Editor's Note: The recently concluded School for Nurse Activists and Patient
Advocates was historic in that it brought together direct care nurses from
around the continent and from a variety of organizations both independent and
affiliated. Two common issues identified by nurses that should be the focus
of their organizations were mandatory overtime and single payer universal
health care. This event also allowed independent nurse organizations to
explore whether the creation of a new national nurses' organization was
either desirable or feasible. While each organization may have varying views
on this, it is clear that at this unique point in history this is plausible.
Massachusetts is committed to an inclusive organization focused on a
progressive agenda serving its existing mission. Unfortunately, Anne
Barnard's otherwise fine article below failed to reflect this MNA quest for
inclusiveness. If, on November 10th, MNA exists as an independent
organization and it's our membership's desire, we will pursue working
relationships with other progressive nursing organizations. Any formal
relationship would have to have the approval of our membership. To follow
developments, go to:
Sandy's Links: <http://users.rcn.com/wbumpus/sandy>
Massachusetts Nurses Association: <http://www.massnurses.org>
Sandy Eaton, RN
Quincy, Massachusetts

Split deepens among nurses

by Anne Barnard, Boston Globe

September 21, 2000

The squabble over who speaks for nurses deepened yesterday as nurses from
Massachusetts, California, and other states announced their intent to form a
new national organization to compete with the American Nurses Association,
which they called too moderate.

The new group would represent only staff nurses, not managers or educators.
It would fight for ''social justice in health care,'' said the California
Nurses Association, which organized the meeting.

The California group took aim at the American Nurses Association, saying it
is dominated by nurse managers who have become ''agents for profiteering at
the expense of patient care.''

More than 20 members of the Massachusetts Nurses Association attended the
meeting, along with representatives from the Maine Nurses Association. The
two New England groups are contemplating seceding from the American Nurses
Association, following in the footsteps of the California group, which left
the parent group in 1995.

The nurses met in Oakland, Calif., just days after the Massachusetts Nurses
Association took another step in that direction. That group's board of
directors voted Friday to support the split, increasing the likelihood that
the full membership - whose 18,000 (sic) nurses make up 10 percent of the
association's members - will choose to break ties in a vote scheduled for
Nov. 9.

After that, Massachusetts association leaders who attended the California
meeting say they will push for the association, which is both a labor union
and a professional association, to be a founding member of a new group.

Nurses, who make up the largest group of health care professionals, are
trying to stake out a more visible role in the debate over health care costs,
access, and quality. They have been energized by events such as the St.
Vincent's Hospital strike in Worcester this year, where strong support helped
the union to win limits on mandatory overtime.

At the top of the agenda should be a ban on mandatory overtime for nurses,
protections for nurse whistleblowers and other safeguards against
commercialization of health care, said Patricia Healey, an intensive-care
nurse at Brigham and Women's Hospital and a member of the Massachusetts
Nurses Association board who attended the meeting this week. And, she said,
the American Nurses Association has been slow on that agenda.

''All of us in our state locals have felt the absence of a strong national
presence pushing these issues,'' said Patricia Eakin, an emergency room nurse
at Temple University Hospital in Philadelphia and treasurer of the
Pennsylvania Association of Staff Nurses and Allied Professionals.

Yet the American Nurses Association also supports all of those positions.
That group, like the California, Massachusetts and other state groups,
supports a bill that was introduced last week in the House of Representatives
that would ban mandatory overtime beyond eight hours in one day, or 80 hours
in 14 days.

The national group says it struggles to keep the peace among member states
with activist union memberships, such as Massachusetts, and those who prefer
a more moderate approach, such as those in Southeastern states. Creating a
new national group would duplicate the American Nurses Association efforts, a
spokeswoman, Hope Hall, said yesterday.

The crux of the debate is whether an organization can represent nurse
managers and nurse educators as well as staff nurses, and still advocate
effectively for patients' and nurses' rights.

''There could be a conflict of interest,'' Eakin said. ''Many of the same
people who are telling us, `You've worked 12 hours and you're exhausted, but
you have to work another four hours,' could be a member'' of the American
Nurses Association, she said.

This story ran on page A02 of the Boston Globe on 9/21/2000.
© Copyright 2000 Globe Newspaper Company.

------------------------------------------------

Nurses Vow Activism on Work, Patient Issues

by Sarah Yang, WebMD Medical News

Sept. 21, 2000 (San Francisco) -- There can be power in numbers, and nurses
from across the U.S. and Canada say the time has come to tap into it.

More than 350 union leaders wrapped up a three-day conference in Berkeley on
Wednesday, confident that they have planted the seeds for a new national
labor organization that will unite nurses from California to Maine.

