Nurses Rebel Across Country
Nurses at Understaffed Hospitals Balk at Mandated Overtime
by Julia Malone, Cox News Service
October 7, 2000
WASHINGTON -- A strike at a major hospital here has become the latest
distress call from the nation's nurses, whose ranks have been stretched thin
in the era of managed health care.
In the nearly three-week-old walkout, nurses at the 900-bed Washington
Hospital Center are decrying working conditions, especially mandatory
overtime, which they say threaten patient safety and make it difficult to
care for their own families.
"We have a life," read the sign worn by Deborah O'Neill as she picketed
outside the medical complex. She said that she works four hours overtime
almost every day in the increasingly busy operating room, which maximizes
hospital revenue by running late into the evenings, weekends and holidays.
"I try not to make mistakes," she said, but she added that fatigue, coupled
with the fast pace of the operating room, invites errors. "We're rushed. It's
an assembly line," she said.
Objections to mandatory overtime have helped spark recent strikes in
Worcester, Mass., at Stanford University's two hospitals in California, and
in Nyack, N.Y. All of the disputes were settled with agreements limiting
hospitals' power to insist on extra hours.
Concerns about overtime are also beginning to surface in non-union states, as
hospitals in many parts of the country operate with 15 percent or higher
vacancies in their nursing staffs.
"We have concerns from a patient safety perspective," said Stephanie Tabone,
the Texas Nurses Association's director of practice. She said her group is
finding evidence of mandatory overtime.
"There are limits for truck drivers and pilots," she said, adding that "there
may be a need" for limiting the number of hours nurses work.
In one Texas case, Laredo's Mercy Hospital agreed last year to limit
operating room nurses to no more than 60-hour work weeks after a nurse gave
the wrong medication while she was working a 72-hour week.
Such working conditions have taken on new meaning following findings by the
Institute of Medicine that nearly 100,000 patients die each year from medical
mistakes. Errors are often linked to overworked nurses, who administer most
of the medications and provide most of the care in hospitals.
Nurses, including their largest member group, the American Nurses
Association, blame overtime as a major contributor.
However, underlying complaints about mandatory overtime is a general lament
by nurses about the state of their profession in the aftermath of managed
care, which has squeezed hospital budgets, reduced the ratios of registered
nurses, and changed the nature of their work.
"We have all watched health care in this country change from providing care
to becoming a business over the last six or eight years," said Brenda
Christian as she sat inside strike headquarters, a few blocks from Washington
Hospital Center.
"When I started nursing 15 years ago, I could spend that extra five minutes
with a patient and hold their hand, brush their hair, give a man a shave so
that he felt good in the morning and felt good about himself.
"Now, nurses cannot practice nursing. They cannot be at the bedside to give
the patient that little extra word of support or that little sign of comfort.
It's 'Quick, quick, get it going. I don't care if your patient is crying, get
her into the operating room.' "
Her hospital, which was acquired recently through by the regional group
MedStar Health, operates on a private not-for-profit basis. However, the
administration keeps a close eye on revenues, especially when it comes to
making greater use of operating facilities.
"We are in a competitive environment," said Dr. William James Howard, medical
director for the Washington Medical Center. "More and more hospitals are
going to a seven-day week."
Howard said it was a mark of success that his institution has "a very busy
operating schedule at least six days a week."
He acknowledged that the pace requires overtime in some areas of the hospital
and said the hospital was responding to the nurses' concerns. But he
dismissed nurses' claims that patient care has been compromised.
"I do contradict that," he said. "We have multiple systems to make sure that
we do not make those kinds of mistakes."
Howard asserted that the striking nurses, represented by the Washington
Nurses Association, were chiefly interested in higher salaries.
"When they say it's not the economics, it's the economics," he said of the
nurses, who now average about $62,000 in annual pay, including bonuses and
overtime.
The strikers, who are seeking a 16 percent raise over four years, insist that
money is not the sticking point in their walkout.
"I'm on the line for my patients' safety," said Agatha Westerhoff, an
operating room nurse who concluded a protest letter to her administration by
describing her own stay in the hospital:
"In my thirty-six hour stay, I saw a nurse three times," she said. One tried
to give her a medication incorrectly, she said. "I stopped her. Her response
was 'I don't feel like going to the pharmacy to get the I.V.." or intravenous
solution, Westerhoff wrote, adding that she was double-charged for many items
on her bill.
"That's why I am on the line," she wrote.
© Cox Newspapers
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D.C. Unionized Nurses Strike
by Derrill Holly, Associated Press
September 20, 2000
WASHINGTON (AP) - Unionized nurses at the largest private hospital in the
nation's capital went on strike Wednesday, but the facility remained open
with hundreds of replacements.
``We have 540 nonunion nurses, and 500 contract nurses on the job with more
on the way,'' said Barbara Ware, a hospital spokeswoman.
Attending physicians with privileges at the hospital are expected to help
care for their patients during the strike. Two hundred interns and residents
also remained on the job.
Although the trauma unit was temporarily closed to new patients early
Wednesday, officials denied any connection to the strike, citing overflow
from the hospital's intensive care unit as the cause.
Talks with a federal mediator continued late Tuesday night, but failed to
break impasses over several issues with MedStar Health Inc., which operates
the 907-bed hospital. No new talks were scheduled, as several hundred nurses
picketed outside the facility Wednesday.
``We put a number of issues on the table and nothing worked,'' said Sandra
Falwell, president of the District of Columbia Nurses Association. The union
represents 1,279 registered nurses at Washington Hospital Center who have
been without a contract since Sept. 10.
The union is seeking wage increases of between 22 percent and 28 percent over
three years. Management has offered 16.5 percent, citing recent settlements
between the DCNA and other area hospitals.
``They refuse to deal with the mandatory overtime issue,'' said Falwell, who
contends nurses are often required to work 50 to 60 hours a week.
Hospital officials say nurses volunteer for extra duty, except when they are
forced to stay until they are relieved during snow emergencies and other rare
occasions.
``I can count on one hand the times I've had to invoke mandatory overtime,''
said Paula Hallenbeck, a nursing supervisor who remained on the job.
Copyright © 2000 The Associated Press. All rights reserved.
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Hospital Center Nurses Strike
by Avram Goldstein, Washington Post
September 21, 2000
More than 1,200 nurses walked off their jobs yesterday at Washington Hospital
Center in a contract dispute that strikers said was triggered more by union
objections to mandatory overtime rules than by demands for higher wages.
Hundreds of D.C. Nurses Association members took to the streets at 5:30 a.m.,
chanting and carrying signs at Irving and First streets NW. They said their
primary goal was to gain greater influence over hospital policies that affect
the quality of patient care.
All day long, passing cars and trucks sounded their horns in support, and the
nurses cheered in return. It was the first strike at the region's largest
medical facility since 1978, when nurses walked out for 31 days.
Inside, city officials and hospital executives reported no significant
service disruptions. A spokeswoman for MedStar Health Inc., the
Columbia-based nonprofit that owns the 907-bed facility, said the workload
was heavier than usual.
Filling in were 625 replacement workers from across the country and 250 nurse
managers who returned to direct patient care, said Lisa Wyatt, the hospital's
vice president of public affairs.
The hospital contracted with Denver-based U.S. Nursing Corp. to provide the
replacements. That company specializes in staffing strikebound hospitals with
outside nurses during work stoppages.
"Everything is going unbelievably smoothly," Wyatt said. "One of our
physicians told the medical director that it's actually going better than
usual."
Wyatt said the hospital had 741 inpatients yesterday and that surgeons
performed about 35 operations, including 11 heart operations, in addition to
about 50 cardiac catheterizations.
"We have seen no change in terms of admitting patients here," Wyatt said. "We
want our nurses to return as quickly as possible, but we are prepared to keep
this hospital operating on a business-as-usual basis until the strike is
settled."
