REALIZING RATIOS Massachusetts kicks off THE VOICE OF ... · matters of nursing practice, community and public health, and healthcare policy. ... It is only because of the true grit

NEW MEDIANurses create their

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REALIZING RATIOSMassachusetts kicks offsafe staffing campaign

January | February 2011NationalNURSE

T H E V O I C E O F N AT I O N A L N U R S E S U N I T E D

Triumph!Even in tough times, Kaisernurses win model contractfor nation’s RNs

Cover_7 2/24/11 7:00 PM Page 1

NATIONAL NURSE,™ (ISSN 2153-0386

print/ISSN 2153-0394 online) The

Voice of National Nurses United,

January | February 2011 Volume 107/1 is

published by National Nurses United,

2000 Franklin Street, Oakland, CA

94612-2908. It provides news of organi-

zational activities and reports on devel-

opments of concern to all registered

nurses across the nation. It also carries

general coverage and commen tary on

matters of nursing practice, community

and public health, and healthcare policy.

It is published monthly except for

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Department.

Please contact us withyour story ideasThey can be about practice or manage-

ment trends you’ve observed, or simply

something new you’ve encountered

in the profession. They can be about

one nurse, unit, or hospital, or about

the wider landscape of healthcare

policy from an RN’s perspective.

They can be humorous, or a matter

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EXECUTIVE EDITOR Rose Ann DeMoro

EDITOR Lucia Hwang

GRAPHIC DESIGN Jonathan Wieder

COMMUNICATIONS DIRECTOR Charles Idelson

CONTRIBUTORS Gerard Brogan, RN,

Hedy Dumpel, RN, JD, Jan Rabbers, Donna Smith,

David Schildmeier,Ann Kettering Sincox

PHOTOGRAPHYJaclyn Higgs, Tad Keyes,

Lauren Reid

it’s sad, but true. Werarely see direct-care regis-tered nurses on television,hear them on the radio, orquoted in news articles. Yetbedside nurses, as frontlinecare providers, are uniquelypositioned to explain to thepublic everything from whatwill or won’t work in nationalhealthcare reform, to how tobetter manage their highblood pressure and diabetes.

It’s high time for nurses to take media matters into theirown hands. One of the best ways to do this, we think, is bycreating our own programs for distribution—through tele-vision, radio, and the Internet. We are now working withGRITtv with Laura Flanders on a segment we’re callingThe Nurses’ Station that will launch this spring. The Nurs-es’ Station will cover news headlines of the day, but from adirect-care nursing perspective. NNU also continues tosponsor Nurse Talk, a hilarious weekly radio interview andvariety program hosted by real, live, bedside nurses. Andsince so many RNs now turn to the Internet for their newsand information, we’re continuing to get out the wordabout our nurses’ movement by branching out throughsocial media networks. Read all about our efforts in thisissue’s feature story.

We also want to highlight some important contractfights and wins this winter. Wilkes-Barre General HospitalRNs in Pennsylvania staged a one-day strike in December,braving bitter cold and snow to show their recalcitrant

management that they were willing to walk the walk,straight to that picket line, over egregious takeaways. InNorthern and Central California, more than 17,000 KaiserPermanente RNs and NPs won a new three-year contractthat stunningly, when compared to negotiations happeningin other parts of the country, included not only zero conces-sions but also many patient care improvements and wageincreases. It’s probably the best contract in the nation and adocument to point to when employers complain that theycan’t meet higher standards during these economic times.

And across the nation, many of our NNU states arerelaunching their 2011 campaigns for safe RN-to-patientstaffing ratio legislation. Massachusetts, Florida, Missouri,and Texas are just some examples of states where RNstaffing ratio bills are in play. The staffing ratios have madea tremendous difference in California (Check out our newvideo on our YouTube channel featuring nurses contrastingthe times before and after ratios.) and are excited that thismodel can be adopted by other states.

We have a lot of hills to climb in 2011, so let’s all resolvethis year to step up our good work and do just a little bitextra. We all know it could mean the difference between lifeand death.

Deborah Burger, RN | Karen Higgins, RN | Jean Ross, RNNational Nurses United Council of Presidents

Letter from the Council of Presidents

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4 News Briefs Massachusetts RNs introduce ratios bill 6 | Wilkes-

Barre nurses strike; Insurance companies profitfrom Medicaid reform 7 | Despite recession, KaiserRNs win stellar contract 8 | Nurses picket BlueShield over rate hikes, increases delayed; Texas RNspush for ratios in contract talks as well as state bills;VA nurses hold quarterly meeting and win firstnational grievance

9 If President Obama Were a Nurse

Healthcare reform would have focused on patients,not corporations. By Rose Ann DeMoro

10 Taking Media into Our Own Hands

Why don’t we ever see direct-care registered nurses on television or radio? Learn how NNU is creating its own nurse media to inform, educate, and entertain.

14 Rising to the Occasion Michigan RN Diane Goddeeris takes her

responsibility as a nurse seriously, whether it’shelping lead the national nurses’ movement orserving on her city council. By Lucia Hwang

ON THE COVER: Kaiser Permanente RNs cele-brate ratification of a new three-year contract.Photo by Lauren Reid.

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Contents

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FINALLY! The whole country

is protesting attacks on the working people of

America. Get updates atprotestintheusa.org

and through our@protestintheusa Twitter feed. Join us by sending in your

reports and actions!

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MASSACHUSETTS

Leaders from the MassachusettsNurses Association, along withregistered nurses from TuftsMedical Center in Boston and St.Vincent Hospital in Worcester, held

joint press conferences outside the two facil-ities Jan. 19 to detail their concerns aboutpatient safety at their hospitals and to callfor legislative support for, and passage of,long-sought legislation to set safe patientlimits for nurses, as well as a bill to ban thedangerous practice of mandatory overtimeas a means of staffing hospitals.

“These two hospitals are poster childrenfor deplorable staffing practices that are rep-resentative of a growing trend in the industrystatewide and nationwide,” said Donna Kelly-Williams, president of MNA, adding thatnurses have filed more than 1,300 reports inthe last year of unsafe situations at both facil-ities where patient care was compromised.