Speaking at a press conference capping off the unprecedented meeting, labor
representatives for hundreds of thousands of nurses said the health care
industry has been besieged by cuts from managed care and Medicare
reimbursements to the point that patient care is compromised.

"There's such a void out there for staff nurses to really be represented and
to have their issues examined and worked on in a logical manner," said Kay
McVay, RN, president of the California Nurses Association, which held the
event.

One big issue is mandatory overtime, a major focus of recent nurses' strikes
across the country. Just last week, U.S. Reps. Tom Lantos, D-Calif., and
James McGovern, D-Mass, introduced legislation prohibiting hospitals from
forcing nurses to work more than eight hours in a day or 80 hours over 14
days, except during a natural disaster or state of emergency.

But the nurses want such federal bills to be passed, not just introduced, and
they say the pull of a national union would make such efforts more effective.
They want minimum nurse-patient staffing ratios, a federal ban on mandatory
overtime, incentives to retain and recruit quality workers, and whistleblower
protection for nurses that complain about unsafe conditions at health
facilities.

There already is a national nurses' organization, called the American Nurses
Association, but McVay and the other nurses said they were dissatisfied with
the representation they have received from it.

"We felt that right now, we are not getting what we need from the American
Nurses Association," said Karen Higgins, chair of the labor relations program
of the Massachusetts Nurses Association.

"I have all the faith in the world that this [formation of a new national
union] is going to occur," McVay said. But she cautioned that it is still too
early to set a timetable for that to happen. "This is the first time we've
been able to bring people together and find out we're not alone. ... This is
just the first step, and I feel very positive about it."

Adding to the sense that action is needed soon are recent news stories
blaming poorly trained or overwhelmed registered nurses for thousands of
patient deaths and injuries nationwide. The reports seem to support what many
nurses had warned would happen: Cost cuts by hospitals are putting stress on
nurses and adversely affecting patient care. The blame, however, should be
placed on a health care system more focused on profits than patients, nurses
say.

"I think nurse errors are at the very least attributed to -- if not
completely dependent on -- the systems that are put in place by the
administration of the facilities in which they work," said Bud Campbell Jr.,
chair of the Economic and General Welfare Council at the Maine State Nurses
Association. "The facilities are the ones that require the nurses to work
extended hours and to take workloads that are at the beginning completely
unsafe, and then go on to blame the nurses for mistakes that they make for
working in those completely untenable conditions."

Kathleen Connors, RN, president of the Canadian Federation of Nurses Unions,
contrasted the "corporatization of health care" in the U.S. with Canada's
system, which guarantees care for all its citizens. "While we call for
improved nurse-patient ratios and more say in how the work gets done, the
desire to create profit is not the bottom line in the Canadian health care
system, and so the incidence of errors is not nearly so substantial."

Connors said the situation is nearing a crisis as more nurses retire or quit,
and fewer people are available to replace them, exacerbating the nursing
shortage worldwide. "It's a well documented fact that it isn't a North Americ
an phenomenon, it is an international phenomena," she said. "What we see are
acute shortages in Australia, New Zealand, Great Britain, and Germany."

The average age for nurses in the U.S. and Canada is in the mid-40s, she
said. McVay said more respect for nurses from the industry is needed to
attract a younger generation to the health care industry.

"There isn't anybody that's sitting here that's an RN that doesn't find a
great deal of satisfaction in what they do," McVay said. "We need to be able
to create an atmosphere that will allow us to go in to bring new people
along."

"Ultimately, the patient is the victim," Higgins said. "We are seemingly
getting caught in the middle of this. It's now time to say that, yes,
mistakes are being made, yes, patients are dying. But let's put the blame
where it belongs. ... Don't go to us, but fix what is wrong with this system
in health care."

© 2000 WebMD Corporation. All rights reserved.

------------------------------------------------------

RNs protest mandatory OT

Nurses meet in Berkeley to formulate steps against
practices they say will force them out of the profession

by Carolyn McMillan, Contra Costa Times

September 21, 2000

BERKELEY -- Nurses from across the United States concluded the first-ever
School for RN Activists on Wednesday with a vow to build a national movement
aimed at ending mandatory overtime and other practices they blame for driving
nurses from the profession and harming patient care.

The event drew about 350 registered nurses from half a dozen unions to the
Claremont Hotel to discuss the future of nursing and develop ways to flex
their political muscle.

"Nurses are no longer taking it -- we're forming something where we will have
a national voice," said Kay McVay, president of the California Nurses
Association, which hosted the event.

