The Sunday New York Times ran a front-page story on the growing nursing
shortage (see below), aptly positioning the issue as a health care crisis
that is threatening the quality and safety of patient care. The MNA worked
with the Times in developing this story, which helps raise awareness of this
issue and the need for legislative action to solve this growing problem. The
article mentions federal legislation, drafted with the help of the MNA, to
ban mandatory overtime, as well as legislation filed in a number of states,
including Massachusetts (in our case, HB 1186 An Act Relative to Sufficient
Nurse Staffing to Ensure Safe Care), that would mandate safe nure-to-patient
staffing ratios. The MNA believes that regulation of staffing levels is the
best and most important step that can be taken to protect patients and save
the nursing profession. To learn about this bill, and other pieces of
legislation that can protect patients and nurses, visit the MNA web site
<http://www.massnurses.org>.

Nursing Shortage Is Raising Worries on Patients' Care
<http://www.nytimes.com/2001/04/08/business/08NURS.html>

Problem May Get Worse
More Nurses Join Unions -- Complaints of Long Shifts and Rising Workloads

by Milt Freudenheim & Linda Villarosa, New York Times

April 8, 2001

Nurses, hospital executives and health care experts say that a shortage of
nurses across the country is becoming so severe that it threatens patient
care.

The vacancy rate for nursing positions at 73 hospitals in New York,
Westchester and Long Island is averaging 8 percent, up sharply from 5.5
percent in 1999, the Greater New York Hospital Association said last week.
The shortage is even worse in California: vacancies in the 470 hospitals
there averaged 20 percent in December, according to the California Healthcare
Association.

At Westchester Medical Center in Valhalla, N.Y., the largest and busiest
hospital between New York City and Albany, more than 25 percent of the
positions for operating-room nurses were unfilled as of late last year.
Surgeries backed up and some were postponed, sometimes for several days.

Since Jan. 1, the hospital has filled about half the openings by recruiting
from other parts of the hospital, bringing in recent nursing school
graduates, and hiring. But Ellen Widera, a longtime nurse at Westchester
Medical, says it often takes months for new people to learn the operating
room routine. "It is stressful having to do their job and your job, sometimes
at the same time," she said. "You're up to your elbows in hepatitis blood and
AIDS blood. It's dangerous." The hospital, which currently employs 1,500
nurses, had 190 openings for nurses on March 1, up from 144 only last
November.

Because of short staffing, many nurses say they are forced to stay on the job
when they are exhausted after a 12-hour shift. "It really ought to be illegal
for nurses to work double shifts," said Lucien Leape, an expert on patient
safety at the Harvard School of Public Health. "You don't allow airline
hostesses to work more than eight hours. Why would anybody think nurses are
less important?"

Hospital administrators and nurses expect the shortage to worsen. Enrollment
in nursing programs is declining even as the population ages. The average age
of nurses is rising.

And some nurses are becoming bitter. The shortage means those still on the
job are responsible for more patients, and those patients are often sicker,
thanks to managed care requirements that more care take place outside
hospitals.

Patients already find it harder to get a nurse to respond promptly when they
call for help. Eighteen percent of consumers rated their last hospital stay
fair or poor in a survey reported in 1999 by Karen Donelan and Robert J.
Blendon of the Harvard School of Public Health.

Frustrated, growing numbers of nurses are joining unions that threaten and
sometimes call work stoppages as their militancy increases. Working
conditions in hospitals were a central issue in at least 36 strikes by nurses
in the last two years, including three in 1999 by the New York State Nurses
Association. Many nurses are also pressing for state and federal staffing
rules.

Hospital executives say they would hire more nurses if they could find them,
but nurses say working conditions in hospitals are driving many of them out
of the profession.

"The nursing shortage is one of the dominant issues in health care today,"
said Peter Buerhaus, associate dean at the Vanderbilt University School of
Nursing in Nashville, whose findings were published in The Journal of the
American Medical Association last year. "In some cases the problem is so
severe that hospitals have had to shut down nursing floors and cancel
surgeries. This crisis has the potential to create a disaster scenario in
terms of the quality of care."

In many hospitals, nurses say they are required to take care of 10 or more
medical and postsurgical patients at a time, and those patients are often
seriously ill. They complain of injured backs after lifting heavy patients
and of risky accidents with contaminated needles.

"In the past year, the number of patients per nurse has increased and
workloads have increased," said Relie Dema-Ala, a nurse at Glendale Memorial
Hospital in Glendale, Calif. "The work is tremendously hard and stressful,"
she said. On Wednesday, nurses at Glendale Memorial voted 167 to 136 to
affiliate with the California Nurses Association.

