More Nurses = Less Death

by Aisha Jahangir - Canada

In my experience, adding more patients to a nurse's workload endangers patients.

This is not just my experience. A 2002 study found that each patient added to a nurse’s workload was associated with a 7 percent increase in death rates.

Overwork also endangers nurses. After rushing through a 12-hour shift, we question our competence, “Why couldn’t I finish everything? Should I have stayed after work to complete all my tasks? I hope I didn’t miss something.”

More nurses are burning out and self-medicating with anti-depressants, alcohol and other drugs. Many are leaving the profession.

In 2004, California became the first state to mandate minimum nurse-to-patient staffing requirements in acute-care hospitals. This was no gift. The California Nurses Association launched a 12-year battle to win nurse-to-patient ratios against fierce opposition from hospital managers and the governor of California.

Now, a new study has confirmed that mandated nurse-to-patient ratios in California hospitals improve patient outcomes as compared with Pennsylvania and New Jersey, two states without such legislation.

California hospital nurses care for one less patient on average and two fewer patients on medical and surgical units than nurses in the other two states. These lower ratios were associated with lower patient mortality.

If the average patient-to-nurse ratios in New Jersey and Pennsylvania hospitals had been equivalent to the average ratio across California hospitals, there would have been 13.9 percent fewer surgical deaths in New Jersey (222 lives saved) and 10.6 percent fewer surgical deaths in Pennsylvania (264 lives saved).

Higher nurse workloads were associated with more complaints from patients and families, more verbal abuse, higher rates of job dissatisfaction and burnout, poor work environments and lower quality of care. Nurses in poorer-staffed hospitals also expressed less or no confidence that their patients could manage their care after being discharged.

Despite the mounting evidence that nurses save lives, the Ontario government is going in the opposite direction, replacing thousands of RNs with lesser- skilled (and lower-paid) health workers.

We need to organize the same kind of fight here that has proved so successful in California.

Aisha Jahangir works as an RN in the Family Birthing Unit at the Guelph General Hospital in Ontario. She is also a local coordinator for the Ontario Nurses Association.  

 Trouble-Makers' Convention

by Eileen Prendiville - USA

Those who think the labor movement is in serious decline would have found no evidence of that at the  2010 Labor Notes Conference in Dearborn, Michigan.

With over 1200 trade unionists in attendance, it was their largest conference ever, and the energy and enthusiasm were pervasive.

Mostly rank-and-file members from hundreds of union locals attended dozens of workshops, networked with each other and perused booths in the main conference area, purchasing books and paraphernalia related to labor, history and politics.

Workshop topics included organizing, building member-driven unions, taking action on the job, contract strategies, the economy, the fight for single-payer, the war, and much more. It was difficult to decide which ones to attend.

In one workshop, “Making Reading Fundamental to Union Building,” authors of fiction and non-fiction books with labor themes led a discussion about the importance of reviving a culture of reading to empower workers with the knowledge needed to tackle workplace and social issues.

Another workshop, “Heat’s On in Health Care Workplaces,” discussed how hospitals are using the economic crisis as an excuse to erode contract standards and cut budgets that directly and indirectly affect patient care.

Another workshop included nurses from the National Nurses United, other nurses’ unions and nursing students. We discussed how our unions could work together instead of fighting jurisdictional battles. We also discussed whether RN-exclusive unions or unions such as PASNAP that include allied health professionals are more effective. We all agreed that nurses are under attack, and we need to support one another for the battles ahead.

I was inspired to learn about workers’ struggles from all over the world and the different ways that workers confront the many obstacles they face.

Discussions and debates in and out of the workshops were lively and congenial. The most incredible part of the conference was the networking and the feeling of camaraderie.

We went home with more energy to keep on fighting.

Eileen Prendiville works as a staff nurse in a San Francisco hospital. She belongs to the California Nurses Association, a member union of National Nurses United.

Big Brother is After Your Job

This warning was posted in the Labor Notes Conference workshop, “Big Brother is Doing More than Watching: Taking on Management’s Plans for Technology.”

In the 1970s, they told us that “the new (computer) technology” would make work easier. They lied.

The new technology turned out to be no different from the old – a means of increasing management control and providing super-profits for technology corporations.

The workshop panel included a UPS driver, a Verizon call-center worker and a hospital nurse. Despite doing very different kinds of work, all three explained how radio frequency identification (RFID) monitoring, video surveillance, computer-controlled work-flow systems and other forms of computer technology are being used to monitor, fragment, de-skill, down-size and speed-up the workforce.

Hospitals are using computer technology to monitor nurse activities: cameras in patient rooms; RFID monitoring of nurse movements and whereabouts; redesigned workstations to isolate nurses and weaken unions; robots that dispense drugs and monitor which nurses dispense which drugs to which patients and how often; and much more.

This mass of information is fed into analytic programs that detect deviations from the statistical norm and draw them to management’s attention. The under-performers are disciplined or eliminated and the over-performers become the new standard expected of everyone.

It’s all about raising productivity – getting the most work out of the fewest people in the least amount of time.

While hospitals and government claim they have no money to fund patient services, they are spending billions of dollars to computerize medical systems.

Technology is just a tool. It can be used to improve patient services or it can be used to dehumanize and degrade patients and workers. It all depends on which class is in control.

Which class is in control?

Management favors technology that treats patients as if they are all the same and no judgment or experience is required to treat them. Because any deviation in treatment is detected and questioned, the role of the health worker is reduced to following protocol - no skill required!

The workshop presented many useful ideas on how unions can control how technology is used in the workplace. The key is using these issues to build the strength of the union on the ground.

At present, management is winning the battle to control every aspect of our lives. However, the widespread application of computer-monitoring is creating a common front for workers to organize as a class in their own interests.

I urge every health worker to read Health Information Technology Basics (2009).

Susan Rosenthal is a Toronto-area physician and the author of SICK and SICKER: Essays on Class, Health and Health Care (2010).

=============================================================================

International Health Workers for People Over Profit (IHWPOP) has joined the Boycott, Divestment and Sanctions Campaign against Israel. We oppose Israel’s repression of the Palestinians and support a single state in Israel/Palestine with equal rights for all.

 =============================================================================

All of the material in this newsletter is made available to the public under the terms of the Creative Commons Code. Readers are welcome to share and use this material for non-commercial purposes, as long as they acknowledge the author(s) and International Health Workers for People Over Profit