McVay and union leaders from Massachusetts, Maine, Pennsylvania, Rhode
Island, Minnesota and Canada said they were in the nascent stages of building
a more activist coalition with the underlying goal of a universal health care
system.

A national association of nurses exists, but several of the participating
unions said they were considering dropping their membership because the group
did not fight hard enough for the issues they care about. CNA left the
American Nurses Association several years ago for similar reasons.

Incessant cost-cutting in American hospitals has made nursing an increasingly
stressful job as RNs find themselves working dangerously long hours or caring
for too many patients, union leaders said. As a result, older nurses have
left the profession and younger workers often avoid the field.

The average nurse is about 47 years old, said Karen Higgins of the
Massachusetts Nurses Association.

"There's going to be a lot of us leaving in the next 15 to 20 years -- and
where will the replacements come from?" Higgins said. "We're in a situation
of crisis. We're becoming extinct before our own eyes."

At many hospitals, nurses frequently work 16 to 20 hours, Higgins and others
said. Nurses can face disciplinary action for refusing overtime, and can even
be stripped of their licenses.

"Mandatory overtime is in every state. Rather than using more nurses,
(hospitals) use mandatory overtime so they don't have to pay benefits," McVay
said. "It's a bottom line issue."

Some federal lawmakers agree that long hours have become a patient safety
issue and are adding to the nursing shortage. U.S. Rep. Tom Lantos, D-San
Mateo, introduced legislation last week to ban mandatory overtime for
licensed health care workers, except in cases of a natural disaster or other
emergency. A similar bill was introduced in the Legislature earlier this year.

Mandatory overtime has also become a major bargaining point in labor
contracts at hospitals all over the state, with CNA winning bans in recent
agreements with several East Bay hospitals.

"Mandatory overtime is a symptom," McVay said. "We all agree we need to take
profit out of health care and take health care off the stock market."

-------------------------------------------------------

Conference Emphasizes Patient Care Over Profits

by Michael Cook, Daily Californian

September 21, 2000

At the conclusion of a conference in Berkeley yesterday, nurse leaders warned
of a national crisis in patient care and condemned the increasing corporate
emphasis of medical services. The 350 participants at the International
Conference of Registered Nurses, representing almost 300,000 nursing staffs
across the United States and Canada, met for four days to discuss problems
facing the profession. Conference participants supported a proposed
legislative ban on mandatory overtime and heard calls for an international
movement of nurses.

"What brought us here was the good work of the California Nurses Association
in demonstrating that mandatory overtime issues, along with lack of staff and
patient safety issues are being faced by nursing organizations right around
the country," said Karen Higgins, of the Massachusetts Nurses Association.
"It was clearly time to get us all in one place and determine whether there
was something we could do."

California registered nurse Kay McVay agreed with Higgins, and said that the
conference helped clarify issues facing the nurses that had previously only
been seen as "local management issues."

"This is one of the most exciting experiences I have had," McVay said. "That
we could all come together, and talk about real issues concerning the whole
nursing profession and our patients, allowed us to reach agreement on
pressing issues."

McVay pointed to the increased corporatization of health care as a common
fear among conference delegates.

"Such medical corporatization, and the ensuing destruction of the health care
system, is a problem we are all facing," McVay said. "We need to take profit
out of health care, take health care off the stock market, and begin to treat
patients as our number one priority - not the last thing considered by the
medical system."

Most delegates, however, viewed the imposition of mandatory overtime for
nurses as their most immediate concern. Mandatory overtime has, in the last
few months, been a prominent issue in nurses' strikes in California,
Massachusetts, and New York.

In response, a bill has recently been introduced in the U.S. House of
Representatives prohibiting mandatory overtime for all licensed health care
employees except physicians.

Jill Furillo, national outreach coordinator for the California Nurses
Association, said that hospitals across the nation are currently requiring
nurses to work overtime on a regular basis.

"Nurses frequently complain that at the end of their shift, they no longer
have the stamina and mental alertness to deliver the quality of care patients
need," Furillo said.

This summer, the Bay Area, including a Berkeley hospital, was recently hit by
several strikes by health care workers demanding more staff.

According to an investigative report that recently appeared in the Chicago
Tribune, at least 1,720 hospital patients have been accidentally killed, and
9,584 injured in the United States since 1995 because of action or inaction
by nurses.

Bud Campbell, a nurse representative from Maine, attributed these statistics
to management cost-cutting, not individual nurse error.

"Those numbers are primarily caused, if not almost completely caused, by
management insisting on profit over good patient care," he said. "If you
don't have the necessary staff, or have staff that have worked 24 hours
straight, of course their ability to judge the best procedure will be
impaired - all because the health care system is becoming a profitable
industry, not a service for all Americans."