At the press conference outside TuftsMedical Center, dozens of nurses from the

facility, along with nurses fromother facilities in greater Boston,attended the event. Many of theTufts nurses wore black scrubs, aweekly practice at the hospital tosymbolize the deterioration inpatient care since hospital man-agement implemented a newstaffing model that has resultedin nurses being forced to care formore patients at one time, while also usingmandatory overtime, and the floating ofnurses from floor to floor as a means ofstaffing the hospital. As a result of the staffingchanges, Tufts Medical Center, which accord-ing to its CEO cares for the sickest patients inthe state, has become the worst-staffed hospi-tal in the city, and the only hospital thatforces nurses in the intensive care unit tosometimes care for three patients at a time.

According to Barbara Tiller, a longtimenurse at the hospital and chair of the MNAlocal bargaining unit, in the last year thesepractices have prompted nurses to file morethan 520 reports of incidents that jeopard-ized patient care, and have caused the nurs-

es to call upon the Legislatureto regulate RN staffing levelsand to seek improvements instaffing through their ongoingunion contract negotiations.

“It is with the utmost concernfor the safety of our patients thatI, on behalf of the 1,100 nurses ofTufts Medical Center, am takingthis opportunity to appeal for

legislative support for desperately neededlaws to set staffing levels and stop the use offorced overtime in this and other hospitals,”Tiller stated. “I see nurses all over the hospi-tal going home late and in tears over howbad their shift was, hearing that they spendsleepless nights wondering what theymissed, or feeling horrible about not beingable to provide the level of care they knowtheir patients deserve. Even one of theseoccurrences is unacceptable, but to have ithappening nearly every day is disgraceful,and it is patently dangerous.”

The St. Vincent Hospital press confer-ence also drew a crowd of nurses from thefacility, with attendance from nurses who

4 N AT I O N A L N U R S E W W W. N AT I O N A L N U R S E S U N I T E D . O R G J A N U A R Y | F E B R U A R Y 2 0 1 1

NEWS BRIEFS

This page: Tufts Medical Center RNBarbara Tiller calls forstate staffing ratios.Opposite: St. VincentHospital RN MarlenaPellegrino explainspatient safety crisis at her facility.

Massachusetts RNs LaunchCampaign for Safe Staffing Ratios

NewsBriefs_Jan 2011 2/24/11 10:18 PM Page 4

work in the UMass Memorial Health Caresystem. Marlena Pellegrino, RN, a medicalsurgical nurse at St. Vincent and chair ofthe nurses’ MNA local bargaining unit, pre-sented a foot-high stack of more than 800reports of unsafe conditions at thefacility. She noted that in 2009, the DPHreleased a report that showed St. VincentHospital had more serious medical errorsand patient care mistakes than any hospitalin the state.

“I am ashamed of these results, and I cantell you without equivocation that our nurs-es and patients are being placed in jeopardyin this hospital every day and on everyshift. It is only because of the true grit of ournurses that there haven’t been more seriousincidents at this hospital,” Pellegrino said.

Speakers at both locations made it clearthat the problems at Tufts and St. VincentHospital, while serious, were not isolatedsituations, but symptomatic of an industry-

wide trend impacting nurses and patientsthroughout Massachusetts and throughoutthe nation.

“The public needs to know, and the Leg-islature in Massachusetts needs to bereminded again, that our hospitals are fail-ing us. Patients in Massachusetts and acrossthe nation are being harmed, physically andemotionally every day on every shift, simplybecause their nurse has too many otherpatients to care for at one time,” said KarenHiggins, RN, who serves as co-president ofNational Nurses United, the largest unionof registered nurses in the country, as wellas co-chair of the Coalition to Protect Mas-sachusetts Patients, an alliance of morethan 125 healthcare, consumer, and labororganizations in the state that is promotingpassage of the safe staffing legislation. Hig-

gins also pointed out that the industry hasbeen exploiting the current economicdownturn to lay off staff, use forced over-time, and float nurses between units simplyto cut costs and boost profits.

The links between poor staffing andforced overtime to poor outcomes and pre-ventable deaths are well documented. Forexample, one study found that every patientabove four assigned to a registered nurseresulted in a 7 percent increase in the risk ofdeath for all patients under that nurse’scare. So when a Tufts or St. Vincent nursecomplains about having seven patients atone time, the science demonstrates that allof those patients are at a 21 percent greaterrisk of death.

Other studies have found that nursesworking mandatory overtime are threetimes more likely to make a medicationerror, and a brand new study released thismonth found that nurses working more

than 12 hours results in an increase inpatient deaths in hospitals. The Institute ofMedicine has recommended that no nurseever be required to work more than 12hours, which is a regular occurrence at TuftsMedical Center.

The safe staffing legislation, the PatientSafety Act, calls upon the MassachusettsDepartment of Public Health (DPH) to setsafe limits on the number of hospitalpatients a nurse is forced to care for at onetime. The bill would also prohibit mandato-ry overtime, such as forcing RNs to workextra hours or double shifts, and protectsagainst the reduction in the number ofother members of the healthcare team,including LPNs, aides, and technicians.Patients would have the right to know anddemand safe limits.

This legislation is similar to a law passedin California, which since its implementa-tion in 2004, has led to a dramatic improve-ment in patient care. A study published lastyear in the Journal Health Services Researchfound that the California law is working,resulting in better outcomes for patients,and a reduction in patient deaths comparedto states without enforceable limits onpatient assignments.

In addition to the Patient Safety Act, theMNA is filing An Act Protecting Patientsfrom Preventable Medical Errors by Prohibit-ing Mandatory Overtime, which wouldspecifically prohibit hospitals from usingmandatory overtime (defined as more than12 hours or 16 hours in a 24-hour period) as ameans of staffing hospitals, except in the caseof a declared state or national emergency.

Because there is now no statewide stan-dard of care, nurses at both Tufts MedicalCenter and St. Vincent Hospital are alsoattempting to achieve safe patient limitsthrough the collective bargainingprocess. However, absent state laws, theonly option for them and other nursesacross the state and nation will be to strikefor patient safety. Last year 1,200 nurses atTemple University Hospital in Philadelphiaand more than 10,000 nurses from severalhospitals in Minnesota waged high-profilestrikes over this same issue.

“Without a legislative solution, we haveno choice but to use all means at our dispos-al to protect our patients,” said Pellegrino.

