Critical condition
by Diane E. Lewis, Boston Globe
May 6, 2001
Fewer nursing school graduates and an aging population of registered nurses have led to a nationwide shortage that is prompting hospitals and health care facilities around the country to scramble for new talent.
At the same time, some veteran nurses are working longer hours to compensate for a shortfall that will probably worsen as the nurses who are most in demand draw closer to retirement, specialists say.
"Every year, the number of nurses has gone up, but the amount of nursing care needed by the public is going up, too, because the baby boomers are now aging," said Robert Rosseter, director of public affairs for the American Association of Colleges of Nurses in Washington, D.C. The group represents 550 colleges.
"We now know that by 2010 there will be a 20 percent shortfall in the number of nurses needed around the country," he added. "The average age of a nurse is now 45. So, within 10 or 15 years, many will be retiring. That, combined with the increased need for new professionals, are two primary factors contributing to the problem."
Most sought after are nurse anesthetists, critical care and operating room nurses, emergency room nurses, pediatric intensive care nurses, oncology or cancer care nurses, and cardiac and gerontology nurses. In some areas of the country, nurse midwives are also in demand.
That's good news for new nursing grads like Sarah Malloy, 22, of Southbury, Conn. A day after attending a recent career fair for registered nurses, she landed an interview at Massachusetts General Hospital. Last week, the hospital hired her to care for patients who have serious medical conditions or have just undergone surgery.
"I gave them my resume and the next day they called," said Malloy, who graduates from the Boston College School of Nursing on May 21. "I was impressed with that, plus the salary was competitive."
Malloy recalled some hospitals so eager to attract qualified graduates they mentioned their nurses were represented by the Massachusetts Nurses Association, an 11,000-member union (sic) and professional association.
At MGH, Malloy sealed a deal permitting her to work four days per week. Her weekly schedule includes two 12-hour shifts and two eight-hour shifts, as well as work on alternating weekends.
But for every new graduate who lands a good job, there is a veteran nurse who says the shortage has placed more demand on their time and services, prompting some to leave the profession.
"Right now, just about every acute care facility in the country is in dire need of nurses," said Barbara Norton, a 44-year-old registered nurse in the neonatal intensive care unit at Brigham & Women's Hospital in Boston.
"We are all getting older and there are not enough younger nurses coming up behind us," added Norton, who chairs the hospital's MNA bargaining unit. "So, clearly the options for people going into nursing right now are greater. On the other hand, older experienced nurses are finding that the pace at some hospitals is more chaotic, the patient pressures are greater, and the overtime is extreme."
Rosseter acknowledges working conditions need to be examined closely, but adds "the perception that conditions are extremely bad and the perception that nursing is no longer a secure field has scared some people away. The truth is, nursing has become a very secure field."
Nursing shortages became a critical issue here after Massachusetts hospitals, feeling pressure to reduce costs, laid off thousands of highly paid nurse specialists in the 1990s, according to Judith Shindul-Rothschild, an associate professor of nursing at Boston College.
When the number of acutely ill elderly patients soared later in the decade, many hospitals found they lacked enough experienced staff. The situation worsened when applicants to nursing schools fell 5 percent at the end of the decade, and some registered nurses began retiring.
The US Bureau of Health Profession's nursing division puts the average nursing salary at $46,782, based on the 2000 US Census. Meanwhile, health care consultants Martin, Fletcher of Texas, report an overall average salary of $48,972 as of April 2001. The figure includes salaries of new and veteran nurses.
In a study of 2,000 hospitals last year, Martin, Fletcher found 85 percent now offer signing bonuses, up from 67 percent in 1999. The bonuses ranged from $2,000 up to $15,000. The average bonus was $6,500.
Most hospitals offer $36,000-$45,000 to start, depending on the region, say industry specialists. Although nursing school applications are down 1.2 percent in New England, many hospitals still feel the sting of prior cost-cutting measures. In Massachusetts, Shindul-Rothschild said, one top teaching hospital offered a Boston College graduate $45,000 to start.
Some small hospitals in Massachusetts are offering nurses 20 to 30 percent less than the amount paid new hires at larger institutions, noted MNA spokesman David Schildmeier.
