Last year was a tumultuous one for Allina Health in Minneapolis and its nursing staff. After a week-long walkout in June, Allina nurses went on strike in the fall as part of ongoing contract negotiations centered around the elimination of union-backed health plans. After a six-week strike, both sides finally reached an agreement that ended the strike and sent the nurses back to work.
As part of its 2016 earnings report, Allina Health reported that while revenue increased over the year, operating income dropped, thanks in part to expenses related to the nursing strike. Allina recorded a $30 million operating loss, a significant $179-million-dollar swing from the $149 million operating gain Allina posted in 2015. As part of its report, Allina cites a $149.3 million of strike expenses, which included hiring 1,400 replacement nurses to cover for the striking staff.
For more information on nursing strikes, check out the Strategies for Nurse Managers Reading Room.
The role of nurses has expanded greatly over the past few years, as nurses are moving from the bedside into all facets of healthcare. Hospitals have started to use nurses’ expertise to help design their facilities, with impressive results.
Hospital design can have a profound impact for both nurses and patients, but facilities are just starting to include nurses in the design process. Health Facilities Management (HFM) reports that involving nurses in design planning can help executives and contractors keep patient-care priorities in mind during construction. Seemingly small decisions, like the placement of sinks, computers, or wall outlets, can lead to an increase patient satisfaction. Nurses have been behind some of the pioneering new hospital designs, such as single-occupancy maternity rooms and the acuity-adaptable patient rooms. As one nurse told HFM, “Nurses spend the most time with the patient… we have a responsibility to be the voice of the patient, family and each other.”
Looking out for each other is another great reason for involving nurses in hospital design. A study published by Hassell and the University of Melbourne found that hospitals designed to accommodate nurses have a better chance of attracting and retaining nurse staff. The researchers identified a link between hospital workplace design and efficiency, health and safety for staff and patients, and staff morale. These factors play a significant role in staff retention, and who better to ensure a facility is attractive to nurses than nurse leaders?
Nurse-led design choices improve conditions for patients and nurses, but they can also help the bottom line. Nurses are involved in many different areas of the hospital, and their input can make operations more efficient and affordable. In one example reported by HFM, nurses saved the Parkland hospital project millions of dollars by eliminating unnecessary equipment and cabinetry in emergency rooms.
Both the survey and HFM article note that despite these benefits, nurses don’t always get a voice in hospital design. But as nurse-designed hospitals flourish, perhaps more facilities will involve nurses in design plans.
For more about Nursing and hospital design, check out: Take Five: How renewal rooms revive stressed out nurses
Enjoy this Ted Talk given by HCPro author Kathleen Bartholomew. Listen to Kathleen discuss the importance of dismantling the nursing hierarchy that can devalue and shame caregivers and creating an atmosphere of open communication and respect between caregivers which ultimately improves patient care.
On March 15, the newly unionized nurses of Kaiser Permanente Los Angeles Medical Center arranged a seven-day strike in hopes of getting their first collectively-bargained contract.
Last summer, 1,200 nurses voted to join the California Nurses Association (CNA), and the walkout was their first major action since joining the union. Negotiations for a new contract have been taking place since September, and this timed strike is part of the negotiation process. The union hopes to improve the conditions both for the RNs and their patients; the nurses report being understaffed, often having to cover units outside of their specialties, and seek economic improvements to attract and retain qualified nurses. Another concern brought up by the union is the hospital’s plans to open a medical school in the next few years, which will put additional strain on the hospital and its staff. The combination of factors led to the strike.
Kaiser Permanente expressed disappointment at the nurse’s tactic, and claims that they made a fair offer last month that went without a response. Additionally, Kaiser notes that their nurses are among the highest paid in the region, and their new offer would keep them there.
All of this is happening among growing concerns about healthcare coverage, as demand has spiked over the past few years.
The striking RNs have gone back to work after seven days of picketing, and negotiations between the two sides are still ongoing.
Nurse managers and their staff often face racism in the work place; Minority Nurse reported that almost half of minority nurses said they have experienced barriers in their career because of their race and educational background. In addition to institutional barriers, there is also the problem of patient racism, where patients refuse care based on the race or ethnicity of the provider. As a nurse, you might be put in the unenviable position of deciding how to handle one of these situations. Do you refuse care to the patient? Do you acquiesce to the patient’s unreasonable demand?
The New England Journal of Medicine published an article last week that provides some useful information about how to handle patient racism. The authors point out that there are a number of concerns to take into account, both legally and ethically. The situation pits a number of rights and laws against each other, including the patient’s right to refuse medical care, laws that require hospitals to provide medical care in emergency situations, and employment rights that dictate that hospitals cannot make staff decisions based on race. Nurses that have been reassigned based on a patient’s racial demands have successfully sued their employers, but if a patient doesn’t receive proper medical attention in a timely manner, facilities are equally liable.
The journal lays out five factors to consider when faced with this difficult situation:
- The patient’s medical condition: If the patient is unstable, treat the patient right away, regardless of the patient’s preference. It is possible that their current condition is impairing their mental faculties.