For more than a decade, the hospitalindustry has fought furiously to defeat anyregulatory measure that would limit theirability to engage in unsafe staffingpractices. Different versions of the legisla-tion have made it to the House and Senatefloors over the past 15 years but have neversuccessfully passed through both chambers.

Following the press conferences, bedsidenurses from each facility headed to the statehouse to ask legislators to cosponsor bothmeasures, which were filed in January byMNA.

”Something must be done. The situationis critical, and there are human lives at stake,”Tiller concluded. “We need the safe staffingbill and a law to ban mandatory overtime. I,along with my colleagues here today, intendto be up at the state house banging on doors,doing our best to convince our elected offi-cials to end this crisis.” —David Schildmeier



The competition is stiff thisseason for the mantel of LatestProfit Craze in America’s hyper-commercial world of healthcare.Big Pharma reported yet another

year of big profits in retail sales, with medsnow accounting for $1 of every $10 spent onhealthcare. Running a health trade grouplikely brings you seven figures with nine of12 healthcare association CEOs making $1million or more, according to NationalNurses United. But the grand prize for prof-iteering goes to the perennial favorite: theinsurance industry, for bilking billions out ofMedicaid.

It may be a government-funded programfor the poor, but there’s a king’s ransom inrunning Medicaid, and the ultimate benefi-ciaries are insurance companies, theirstockholders, and top officers. Insurers arecrowing over the $40 billion treasure trove

in new Medicaid revenue expected over thenext three years—that’s on top of the $56.6billion insurers are already pulling down forthe administration of poverty healthcareprograms. And there’s lots more to come.“The Medicaid space is a significant long-term growth opportunity for us,” insurerUnitedHealth Group told the Wall StreetJournal at the end of 2010.

The next big bounty expected is approxi-mately $38 billion, according to CitigroupResearch, due in that magical year of 2014,when the new healthcare law kicks in, trig-gering an anticipated 16 million new Medi-caid enrollees. Except for those 16 millionneedy patients, no one else is waiting until2014. Deals are being cut between govern-ment overseers and insurance execs at thisvery moment, as the whirl of revolvingdoors at corporate healthcare headquartersgains momentum.

About three-quarters of Medicaid is runby privately managed plans—mostly insur-ance companies—and states are handingout those contracts, which often run in five-year increments, with a frenzy. “States wantto get vendors lined up now to avoid disrup-tion in 2014,” explained Avery Johnson ofthe Wall Street Journal. No doubt. “Avoid-ing disruption” is what gets you a “buy” rec-ommendation over at Citigroup Research.

Healthcare spending totaled 17.6 percentof US GDP in 2009, or a record $2.5 tril-lion. Of those trillions, Medicaid—which islinked to poverty rates and reflects a not-so-subtle indication of high levels of citizenpoverty—accounted for 15 percent of allhealth spending.

Officially, the U.S. poverty rate is 14.3percent, but poverty organizations insist thenumber is higher. Economic Policy Institute

PENNSYLVANIA

More than 400 registerednurses at Wilkes-Barre GeneralHospital staged a one-daystrike on Dec. 23 to show theiremployer, the giant Tennessee-

based for-profit hospital chain CommunityHealth Systems, that they refused to toleratethe current state of contract negotiations.

Eighteen months after CHS purchasedWilkes-Barre General Hospital, nurses atthe community hospital in northeastern

Pennsylvania are still without a contract.CHS has proposed unaffordable healthcare,which is already causing financial hardshipsfor non-union employees at the hospital,but the nurses have resisted. The companyhas refused to discuss nurse-to-patient

ratios, risking patient safety and outcomesfor its bottom line. In addition, CHS wantsto put language into the contract whichwould allow it to unilaterally make changesto benefits and policies, thus nullifying thecontract.

These unacceptable proposals have beendelivered to the Wilkes-Barre nurses timeand again via a federal mediator, becauseCHS representatives—when they actuallybothered showing up to bargaining ses-sions—would almost never enter the roomduring negotiations.

“We are frustrated and angry at the way

that Community Health Systems has beentreating us on the job and at the bargainingtable,” said Fran Prusinski, a critical carenurse and member of the nurses’ bargainingcommittee. “Despite the record profits thatthey extract from our community to send to

Tennessee, they treat us withdisrespect and a ‘take it or leaveit’ attitude.”

That disrespect for the nurses,the patients, and the communityforced the Wyoming Valley Nurs-

es Association/PASNAP to stage the one-daystrike right before Christmas. Nurses at Wat-sonville Community Hospital in California,which is also owned by CHS, staged a strikeover similar issues last October.

In the early morning hours of Dec. 23,


How Insurance Companies Will MakeEven More Money Off Medicaid

Wilkes-Barre Nurses Strike for Patients, Respect

NEWS BRIEFS

(Continued on page 8)



nurses and supporters gathered in front ofWilkes-Barre General Hospital to greet thenight shift as they exited the building, offi-cially beginning their 24-hour strike at 7 a.m.

Snowflakes were falling and the windwas icy, but the mood on the picket line wasupbeat as the nurses marched and chanted.More and more striking nurses joined thefour simultaneous picket lines, as did sever-al doctors, PASNAP nurses from Communi-ty Medical Center in Scranton and TempleUniversity Hospital in Philadelphia, mem-bers from more than a dozen other unions,the Northeast Area Labor Federation, andsupporters from the community. Notably,nurses represented by SEIU joined thepicket line from Mercy Hospital of Scran-ton, a nearby hospital which CHS isattempting to acquire. Back in November,Wyoming Valley nurses had spoken outagainst CHS at a public meeting about thesale of Mercy Scranton.

At noon, the striking nurses hosted a rallyin front of the hospital, during which theirsolidarity was evident. Elaine Weale, anacute-care RN for 31 years, said she receivedpositive reactions from the community asthey passed by. “Several of us were asked howwe were able to tolerate such frigid tempera-tures and biting wind,” said Weale. “Weresponded ‘We work in worse conditionsevery day’ and continued picketing.”

As dusk fell, the strikers gathered for acandlelight vigil. Huddled close together, theirfaces glowing in the soft flames, the nurses lis-tened as their coworkers gave more somberspeeches about strength and solidarity. Theyreflected on why they fight so hard for theirprofession: responsibility to their patients, totheir families, and to all those who put theirtrust into the caring hands of a nurse.