At the same time, adjusted for inflation, average nurse salaries have hardly
changed since 1992, according to a report in February by the Bureau of Health
Professions in the federal Department of Health and Human Services. The
average salary of a full-time registered nurse was $46,782 last year, it
said. Hospitals, squeezed by managed care, have generally kept their salaries
in check.

There were 2.2 million registered nurses working in health care last year,
according to the Bureau of Health Professions report, but 494,000 nurses were
not using their licenses, compared with 443,000 in 1996 and 387,000 in 1992.

"We've burned out an entire generation of care givers," said Jeff Goldsmith,
president of Health Futures, a hospital consulting firm.

Hospital executives say they are trying hard to recruit more nurses, offering
perks like health club and spa memberships, "night out" baby- sitting for
nurses' children and even vacations in Hawaii.

The Tenet Healthcare Corporation, the second-largest for-profit hospital
chain, is experimenting with providing cordless phones for nurses to use at
work, scholarships for their children and discount purchasing programs. Tenet
would like to hire 3,000 more nurses for its 110 hospitals, said Alan R.
Ewalt, executive vice president for human resources.

But recruiting has been only moderately successful, and demand for bedside
nurses has outpaced additions to the work force. There are now 100,000
openings for registered nurses, according to Joseph Boshart, president of
Cross Country Travcorps, one of the largest temporary nurse staffing
companies.

The American Association of Colleges of Nursing in Washington said that enrol
lment of nursing students in entry-level bachelor's degree programs fell by
2.1 percent in the fall of 2000, the sixth annual drop. The lower enrollments
mean the average age of nurses is rising. The health professions bureau says
the average age of the 2.6 million registered nurses is 45.2 years and
rising. In 1980, 52 percent were estimated to be under 40, compared with 31.7
percent currently. And only 18.3 percent of nurses are under 35, compared
with 40.5 percent 20 years ago.

Older nurses are often less willing to take on more patients and mandatory
overtime. "Some nurses are just unable physically to handle the heavy demands
of patients," said Linda Aiken, director of the Center for Health Outcomes
and Policy at the University of Pennsylvania School of Nursing. In a recent
survey in Pennsylvania, 41 percent of the 14,000 nurses responding said they
were dissatisfied with their job, and 22 percent were planning to quit within
the next year.

P. K. Scheerle, a nurse who is now chief executive of American Nursing
Services, a temporary staffing agency, said: "When I was a young nurse I used
to be able to work 12-hour shifts, but now that I'm in my 40's and with
children at home, if I worked that kind of shift, muscling eight patients,
I'd be totally exhausted."

About 350,000 of the 2.2 million nurses working in health care are union
members today, up from 300,000 in 1995, according to the Census Bureau. And
the nurses unions are becoming more active: the Massachusetts Nurses Ass
ociation voted to leave the American Nurses Association on March 24, saying
the national group was too moderate. The California Nurses Association, which
became independent in 1995, announced an alliance last month with the United
Steelworkers of America, which already represents other employees in a number
of hospitals.

"Wages are always an issue, but they are not the principal issue," said Susan
Bianchi-Sand, director of United American Nurses, the labor union affiliate
of the American Nurses Association. "Safe staffing and the quality of patient
care are higher priorities."

Nurses are getting increasing attention from legislators. In Washington, they
have been pressing, with bipartisan support, for increased federal subsidies
for nursing education. And last month, Representatives Tom Lantos, Democrat
of California, and James P. McGovern, Democrat of Massachusetts, introduced
legislation that would ban mandatory overtime for nurses.

But last week, President Bush proposed to cut spending for medical education
by 60 percent, to $140 million from $353 million.

California, Kentucky and Virginia are setting standards for appropriate
staffing. Legislators have introduced less specific proposals in New York,
Ohio and Oregon.

In addition, 15 states, including New York, Connecticut, California and
Illinois, are weighing bills that would prohibit forced overtime for nurses.
Maine passed an overtime measure, and New Jersey is drafting overtime
regulations.

"Mandatory overtime is a huge issue," said Stephanie Reed, a lobbyist in
Washington for the American Nurses Association. "Nurses have to work overtime
when they are exhausted. The nurses have a tremendous fear of making
mistakes. It's a patient safety issue."

