Florida dumps surgical standards after failing hospital donates to GOP

By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

In a decision that has shocked pediatric surgeons across the state, Florida recently repealed a 38 year-old rule establishing state standards for pediatric cardiac surgery. The decision comes on the heels of a scathing investigative report by CNN, which found that St. Mary’s Medical Center in West Palm Beach had an abysmal record in performing pediatric cardiac surgeries—including a death rate three times the national average.  St. Mary’s was also failing to meet the state’s quality standards, which include proficiency in performing the surgeries as well as a mechanism for outside physicians to conduct an expert panel review of such surgical programs. The rule also established standards and criteria for staffing, minimum physician and facility volumes, and data reporting for hospitals that perform pediatric cardiology surgery.

Florida doctors and medical experts were strongly against the repeal. Louis St. Petery, a pediatric cardiologist in Tallahassee and former executive vice president of the Florida chapter of the American Academy of Pediatrics, told CNN that “The whole situation is outrageous. It’s just outrageous.” William Blanchard, a pediatric cardiologist and former medical director of the Nemours Children’s Clinic in Pensacola, stated at a hearing on the standards that getting rid of them is “both poor public policy and poor politics.” Jeffrey Jacobs, a professor of surgery at Johns Hopkins, further argued that the standards “are necessary to protect the vulnerable children with heart disease.”

For those who wonder why Florida repealed its standards despite the strong opposition of the medical community, look no further than the contributions of St. Mary’s parent company, Tenet Healthcare, to Florida governor Rick Scott and the legislative majority GOP party. In fact, Tenet has donated more than $200,000 to Governor Scott and the GOP over the last several years. David Nykanen, a pediatric cardiologist and member of the state’s Cardiac Technical Advisory Panel, pointed out to CNN that Scott has been in office since 2011 and his administration never objected to the standards until a Tenet hospital was found publicly not to meet them. “The coincidence is just a little too much,” said Nykanen, co-director of the Heart Center at Arnold Palmer Hospital for Children in Orlando. “It’s just a little hard to swallow.” In fact, the standards have been in place since 1977, and many physicians pointed out that they served as an example for other states such as Pennsylvania, which has similar standards for pediatric cardiac surgery.

So what does this mean for us Minnesotans? For one, it’s a warning. If you think something like this could never happen in Minnesota, you are wrong. Big corporate healthcare is alive and well in our state, and as corporations like Fairview, Allina, Mayo, Sanford, Essentia and others swallow up their competition, they become bigger and bigger players on the political scene, wielding outsized influence at the capital with their brand and their political contributions. We have seen big corporate healthcare advance its aims more and more through the legislative process, not necessarily in the interest of what’s good for Minnesotans, but rather what’s good for their bottom lines.

Community EMT, the nurse compact, telehealth, and so on.  It’s not Minnesotans advancing these issues, it’s big corporate healthcare. When Minnesotans hear that a bill is being pushed by Mayo, or any of the other large corporate healthcare players, we tend to automatically assume that it is good for us and in our best interest, but we need to dig deeper and uncover who big corporate healthcare is actually looking out for. We as citizens must remain vigilant, because what happened in Florida could happen to us.

Single Payer Healthcare Becoming Big Part of Debate

By Rick Fuentes

MNA Communications Specialist

Rick Fuentes

 

It was no surprise to hear Vermont Senator Bernie Sanders declare his support for Single Payer healthcare during last weekend’s Presidential debate.  Sanders has long been a proponent of a system that creates “Medicare for All.”  That model would cover everyone in the country through a publicly-funded agency that paid for services to every provider in the country.  After all, Sanders’ home state of Vermont adopted a Single Payer system that covered almost everyone in 2011.  Green Mountain Care, as its called, was due to be fully implemented by 2017 (it’s since been put on hold indefinitely).

 

What’s surprising now is the state of Minnesota is finally studying the idea.  Last year Governor Mark Dayton appointed a 29-member Health Care Financing Task Force to study how to improve delivery and reduce costs of patient care – from prevention to treatment.  On Friday, January 15, the task force voted to adopt 30 measures to recommend to the Minnesota Legislature.  One of those is to study the costs and outcomes that would be generated by a Single Payer system and compare those with the current model.  You Can read about the task force’s findings here at the Minneapolis StarTribune or the St. Paul Pioneer Press.  If lawmakers adopt the study idea, it would be the state’s first look into how to dramatically affect the way healthcare is both paid for and delivered.

 

Rose Roach, MNA Executive Director and Minnesota Health Care Financing Task Force Member

“The issues raised within this task force have made it very clear that we must deal with financing the system before we can begin to deal with the care delivery issues,” said MNA Executive Director and Task Force Member Rose Roach. “We need to move to a place where people get the care they need when they need it, and we save money overall.”

