Not only do physicians obtain automatic commission as officers in the armed forces. Nurses make up an enormous contingent, and increasingly so. After this appointment, I see not only an increase in nursing representation, but also a greater inclusion of female providers in general.
Maj. Gen. Patricia Horoho would become the first nurse and the first woman to serve as the Army Surgeon General if the Senate confirms her nomination and simultaneous promotion to lieutenant general, which were announced by Defense Secretary Robert Gates on Tuesday.
Major Horoho also served as a medic to the infirmed immediately following the attack on 9/11. | LINK
Since the late 20th century, innovation in long term care (LTC) has been fueled by a desire of healthcare systems – in this case, owners of skilled nursing facilities — to achieve new quality benchmarks in healthcare delivery at a reasonable cost. Thanks to major pieces of legislation over the past 15 years emphasizing patient safety, healthful outcomes, and cheaper methods of treatment delivery; LTC as a discipline has undergone a sea change for the better. As a geriatrician, I have seen this evolution firsthand. That’s why I absolutely love seeing developments like this
Working with a psychiatrist and a pharmacist, [nurse and resident care coordinator in a Two Harbors, MN nursing home, Eva] Lanigan started a project last year to find other ways to ease the yelling, moaning, crying, spitting, biting and other disruptive behavior that sometimes accompany dementia. They wanted to replace drugs with aromatherapy, massage, games, exercise, personal attention, better pain control and other techniques. [..] Within six months, they eliminated antipsychotic drugs and cut the use of antidepressants by half.
The savings in cost due to the cessation of expensive psychotropics (even if informed consent enabled usage), the avoidance of chemical restraint and its obvious negative effect on patient safety, and the increase in patient quality of life without the need for specialized dementia care (again, at an enormous increase in care delivery cost) are at least three major reasons why innovation in geriatric care is so important in the age of reform. And it’s happening right here in Minnesota. Excellent.
It may not have carried the same amount of press that the threatened prolonged walkout in the Twin Cities got, but the potential strike affecting nurses and patients in the neighbor to the north — Duluth — was averted after a marathon session yesterday. At issue was the similar bargaining chip — patient-nurse-staffing ratios. The two major health systems reached an agreement which pre-empted even a one-day walkout, which is farther than the Twin Cities nurses went in their negotiations with 14 separate hospital employers before reaching an eventual agreement.
Nurses also got a percentage raise increase that bested what their nursing counterparts at St. Luke’s Hospital and in the Twin Cities recently got. Instead of increases of 0 percent, 1 percent and 2 percent over three years, which the other nurses got, SMDC [St. Mary's-Duluth Clinic] nurses did better in year two with a 1 percent wage hike for the first six months and another 0.8 percent increase the rest of the year.
Add to that the gains made by nurses for enhanced access to continuing education and other minor fringes, and one can see the success of these comparatively more civil negotiations between nursing and hospitals. Now, it’s back to patient care in Duluth. | LINK
Twin Cities nurses have averted a strike, and today, they and the hospitals they fought long and hard with on the issue of staffing ratios and patient safety have agreed to a contract ratification. Bittersweet for the nurses. They did not have to go through what was (for some) an indignity, further exacerbating what was amounting to an increasingly newsworthy credibility gap among patients and families; but they did concede their signature issue — and some see that as a political and PR loss.
[Union negotiator Kevin] Campbell said he realized at that point that the hospitals were not prepared to discuss staffing the way the union hoped. In that case, he said, “it is not in the best interest of nurses or patients to pursue it.”He said the union would turn to the Legislature for help, as nurses successfully did in California. “They could end up like California, where the Legislature crammed it down their throats,” he said.
That’s right. The next step for the MNA could be the MN state legislature. Seems like its time for all three Dem candidates to start stumping for union votes right here ahead of next month’s primary if the nursing bargaining unit has a shot in ultimately getting what it set out to do, even if caution and dignity have fallen by the wayside. | LINK
Some headlines prior to the Independence Day holiday. Normal posting resumes here at Doctor Pundit on July 6. Have a happy and safe holiday weekend!
