US NURSES STRIKE OVER RATIOS

Largest Ever Nurses' Strike Could Be Sign of Future Unrest

Robert Lowes

June 11, 2010 — A 1-day strike of 12,000 nurses in Minneapolis and St. Paul, Minnesota — said to be the largest in US history — ended as planned this morning, but experts expect more labor unrest to roil the hospital industry.

The nurses on strike from14 hospitals in the Twin Cities belong to the Minnesota Nurses Association (MNA), an affiliate of an ambitious new "super union" with 155,000 members called National Nurses United (NNU). The NNU advocates nationwide adoption of nurse-to-patient staffing ratios that it deems low enough to ensure good patient care and prevent nurse burnout.

Staffing levels figure heavily into continuing negotiations between the Minnesota nurses and their hospitals over a new labor contract. Other points of contention are wages and the Minnesota hospitals' proposal to reduce the nurses' pension benefits.
The Minnesota nurses set their strike date of June 10 about 2 weeks beforehand, giving hospitals time to prepare. Maureen Schriner, a spokesperson for a trade group called Twin Cities Hospitals, said the 14 affected hospitals brought in 2800 replacement nurses on Thursday. Some hospitals rescheduled surgeries.

"Things ran smoothly," Schriner said. "The level of patient care was the same as it always had been."

The strike is the third major labor battle waged by the NNU this year. Members of an NNU affiliate in Philadelphia went on strike from Temple University Hospital for 28 days this spring, and just this week, a state judge issued a temporary restraining order to stop members of the affiliated California Nurses Association (CNA) from walking off their jobs yesterday at University of California medical centers and student health facilities. The NNU was formed last December when the CNA merged with the Massachusetts Nurses Association and United American Nurses.

NNU leaders say they will take aggressive action wherever hospitals put profits above patient care and the well-being of nurses.

"This phenomenon is not just in Minnesota," NNU co-president Jean Ross, RN, told Medscape Medical News. "In this recession, employers expect everybody to sacrifice whether there's a need to or not, or whether it's prudent or not, and it always comes on the backs of nurses.

"This union is prepared to do what it needs to do to get its needs met. What's good for nurses is good for patients."

Labor Historian Expects More Strikes in Era of Consolidation

Over the past 10 years, strikes by nurses have been "sort of rare," Peter Buerhaus, PhD, RN, a professor of nursing at Vanderbilt University in Nashville, Tennessee, told Medscape Medical News. Dr. Buerhaus said the drive to unionize nurses comes at a time when many aspects of the hospital workplace have improved, leading to higher job satisfaction.

"It's a much better picture than it was in the 1990s," said Dr. Buerhaus, referring to surveys of nurses that he has helped conduct over the years.

To Peter Rachleff, PhD, a labor historian at Macalester College in St. Paul, this week's 1-day strike illustrates how the nursing profession is responding to a healthcare industry marked by consolidation among health insurers and hospitals. "A new generation of nurses sees collective action as necessary to develop national standards for how they work," Dr. Rachleff said.

Asked if he expects to see more nurse strikes in the near future, Dr. Rachleff replied, "Absolutely."

In one sense, said Dr. Rachleff, nurses are trying to fill in the details of healthcare reform legislation enacted by Congress.

"The nurses are addressing issues of delivery of care that weren't clear in the larger macro discussion," he said. "They're taking it to the next level."

Opinion Divided on Value of Mandatory Staffing Ratios

One detail of healthcare reform dear to nurses in the Twin Cities is staffing levels. Their union is asking hospitals to maintain a ratio of 1 RN to 4 patients in medical and surgical units, and 1 RN to 2 patients in critical-care units, for example.

NNU co-president Jean Ross said some hospitals in the Twin Cities assign 3 patients per nurse in intensive care units instead of the 2 patients sought by the union.
"When things get more hectic, you're more likely to miss fine changes in a patient's condition," she said. "You can't be as watchful. You're afraid you're going to maim or kill someone."

The NNU maintains that mandatory staffing levels — already the law of the land in California — will not only save lives, but also solve the nursing shortage by improving job satisfaction. However, the nursing profession is divided on the effectiveness of mandatory staffing levels, with supporters and opponents pointing to research that supports their respective positions.

The trade group Twin Cities Hospitals argues that there is no objective evidence linking specific staffing ratios and patient safety. It calls the union proposal inflexible and expensive, adding at least $250 million to the annual expenses of the 14 affected hospitals.

Maureen Schriner, the spokesperson for Twin Cities Hospitals, said that previous contracts between the hospitals and nurses contained detailed language on staffing levels that in some cases exceed what the union is demanding.

"Instead of trying to work with what we already had, they came forward with their own ratios," said Schriner.