 

Of course, lawmakers will have to enact the study and the other recommendations of the task force to start to move Minnesota toward better healthcare.  As the articles above state, that might be tough in a legislature where Democrats have the Senate but Republicans control the House.  As bedside witnesses to what works and what doesn’t work in healthcare, nurses have a collective and respected voice on how to improve it.  Lawmakers need to hear that unified voice.

 

“As nurses, we see patients who waited too long to get care, and now their conditions are more severe,” said Mary C. Turner, MNA President in a press release last week. “The health of the patient impacts the health of the community. When patients can get the care they need, it saves their families money. It saves businesses money, and it helps the state budget too,” Turner said.

 

 

Should Supervisors Perform Bargaining Unit Work?

By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

It’s happened to just about every RN at some point or another. Your unit is short staffed, and you’re doing the best you can — but you’re stretched too thin, and your patients aren’t getting the care they’re paying for and deserve. So you call your nurse manager. What happens?

Staff-nurse supportive nurse managers do their best to avoid these situations in the first place by staffing appropriately. However, sometimes it’s just not possible to prepare for unexpected events and changes in acuity. That’s why top nurse managers, when confronted with these situations, advocate for their units in order to get another bedside RN called in to lend a hand.

Some nurse managers may also offer to help out themselves. In limited circumstances, this may be acceptable. If the nurse manager is competent to perform the work, if there was no way the nurse manager could have anticipated the staffing needs in advance, and if the nurse manager is performing the work only in limited emergency circumstances, then MNA is unlikely to pursue a grievance for a supervisor performing bargaining unit work.[1] In such instances, the needs of our patients come first.

If, however, the nurse manager precipitated the staffing crisis through purposeful unsafe staffing, if the nurse manager is not competent to perform bedside RN care, or if there is a continuous pattern of unsafe staffing and supervisors performing bargaining unit work, then MNA can and will take action. As above, in such instances, the needs of our patients come first.[2]

A continuous pattern of supervisors performing bargaining unit work indicates a greater underlying problem—unsafe staffing. As Carrie Mortrud, RN, MNA Safe Patient Staffing Specialist, puts it:

We appreciate nurse managers who step up to the plate and help the team in emergency circumstances that could not have been anticipated. When nurse managers continuously do this, however, they are covering up a larger systemic and often chronic problem — unsafe staffing. They are putting a Band-Aid on an arterial bleed. Clearly a tourniquet is needed — with a temporary Band-Aid.

In those instances, nurse managers need to step up to the plate in another way: by staffing appropriately and hiring more nurses. This protects our licenses, our jobs, and more importantly, our patients.”

Are you experiencing a situation where your nurse manager is continuously performing bargaining unit work? We want to know!  Please let your steward, labor representative, or MNA’s Regulatory and Policy Nursing Specialist Mathew Keller know right away.

 

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[1] See, for example, Essentia Health Virginia Contract p. 4: “Except in cases of emergency (an unplanned immediate need) or an unavoidable situation where patients would be deprived of needed nursing care, non-bargaining unit personnel shall not be used to perform bargaining unit work.”

[2] Please note that, in rare instances, smaller hospitals have negotiated language allowing supervisors to perform bargaining unit work.  See, for example, Deer River Contract Article 3.1: “Due to the relatively small number of RNs employed at the HealthCare Center and the relatively small size of the facility, the HealthCare Center has working managers who perform bargaining unit work in addition to their management duties.  Any significant expansion of managers doing bargaining unit work beyond that typically done at present shall be open to negotiations between the parties.  The minimum staffing for acute care at the facility will include two bargaining unit RNs if one RN is ER capable and one RN is charge capable.”

Nurse-Endorsed Candidate Jim Abeler Wins Republican Primary

Minnesota Senate candidate Jim Abeler

MNA-endorsed candidate Jim Abeler won an important Republican primary for the special state senate election in Senate District 35 yesterday. Abeler now moves on to the special general election on February 9, to replace Senator Branden Petersen, who resigned his seat.

Issues that directly affect our profession – like attempts to allow others to do registered nursing work – are decided in the political arena. To ensure that our voices are heard in those deliberations, MNA endorses candidates who stand with us on the issues. MNA is proud to support Jim Abeler.
Jim is a chiropractor and former Republican State Representative from Anoka. MNA nurses endorsed Jim several times for State Representative, and we have worked well with him on nursing, health care and labor issues. We know we can count on Jim Abeler to stand with us on issues of nursing practice and patient safety.