The medical-loss ratio measures how much of premiums insurers pay out for medical care versus administrative costs. The new law requires that insurers use at least 80% of the premiums from individuals and small businesses to pay for medical care and profit-taking, and 85% of premiums from larger employers. Health insurers are waiting for regulators to clarify how companies must account for the numbers—whether they can average the MLRs of their subsidiaries, for instance.
[LINK]
An agreement has been reached between the Minnesota Nurses Association and 14 Twin Cities hospitals, averting the largest modern-day strike of its kind.
[A] joint statement from the union and hospitals said: “The registered nurses and the hospitals believe a settlement of the labor agreement at this time is in the best interests of patients and our community.” [...] [T]he two sides “have agreed to a renewed commitment to working through both parties’ staffing issues through the existing committee systems at the various hospitals.”
We’ll see what develops. | LINK
While it is no surprise that the latest negotiations among Twin Cities hospitals and the area’s nursing mega-union have broken down, what is somewhat startling — even sobering — among players in both sides is the reality that, in just a week, they will have to adjust for a walkout whose implications on staffing, healthcare delivery, and (most important) the cost of modifying for these factors will be felt far and wide. With just the hint that the motivations behind the strike may be a little more political on the side of nursing, its rep. is abandoning advocating for changes, among other matters, to pension benefits in favor of the primary reason for striking in the first place — their contention that burdensome staffing ratios need to cease.
Nurse-to-patient staffing ratios are the key issues for the union. The MNA says nurses are stretched too thin, and patient safety is at risk. Nurses have proposed cementing ratios in their contract, but the hospitals have rejected it, saying that it would cost them $250 million year without evidence that it improves the quality of patient care.
With a walkout all but certain, the local media appear to be focusing on the effect scabs will have on strike numbers because of the potential of the hospitals to absorb the long-term cost of replacements on their end. | LINK
The real (as opposed to symbolic) battle lines have been drawn. Twin Cities nurses, who recently voted to walk out for 1 day last week in a show of mutual support for changes in staffing conditions on the premise of improving patient care, will again vote next Monday to walk out indefinitely. The one-day strike led to the conclusion that the hospitals were essentially operating in the black and weathering the recession against short-term losses to reap longer-term gains. Nursing contends that their employers — represented by 14 metro area hospitals — are just sitting on profits as patient care suffers at current oppressive staffing ratios and less than desirable pay conditions.
The ball has always been the nurses’ court. Now they must act. But do they have the full support of its collective?
The prospect of an open-ended strike had already ignited a debate on the [Minn. Nurses Association]‘s Facebook page late Monday. One post called for nurses to “march on,” while another cautioned against becoming “sheep to be led to the slaughter.”
Will the sixty-six percent yea vote needed to effect a new date for an indefinite walkout occur? We’ll see. For every day until that vote takes place, the mega union must convince patients — well, more like the public — that what they are proposing is in the best interest of the community, the patients, and most importantly — the overall state of healthcare as a bastion of quality performed in a cost-effective manner. | LINK
Just as quickly as it had begun, the largest (one-day) strike in history has ended. The walkout begun a little over 24 hours ago concluded this morning at promptly at 7 AM. Of course, both sides were spinning pre- and poststrike operations as “going smoothly” and “achieving goals”. At the same time, they lobbied mutual criticisms — with the hospitals speculating the MNA move was all about generating publicity and increasing its rolls; and the nursing collective accusing the employer hospitals of putting profits above patients.
Apparently, no one really thought that — though concluded — the issues surrounding the walkout would cease to exist. To the contrary, there seems to be more confusion about where things stand at this time. Both sides will consider the entire episode a success, but the major issue is which side will push which agenda next. The hospitals have proven that their internal processes can contain costs[1] if contingency planning was adequate. The scope of the (re) actions of the hospitals was to be expected. Such costs are part of its budget. Year end balance sheet agreements are the end result.