The University of California at Irvine Medical Center offers a $3,000 signing bonus to nurses who are willing to work in such hard-to-recruit areas as pediatrics, critical care, and the hospital's pediatric intensive care unit, said nurse recruiter Connie Worden.
"Right now, nurse recruiting is more focused than it was before," noted Worden. "We used to run an ad and attend a job fair or two. Now, we have to partner with nursing schools to get new grads, attend several job fairs, and attend conventions all over the country. I've been as far as Canada to get our name out and to recruit."
Rosseter believes that as more occupations have become available to women, many would-be nurses shifted to careers in medicine, biotechnology, biomedical engineering, biology, anesthesia, and other fields.
"Oftentimes, people do not understand that nursing involves many more occupations than caring for patients," said Rosseter, whose organization has joined 25 others in launching a campaign to attract more people to the profession. "There are nurses who teach, do nurse research, hospital administration, or work in settings other than hospitals. Some are involved in home health care. Others are in elder care facilities, government facilities or they work at businesses."
Shindul-Rothschild says nurse salaries in this region must be increased, and she said greater efforts must be made to attract interns from urban schools.
"The latest statistics from the 2000 US Census and the US Division of Nursing show that when you control for inflation, nursing salaries have not risen much in Massachusetts over the last decade," said Shindul-Rothschild. "And yet, the two most important issues to nurses, are quality of work life and salary."
Diane E. Lewis can be reached by e-mail at dlewis@globe.com.
© Copyright 2001 Boston Globe Electronic Publishing
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FOR IMMEDIATE RELEASE
Contact: David Schildmeier (MNA) (781) 821-4625 x717 or (781) 249-0430 (Mobile)
St. Elizabeth's Nurses Celebrate Nurses Week on the Picket Line May 9th and 10th Protesting Poor Staffing, Mandatory Overtime and the Need for Salary Hikes to Recruit Nurses
BRIGHTON, Mass - The week of May 6 - May 12 is National Nurses Week, but the nurses of St. Elizabeth Medical Center in Brighton will not be attending any of the Nurses Week events sponsored by hospital management this year. Instead, they will be boycotting these events, and appealing to the general public for support for their call for increased salaries to help improve substandard working conditions and unsafe staffing levels at the facility caused by a loss of nurses to better paying, better staffed facilities in the area.
The nurses will be conducting informational picketing outside the main entrance to St. Elizabeth's Medical Center, located on 736 Cambridge St. in Brighton, on May 9, 2001 from 11 a.m. to 6 p.m. and on May 10, 2001 from 3 p.m. - 6 p.m. The nurses are currently working under a 5-year contract. While the contract runs through 2003, the nurses have appealed to the hospital to reopen the contract to negotiate much needed solutions to severe problems with staffing, mandatory overtime and the nurses' salary. The hospital has refused to reopen the contract to address the staffing and mandatory overtime issues, but has agreed to conduct informal discussions over the nurses' pay scale. On April 26, the hospital met with the nurses and offered an additional 2.5 % increase over the next two years. The nurses took the offer back to the rank and file membership on April 30, where the offer was resoundingly rejected.
"Staffing at this hospital is chronically inadequate and, all too often, unsafe," according to Cece Buckley, RN, a critical care nurse and co-chair of the Massachusetts Nurses Association collective bargaining unit at the facility. "We're very disappointed that the management of this hospital refuses to seriously address these concerns, especially while our patients are subjected to inadequate care, and while nurses continue to leave this hospital because of those very conditions. We are also extremely disappointed at their half-hearted attempts to address our salary concerns, as this is the primary reason we are losing nurses to other facilities."
In addition to holding the picketing, the nurses have taken additional steps to protect their patients, including sending a strongly worded letter of appeal to the hospital's board of trustees, which includes a petition signed by more than 400 nurses. The letter to the trustees is both a plea for intervention and a warning about the impact on patient safety if appropriate steps are not taken to address the nurses' concerns. It reads, "The nurses of this hospital want you to know that we are headed towards a crisis at this institution and that steps need to be taken to ensure this facility can live up to its own mission statement, and its commitment to quality patient care. As we continue to suffer the effects of a dramatic nursing shortage, this facility cannot maintain safe standards of care nor improve our dangerous working conditions without first instituting a pay scale that will retain and recruit the highly skilled nursing staff required of this institution."