The next morning, Wilkes-Barre nursesand supporters gathered again on the samecorner. When the strike was officially over at 7a.m., the nurses walked back into the hospitalas a group, with a renewed sense of missionand their heads held high. The one-day strikewas a success, but the fight far from over.

“Though we know that this is only thebeginning of a long struggle against Com-munity Health Systems, we are prepared tocontinue fighting for as long as it takes,”affirmed Bill Cruice, PASNAP executivedirector. “CHS is trying to make an exampleof our unionized nurses here in Wilkes-Barre, but they will soon find out the powerof solidarity.” —Emily Randle

CALIFORNIA

Bucking national trendsduring this severe recession,some 17,000 registered nursesworking at northern and centralCalifornia Kaiser Permanente

facilities in February ratified a new three-yearcontract that included no concessions andbuilt even more patient protections into apact that was already the best in the nation.

Notably, the California Nurses Associa-tion was able to negotiate this new agree-ment without protracted bargaining or fight,and even before the current contract expired,showing the collective power of the RNs.

“I am pleased that Kaiser did not try to usethe recession to squeeze concessions from thenurses because that would have lead to mas-sive mobilization and a potential strike,” saidZenei Triunfo-Cortez, RN, chair of the Kaiserbargaining council, and a CNA/NNOC co-president. “This proposal protects ourpatients, defends our hard-fought economicand practice standards in a tough economicenvironment, and demonstrates again thestrength of our professional union, CNA/NNU, and the unity of Kaiser nurses.”

The new contract includes more than 20professional and economic enhancementsfor all classifications of registered nurses andnurse practitioners. It spells out improve-ments on working conditions, such as fixedschedules so that nurses can better balancetheir work and home life, and on staffingissues, such as the formation of a new region-al education committee devoted to GRASP,the acuity system that Kaiser uses. On theissue of compensation, nurses will receive a 5percent increase in compensation each year.

“There’s something for everybody to like init,” said Deborah Burger, a gastroenterology

and infusion center RN at Kaiser Santa Rosa,a CNA/NNOC copresident, and a member ofNational Nurses United’s council of presi-dents. “The call center nurses are now able todevelop an assessment tool for RNs and get alittle more break time away from their desks.The home health nurses got Kaiser to recog-nize that home health visits take more time,and requires an acuity tool for measurement.And it also acknowledges that even in thesetough economic times, nurses still deserve payincreases so that they don’t fall behind the costof living.”

While nurses are “ecstatic” about the newcontract, Michelle Vo, a clinic RN at KaiserFremont and a member of the CNA/NNOCBoard of Directors, said that the agreementis “only as good as the people who enforce it.If it’s not enforced, it doesn’t mean anything,it’s just writing on a piece of paper.” Despiteposting healthy profits the last few years,netting $1.7 billion in profit for the firstthree quarters of 2010 and $2.1 billion in2009 according to various business journalreports, Kaiser has been shutting downmany outpatient clinics, and closing or con-solidating unprofitable hospital units suchas pediatrics and psych, forcing patients todrive farther for care or go without. Vo saidnurses are committed to challenging Kaiseron every cut. “I’m glad Kaiser didn’t want topick that fight [on the contract],” said Vo.“But now the fight is over direct patient care,whether at the bedside or in the clinic.”

Burger said the Kaiser contract sets asolid precedent for all other nurses cur-rently bargaining and preparing to bar-gain contracts. “No matter what anybodysays, there’s still a nursing shortage,” saidBurger. “This contract raises the bar forother systems and puts pressure on themto work with their nurses to provide thebest care you can.” —Staff report

Despite Recession,Kaiser RNs Win Stellar Contract


Californiapublicly embarrassing ahealth insurance company doeswork, or at least for 60 days.Hundreds of nurses, patient, andother activists organized by theCalifornia Nurses Association picketed the SanFrancisco headquarters of Blue Shield on Feb.1 to protest imminent rate increases of up to 59percent for policy holders. That same day, BlueShield announced it would delay the rate hikesfor 60 days—something it had refused to dobefore, even when asked to by California insur-ance commission Dave Jones.

At the same time, the research division ofCNA released a report detailing how sevenhealth plans denied, on average, 25 percentof all insurance claims in the first three quar-ters of 2010. The worst offender, PacifiCare,denied 43.9 percent of claims. “Insurancecompanies that gouge patients and deny careshould be shut down,” declared Martha Kuhl,a pediatrics oncology and hematology RNand the treasurer of National Nurses United.

Patrick Killelea, a contract programmerfrom Menlo Park, Calif., said that BlueShield rates for his family have skyrocketedfrom $450 per month to $777 per month injust the past year. Kerry Abukhalaf, whoowns a computer consulting business withher husband in Alameda, Calif., said thather family’s rates have risen by more than$200 per month and they are consideringjust finding a policy for their young son butdropping coverage for themselves. On top ofthese high premiums, each family hasdeductibles of more than $8,000 per year.

“It’s completely not worth the price,” saidAbukhalaf, noting that their premiums arealmost half as much as their monthly rent.“It’s just a big rip off.”

Texastexas nurses kicked off the new yearwith a double shot: contract proposals innegotiations with HCA-affiliated hospitalsand state legislation in Austin. The sameNNOC contract proposals for minimumstaffing and safe patient care will be made byunion negotiating committees in Florida,

Nevada, Kansas, and Missouri.The Texas RN negotiatingcommittee used stories from their hospitals to illustrate theneed for six principles of safepatient care —

Enforceable minimum staffing levelsthat are based on patient acuity.

The right of RNs to refuse unsafe staffingassignments, including unsafe floating.

The right of RNs to advocate for patientswith protections against retaliation.

Lift protections for RNs and patients.Protection from technology that under-

mines or slows down the nursing process orundermines the clinical and professionaljudgment of RNs.

A paid professional practice committeeconsisting of only bedside RNs that canrequire meetings with the CNO to addressand correct staffing and other patient careissues.

Contract negotiations took place in Corpus Christi recently and will continue in Brownsville later this month.

Veterans Administrationrepresentatives and directors from all 22VA units met in Orlando, Fla. January 8-9 forthe first quarterly meeting of NNU-VA. Theleaders of the VA units met to discuss issuesof each VA unit and to set a united strategyfor dealing with upcoming contract negotia-tions and overall implementation of a repre-sentational and mobilization plan for thealmost 8,000 staff RNs of NNU-VA. One newissue identified at the meeting was a lack oftimely evaluations for staff RNs in many ofthe VA units. Attendees set a plan to gatherdata and prepare to file a national grievanceon this issue with the VA.

