Should Nurses Strike?

Nurses once had a reputation for being doormats.

Let’s face it: We could be abused pretty badly before ever fighting back. We’d work three different shifts in one week, work unpaid overtime, might not even get a bathroom break much less a meal break, and the pay – well, for years it was pretty paltry.

Nurses are much better paid now, but patient safety has become an issue and nurses are speaking up and standing their ground.

I’m not sure when it started or by whom, but some years ago, a group of nurses began collecting horrendous stories about patient endangerment and adverse outcomes due to staffing shortages. This probably helped to swell the ranks of the unions and the willingness of nurses to go on strike – something nurses do only when we see no alternatives.

Earlier this month, 4,000 union nurses (with the California Nurses Association) were planning to strike March 21 at eight hospitals in the San Francisco Bay area. According to the San Francisco Chronicle, a union representative said that the strike is intended to call attention to “serious problems with patient care,” and a “pattern of patient safety risks” by the “hospital’s refusal to schedule RNs to care for patients when nurses are on legally mandated meal or rest breaks.”

Nurses there also are unhappy with the hospital’s proposals for employee pensions and health care plans.

“When there are not enough nurses, patients are put at risk, period,” a union representative told the Chronicle. “We don't want to strike, but our ethical obligation as patient advocates demands it."

Have you ever participated in a strike?

If so, why and for how long?

Was the strike successful in gaining its objectives?

How did you feel about participating in the strike?

If you’ve never been a part of a strike, would you consider doing so?

Nurses' Former Jobs Kind of Amusing

I’m always fascinated by some of the jobs that nurses have held before they entered the profession – or even after they did.

I have an acquaintance who owned a garbage collection business with her husband before he died. She sold the business and entered nursing school while in her 40s. Another friend trained race horses and abruptly decided to change careers just before her 40th birthday.

I met a nurse on a trip to Turkey who was a traveling companion for a very wealthy New York socialite, then in her 80s with early-stage dementia. The nurse’s job was to take this woman on extended overseas trips several times a year, with the idea of keeping her mind as sharp as possible.

A cousin of mine went into nursing after being a nun for a decade.

I was young when I entered nursing and hadn’t had much time to do anything very interesting, but I went into journalism after working as a nurse for 15 years. I thought my nursing days were behind me, and didn’t mention my background when I interviewed for the newspaper job. But after several years, the word got out, and soon I had visitors at my desk a couple of times a week.

“I hear you’re a nurse,” they always began.

Then the questions:
What should I do about (fill in the blank) this skin rash? My father who I think has Alzheimer’s? My back pain? This prescription? Finding a doctor? My carpel-tunnel? My mother who needs surgery but has no insurance? Of course, I didn’t have all the answers, but usually knew where they could be found. As a journalist, I had a lot of unusual experiences.

I spent the night in an apartment full of strangers to cover an anti-abortion rally. My bed-mate (another woman whom I didn’t know), informed me not to worry if she had a seizure in the middle of the night. It was just her uncontrolled epilepsy.

I spent some time in the air more than once for various stories.

Once I jumped off a cliff over the ocean to ride with another hang glider, and for another feature, I rode in an open-cockpit ultralight. I was lucky enough to ride in several World War II airplanes, make an aircraft carrier landing (as a passenger), and take three trips in hot air balloons. Fortunately, I only crashed once.

I’ve been rock climbing, zip-lining and up-close-and personal with some very large reptiles – all fun, but once is enough.

I know there are many of you that have some great stories to share.

What adventures – in and out of nursing – have you had?

Health Care and Iraq Two Big Issues in November Elections

Health care and the war in Iraq (and other places) look to be The Big Issues in the upcoming November election. I admit that I’m watching how things unfold during the campaigns with at least as much interest as I watch “Survivor” (OK, now you know). My ears always perk up when the candidates discuss health care.

Sadly, I have friends and acquaintances among the 47 million that statisticians say don’t have insurance. Others I know are scared to retire early because they know they can’t get insurance on their own. Still others can’t change jobs because their new health care plans wouldn’t include their doctors.

For several years, when my husband was self-employed, I carried the coverage because I was an employee. It was a lot cheaper than if my husband purchased health insurance as an individual. Now he’s an employee and carries the insurance for both of us. He’s holding off on retirement to keep the coverage for me.

According to recent news stories, many states are grappling with The Health Insurance Dilemma.

California is decreasing payments to physicians for Medicaid patients. Florida is cutting $500 million and Maryland $40 million from their Medicaid budgets. Maine wants to charge Medicaid recipients and cut health department funds. Massachusetts wants legislation that requires public reviews of insurance companies that try to increase premiums by more than 7 percent.
Georgia wants to create a Web site that compares health insurance plans.