On both fronts, their concerns about staffing conditions and their pay, the nurses have a very strong case to make. In the past year, nurses at St. Elizabeth's have filed more than 300 official reports of unsafe staffing conditions, where nurses signed a form objecting to their patient assignment because it placed their patients' lives in jeopardy. In addition to being assigned too many patients to care for on a regular basis, mandatory overtime is a regular occurrence at the facility, and the dangerous practice is being used as alternative means of staffing the facility.
Buckley is well aware of the dangers of the practice of mandatory overtime. She tells a story of being forced to work extra hours against her will, and against her doctor's orders when she was pregnant last year.
"I was eight months pregnant, working in a surgical intensive care unit," she explained. "While I usually work 12-hour shifts, my doctor had given me a note for my managers telling them I shouldn't work past 8 hours, given that I was beginning to have Braxton Hicks contractions and I needed to be careful about my work level. I was working eight-hour shifts, when at the end of one shift with a unit filled with very compromised patients, there was no one to replace me. A supervisor asked me to stay. I refused to volunteer, citing my medical condition. The supervisor agreed and called the nurse manager at home who then mandated me to stay and work a 12-hour shift. I got through the shift, and nothing bad happened, but it could have. I had to make a choice between leaving a very ill and vulnerable patient or potentially harming my child or myself. I should have never been placed in that position. No nurse should be forced to make those choices. It's up to a hospital to have staff to operate. But nearly every day they are forcing a nurse in this hospital to make similar choices."
As to the nurses' concerns about their salary level, a comparison of the St. Elizabeth's nurses' pay scale with other comparable hospitals in the region shows them too far below their competitors. The disparity is most acute for the more experienced nurses, where St. Elizabeth's nurses at the top of the salary scale are paid 25% below nurses at Brigham & Women's Hospital, 14 % below nurses at New England Medical Center and 17 % below nurses at Boston Medical Center. St. Elizabeth's salary scale barely exceeds that of many smaller community hospitals.
The disparity in the nurses' pay has great implications for quality and safety of care provided, given that the health care industry is in the midst of a severe and growing shortage of nurses and the area of greatest need is among experienced nurses in specialized areas of practice, such as emergency nursing, critical care and operating room nursing. This is precisely the area where St. Elizabeth's is experiencing a loss of nurses to other betterpaying facilities.
According to Sheila Ainsworth, an operating room nurse and co-chair of the nurses' bargaining unit, "In a recent two-week period this year, four operating room nurses and technicians left the facility for better pay at another hospital. In one week, three nurses resigned. These were experienced nurses who could no longer take the backbreaking working conditions and lower pay. They had enough and they left for greener pastures," Ainsworth said. "It's devastating for those of us who remain, because now we have less support and we can't recruit replacements because we can't compete with other hospitals vying for these nurses. We need to be able to retain our own nurses."
To add insult to injury, the operating room nurses' resignations came just around the time the hospital was making their 2.5 % per year salary offer to the nurses. That same week, hospital management gave the surgical technicians in the operating room a $5,000 bonus to convince them to stay on.
"If you want to know why nurses are on the street during Nurses Week and not attending hospital-sponsored functions with our managers, there is your answer," Ainsworth said. "They have shown absolutely no respect for their nurses or their patients. They are content to work us beyond our limits, to place us in dangerous situations, and worse than all that, they are doing it at the expense of the safety and well being of those we care for."
The hospital's actions come on the heels of a widely publicized study released in April by the Department of Health and Human Services that clearly demonstrates a strong link between poor staffing and a variety of serious complications for patients, including the deaths of thousands of patients in America's hospitals. Another study of nurses showed that one in five nurses is planning to leave the profession in the next five years because of poor staffing, mandatory overtime and hazardous working conditions.
"We want the community to understand that we are out here as much for them as for ourselves," Buckley said. "In this case, issues of salary and staffing go hand in hand. Since they refuse to talk to us about fixing the staffing problem, the only thing we can fix is the issue related to salary, which can help the staffing at our hospital."