-------------------------------------------------

Nurses say lighter load is key to deficit

Shortages of staff, low morale aired at Oakland conference

by Suzanne Bohan, Oakland Tribune

OAKLAND -- Unless their load is lightened, a critical shortage of nurses is
inevitable, nursing activists said Wednesday at a conference at the Claremont
Resort and Spa.

"We feel we're in a crisis," said Karen Higgins, chair of the labor program
for the Massachusetts Nurses Association. "People are leaving the profession
because they know they can't deliver the kind of care they want to."

Higgins was one of 350 attendees from the United States and Canada at the
three-day conference, which concluded Wednesday. The conference focused on
building a new international organization of nurses to more forcefully
address pressing issues facing nurses in the workplace.

Repeatedly, the issue of mandatory overtime for nurses was identified as a
keystone issue.

"The issue of overtime has emerged and is now as hot an issue as any," said
Richard Holober, political director of the California Nurses Association, a
35,000-member organization based in Oakland and one of the conference
organizers.

On September 14, U.S. Reps. Tom Lantos, D-Monterey, and James McGovern.
D-Mass., introduced legislation (HR 5179) that would prohibit mandatory
overtime for registered nurses nationwide. On Wednesday, nurses were on
strike in Washington, D.C., protesting mandatory overtime, according to
Holober. At Stanford University's two hospitals, nurses staged a 51-day
strike in June and July protesting forced overtime requirements.

The issue is in part connected to cost-cutting decisions in the mid-1990s,
according to Holober.

"There was an effort in the 1990s to reduce the ranks of nurses and replace
professional nurses with lower skill nurses," he explained.

The policy proved "a fiasco," he said. "Hospitals have realized they can only
care for patients with professional nurses, so they're addressing the
shortage with mandatory overtime."

What's resulted, Holober said, are workdays that commonly run from 12 to 16
hours. "Workloads are exhausting," which leads to increased risk for patient
safety, he said.

A decline in the number of nursing programs at colleges and universities
nationwide is also contributing to the shortage. The trend in the mid-1990s
toward hiring lower-skilled nurses was part of the reason for the decline,
according to Holober, as is more attractive working conditions in other
fields.

"You retain nurses in the profession by giving them respect and recognition.
We're not seeing that." said Higgins. Young people, young women, have
tremendous opportunities now."

Another conference attendee, Kathleen Connors, President of the Canadian
Federation of Nurses Unions, said in Canada, there are now 262,000 registered
nurses, but only 20,000 of those are between the ages of 20 and 24. A similar
trend is occurring in the United States, Higgins pointed out.

"Our average age is 45 to 47," she said. "We can't continue the way we're
going."

-----------------------------------------------------

Fixing overtime misuse

Contra Costa Times Editorial

September 26, 2000

Nurses from across the country met in Berkeley last week to address a
critical issue in their profession -- mandatory overtime. The first-ever
School for RN Activists focused on starting a national movement to end this
widespread practice. It's good to see this matter challenged by those most
affected by it, and targeted for overdue correction.

Mandatory overtime has the potential for harming patient care.

The practice probably is, as the nurses contend, a major factor in driving
nurses out of a profession already hurting for trained caregivers.

Finally, there is the inhumanity of a system that comes close to forced
labor. Mandatory overtime is an oxymoron in the traditional sense of pitching
in to work extra hours in a pinch. In an earlier day, workers volunteered to
work overtime; most welcomed the occasional opportunity to fatten their
hourly paychecks.

Mandatory overtime eliminates the element of choice for the nurses or any
other employees. Keep working -- or else. In the case of nurses, refusing ov
ertime can often result in disciplinary action, even loss of one's license.

This is not good health care. Not for the nurses' health at an average age of
47, according to a statistic that came out of the Berkeley meeting. Not for
the well-being of the patients in their charge. Nurses can get tired and
perhaps inattentive after a shift that may last 16 to 20 hours. And nursing
is stressful work at best.

U. S. Rep. Tom Lantos, D-San Mateo, introduced legislation earlier this month
to ban mandatory overtime for licenses health care workers, except in times
of a natural disaster or other emergency. A similar bill was introduced in
the Legislature earlier this year. These measures deserve to move forward.

The California Nurses Association has won bans on mandatory overtime in
recent agreements with several East Bay hospitals.

These are welcome signs of progress.

At the same time, efforts should be stepped up to attract more people to the
nursing profession to eliminate the need for overtime as far as possible, and
to replace today's nurses who will be retiring over the next 15 to 20 years.