Then Representative Jim Abeler with MNA nurses at the 2014 informational picket at North Memorial Medical Center.

MNA nurses conducted phone banks to nurses in SD35 and are pleased that we played a small part in Abeler’s win.

For nurses who live in SD 35 (Anoka, Ramsey and parts of Coon Rapids), please get out to vote for Jim Abeler in the general election on February 9. Polls will be open from 7:00 am to 8:00 pm. To look up your polling place visit http://pollfinder.sos.state.mn.us/

Minnesota Nurses Head to Iowa to Doorknock for Bernie

 

It was a lovely day in Iowa this past Saturday. I along with Pat Webster were door knocking for Bernie Sanders.

We came up to this house and the folks there insisted that we come in and sit a spell. The house was very modest surroundings but these folks were so thrilled to be talking to us nurses, it was heart warming!

I couldn’t help thinking that Bernie Sanders is the kind of President that is needed to help those who don’t ask or expect anything from the government but who need it the most. Barb Martin and Jean Ross were out on another route.

We all had a very rewarding day, and despite having to climb my share of icy stairs after recent knee surgery I will be going again the end of January. When I will once again meet more delightful Bernie supporters.

Hope you can join me,

Mary C Turner

President of Minnesota Nurses Association

 

Nurses once again ranked the most trusted and ethical profession in the U.S.

Once again, Americans say nurses are the most trusted profession in the country,  according to a Gallup poll released December 21.

Nurses have been first in the annual Honesty and Ethics Ranking every year since 2005.

“With an 85 percent honesty and ethics rating – tying their high point – nurses have no serious competition atop the Gallup ranking this year,” according to the national polling firm.

“Minnesota nurses are proud of the trust the public places in us,” said Minnesota Nurses Association President Linda Hamilton. “People know that we are dedicated professionals who fight to make sure all patients receive the quality care they deserve.”

Here are the top five most trusted professions:

1. Nurses
2. Pharmacists
3. Medical doctors
4. High school teachers
5. Police officers.

Say ‘no’ to UAP charting requests

By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

In a cost-saving move, when certain units at a Minnesota hospital are short staffed, managers are asking nurses to allow Unlicensed Assistive Personnel (UAP) to chart under the RN’s license.  This allows UAPs to care for patients autonomously without supervision and oversight from RNs.

Needless to say, this practice is incredibly dangerous for many reasons, three of which we will highlight here.

1. UAPs simply do not have the training or expertise to independently care for patients without proper RN supervision (and chart accordingly).
2. Charts are legal documents, and when others chart using your name and login, it is legally the same as if you completed that charting and said that you did the work being documented.
3. All electronic medical records track patient lookups and history; therefore, if the UAP utilizing your chart is looking at other patients, there is a strong possibility of HIPAA violations.

Far from a cost-saving practice, allowing UAPs to chart under someone else’s license is dangerous for the UAP, for the patient, for the nurse, and for the facility.

It cannot be emphasized enough how incredibly dangerous this practice is.  In fact, we have seen nurses in other facilities be disciplined for failing to log off their medical record properly, therefore resulting in someone else charting (inadvertently) using the nurse’s login.

Have you been asked to allow another to chart under your license?  We need to know.  Please contact your steward, your labor rep, and me — at Mathew.keller@mnnurses.org.

 

Laugh, cry, learn, and share at Ethics Book Club

 

By Sue Kreitz, Chair of MNA Ethics Committee

You’re invited to participate in a book club dedicated to reading and discussing the many ethical issues that RNs and other healthcare workers face every day.

MNA’s Ethics Committee Book Club meets five times a year to have some heartfelt conversations about ethics.

It gives you the chance to read some great books and occasionally even meet the authors who have joined our meetings in person or through Skype.

Our next book club is Dec.1.

We chose Critical Care: A New Nurse Faces Death, Life and Everything in Between.

This book was written by a former English professor, Theresa Brown. In this memoir, Brown recounts experiences from her first year as an oncology nurse. She is a regular contributor to the New York Times blog, “Well,” and CNN.com. As a writer, she was looking for a change in her career to give her something more fulfilling in her life.  Her choice was bedside nursing.

• “In her journey in the life of critical care, she has opened new doors of what it is like being a nurse. She describes how it feels to be delivering patient care, the frustration of giving bad news to a parent regarding a poor diagnosis of their child, learning to work with so many different medical personalities both nurses and doctors. Many frustrations of medicine in finding the right diagnosis and treatment for so many issues. With great compassion and her disarming sense of humor, she shares the trials and triumphs of her patients and comes to realize that caring for a patient means much more than simply treating a disease. Deeply moving and at times, sobering, Critical Care sheds light on the issues of mortality and meaning in our lives. This is a well written account of a nurse’s first year in medicine, a medical memoir that combines lyricism and compassion with honesty and well-timed laugh out laugh wit! This book offer a” palpable testimony that nurses are the first responders and primary healers in our times of crisis.” This is a quote from Dr. Mehmet Oz, Author of YOU: The Owner manual health series.

