Jumat, 11 Juni 2010

Okay, I'm finally forming an opinion on the MN nurses' strike.

For those of you who don't know, I work in a non-union shop. Texas as a whole has not been friendly to unions; we're considered at work-at-will state (though whose will that is is sometimes in contention). The whole union/nonunion thing is therefore a little bit of a closed book to me.

I've stated in the past that I will not scab for the management of a union shop during a strike. I've gotten a couple of emails and one comment in the past week or so asking why that is. First, it's because I believe strongly in what unions have accomplished in the past and what they continue to do now. The value of unions in certain industries is debatable, as are the actions of certain union leadership, but let's be clear: the forty-hour work week, safety standards in industries like construction and mining, and fair pay and benefits did not come out of the goodness of business leaders' hearts.

Second, the key to an effective strike is that management feels some discomfort. If people are willing to break a strike, that means the discomfort doesn't happen. Yeah, management will feel the pain in paying those people a C-note per hour, but it's not as uncomfortable as seeing and feeling the effects of other workers refusing to break the strike.

And now you all can picture me in my red T-shirt, fist in the air, singing "Solidarity Forever".

As for the nurses' strike in Minnesota (and the concurrent one in California): I've read the proposal from the Minnesota Nurses' Association (PDF can be found here) and am flummoxed.

It's not any different from the staffing guidelines we have at Sunnydale and in the Ginormo Research And Education System, Incorporated as a whole. Right down to the ten percent wiggle room in beds for OB and ER patients, it's what we do. Yes, there are times we go on divert and have to reschedule elective surgeries, though it's not common. Yes, there are times that ICU nurses have to work overtime (though there are guidelines in place for that, as well: I can't work more than four days without a break, for instance). Yes, there are times that managers have to come in and work at the bedside, though that's *exceedingly* rare. Overall, though, it seems to work pretty well.

We have some flexibility in how we staff, not just according to patient numbers, but also according to patient acuity. People on continuous dialysis, for instance, always are one-to-one, as are complex kiddos in the NICU. If a charge nurse decides that a patient needs to be one-to-one or two-to-one for some reason, that happens. (Don't ask me how; I'm not a critical-care charge nurse, thank Frogs.)

Though we float from place to place, we do so within reason. A neuro-critical-care nurse like myself is not going to float to a transplant unit or to OB. Likewise, a med-surg nurse from an oncology floor isn't going to end up in a neuro or orthopedic unit. We have a pool of float nurses who are trained eight ways from Sunday to handle damn near everything, and the OB and baby-people have their own float staffs.

Is it expensive? You bet your ass it is. Is it labor-intensive in terms of training and scheduling all those people? Yep. Does it result in some of the best patient outcomes in the country? As my six-year-old neighbor would say, "Well, DUR."

We have had no--I repeat, no--cases of hospital-acquired pneumonia, central line infections, or UTIs in the past three quarters in our critical care units.

So. Given my own experience with what seem to be very reasonable demands on the part of the Minnesota nurses, I have to say: my primary opinion on this strike is that it was warranted. I support their demands. I support their right to strike. I hope like hell they get the staffing levels they want and need.

But then, I'm a pink-socked Marxist with a poster of Che above her bed.