NNU-VA has already been working toimprove working conditions in the VA. InJanuary, NNU-VA won its first successfulnational grievance with the VA over a con-tract violation of the master contractregarding dues deductions. VA Nurses are“protecting America’s heroes” every day, andwill continue to represent and support themin their work. —Staff report


From left: Nurses and patients picketBlue Shield head -quarters; VA nurses in Orlando, Fla.

sent out a recent reminder that “[today’s]official poverty threshold is set at threetimes the food budget in 1959, adjustedfor inflation. But because of majorchanges in the typical family budget overthe past 50 years, many critics say thismethod is outdated and usually underes-timates the amount of income a familyneeds to cover basic expenses.” TheBrookings Institute found one in threeAmericans was living at twice of povertyor less. If corporate America continues tosuccessfully play its trifecta—hoardingcapital, maintaining low wages, anddownsizing labor—the poverty trendswill be hard to buck, good news for thosemaking money on Medicaid.

The new law sets the Medicaid eligi-bility bar higher than today—to 133 per-cent of poverty. That means, in 2014, anindividual earning about $15,000 a yearwill qualify. At this new level, Californiais expected to add 2 million to its Medi-caid rolls; Texas is a close second with anestimated 1.9 additions to come.

Against this backdrop of growingpoverty and greater access to Medicaid,enter the insurance companies, alreadymilking their Medicaid contracts andteed up for billions more. The need to cutthrough the profiteering that defines thisindustry-dominated insurance system,one in which revenues are high andresults are not, could not be more glar-ing. And CNA/NNU’s Top 10 Reasons toreplace it with universal, single-payerhealthcare could not be more compelling.

The list provides a blueprint for criti-cally needed change, including one levelof comprehensive care, fair reimburse-ments applied equally to all providers,and sensible cost savings. Preventivecare, quality of care through appropriatestaffing ratios, and elimination of waste-ful administrative costs all have a proventrack record in saving dollars and lives.

With diabetes and obesity at near-epi-demic levels, and other indications of apublic health system in demise, any delayin breathing sense into our nation’shealthcare will have disastrous results. Forthe vast majority of Americans who fundMedicaid and for the poor who rely on itsbenefits, Medicaid as a profit center is thebiggest booby prize of all. —Carl Ginsburg

WRAP-UP REPORT(Continued from page 6)


Imagine how it all could havebeen different. Imagine if thoseredesigning our healthcare systemwere more like you. Imagine if President Obama were a nurse.

If President Obama were a nurse,he would start with an assessment of thepatient (the healthcare system in this case)and a care plan intended to bring abouthealing and recovery—not by offering theinsurance and drug industries sweepingconcessions to enhance their profits and buy their support.

Or the compromised policy wonk“experts” from corporate-funded think tanksmore interested in protecting the status quothan proposing real therapies.

If the president were a nurse, his focuswould have been the desired outcome, amore humane healthcare system based onpatient need and eliminating all the barriersto optimal care, not on appeasing everyoneinvited into the room.

The president would start by listening tothe hands-on nurses and other direct care-givers, to the patients and their families, tothose who have no more patience for fight-ing with the claims adjustors and drugformularies and hospital managers.

He would know that you don’t treatcancer with an aspirin because aspirin iseasier to get. That if you tell patients you aregoing to get medication for their pain, youdon’t come back with just a glass of water.

If President Obama were a nurse, hewould understand that everyone shouldhave access to high-quality healthcare whenthey need it and where they need it, care notbased on ability to pay, or whether you havemet your annual deductible or co-payment.

He would know that no one should facebankruptcy because of medical bills, or haveto choose between taking their child to thedoctor or paying for their rent or mortgage,or skipping needed medical visits or cuttingtheir prescription medications in half.

And, he would never settle for a piece-

meal, substandard plan that does so little toprotect those patients and families.

If the president were a nurse, he wouldinstinctively know that health insurance is nothealthcare. He would not have endorsed“reform” predicated on forcing every Americanto buy expensive and wasteful private insur-ance, especially with no controls on what theinsurers can charge or adequate recourse forwhen they deny medical treatment.

He would lead on healthcare not by seekingto lower the expectations of those favoringcomprehensive reform, and barring them fromthe debate while giving handout after handoutto the healthcare industry, free market funda-mentalists, and all their advocates in Congress.

He would lead by standing up to the insur-ers and the drug companies and all the politi-cians they fund who believe healthcare is aprivilege, not a right. He would rally andinspire the public to support the reform, suchas expanding Medicare to cover everyone, thatreplaces the cruel and dysfunctional systemwith one based on caring and compassion.

If the president were a nurse, he wouldpraise the examples of Canada, and France,and Taiwan, and Great Britain, and all thosecountries that don’t siphon off 30 cents ofevery healthcare dollar for paperwork andprofit, where access to care is based on individ-ual need, not on the size of your bank account.

He would not enable the attacks by Fox

News, the Tea Party, and rightwing politi-cians on “government” healthcare bydefending the role of government in assur-ing a social safety net that covers everyone.

He would explain that what Americastands for is justice and fairness, not greedand a multi-tiered healthcare system. Thatevery patient matters equally, and the poorand powerless are entitled to the same levelof care as the rich and well connected.

If the president were a nurse, he wouldproudly proclaim the benefits of a publiclyfinanced, more humane healthcare system thatalso benefits everyone by creating millions ofjobs through the delivery, not the denial, of care.

He would explain it is better to spend ournation’s resources on healing and educationthan on warfare and building weapons, thathow it cares for those most in need is thetrue measure of a nation’s greatness.

If President Obama were a nurse, he wouldprobably go home from work each night andcry over what he saw that day. And he wouldvow, anew, each night to reach out to Americaand look for ways to organize and build a betterand more humane nation. And, he wouldknow he would have no choice but to stand upand fight head on the big corporations who arebleeding our nation dry for all of us.

Rose Ann DeMoro is executive director of National

Nurses United.