The nursing collective, on the other hand, have the burden to bear in the coming days and weeks. Do nothing, and watch the healthcare punditry and analysis closely scrutinize their actions. Even if the nurses’ decision to strike was justified, what did it really accomplish? How will their success be measured as a group action? Most of the nurses are back on the job this morning. Status quo reigns today at the hospitals. In the effort to keep operations running smoothly and maintaining the status quo, which side’s actions during the strike successfully justified their original positions which led to the strike? That’s the key question. | LINK
Armed with massive picket signs, steely resolve, and — for some — heavy hearts, the 12 000-member strong MNA union officially went on strike today in the Twin Cities. The first nursing walkout since 2001, and the largest such strike in history — the action comes as no agreement could be reached among the 14 metro area hospitals and their nursing employees on matters as crucial as patient staffing and incremental pay raises.
Local media is all over over the story, which of course, includes live-blogging and Twitter and Facebook feeds. The area hospitals have been preparing for this for weeks — canceling all non-emergent elective procedures, shoring up physician coverage, and making sure the immense cadre of replacement nurses hits the ground running. | LINK
UPDATE: Strike coverage by local hospitals is immediately put to the test, as a fight in a Minneapolis suburb results in one stabbing death and transport to local hospitals for other injured patients needing emergency surgery. | LINK
As Minnesota prepares itself for the “nursing strike of the century”, scheduled to take place for at least 1 day tomorrow; that other looming strike in California appears to be halted. A San Francisco judge has issued a temporary restraining order preventing the walkout.
Nurses represented by the California Nurses Association planned to join 12,000 Minnesota nurses in the one-day walkout that, even without the California nurses, would still be the largest registered nursing strike in U.S. history. Nurses from both states who are part of a larger union called National Nurses United say staffing issues – not wages – are at the heart of the disputes.
The California nurses are employees of five Univ. Of Ca. medical centers. The holdup appears to be technical matters in preventing the strike from going forward tomorrow. | LINK
The 12000-member nursing mega-union is playing PR hardball, going after the emotional jugular in advance of a walkout over staffing demands that seems all but certain.
In a news release Monday, the union cited several examples of what it calls dangerous staffing. Among them: a nurse at Methodist Hospital in St. Louis Park who said a dying patient “had to sit in his own feces” because no one was available to clean him up, and a nurse at Mercy Hospital in Coon Rapids who called for help when a patient’s surgical incision ripped open, “but nobody came.”
An expected and noble strategy, but one that could backfire. Although tableaus of patient horror stories like these evoke a visceral response, assigning these incidents to something as isolated, discrete, and simple as staffing inequities irresponsibly assumes public ignorance of the end product of something more insidious and global — a broken healthcare delivery system that yearns to be fixed via negotiation and cooperation, not bullying and scare tactics. Twin Citians as citizens and patients can easily understand that. | LINK
The June 1 deadline for a walkout imposed by the Twin Cities nursing collective is still somewhat virtual. As of today, the possibility for what is being sensationally plugged by the media as the “biggest in history” (even if for just 1 day) is still a tentative one. The Minnesota Nurses Association, which is organizing the possible strike, has now apparently decided to utilize a federal mediator[1] as it returns to the bargaining table. To date, the majority of Twin Cities hospitals against whom the nurses are threatening walkout, have yet to accept union proposals that call for an increase in real wages of over 19 percent over the next three years.[2] Hospitals contend that such expenses would incur an almost quarter billion dollar commitment in the short term, thwarting planned investments in innovation and other future costs.
UPDATE: A press conference is called for today at 1 PM. | LINK
UPDATE: New strike date — 6/10. Twin Cities hospitals feel a little put off . | LINK
It is disappointing that the nurses’ union used the pretext of returning to negotiations just one day ago to then turn around and one day later order a strike. Consistent with their pattern, the union makes representations of willingness to negotiate while driving toward a strike. There is an inherent barrier to good faith negotiations when one party is actively engaged in planning for a strike.
In the high-stakes game of hospital revenues and healthcare market share, is it really surprising that any perceived good faith by either side is just that — perception?
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