The striking nurses complained that management has abused its power, solving
persistent scheduling problems in the operating rooms and other units by
requiring nurses to stay on for overtime shifts. Nurses said hospital
managers do this partly because Washington Hospital Center, like hospitals
nationwide, suffers from a chronic shortage of available nurses.
"These nurses are tired," said Ramona Gonzalez, a 20-year veteran of the
hospital. "They want their benefits. They want their holiday and vacation
time."
Gonzalez said the nurses want a program restored that would allow them to
work weekends only, putting in two 12-hour shifts.
Bargaining broke off late Tuesday, and no other meetings have been scheduled,
according to officials from both sides.
The hospital has offered the nurses an aggregate raise of 16.5 percent over
three years and a limit on mandatory overtime to two shifts every six weeks.
Wyatt said the nurses want raises of 22 to 28 percent over the three years.
The union, though, said it has asked for a wage increase of 20 to 22 percent
over three years, plus tighter restrictions on required overtime; only in
emergencies would nurses be forced to stay on after their shift.
Washington Hospital Center said its offer compares favorably with raises
accepted by the D.C. Nurses Association for other hospitals in the past year.
Under the expired contract, the average nurse at Washington Hospital Center
collects $60,626 a year, including base pay, bonuses and overtime.
On the picket line, nurses complained that hospital officials have refused to
give them a voice in setting hospital policies. "They're not interested in
our input or heeding our alarms," said Sharon Clark, an emergency nurse who
has worked at the hospital for 25 years.
She said the nursing shortage has forced the hospital to assign recent
nursing school graduates as supervisors and left some nurses overwhelmed with
too many patients to care for.
D.C. Health Department Director Ivan C.A. Walks said the replacement nurses
began months ago to apply for temporary licenses to practice in the District.
So far, he said, the city has issued 700 such permits.
"All the nurses are D.C. licensees and working legally," he said. Any
complaints or concerns about the quality of care in the hospital are
investigated immediately by two Health Department officials who are stationed
in the hospital, Walks said.
Clark said she bears no ill will toward the replacements. They are to be paid
an average of $2,700, plus expenses, to work five 12-hour days a week. Some
specialized nurses will get as much as $5,000.
"I'm not angry," Clark said. "I'm a little disillusioned. For [the
replacement workers], it's a personal necessity. I'm hoping they're as
competent as the nurses who are striking."
The local nurses have no strike fund, but union officials said the job action
could go on for a long time because nurses are always in demand for temporary
work--even while they strike.
"It's difficult for nurses without benefits," said union official Gwen E.
Johnson. "Staying out longer will be a financial challenge, but there are
options."
© 2000 The Washington Post Company
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Imported Nurses Step In for Strikers
by Avram Goldstein, Washington Post
September 24, 2000
Some 1,200 striking nurses have stayed away from their jobs at Washington
Hospital Center since Wednesday, picketing and shouting for higher wages,
limits on mandatory overtime and a greater voice in hospital policy making.
But the medical facility has not missed a beat. A battalion of temporary
nurses from across the nation has converged on the hospital--the largest in
the Washington-Baltimore region--and to the delight of the medical staff, has
kept the place humming.
The 907-bed hospital had a busy week, with more than 770 patients on hand
Thursday and Friday. Yesterday, the count fell to 684, still busy for a
weekend.
The replacements work for Denver-based U.S. Nursing Corp. The privately held
company flew in nearly 650 people such as Cas Szymoniak, 30, from Birmingham,
Ala., who is assigned to a hotel and shuttled in each day to care for
patients recovering from cardiac surgery.
The company has a virtual lock on an unusual marketplace niche: It provides
replacement nurses for hospitals whose nursing staff members are on strike.
Without substitutes, the hospital would have to cut services significantly
until the strike ended. Hospitals pay U.S. Nursing for all employee expenses
and salaries, plus fees to cover operation of a central office with more than
100 staff members.
To Szymoniak and other replacement workers, many of whom come from states
where nurses are low-paid and lack union protections, the strike is an
opportunity to collect fat paychecks while providing care to patients whose
need for medical attention is nonnegotiable.