Iowa will make insurance for kids mandatory and provide coverage for low-income families. New Mexico is passing laws that will make it more difficult for insurance companies to cancel policies and deny claims. Oklahoma has joined a multi-state suit against the federal government which claims it overstepped its bounds when it eliminated millions of dollars for Medicaid.

Oregon is holding a lottery to see who of the 80,000 people who signed up will get the state’s health care coverage (there are only “a few thousand slots”). And finally, Washington state’s legislature overwhelmingly voted to require insurers to receive approval from the insurance commissioner before changing premium rates, and – get this – the legislature wants insurance companies to return excess profits to the state.

Does anyone see a trend here?

And are all these attempts at fixing our non-system just Band-Aids for a systemic disease?
Should we have a national universal health care plan, or should states re-invent the wheel to meet their own needs?

What do you think?

Nursing shortage: Are foreign-trained RNs the answer?

The nursing shortage is real and the numbers scary.

Consider these facts from a myriad of sources compiled by the American Association of Colleges of Nursing (AACN):
• According to an article in the January/February 2007 issue of Health Affairs, in 2020, there will be 340,000 fewer nurses than this country needs – about three times the current shortage.
• We aren’t getting any younger. More than half of the nurses currently working plan to retire between 2011 and 2020.
• Hospitals in the United States have, on average, an 8.5 percent vacancy rate for RN positions.
• According to a report by the AACN, U.S. nursing schools turned away 42,866 qualified applicants from BS and graduate nursing programs in 2006. Not enough teachers, clinical sites, classrooms, preceptors and money.

I could go on, but you get the idea.

So how do we fix the problem?

Some think we should import nurses from other countries. For instance, there are lots of nurses in Mexico who want to come here. It’s no mystery why. A nurse in Mexico might make $600 a month. A few miles north of the U.S. border, the salary is $3,700 a month.

By the way, the Chicago-based National Council of State Boards of Nursing, which administers the standardized RN licensing exam, says that most foreign-educated nurses who qualify to work here come from the Philippines, India, South Korea and Canada. And a 2004 study by the Immigration Policy Center reported that 11.5 percent of working RNs were foreign-born. Experts say this proportion will grow while we figure out what to do.

Some think we should allow more foreign grads into the country. It’s is a quick fix while we increase capacity at U.S. nursing schools.

Opponents say the language barrier is a problem, as well as inferior education programs in other countries. Still others think an abundance of foreign grads will drive down salaries.

Should we allow more foreign nurses to work in the United States?

What are your ideas for fixing the shortage of RNs?

If we do, what are the benefits and/or consequences?

What do you think?

Prescription for a Solution?

Nurses in many states can prescribe drugs. Different states have different rules, and I’m not sure what they all are, but they involve different clinical specialties and different levels of independence.

I imagine the first person to suggest that nurses be able to prescribe drugs was probably nearly burned at the stake – or at least pronounced heretics, especially by physicians. After all, if nurses can write prescriptions, who needs a doctor?

Of course, it’s not as simple as that, and neither is the previous political in-fighting that has apparently occurred between various nurse-factions. A front-page story in March/April/May issue of The Nursing Voice, a publication of the California chapter of the American Nurses’ Association, makes a call for all advance practice RNs to band together to push for legislation that allows all of them to prescribe drugs without working under the authority of a physician.

There are four types of advance practice RNs: nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists. In California, they have different degrees of authority in prescribing.

The nurse anesthetist is the only one who can prescribe independently (while working in the OR and once the physician has ordered anesthesia).

Nurse practitioners and nurse midwives have “furnishing” authority – that is, they work in a dependent role supervised by a physician.

The clinical nurse specialists can’t prescribe at all.

According to the article, there have been rivalries among these four groups. But now there is a call from one of the clinical nurse specialists group (whose members can’t prescribe) to all advanced practice nurses to help push for a bill that allows all advance practice nurses the authority to prescribe without physician supervision. The group says that everyone should have a hand in crafting legislation language because the end result will be more cost-effective health care.

More nurses who can prescribe also will help meet the needs of the underserved “within the hospital and the community.”

Nurses who are allowed prescribing privileges would have to meet stringent educational criteria and guidelines.

Should all advance practice nurses have the authority to prescribe medications independently?

Are some specialties more qualified than others?

Should there even be a debate at this point about whether nurses should be allowed to prescribe at all?

What do you think?