Rose Ann DeMoroExecutive Director, National Nurses United

If PresidentObamaWereaNurseHealthcare reform would have focused on patient needs, not corporate greed


■ 50.7 million Americans are uninsured.■ Blue Shield raised individual premiums

by up to 59 percent in California. Familyhealth insurance premiums nationally morethan doubled between 1999 and 2009, faroutpacing workers’ earnings and inflation.

■ Workers pay 47 percent more nowthan in 2005 for coverage they get throughjobs. Since 1987 the number of Californianscovered by insurance provided through anemployer fell from 65 to 52 percent.

■ California’s seven largest insurersdenied more than one-fourth of all claimslast year.

■ Nurses suffer more back injuries thanother occupations, yet the administrationwithdrew a rule, first eliminated by theBush administration, to require employersto report musculoskeletal injuries.

Tell us what YOU think at nationalnursesunited .org /obama.

Ayearafterhealthcarereform,howarewedoing?

RAD.REV_Dec 2/24/11 6:10 PM Page 9

Nurse Media_3 2/24/11 5:49 PM Page 10

uick. name the last time you saw a direct-care registered nurse interviewedon the nightly news about health insurance reform or skyrocketing healthcarecosts.

Or about our national epidemics of obesity and diabetes?When was the last time you even saw a real, practicing, bedside nurse on tele-

vision at all? Or heard one on the radio? Or quoted in a national news magazinebesides this one? (Soap operas and fictional programs don’t count!)

Probably never, is the answer. Though registered nurses are among the mostknowledgeable, educated, frontline healthcare providers in the country, their voices

are rarely ever heard or consulted by mainstream media organizations. They turn toDr. Oz or Dr. Phil, or in the case of healthcare reform, insurance company CEOs, to weighin on health and health policy issues.

National Nurses United has been more successful than most organizations in gettingregistered nurses presented in the media as healthcare authorities, but it’s an uphill climb.Mainstream media doesn’t view our dysfunctional healthcare system from the same per-spective that nurses do.

That’s why nurses need to take media matters into their own hands. While we’ll continue toinfluence how the mainstream media covers healthcare issues, National Nurses United is part-nering with television and radio producers to create programs in which nurses get star billing,and to explore other ways of reaching our nation’s communities.


NNU nurses are not waiting around formainstream news organizations to

tell our stories. Instead, we’re creating our own outlets for informing, educating,

and entertaining. A STAFF REPORT


“Especially in terms of health policy, the voice of those of us at thebedside—the nurses—is missing or ignored in the mainstreammedia, and it’s a credible voice that the public should have directaccess to,” said DeAnn McEwen, a critical care RN and aCNA/NNOC copresident. “We see the effects of our failed social poli-cy at the bedside because we see patients and their families’ livesdeteriorating along with the economy and the environment. We canconnect the dots for people. Our voice would be one of advocacy toinfluence healthy policies and reset the nation’s moral compass.”

This spring, NNU is helping GRITtv with Laura Flanderslaunch The Nurses’ Station, a new segment of its daily, 30-minuteprogressive current affairs program that airs on Dish network andDirecTV on cable and public television stations nationwide, and isalso available online. GRITtv approached the nurses because of ourpublic fights to extend Medicare for all, nurse-to-patient ratios, andour ground-breaking political campaigns taking on corporatemoney in politics and candidates such as Meg Whitman. Recogniz-ing that nurses are respected as the most ethical profession, and areout there mobilizing when so many seem to be disengaged, GRITtvproducers see nurses as progressive role models. Collaborating onthe segment was a natural for NNU because we want to broadcastour message in a variety of platforms, and know that nurses arehungry for real depictions of their lives and concerns.

The Nurses Station would tackle news headlines and otherissues of importance to nurses and patients, but with a nursingtwist. For example, the January shooting in Arizona of U.S. Rep.Gabrielle Giffords, which also killed six in the crowd, was coveredaround the clock from much the same angle by all the major newsorganizations. Was the alleged gunman, Jared Loughner, a druggie?Was he a left-winger or a right-winger? Was he a disturbed loner?

GRITtv producers approached the story from a big-picture angleby interviewing Tucson registered nurse Rexanne Darnell about thesevere cutbacks the state has made to mental health services andMedicaid programs. These kinds of mental safety net programsmight have helped avert this tragedy.

“We’re seeing very, very violent patients and patients who, sadly,haven’t been hospitalized for years and years,” said Darnell during a

GRITtv interview. “They’re coming and saying, ‘I used to get a goodmedication and I used to have a case manager who followed me andhelped me. But now I have nothing. I’m terrified to leave my house.’They’re becoming more and more paranoid and staying in wherethey’re at. They can’t go and seek help for themselves. It’s up to us tomonitor, to help, to assist them because they don’t know when theirneeds are not being met.”

The Nurses’ Station plans to explore many more issues of concern toRNs and the wider public, including how Obamacare is affecting indi-vidual states and how RNs in states such as Texas and Florida havemanaged to organize despite traditionally anti-union climates. Andsince RNs understand that patient health doesn’t just depend on howmany vegetables a person eats or what kinds of medications a persontakes, the program will also delve into how forces such as the economyinfluence health and health access, and even international issues.

“This segment is where the grit of everyday nursing meets theanalysis of our healthcare system to form a unique, compelling pro-gram,” said Michael Lighty, director of policy for the CaliforniaNurses Association/NNU. “Media looks for sensational stories.GRITtv covers the stories that change lives.”

Experts who have studied the image of nurses in the generalmedia agree. “Nurses are patient educators and are therefore thebest professionals to present health information to the public,” said


“Nurses have to tell their stories,because though everybody claims to know nurses, rarely do nurses

speak for themselves in media of theirown creation,” said Lighty. “This is the only way to convey the reality

of the decisions, interventions and experiences of nurses at the bedside.”

Nurse Talk RN hosts Dan Grady and Casey Hobbs

cutting it up in the studio


Sandy Summers, an RN who runs the nonprofit group, The TruthAbout Nursing, and is coauthor of Saving Lives: Why the Media’sPortrayal of Nurses Puts Us All at Risk. “When nurses educate thepublic, they’re not only giving them valuable health information,the public is also learning that nurses are health experts—a differ-ent image than most television shows portray.”

The Nurses’ Station plans to debut some time in March with asegment following up on many of the patients originally featured infilmmaker Michael Moore’s document SiCKO, which showed howinsured patients were often denied care by insurance industrybureaucrats. Four years later, how have many of the patients in thefilm fared under our deteriorating and changing healthcare system?