In a financially driven health system in which nurses struggle for money and
power, Szymoniak sees his temporary assignment as an act of
self-determination.
"The nurses back home are grumpy and unhappy and stuck in this life," he
said. "I'm making things work for me instead of me working for someone else."
Replacements go home with typical weekly paychecks of $2,700--far more than
they could earn at home, where the cost of living is lower than in northern
cities, where strikes are more common. In a few top specialties, they can
earn more than $4,000 a week.
When Szymoniak gets home, he figures that for the rest of the year, he will
have to work only one day a week as a contract nurse in Birmingham. That will
enable him to spend more time with his wife while paying off debts and
getting his life in order. "I won't have to work when I'm 70," he said.
But nursing unions across the nation despise U.S. Nursing and its employees.
They say the company emboldens hospital administrators to not compromise with
nurses unions and then sends in mercenaries to get through the work stoppages
that follow.
Charles Idelson, spokesman for the California Nurses Association, said U.S.
Nursing workers performed poorly at two Stanford University hospitals during
a 50-day strike that ended in July.
"This corporation doesn't care about the safety of patients inside that
hospital and is only in there to make as much money as they can, as quickly
as they can," Idelson said. "Patient safety is their last concern."
State health officials in California said they found no serious problems
created by the replacements. A U.S. Nursing worker from Arizona died at her
motel after working 20 consecutive days, but a coroner ruled that she died of
natural causes.
While Washington Hospital Center nurses are demanding better working
conditions, including limits on mandatory overtime, U.S. Nursing employees
expect to work 12 hours a day every day for the first two weeks, then to cut
back to five 12-hour days a week.
So far, D.C. Health Department Director Ivan C.A. Walks's staff has cited no
failures at the hospital. "They aren't seeing anything that makes us worried
or want to step in," Walks said Friday. "I haven't heard any reports of bad
care."
Indeed, doctors at the hospital Friday were elated with what they described
as the positive and professional atmosphere. Gastroenterologist David
Morowitz praised the quality of the work done by temporary nurses in the
endoscopy department. He was even more impressed with their attitudes.
"They're not rude," Morowitz said with amazement. "I've got a technician who
says 'Thank you.' "
Hospital medical director Wm. James Howard lauded the nurses for being able
to walk into an unfamiliar setting and make things work. "It's kind of like
being the fighter pilots of nursing," he said.
U.S. Nursing employees and executives are accustomed to being condemned by
strikers, but they say the need for patient care trumps any contract dispute.
"If your mother was in this hospital and the nurses walked out, wouldn't you
want another nurse to come in and take care of her?" said David Pointer, 42,
an Alabama nurse in Morowitz's unit.
The replacements have no contact with the strikers, who are picketing a block
away from the entrances. They know the strikers resent them, but one U.S.
Nursing employee said he sees his role as enabling the unions to express
themselves without endangering public health.
"We allow them to get their point across," said Robert Sampson, 47, of
Houston, who was assigned to the emergency room.
The company maintains a roster of 20,000 registered nurses. As strikes draw
near, U.S. Nursing arranges air travel, lodging and work schedules, and the
nurses come for a few weeks or a few months and might rotate in and out. The
longest strike the company worked lasted nine months.
The company has a few married couples who work strikes together, said its
general counsel, Richard M. Green. A few workers have married after meeting
during an assignment. With or without romance, many U.S. Nursing workers see
this as an exciting break from routine.
"Most women work more than 12 hours a day," Green said. "They take care of
their children and husbands and also work. If you have a bed made for you,
you're around friends and staying in a hotel, and you're eating meals that
you don't have to prepare, working a 12-hour shift is not onerous--it is an
adventure."
© 2000 The Washington Post Company
------------------------------------------------
Editor's Note: These valiant Washington Hospital Center nurses deserve
all-out material and moral support. As in this year's other heroic strikes in
New York, Massachusetts and California, mandatory overtime and patient safety
are the central issues. For ongoing information, go to DCNA's new web site
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