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Support Fairview Nurses Fight for Safe Staffing!
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Also posted at the Health Care Workers' Advocate Web site

Support Fairview Nurses Fight for Safe Staffing!
Statement by Doug Mann, LPN Mpls School Board Candidate (7 June 2001)

Edited version of Q & A from Socialist2001 5/25/01

Why Is It Profitable to Short- Staff Hospital Nursing Departments?
Support Fairview Nurses Fight for Safe Staffing!

At 5:30 AM on June 3 about 1350 Registered Nurses went on strike at two hospitals owned by Fairview Health Services, one in Minneapolis and the other in Edina.  Most of the striking nurses are dissatisfied with their employersí contract offer because it didnít adequately address the issue of the unsafe staffing. Fairview management made no commitment to reduce patient-to-staff ratios and denies that their nursing units are seriously understaffed.    

Fairview nurses are not alone in voicing concerns about unsafe staffing.  A majority of hospital nurses surveyed by the Minnesota Nurses Association report they cannot consistently do the basic care needed by their patients in a timely manner, administer medications safely, or adequately monitor medically unstable patients due to short-staffing.  

On the other hand, Hospital and nursing home owners assert that the quality of care has not been compromised by todayís "lean staffing."  Evidence of patient neglect is explained away or the blame is shifted to the patients themselves. For example, pressure sores (bed sores) are commonplace in nursing homes today, but rarely or never occurred in most nursing homes twenty-five years ago.  The standard explanation by nursing home owners is that pressure sores can no longer be prevented because nursing home residents are generally older and sicker now than they use to be.    

An understaffing crisis came about after politicians legislated away minimum staffing requirements and massively cut appropriations for health care in the 1980s and 1990s. For example, the Minnesota legislature repealed minimum staffing requirements for nursing homes in 1985, and the US Congress cut the budget for Medicare and Medicaid by $200 billion early in 1993.  Hospital, nursing home and clinic owners responded to this situation by massively cutting positions for health care workers.

The MNA leadership has proposed that the nurses and hospital management have a mutual interest in reducing the workload of RNs.  The formula is: increased staffing = better patient care = lower costs = higher profits.  In theory, the cost of increased staffing could be offset by a reduction of costs associated with better patient outcomes, including fewer medical and nursing malpractice lawsuits.  However, poor patient outcomes also lower health care costs, especially by reducing the life expectancy of patients who need 24 hour nursing care at frequent intervals or on a long term basis.
No confidence should be placed in hospital management to voluntarily reduce the workloads of RNs.  If they could improve their bottom line by significantly reducing the workloads of RNs who do the bedside care, they would have done so by now.   For many years, hospital and nursing home owners could ignore the complaints of nurses about understaffing, giving nurses no choice but to go along with "lean staffing" policies or quit because there were more nurses than nursing jobs. But that situation has changed in recent years because so many nurses have been opting to quit the profession.

The Fairview nurses can expect a fairly prolonged strike. If the strike goes on for 3 to 4 weeks, it is likely that upwards of 20% of the striking Fairview nurses will find other jobs, and it will take a while to recruit enough regular staff nurses to run the hospital at full capacity. But donít expect Fairview management to cave in because of the high cost of agency nurses.
There is a chance that Fairview Hospital will give some ground on the staffing issue if their refusal to do so becomes a public relations nightmare for the entire health care industry, and if the strike clearly reinforces the position of RNs, LPNs and nursing assistants who are speaking up for their patients and themselves on the issue of understaffing. Thatís why it is important for those who support the nurses to join the picket line and to help out in any other way they can.  



A READER'S QUESTIONS : Are you a nurse? I'm not, and I don't plan to be. Nurses get paid a living wage so why should I care if they get a raise? It seems to me that the strike is effecting everyone else in the hospital in a negative way. Such as layoffs of other positions to pay for the nurses strike. What about the LPN's, Unit Support, and Nursing Assistant's. Should they support a nurses strike when the money in the budget is being taken away from their positions to pay for nurses increasing salaries?  

RESPONSE:  The RNs are not only fighting hospital management.  The hospitals have been cutting back on staffing and holding down the wages of health care workers for many years as part of a one-sided class war.  The RNs are not your enemy.  The RNs are not the enemy of the LPNs, Health Unit Coordinators, and workers in other industries.  We are often pitted against one another.  But we all have more in common with each other than we have with the people who own the hospitals.  

For years the RNs have been engaged in "win-win" bargaining with the employers, and so have most unionized workers.  However, it generally works out that only a section of the workforce "wins" in the short term, but usually not in the longer run.  How does "win-win" bargaining work?  Workloads are increased for the people who do the direct patient care so Congress can cut the Medicare budget, so hospitals and HMOs can improve their bottom line, and so the caregivers can get a little pay hike. Another "win-win" stratagem is presenting union members with a contract offer that cuts the hourly pay rate for new hires, but gives a small pay increase to every one who votes for the contract.  The big winner is the employer.    
If the Minnesota Nurses Association forces the hospital owners to up their wage offer and agree to minimum staffing requirements, it would set a higher standard for RNs and other health care workers at other hospitals and at other health care facilities.  The struggle of the RNs for better pay and working conditions could set a positive example for other health care workers and workers in other industries.  This is not another case of "win-win" bargaining.  That's why the hospital owners have come up with huge sums of money for strikebreaking purposes.

Where will the money for higher wages and better staffing come from?  Won't it come out of the pockets of workers enrolled in HMOs?  Of course it is also possible, in theory, that the cost of a settlement between the hospitals and the RNs could be shifted to those who plan to get the lion's share of a 1.3 trillion dollar tax cut just approved by the US Congress.

Consider what happened in France during December 1995.  The French Parliament voted to cut pension benefits for public service sector workers.  The affected workers went on strike.  The French government reversed its decision on the pension benefits.  The workers prevailed because they had tremendous support from the French working class.  When the French government tried to cut the minimum wage for young people, when it tried to make college students pay tuition, there were massive protests, and the government backed down.  Why? Unions in France only represent about 7% of the workforce compared to about 13% in the US.  However, the unions are actually much stronger in France because "win-win" bargaining didn't catch on in France the way it did here.  That's why the poorest 2/3 of the workers in France have a higher standard of living than the poorest 2/3 of workers in the US.   


Why Is It Profitable to Short- Staff Hospital Nursing Departments?

On the June 1 Mid-Morning Show on Minnesota Public Radio, Diane OíConner, an official of the Minnesota Nurses Association asserted that hospitals, health insurance companies and HMOs could actually cut health care costs by increasing staffing levels.   Studies show that increasing a nurseís workload has an adverse effect on patient care.  When you increase a nurseís workload beyond a certain point, you see a big increase in complications like pneumonia, pressure sores, and urinary tract infections, more medication errors, and less effective monitoring of medically unstable patients.   What the hospitals save on staffing is offset by  longer and/or more frequent hospital stays for many patients.    

On the same Mid-Morning Show, Roger Feldman, a U of MN health economist disputed  OíConnerís assertion that hospitals could actually cut their costs by increased staffing levels.  Evidently low-quality health care also saves the HMOs and insurance companies some money, such as when low-quality nursing care shortens the lives of patients who need round-the-clock nursing care on a long term basis.