On radio, NNU continues to sponsor Nurse Talk, a weekly radioprogram airing in Boston, the San Francisco Bay Area, and avail-able on the Internet, that’s hosted by registered nurses Casey Hobbsand Dan Grady. The show has been running since 2009 and nowreaches 50,000 listeners per month. Hobbs and her partner PattieLockard got the idea to create an hour-long interview and varietyshow along the lines of National Public Radio’s popular Car Talkprogram. “We said to each other, ‘This show would be hysterical ifwe had nurses do it,’” said Hobbs, who currently works as a hospicenurse. “People like to talk to nurses; they don’t talk to doctors. Theidea was to educate and provide information, but also have fun.”

Almost any material is fair game for Nurse Talk. The hosts haverecently examined serious topics such as massive insurance premiumhikes by the nation’s largest HMOs, workplace violence against nurses,and the need for national RN-to-patient staffing ratios. In the samehour, they field often hilarious health questions by phone from listen-ers and interview quirky RN personalities, such as the Laryngospasms,a group of practicing nurse anesthetists who create and perform med-ical musical parodies. Hobbs and Lockard aim to expand their listener-ship and would love to air their radio show on a station during drivetime (peak commute hours when many listeners are in their cars).

Today, many registered nurses also get their news and learn aboutissues via the Internet, whether it be through websites, blogs, bulletinboards, their Facebook and Twitter friends, or their professionalLinkedIn network. In recent months, NNU revamped its website,www.nationalnursesunited.org, to be more streamlined and useful forregistered nurses. National news affecting healthcare and nursing fea-tures prominently on the homepage, and buttons to all of NNU’s socialmedia profiles, like Facebook, our Twitter feed, our YouTube channel,and our Flickr photo albums, are easy to find and click near the top ofevery page. A link to this publication is listed under “RN Resources.”

NNU produces a whole host of sometimes funny, sometimes seri-ous, but always informative, videos on topics ranging from what it’slike to organize at a new facility to testimonials about the need forsafe RN-to-patient staffing ratios. Often the videos simply providecoverage of our events that you just won’t find on network news oryour local tv station. You can watch them all on our YouTube chan-nel, comment on them, and share them with friends and coworkers.

NNU is also exploring other social media platforms to furtherconnect nurses to the organization and to one another, to informand educate them, and to relate experiences that otherwise mightnever get shared with a wider audience.

“Nurses have to tell their stories, because though everybodyclaims to know nurses, rarely do nurses speak for themselves in media of their own creation,” said Lighty. “This is the only way to convey the reality of the decisions, interventions and experiences of nurses at the bedside.”


How to Watch,Listen, Read,

and Share

EThe Nurses’ Station on GRITtv

Launch date TBDGRITtv airs four times daily on Free Speech TV (Dish Network channel 9415 and DirecTV 348),

on cable, and on public television stations. Check out www.grittv.org for where to watch

and to view past episodes.

NNurse Talk

Boston area: Listen on station WWZN 1510AM every Saturday at 11 a.m. EST or live stream

at www.revolutionboston.com

San Francisco Bay Area: Listen on Green 960AM every Sunday at 2 p.m. PST or live stream

at www.green960.com.

Podcasts are available any time at www.nursetalksite.com,and you can also download and listen through

TheRadioFactory.com or iTunes.

UNational Nurses United’s social media platforms

Visit our website at www.nationalnursesunited.org.Friend us! Our Facebook profile is under

“National Nurses United.”Our Twitter feeds are @rnmagazine,

@nationalnurses, and @protestintheusa.

Check out photos of everything we’re doing at www.flickr.com/nationalnursesunited.Watch videos on our YouTube channel atwww.youtube.com/nationalnursesunited.

Also check out the California nurses’ channel at youtube.com/calnurses, the Minnesota nurses at youtube.com/mnnurses, and Massachusetts

nurses at youtube.com/MNAWebmaster.

Nurse Media_3 2/25/11 10:26 AM Page 13

Registered nurse diane goddeeris hasalways been a champion of nurses for as longas she could remember. As a young girl whoneeded a series of surgeries—starting fromwhen she was a toddler—to properly align hereyes, she never forgot the nurses who watchedover and comforted her. “This is back whenthey put you to sleep with ether and a rubberface mask, and when they didn’t allow parents

to stay with their kids in the hospital,” remembered Goddeeris. “I wasscared and alone. But the positive thing was the nurses. The nurses tookcare of you. They’d scoop me up and I’d sit with them and play withthem. They were very influential.”

When Goddeeris declared while growing up that she’d like tobecome a nurse someday, her father constantly dissuaded her, sayingthat she “was too smart to be a nurse” and that she should become adoctor or a lawyer. She always replied, “Nurses are smart, too!”

It’s a good thing for the nurses’ movement that Goddeeris didn’tlisten to her dad. Today, Goddeeris is an obstetrics informatics nurseat Sparrow Hospital in Lansing, Mich., a longtime nursing leader inher state with the Michigan Nurses Association, and a national nurs-

ing figure as a member of National Nurses United’s executive council.She was instrumental in the late 2000s in helping the Michigan Nurs-es Association refocus itself on staff nursing issues by breaking awayfrom the American Nurses Association and in the 2009 formation ofNational Nurses United. In addition to these roles, Goddeeris is anelected member of East Lansing’s city council and its mayor pro tem,where she grapples with issues such as high unemployment and usesher healthcare expertise to help keep the city’s healthcare costs down.

“Nurses are not silly angels. A nurse is a strong, smart person mak-ing life-and-death decisions,” said Goddeeris. “And NNU is the nurses’movement now, with nurses united across the country fighting for thesame things: safe, quality patient care and safe working conditions.”

Goddeeris grew up in the Detroit area and was among the firstgeneration in her family to attend college. While getting her bache-lor’s degree in nursing from the University of Michigan, she wasattracted to the obstetrics field because “it wasn’t routine, and nurs-es had to make decisions on a dime.” After graduation, Goddeerisworked in Wisconsin for a couple of years as a labor and delivery

nurse. While she was there, the nurses decided to unionize. Goddeeris’ father worked as a union printer, so she knew from an

early age that “you had to have a union if you wanted a voice in yourpractice and if you want to make changes.” She remembered that unionswere part of her family’s general dinner table discussions, and wheneverthe printers union held a meeting, her father always made sure to attend.