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Youngstown Nurses Strike
May 5, 2001
The Youngstown General Duty Nurses Association (YGDNA) at the Western Reserve Care System/Forum Health has officially gone on strike beginning at 3:30 p.m. May 1, 2001. There are 771 nurses in the bargaining unit. Bonnie Lambert, President of the YGDNA, said "Youngstown nurses would rather fight than quit. We are fighting for our patients, our families, our lives and our professions. We have tried to negotiate an agreement that will attract and retain registered nurses; however, many issues remain unresolved."
Two of the most important practice issues involve safe staffing and the elimination of mandatory overtime. The nurses call for an end to unsafe working conditions that are eroding patient care. Nurses are routinely assigned more patients than they can safely care for. Such understaffing interferes with the close monitoring of patients nurses provide in order to quickly access critical signs and symptoms. Nurses are being forced to work mandatory overtime. When nurses are overly tired from excessive hours, they put themselves and their patients at increased risk of error and injury. Nurses are expected to float to units beyond their clinical specialty and without the proper training. These practices lead to unsafe patient care.
Meanwhile, management has not provided an economic package that will recruit and retain RNs in this climate. Youngstown community support for the nurses has been overwhelming. Area businesses, other labor unions, and citizens of the community have donated food, money, and other items. Nurses throughout the region and state are banning together offering support of any kind to the nurses at YGDNA.
Special events and activities are being planned for the picket line. Stay tuned to this web site <http://www.ohnurses.org> for frequent updates regarding the strike at the Western Reserve Care System/Forum Health in Youngstown.
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Nurses are making fair and overdue contract demands
Counterpoint Op-Ed in Minneapolis Star Tribune
by Martha Lewis-Hunstiger, RN
May 5, 2001
Can hospitals in the Twin Cities function without nurses?
It appears we are about to find out, unless members of the Minnesota Nurses Association, which is currently negotiating our contracts, can begin to feel respected and listened to by our employers.
The prospect of a nursing strike is frightening to many. Nurses are seen as the last defense against errors reaching patients. We are the ones who mediate between lifesaving technology and those who receive the benefits of that technology, often at the most vulnerable moments of their lives.
Misinformation and distortions in the article "Deadline looms in nursing talks" (Star Tribune, April 29), particularly some statements made by Shireen Gandhi-Kozel, assistant vice president of the Minnesota Hospital and Healthcare Partnership, only serve to obstruct what should be a respectful, fact-based process. I will address two of the most serious errors.
Pay. The article states that the average full-time nurse makes $52,000 a year. I made $3,000 more than that last year (excluding overtime), working full time including every other weekend, after 32 years in nursing. I am not the average nurse; at my hospital, the average nurse is at the seven-year pay level.
I pay $300 a month for health insurance; senior administrators in my hospital pay $86 a month for the same coverage.
The statement that nurses are asking for raises of "about 60 to 100 percent" (Gandhi-Kozel translates this to $100,000 a year for the average nurse) is simply not true. Our proposals are a package that includes wage increases, more equitable benefits and longevity bonuses for nurses after 20 years (the current contract stops there). The total increase for me would be far less.
The 100 percent figure refers to a hypothetical nurse who works full time on permanent night charge after 30 years. Is this the average nurse? I hope not. Is that the career you would want for your son or daughter, to be working permanent nights after 30 years?
Part-time work. The article states that only 13 percent of nurses are scheduled to work full time, omitting mention of the hours we actually work, including overtime. Gandhi-Kozel says there are enough nurses, if more of them would work more shifts.
This echoes frequent references in the media to all those nurses who work two or three days a week. Part-time hospital nurses do not work two or three days a week. They work between four and nine 8-or 12-hour shifts in a two-week period, some days but often all evening or all night, every second or third weekend and half the holidays every year.
Many of them rotate between these shifts to accommodate caring for their children or elderly parents, or school.
There is one group who could be said to work two or three days a week: part-time operating room nurses, who also take evening, night, weekend and holiday call. Do you know anyone who needed surgery in the middle of the night? Did you think that the OR nurses had been sitting at home waiting for the phone to ring, that they hadn't already spent all day and all evening managing their homes or going to school, or either working that day or preparing to work the next day
The physical and mental demands of nursing are such that we are not all able to do it full time, especially as we age. I am 53. I can't safely lift anyone heavier than 20 pounds. I still climb in and out of helicopters, but the day is coming when I can no longer do that for 80 or more hours every two weeks. Will you still want the benefit of my years of experience?
