Executive Director's Column: Holding the line on standards
From the Massachusetts Nurse Newsletter
January/February 2010 Edition
Executive Director's Column
By Julie Pinkham
No doubt that all of us have felt the impact of this recession, either directly or indirectly. Certainly, those in the public sector are hit the hardest from the fallout of this economic crisis. Health professionals in the commonwealth have provided health services to populations the private sector has little economic incentive to serve. But with state revenues down, slashed services are all that is available to many of the folks who are most in need.
The majority of us have suffered hits that are more indirect. Major losses in your 403b have likely put your retirement plans on hold. Maybe you were once one of two wage earners in your household, but now you are the only breadwinner available to pay the bills and the mortgage. Either way, these times are challenging to say the least.
In a down economy, health care is generally one of the few stable environments. This is largely because health care, much like durable goods, is a necessity. While elective surgeries may go down, serious health care needs and procedures are inescapable. As a result the health care industry is more stable than other industries during recessions.
But while this is true, the economic environment provides a vehicle for health care institutions to take advantage of and penalize their workforces.
For those of you who went through the 90s, today’s work climate may feel oddly familiar. Back then economic instability, the need to cut costs and the desire to increase efficiency (in that case, due to the advent of managed care and health care deregulation) all became the rationale to introduce “new models” of patient care delivery. All these models where touted by consultants as being leaner without affecting patient care, although there was never any clinical research to prove this.
So as hospitals redesigned patient care under this “new model” they worked to redesign nurses right out of nursing. Subsequently, nurses were laid off, jobs were left unfilled and there was rampant use of unlicensed personnel to replace nurses. The delivery of care in many institutions changed to one where nurses had just an arms-length relationship with the patient while delegating tasks to a cadre of non-licensed staff. Those of you who went through it remember the outcome, and it was not good. Hospitals reaped record cash surpluses while nurses’ job satisfaction plummeted, patient outcomes deteriorated and patients were endlessly frustrated by their inability to access a nurse.
Years later—after even management admitted the plan was an abysmal failure and scrapped it— they are right back to repackaging the “new model” while telling themselves that “this” is not “that.” Waddle, waddle, quack, quack … I’m calling this a duck. And I do mean duck because they are starting to swing away at 15-plus years of your efforts to beat back these negative policies and to get safer staffing standards in place—standards that, while not perfect, better allow you to safely deliver care.
Along with this effort in the name of “leaner meaner,” hospitals are looking for concessions and roll backs of any favorable benefits and working conditions you achieved over the years through your contract negotiations. These efforts fall under management’s “you’re lucky to have a job” mantra. Prior to the economic downturn the hospitals stated one of the reasons they could not agree to staffing ratios was because there were not enough nurses available to meet the requirement. Now they argue they cannot afford them. For those institutions that just completed another banner year in surplus their argument is more refined: It is not that we do not have the money now; we just do not know if we’ll have it next year.
Unfortunately, that argument rings a bit hollow if you work at a hospital that has been making a profit for three years straight. For many of the hospitals their reduced surplus or losses have more to do with reserve market losses than losses incurred from operating the hospitals. Ironically cutting back on nurses may indeed result over time in losses in operating the hospital. Nurses provide patients with the safe, quality care they deserve. But speeding nurses up by increasing patient loads translates to increased lengths of stay, recidivism and poor patient outcomes—all of which are bad for hospitals.
At the bargaining table we are seeing the attitude play out in calls for cuts, whether the budget is unfavorable or not. Favorite targets are defined benefit pension plans, health insurance, flexible schedules, time-off benefits and salary scales. Hospitals are betting that, in this climate, you will be loathe going public and thus now is their opportunity to gut the contract you built over the years. And if they cannot get the reductions from you now they are betting you will sell out future members and cut their benefits going forward. This “divide and conquer” strategy creates a race to the bottom on contract standards—standards you and your predecessors fought for and that management agreed to in order to recognize the value of your professional work.
In the end, when you are sitting down at the table with management, you should follow your gut. If you believe the hospitals are gaming the environment—that their efforts at your facility are not about a working relationship that reflects the reality of your institution— do not capitulate. Rewarding bad behavior never improves the behavior. We have excellent resources at the MNA that can help you understand your institution’s true financial status; you do not need to resort to gutting the contract just because management says they “may not have the money next year.”
Effective negotiations are led by a well-informed bargaining unit. Get the information you need, develop a strategy that makes sense...and do not be "gamed."