Address of original story:
http://www.contracostatimes.com/opinion/editorials/stories/xxtusec_20000926.ht
m

(c) 1999 Contra Costa Newspapers

---------------------------------------------------

New Jersey governor vetoes overtime legislation

by Kimberly Fryling, Assistant Editor, Healthcare Group

September 22, 2000

Yesterday New Jersey Governor Christie Todd Whitman conditionally vetoed
legislation that would prohibit mandatory overtime for healthcare workers.
This is the first legislation of its kind in the nation. (See related
article: NJ legislation would prohibit mandatory overtime.)

Whitman issued a conditional veto, meaning that, in principal, she agrees
with what the legislation is trying to accomplish but that she seeks changes
with certain portions of the bill. The changes involve authorizing the
Department of Health and Senior Services, in consultation with the Department
of Labor, to put out regulations setting a reasonable restriction to
mandatory and voluntary overtime. Whitman is recommending that the
departments develop guidelines outlining maximum number of hours worked per
day and per week, as they deem appropriate for hourly healthcare employees.
However, in emergency situations, hospitals and other healthcare facilities
should be allowed to override this maximum number of hours and require their
employees to work overtime.

At this time, the legislation awaits action from the New Jersey Assembly. If
the Assembly chooses to adopt Whitman's suggested changes or if the majority
of both houses of legislature override her veto, then this bill will become
law. However, a representative from Governor Whitman's office told Nurses.com
that in most cases of conditionally vetoed bills, the Assembly will concur
with the governor's suggested changes.

Whitman may have heard the message from the American Nurses Association (ANA)
released earlier this week. The ANA had pleaded with the governor not to veto
the bill and urged her to consider similar legislation that is now being
considered at the national level that would limit the number of hours
healthcare workers are forced to work. (See related article: Mandatory
overtime bill introduced in Congress.)

It appears New Jersey nurses are chalking this conditional veto up as a
victory rather than a defeat. In a press release from the New Jersey State
Nurses Association (NJSNA), Andrea Aughenbaugh, RN, and CEO of NJSNA noted,
"New Jersey legislators were successful with this bill, because they clearly
understood that health care workers' exhaustion carries a greater price and
now the Governor has heard the message, as well."

"We appreciate the fact that Governor Whitman listened and has heard
nursing's voice as we testified on the safety issue for prohibiting mandatory
overtime for routine staffing, especially the impact this method has on the
safety and quality care our patients deserve," Aughenbaugh added.

Copyright ©1996-2000. Nurses.com. All rights reserved.

------------------------------------------------------

A response to a letter by Diana Mason, RN N.Y., N.Y. in The American Nurse
September/October 2000 edition:

Regarding the opinions offered by Diana Mason in The American Nurse on the
issue of Massachusetts considering disaffiliating from the American Nurses
Association, I would like to respond.

I strongly agree with Ms. Mason's assertion that individual nurses and ANA
should be "more proactive and even militant ..." The fact that ANA and
individual nurses have not become more aggressive and militant is an
indictment against all of us, a profession which claims to be the sentinels
of the American health care system. I believe we will be held accountable
for this in the not too distant future. The fact that individual nurses have
not been more proactive and militant is more understandable when we know all
too well the personal price of speaking out alone.

As an individual member of the Massachusetts Nurses Association who has
worked closely with ANA staff, I can say the decision to support the
disaffiliation from ANA has not been an easy one for me, in fact painful at
times. I have listened to many varied opinions by those I respect deeply on
both sides of the issue. My decision was based on nursing's history, the
current state of the profession, and financial considerations among others.
After reviewing the facts as I know them, I personally feel strongly that as
things currently stand, this is the best move for MNA membership at this
time, and for all of nursing in the future.

To thoughtlessly insinuate that "Maine and Massachusetts think the national
level of advocacy is unimportant" is not only absolutely untrue, it suggests
an absolute lack of knowledge regarding the discussion that is occurring.
Only the most uninformed reader could possibly believe that to be true.

MNA, along with many other associations, has made many significant
contributions to the profession of nursing. MNA has continuously contributed
strong leadership in the ANA House of Delegates, and did so again only a few
months ago even though the proposal to leave was well underway. The
commitment of MNA to the national level of advocacy is undeniable.

We are a committed professional organization made up of well educated members
with many diverse viewpoints. The decision to consider disaffiliation was
made based on several solid arguments, none of which was to divide or weaken
the nursing profession. Blithe, inaccurate comments such as this only serve
to exacerbate the festering distrust which has led MNA to consider such an
action.
Barry Adams RN
MNA/ANA member

--------------------------------------------------

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