If you want to know what we nurses are seeking, don't ask someone who has a vested interest in diminishing our worth. Ask us. For me personally, these are the most important issues: Substantial increases in pay for those nurses who will take my place.
The occupation of giving direct care to hospitalized patients combines moment-by-moment, life-or-death stresses with the career-long disruptions of providing 24/7/365 coverage in a 9-to-5, Monday through Friday world. We deserve to be compensated accordingly.
Equity in benefits. We will not pay more for health care coverage than others in our organizations who make more.
Contractual protection for speaking out when we see unsafe actions or conditions.
Members of my family have been providing health care in Minnesota for more than 90 years. We maintain this tradition knowing that to give the care people need and deserve, we must first care for ourselves. --
Martha Lewis-Hunstiger, Minneapolis. Staff nurse, newborn intensive care unit, Children's Hospitals and Clinics.
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Warning to stay away from hospitals
<http://www.thewest.com.au/20010507/news/state/tw-news-state-home-sto7816.html>
by Jean Perkins
May 07, 2001
THE public is being urged to stay away from Perth's big public hospitals today because the Health Department cannot guarantee safe staffing levels.
A strike by nurses fighting for better pay and conditions also has caused the cancellation of most elective surgery in the adult teaching hospitals.
Senior health officials say it is inevitable some operations at the State's main children's hospital will be cancelled. Nurses will strike from 7am today despite the WA Industrial Relations Commission strongly recommending on Saturday that all proposed industrial action be stopped.
Princess Margaret Hospital and King Edward Memorial Hospital acting chief executive Bill Beresford said last night that members of the public needing non-urgent medical attention should consult their GPs first.
"If it is a real emergency they should call an ambulance which will take them to the closest hospital," Dr Beresford said.
Emergency departments at the big hospitals were staffed but delays for non-urgent cases were likely.
Dr Beresford said the hospitals"senior managers would assess early today how much elective surgery could be carried out. "Many operations have been cancelled today while others have been given the option of attending hospital with the risk of cancellation," he said. "We particularly do not like cancelling children's operations but it is inevitable some may have to be."
Dr Beresford said he had spoken to Australian Nursing Federation officials and was confident they would help ensure patient safety in critical care areas.
ANF State secretary Mark Olson said he did not know how many nurses would not turn up to work but believed it would be at a similar level to industrial action three years ago when up to 75 per cent at some hospitals went on strike.
He said there were dangers for the nurses if they ignored the commissioner's recommendation to return to work but neither he nor the nurses should take responsibility for any disruption that occurred.
"If there's disruption, which there will be, it will fall squarely at the feet of the Minister and the new Government," Mr Olson said.
Health Minister Bob Kucera said the strike was unnecessary.
"There really is no need to disrupt hospitals because we have got a way forward," Mr Kucera said.
Opposition health spokesman Mike Board said it was disappointing the dispute had not been resolved.
"They have taken three months to get the nurses to a point where they are no better off than they would have been under the previous offer," Mr Board said.
Nurses will vote at a meeting at 10am today whether to return to work.
© 2000 West Australian Newspapers Limited
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Nova Scotia nurses prepare for strike vote should conciliation fail
<http://www.canoe.ca/AtlanticTicker/CANOE-wire.NS-Nurses-Strike.html>
May 7, 2001
HALIFAX (CP) -- Nova Scotia nurses are preparing to take a strike vote should conciliation with the provincial government fail.
Union president Heather Henderson said Monday the union is hoping a deal can be hammered out, but officials have to be prepared in case conciliation fails.
She said the Tory government has not seemed willing to address union concerns seriously.
Some of the issues include wages, excessive workload and the shortage of nurses.
Right now, nurses in the province earn $23 an hour and according to Henderson that's the lowest in the country.
Conciliation talks are slated to go next week. Henderson said any strike vote will be taken in early June.
Copyright © 2001, Canoe Limited Partnership. All rights reserved.
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