Before each book club meeting, one of the Ethics Committee members shares some background on the book to help spark conversation about how the book fits in with ethical nursing concerns in our practice.  It’s not too late to grab our December book and read it before our book club on Dec. 1!

The meetings are at the MNA office at no charge for members. A light dinner is include in your registration. Non-MNA members pay a  $10 fee for the event.

We hope to see you at our book club! Please join us on Tuesday, Dec. 1, from 5-7 p.m. at the MNA office, 345 Randolph Ave. Suite 200, Saint Paul, MN 55102!

If you can’t make it Dec. 1, here’s the list of books for 2016:

Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry’s Quest to Manipulate Height by Susan Cohen and Christine Cosgrove (2009): Tuesday, Feb. 16

Hiding in the Open: A Holocaust Memoir by Sabina Zimering (2001): Tuesday, April 19

America’s Bitter Pill by Stephen Brill (2014): Tuesday, Aug. 16

Being Mortal: Medicine and What Matters in the End by Atul Gawande (2014): October 2016 (actual date, time, location TBD).

The Insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens by E. Fuller Torrey (2008, 2012): Tuesday, Dec. 6

We look forward to exploring important ethical concerns that affect you and our profession in 2016!

Apply for MN Board of Nursing, other public service opportunities

By Geri Katz, MNA Political Organizer

Have you ever thought about serving the public beyond your day-to-day job? Applying your nursing expertise to public service in order to make the public safer in different health care settings throughout Minnesota?

The State of Minnesota is always looking for interested and engaged citizens to serve on state boards and councils. Several have designated positions for RNs.

The one most nurses are most familiar with is the Minnesota Board of Nursing, which protects the public’s health and safety through regulation of nursing education, licensure and practice.

Two RN positions, one APRN position, and one LPN position, on the Board of Nursing will open up in 2016. Governor Dayton will fill those positions. The time commitment, approximately 150‐175 hours annually, includes monthly meetings in St. Paul and ad hoc committee meetings.

Several other board or council vacancies call for an RN or a union member as well. Here’s the full list:

• Minnesota Board of Nursing: two RN positions, one APRN position, one LPN position;
• Maternal and Child Health Advisory Task Force: “professionals with expertise in maternal and child health services;”
•  Ombudsman for Mental Health and Developmental Disabilities: one nurse representative;
• Minnesota e-Health Advisory Committee: one nurse representative;
•  Medical Services Review Board: one Registered Nurse Alternate;
• Occupational Safety and Health Advisory Council (Appointed by Commissioner of Labor): two labor members, one Occupational Health professional;
• Occupational Safety and Health Review Board: one labor member;
• Public Employees Retirement Association: one retired annuitant;
•  State Advisory Council on Mental Health: one Registered Nurse.

These are all appointed positions, some of which will be competitive. MNA staff can help you through the application process if you want a chance to serve.

They are all great opportunities to put your nursing experience to work in a new setting, learn more about how state government affects nursing and health care, and be a part of the team that makes decisions about our future.

If you are interested in learning more about any of these opportunities to serve the public, please contact Geri Katz.

MNA congratulates 2015 award honorees

The Minnesota Nurses Association honored members and friends who advocated for nurses, patients, our communities, and the nursing profession in the last year at our annual Honors and Awards Banquet on October 5.

Congratulations to all!

 

Public Official Award: Sen. Chuck Wiger

Sarah Tarleton Colvin Political Activist Award: Mary Turner, North Memorial Medical Center, Robbinsdale

Distinguished Service Award: Kathleen Moore, Children’s Hospital and Clinics-Minneapolis

Logsdon-Wedel Award: Margaret McIntosh, Children’s Hospital and Clinics-Minneapolis

President’s Award: Barbara Martin, Retired

Elizabeth Shogren Health and Safety Award: Jane Gilbert-Howard, St. Luke’s Hospital, Duluth

Mentorship in Nursing Award: Jody Haggy, Fairview Riverside, Minneapolis

Paul and Shiela Wellstone Social Justice Award: Niki Gjere, Fairview Riverside, Minneapolis

Creative Nursing Award: Rochelle Boyce, Children’s Hospital and Clinics-Minneapolis

Ruth L. Hass Excellence in Practice Award: Paula Boeckmann, United Hospital, St. Paul