- The patient’s decision-making capacity: Try to assess if the patient is capable of making decisions for themselves; psychosis or dementia are important factors to consider. If the patient lacks decision-making capacity, try to persuade the patient to reconsider their request.
- Reasons for the request: If there are clinical or ethnically appropriate reasons for reassigning staff, that should be taken into consideration. For example, if there are language barriers or religious concerns, it might be reasonable to accommodate the patient.
- Effect on the provider: Always take into account the effect a decision might have on the employee. “For many minority health care workers, expressions of patients’ racial preferences are painful and degrading indignities, which cumulatively contribute to moral distress and burnout,” according to the article. Always try to support staff when possible, and discuss their preferences when deciding how to respond.
- Options for responding: In some situations, staffing might dictate your decision. If the department is understaffed and you cannot provide proper coverage by reassigning, try to persuade the patient.
If faced with a non-emergency situation and a patient is deemed capable of making decisions, the article suggests that it may be best to suggest that the patient seek care elsewhere; though that also has its risks depending on the availability of other treatment.
For more information on this difficult issue, including a useful decision-making tool, read the New England Journal of Medicine’s full article.
Hiring a competent nurse staff is only half the battle. The other half is keeping them. A new study published in Nursing Ethics found the turnover rates for RNs is 16.5%, with each resignation costing a hospital between $44,380 to $63,400 a nurse. Furthermore, newly licensed nurses scored lower on job satisfaction and were more likely to leave their job within two years.
The Nursing Ethics report found that intergenerational conflict was a big part of nurse dissatisfaction; with millennials, Gen Xers, and baby boomers butting heads at the hospital.
“Younger generation nurses feel like they don’t have power over their practice, they’re not in charge, and that is logical because they are novice practitioners,” study author Charleen McNeill said in a press release. “However, they bring a knowledge of technology that seasoned nurses may lack. In turn, more experienced nurses support the clinical learning and professional role formation of new nurses. Successful nurse-leaders find ways to garner the strengths of each generation of nurses to achieve the best patient outcomes.”
McNeill said instead of looking at it as conflict, nurse-leaders need to leverage the strengths of each generation and determine strategies to empower all generations of nurses. Their research suggested a strong correlation between professional values and career development. They also found that both job satisfaction and career development correlated positively with nurse retention.
“The work culture that leaders create – the environment that nurses are working in – is the most important thing related to retention,” McNeill said. “It’s very expensive to hire new nurses. When we have good nurses, we want to keep them so we need to understand what’s important to keep them.”
For more tips on retention, conflict resolution and recruitment, check out the following articles from our Strategies for Nurse Managers site!
Nursing Peer Review in Action: Experienced Nurses Share Best Practices and Lessons Learned
Thursday, December 3, 2015 at 1:00-2:00 p.m. Eastern
HCPro is hosting a free webcast on December 3 about formal, case-based nursing peer review. Join Sarah Moody, DNP, RN, NEA-BC, and June Marshall, DNP, RN, NEA-BC, for a free 60-minute webcast on how incident-based nursing peer review benefits an organization and elevates nurse practice.
These experienced speakers will clarify the difference between formal, incident-based nursing peer review and the type of review that involves peer evaluation of nurses’ performance. They will demonstrate how incident-based nursing peer review can elevate quality and the professionalism of nursing through sharing case studies and lessons learned.
Moody and Marshall have many years of experience leading nursing peer review committees as incident-based nursing peer review is mandated by the Texas Nursing Practice Act.
For the full agenda and to register for this free webcast, visit http://eventcallregistration.com/reg/index.jsp?cid=58467t11.
As promised last week, we’ve added a free download from Kathleen Bartholomew’s Ending Nurse-to-Nurse Hostility, Second Edition, in honor of being the only book chosen by the American Nurses Association as a recommended bullying and horizontal hostility prevention tool.
To access the download site for a tool you can use to evaluate the health of your workplace as regards bullying, lateral violence, and other undesirable behaviors, click here.
To read last week’s story the ANA position statement on workplace violence and the nursing profession, click here.
On August 31, the American Nurses Association issued a press release announcing its updated position statement on workplace bullying and violence, stating that the “nursing profession will no longer tolerate violence of any kind from any source.”
Among the interventions recommended as “primary prevention” is the HCPro classic work by Kathleen Bartholomew,
Ending Nurse-to-Nurse Hostility, Second Edition. In fact, Ending Nurse-to-Nurse Hostility has the distinction of being the only book recommended to RNs and their employers in the statement as a front line tool for preventing incivility and bullying.
We are so honored to have published Kathleen’s work, and congratulate her for this wonderful recognition of a lifetime commitment to making the nursing workplace a healthier, more collegial place. If you would like to add your best wishes, feel free to comment below!
As promised in last week’s post, Try This: Build nursing team self-esteem, the exercise that Kathleen Bartholomew uses to encourage nurses’ self-esteem has been posted to our Tools Library.
To download the Hierarchy of Voice tool, click here.
Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew