that they love their profession and are proud to do their best for each patient. But it hurts when quality of care is sacrificed for the dollar sign — when their employers see patients as numbers, not people.

That’s why 600 nurses at Flint’s McLaren Hospital turned to AFSCME in their uphill battle to organize a union in 1996.

BIG BUSINESS. "At one time, it was a pleasure to work at the hospital. I enjoyed coming to work," says Alan Napier, RN, president of AFSCME Local 875 (Council 25). "Things changed: they cut staff, took away longevity and the pay scale. Greed ballooned."

Although Napier had not taken part in the union organizing drive, he realized he had to get involved if he wanted a voice. Soon he was serving on the bargaining team.

They won a first contract in 1999. Management seemed set on ignoring the agreement, however, interpreting even the simplest language for its own benefit.

The nurses’ frustration level grew, and when Local 875 went back to bargain for a wage re-opener and a resolution to the problem of mandatory overtime, management balked — refusing to bargain in good faith.

In November 2000, McLaren’s nurses struck. They picketed for 73 days throughout the Thanksgiving and Christmas holidays, in some of the worst weather Flint has seen.

TIME OUT. Mandatory overtime is an issue for nurses across the country. They know that emergencies can arise, and they are ready to put in the extra hours in those situations. The real problem occurs when the employer — rather than recruiting and retaining adequate staff — consistently forces nurses to work double or triple shifts on a regular basis. UNA nurses in California, Connecticut, Hawaii and elsewhere have lobbied for legislation to limit the practice.

At McLaren, overtime abuse was worst for operating room nurses. Unlike other Flint hospitals, McLaren has unlimited OR boarding, so operating rooms are available around the clock. This brings in big bucks when doctors want to schedule surgery after their regular hours, but it also causes ongoing staffing turmoil.

Leslie Bond, RN, has endured her share of mandatory added shifts. A nurse in pre-op holding, she recently worked her regular day shift, got home at 4 p.m., and was called at 9 p.m. to return to the hospital two hours later. "Then I worked through until 2 p.m. the next day," she says. "For the rest of the week, you feel kicked in the gut." To add insult to injury, she didn’t get overtime pay for the last 12 hours, because it was on the first day of a new pay period.

After a similar siege of overtime, Bond scared herself by falling asleep in the car in her driveway. "The unpredictable scheduling has had devastating effects. One of my co-workers lost her day care. The facility said it could no longer watch her children because she had so many problems picking them up on time."

The new contract language will systematically limit "mandation" — a major victory.

Union representation has also given McLaren’s nurses a number of other benefits, including protection from harassment.

"We used to have a manager who would stand in the middle of the floor, curse at us and say, ‘I can say anything I want. You don’t have a union.’" With AFSCME behind them, the nurses were able to grieve the offensive behavior. That supervisor is gone.

Bond’s experiences have left their mark on her family. "My daughter is a junior in high school. She says, ‘I would never consider becoming a nurse. I tell my friends not to do it.’"

STRENGTH IN NUMBERS. Jennifer Johnson, RN, works in McLaren’s operating room. In her 22 years of nursing, she has had many problems with day care and baby sitters. "I have to tell sitters, ‘I’m on call, so you have to be on call.’ Until this year, I had to have a sitter just for emergencies."

While on strike, the nurses realized how the stress was affecting them. As a result, says Johnson, "That strike just strengthened us. We really got to know nurses all over the hospital. We learned to care about each other."

They won their major demands: the reinstatement of the pay scale and systematic discontinuation of mandatory overtime. Johnson has already seen results. "In the OR, management will now tell a doctor who wants an operating room, ‘I’m sorry. You’ll have to wait. We don’t have the staff right now.’ That never used to happen."

As Local 875 prepares to bargain its new contract in the fall, McLaren’s nurses will maintain their spirit of solidarity as they seek the respect they deserve.

ASK A NURSE. The Connecticut Health Care Associates (CHCA), an AFSCME Local 1199 affiliate, wanted to know how nurses were faring, so it sent a survey to 1,000 RNs across the state. Almost 75 percent had experienced "restructuring" at their facilities. From the nurses’ standpoint, those changes led to the elimination of services and to staffing patterns that have negatively affected the quality of patient care.

Survey respondents reported that job security, wage/benefit cuts and workplace safety are all serious concerns. In addition, 59 percent of the nurses whose facilities had been restructured said they had not been consulted during the process. And of the 35 percent who said they had been consulted, half reported that management had not seriously considered their suggestions.

The CHCA took these results to the Connecticut legislature, which is considering three major bills that will impact nursing: One will outlaw mandatory overtime abuses; the second will ensure that nurses administer medicines. A third major bill will establish a trust fund for nursing education and the training of health care personnel who want to become nurses.

"This is a big year for nurses in Connecticut," says CHCA Pres. Mary Lou Millar, RN.

FACES OF NURSING. One problem CHCA members have seen first hand is the tension arising when management pits nurse against nurse: in this case, RNs against LPNs.

Over the past decade, LPNs at the Waterbury Hospital have been phased out. According to management, says Marie Simpson, LPN, this was done because registered nurses "had issues working with LPNs."

Simpson is still surprised by that rationale. A nurse in labor and delivery for 31 years, she operates as a valued team member. She believes management has made it much more difficult for nurses to ensure high-quality care now that most experienced LPNs have been replaced by Patient Care Associates, who often have inadequate training.

Simpson questions the hospital’s priorities. Rather than focusing on retaining and upgrading current staff, "they put all their money into bonuses for new nurses. Those nurses come for the bonus and then go elsewhere for the next one. Ten years from now, I don’t know what’s going to happen. With all our experience, we don’t have anyone to pass it on to."

Kathleen Chipelo, RN, has been a nurse for 32 years — six as an RN. She realized her job was in jeopardy when Waterbury Hospital started its LPN phase-out, so she went back to school.

"It was a lot of work, especially since I have a family," she says. But Chipelo is grateful that her union had negoti-ated a tuition reimbursement program. I love my profession — working with the people. You learn new things every day."

But Chipelo has mandatory overtime horror stories. "One day I stayed from 3 to 11 p.m. after completing my day shift. I didn’t get home until quarter of 2 in the morning and had to get up at 5 for my next shift." Chipelo and her co-workers "stormed the office of one of our vice presidents. They took a better look at the situation and hired more staff.

"Truck drivers are covered legally for how many hours they can work at a time," she notes. "Nurses should be, too."

COME TO PARADISE. It seems easier to recruit nurses to her hospital in Maui, says Susie Uwekoolani, RN, a member of the Hawaii Government Employees Association (HGEA)/AFSCME Local 152. Retaining them is another matter: "You might be able to attract nurses because of the weather, but they don’t stay." Her hospital, the Maui Memorial Medical Center, is the only acute care facility on the island. Short staffing creates an ongoing crisis.

Uwekoolani has worked the night shift for years and is now a charge nurse in the intensive care unit. She decides which patients are assigned to the night nursing staff. The escalating turnover rate increases job stress, because she often has to guess at an individual nurse’s expertise.

She is proud of her co-workers and their professionalism — for example in the face of needlestick injuries. Needlesticks are a genuine concern throughout the health care industry, and AFSCME is always fighting for safe equipment. Uwekoolani’s hospital had brought in allegedly safe needles, "but they were inferior. We refused to use them. We held a massive petition drive, and everybody on each floor signed. ‘These needles are junk,’ we told them. ‘We just don’t want to use them.’" The nurses won.

Currently, the HGEA has a bill in the Hawaiian legislature to limit mandatory overtime and ensure safe equipment for health care workers. These are important steps, says Uwekoolani, but they do not reach the underlying problem. "Management doesn’t value longevity or commitment. That has to change."