Copyright 2001 The New York Times Company

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

Hats Off to the California Nurses Association for their fifth successful
organizing campaign in two weeks (see press release below)! As the
Massachusetts Nurses Association pursues final steps toward disaffiliation
from the American Nurses Association, it is instructive to look to the
California Nurses Association, which was the first state to choose this path
back in 1995. Since disaffiliating from the moderate ANA, the California
nurses have utilized their resources to wage an aggressive campaign on behalf
of patients and the front-line nurses who care for them. This effort has
resulted in passage of the nation's first safe staffing legislation, and in
nearly doubling their membership from 20,000 in 1995 to more than 36,000
members today. Coincidentally, the MNA currently has 20,000 members and has
safe staffing legislation before the Massachusetts legislature. The nurses of
Massachusetts, like those in California, are ready and willing to organize,
be it in the workplace, in their communities and in the halls of the
legislature for fundamental changes in nursing and the health care system. To
learn more about what the MNA is doing to support reform of our health care
system, including our primary goal of passing a safe staffing bill, visit the
MNA web site at www.massnurses.org <http://www.massnurses.org>.

For Immediate Release
April 12, 2001

San Gabriel RNs Vote by 74% for Calif. Nurses Assn.
Fifth So. Calif. Hospital Win for CNA in 3 Weeks

San Gabriel Valley Medical Center Registered Nurses voted by 74 percent late
Wednesday to affiliate with the California Nurses Association. Results of the
secret ballot vote, conducted by a neutral private arbitrator, were 159 to 55.

The San Gabriel hospital is the fifth Southern California facility in just
two weeks where the RNs elected to join CNA, the state's largest organization
of nurses. All together, CNA has won the five elections to represent some
1,700 RNs by an aggregate 72 percent.

"We feel so proud to be part of a collective voice, led by the California
Nurses Association, which has provided us this opportunity to be an advocate
for patients and nurses. We feel very happy to be part of this movement,"
said Marina Bass, RN, who works in the Definite Observation Unit at San
Gabriel.

"This is a snowball rolling in Southern California," said Kathy Patane, RN, a
City of Hope nurse who is on the CNA Board of Directors representing the Los
Angeles area. "It's exciting to see nurses empowering themselves."

Becky Lopez, RN, an intensive care nurse who has worked at San Gabriel for
over 19 years, said she was "really looking forward to having a stronger
voice for patient advocacy and working with a professional organization. I'm
excited to work with all the other nurses here to assure safe staffing and
make our medical care here the best we can."

"When the numbers were announced, we were all screaming," said Jennie Zhang,
RN, a recovery room nurse at San Gabriel. "It feels so powerful to see people
coming from other departments and other hospitals. I really feel that we are
all together, and not alone."

"I'm so happy that we took one big step towards realizing our dreams, and to
be a part of a big organization that has the same goals that I have, to
improve our working conditions in our hospital and to be treated fairly,"
said Sony Palpallatoc, an ICU RN at San Gabriel.

"I'm hopeful that with CNA's help, I can enjoy the future at my hospital,"
added Debra Abdessian, another San Gabriel RN.

The San Gabriel victory continues a remarkable wave of pro-CNA votes by RNs
in hospitals that are part of the Catholic Healthcare West system,
California's biggest hospital chain and the largest Catholic system in the
Western United States.

In the past two weeks, RNs at California Hospital Medical Center in downtown
Los Angeles, Glendale Memorial Hospital and Health Center, and Community
Hospital and St. Bernardine Medical Center, both in San Bernardino, have also
voted for CNA.

RNs at two other CHW hospitals are also voting soon on CNA representation.
Nurses at Marian Medical Center in Santa Maria on California's Central Coast,
vote tonight, and an election is set at St. Dominic's Hospital in Manteca
next week, April 17 and 18.

All the elections are being conducted in accordance with a landmark
organizing and representation agreement for unrepresented RNs in California,
Arizona, and Nevada signed last month by CNA and CHW.

The pact provides for expedited private elections, a pre-election environment
free of employer coercion and intimidation to assure a fair, democratic
decision by the nurses, and assurances that the RNs are free to discuss
issues of CNA representation among themselves.

With the San Gabriel vote, CNA now represents over 6,700 RNs in 20 CHW
hospitals, and over 36,000 RNs overall.

Contact: Charles Idelson, 510-273-2246 or pg, 415-559-8991, or David Johnson,
310-240-1900.

David Schildmeier
Director of Public Communications
Massachusetts Nurses Association
800-882-2056 x717 (Within Mass. only)
781-830-5717
781-821-444(fax)
781-249-0430 (cell phone)
508-426-1655 (pager)

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

Nursing a Grievance
<http://www.thenation.com/doc.mhtml?i=20010416&s=nichols>

by John Nichols, The Nation

April 16, 2001

Six years ago the California Nurses Association -- a militant union that has
become a prime mover in campaigns for national healthcare reform, an ironclad
patients' bill of rights and whistleblower protections for nurses -- broke
with the American Nurses Association. Now, following the CNA's lead, the
20,000-member Massachusetts Nurses Association has voted by a 4-to-1 margin
to end