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

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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.

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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

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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

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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!

• Veterans Admin admits to the debacle surrounding dirty dental instruments placing hundreds of patients at risk of HIV transmission. [LINK]
• Minnesota nursing strike may be averted, but time will tell if threat to strike was more of a bluff. Hospitals and nurses pledged to work within the constraints of internal governance. [LINK]
• How’s healthcare reform going? Just fine, according to some. [LINK]
• How influential will states’ insurance commissions be when regulating insurers’ medical loss ratios in the age of reform?
  

  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]

• Study: Genes key to longevity. [LINK]

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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

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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

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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

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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

1. Via reducing patient counts and unnecessary procedures, hiring appropriate staffing in an expeditious manner.

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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

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