But instead of helping the RNs, the Wisconsin Nurses Associa-tion decided to discontinue its collective bargaining operations, sothe nurses formed their own individual group with the help of theteachers union. That was Goddeeris’ first inkling that somethingwas amiss with the state nursing organization and its umbrellagroup, the American Nurses Association.

“That seed was planted. I thought, ‘What in the world was goingon there?’” she said. “Everybody is supposed to be working together.”

Toward the end of 1979, Goddeeris moved back to Michiganwith her family and continued working part time as a labor anddelivery nurse at Sparrow Hospital while raising three children.Though she was not one of the main organizers, she supported suc-


Rising to the Occasion

Michigan RN Diane Goddeeris takes her responsibility as anurse seriously, whether it’s helping lead the national nurses’

movement or serving on her city council. By Lucia Hwang

Profile_Jan 2/24/11 9:10 PM Page 14

cessful unionizing efforts by all the employees at Sparrow in 1987and did her best to stay involved by attending Professional Employ-ee Council at Sparrow Hospital (PESCH) meetings.

Though Goddeeris had always kept her schedule full with work, fam-ily, teaching, and community projects, she started in the early 1990s tohave more time to devote to union activism. She started out by replacinga PESCH bargaining committee member and continued to help bargain

better and better contracts for her hospital that addressed appropriateRN staffing as well as staffing for other professions, language againstunsafe floating, and the elimination of mandatory overtime.

Goddeeris worked her way up to become treasurer, then vice pres-ident, and eventually president of the Michigan Nurses Associationin 2007. While president, she tackled the thorny issue of extricatingMNA from the American Nurses Association and successfully spear-headed the campaign to disaffiliate in summer 2008—as did manyother state nursing organizations around that time.

For decades, the ANA had been collecting millions of dollars indues from its state affiliates—the vast majority of which were paidby direct-care, staff nurses—yet did very little to address the con-cerns of bedside nurses or even actively worked against their inter-ests by siding with hospital management and corporations.Hospitals were consolidating and restructuring in pursuit of higherprofits, which meant massive layoffs of nurses and dramaticchanges in the way remaining RNs practiced nursing. Yet the ANA,whose leadership was dominated by nursing executives and educa-tors, did little to defend the practice of staff nurses.

“Our members were sending dues to ANA but we didn’t feel staffnurses were respected or our issues were given any attention,” remem-bered Goddeeris. “There were so many changes in healthcare.” So aftergetting approval from the Michigan membership, Goddeeris announcedon June 27, 2008 at the ANA convention, “Bye, we’re leaving.”

MNA shifted its energies into working with United American Nurs-es, the Massachusetts Nurses Association, and the California NursesAssociation to form National Nurses United in 2009. She said that thecreation of NNU was one of the seminal moments of her nursing career.She is proud of NNU’s already phenomenal growth through new organ-izing of nurses, especially in right-to-work states where under conven-tional wisdom most unions would not venture. She’s gratified to beworking with a nursing association that actually fights to improve thepractice of nursing and increase staffing at the bedside. And she is gladto be part of a real nurses’ movement where nursing leaders are nowlinked across the country, learning from and mentoring one another.

In her current position as an OB informatics nurse, Goddeeris helpsher hospital build its electronic medical records system for the obstetricsunit, acting as the bridge between the technology and the needs of nurs-es to provide safe patient care. While the switch of many hospitals to

computerized charting and other EMR systems often has hindered theability of nurses to practice their profession, her “fight has always beenfor the frontline people to have ease and accessibility,” said Goddeeris.

When she is not acting as a nursing leader, Goddeeris is busy as acivic leader in her community of East Lansing. Having previously servedon the city’s planning commission and various other committees, God-deeris threw her hat into the ring for an appointment to a vacant spot on

the East Lansing City Council in 2006. She was selected andreelected in 2007. As a member of the council and its currentmayor (the mayorship rotates among the councilmembers),Goddeeris has been confronting challenges common to manymunicipalities, such as how to keep healthcare costs down forcity employees and how to keep and create jobs.

Though she is proud to have helped keep the inflationof East Lansing’s healthcare costs to 3.5 percent this pastyear, Goddeeris said it’s not sustainable and supports asingle-payer healthcare system. “Working in this health-

care system, I’ve seen all the options,” she said. “There’s noquestion we have to change, and the only way we can get

change is if nurses have a voice and are at the table.”“There’s a lot of work to do with nursing, and it isn’t easy to get

nurse involvement,” said Goddeeris, remembering the hectic earlierdays of her career with work, young children, and her communityactivities. “And that’s okay, but you still have a responsibility as a mem-ber to support your union and be doing something, whether that’sthrough a donation or just reading everything to stay informed.”

Lucia Hwang is editor of National Nurse.


ProfileName: Diane Goddeeris, RNFacility: Sparrow HospitalUnit: OB informaticsNursing for: 34 yearsSign: PiscesPet nursing peeve: When nurses don’t stretch outside their comfort zone and realize they have the power to make a difference.Favorite work snack: “Give me a bag of chips and I’m happy.”Latest work accomplishment: Proud of the mentoring she’sdone with some nurses within MNA and her OB unitColor of favorite scrubs: She doesn’t wear scrubs now, but redHobbies: Community work and serving on the city council!Favorite show: “Reality TV shows are my guilty pleasure, espe-cially the ones like Survivor or The Amazing Race where peoplehave to figure out how to be a leader and solve puzzles.” Secret talent unrelated to nursing: Any card game involvingstrategy. She often plays the game 500.

“Nurses are not silly angels. A nurse is astrong, smart person making life-and-deathdecisions. And NNU is the nurses’ movementnow, with nurses united across the countryfighting for the same things: safe, quality patient care and safe working conditions.”

Profile_Jan 2/24/11 9:11 PM Page 15

Save the date! Mark your calendars!Come show the nation and the president your nurse values

Caring | Compassion | CommunityNational Rally Tuesday, June 7 10 a.m.

For more details, visit www.nationalnursesunited.org

Cover 4_DEC 2/24/11 6:13 PM Page 28

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REALIZING RATIOS Massachusetts kicks off THE VOICE OF ... · matters of nursing practice, community and public health, and healthcare policy. ... It is only because of the true grit