18 minute read
• 2020 Concern for Safe Staffing Data Report
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Nurse Practice and Education
For more than 20 years, nurses of the Minnesota Nurses Association (MNA) have been collecting information on how short staffing impacts patient care and patient safety. Evidence-based studies demonstrate that it is critical to have adequate staffing because it results in better patient outcomes (Dixon, 2021). Studies show that the number of patients a nurse has at one time affects their ability to safely care for patients and ultimately advance their plan of care through to discharge. Nurses are perplexed that hospital management continues to ignore their calls for staffing, despite knowing that hospitals are frequently cited for staffing deficiencies when CMS conducts an audit.
• Patients were more acute. • Patients presented with high acuity symptoms no one knew how to treat. • Delivery of care changed every single day. • Management often refused to help. Meanwhile, the Minnesota Board of Nursing expects registered nurses to continue to deliver safe, ethical, and therapeutic care.
MNA nurses cannot be expected to continue to fight a pandemic in a hospital system that doesn’t provide resources for them. Patients have a right to expect safe care and that hospitals will fulfill their commitments to provide safe, quality care to their communities. Most critically, hospitals must provide enough resources, including enough trained registered nurses every minute of every day to deliver critical nursing care. Patients deserve no less. Data was amended to gather more patient centered data and an electronic version of the CFSS form was created
Clearly, 2020 presented challenges with registered nurse staffing like never before: CFSS Form Evolution Timeline 1990’s
Concern for Safe Staffing (CFSS) form was created to collect unsafe staffing data related to the nurses’ work environment
2010
2014
Data points were added regarding substandard care, like delayed care, missed patient care, and use of last minute solutions
2015 MNA began categorizing the data collected by CFSS forms to enhance our analysis of unsafe staffing
Data points were added regarding violence in the workplace and homecare nurse specifics
2019
3769 CFSS forms were submitted in 2020, marking a 8.67 percent increase from 2019 and producing the following important data:
• 657 reports of nurses refusing patient assignments to rectify a short staffing situation • 2649 incidents were reported where care or treatments were delayed by short staffing • 2162 accounts of staffing issues causing a delay in call lights being answered • 2859 occurrences of unresponsive management • 337 instances of patients being rushed through discharge or given incomplete teaching
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Category of Safe Staffing Concern 2019 2020 % Change 2019 to 2020
Delays in care or treatments or incomplete assessments 2264 2649 17% Delay in medications 1569 1965 25% Inability to answer call lights 1736 2162 25% Incomplete discharge or rushed teaching 355 337 -5% Management response - NONE or inappropriate 2499 2859 14% Temporary solution - closed unit 482 610 27% Short staffed >25% of what is needed 393 663 69% Patient left without being seen or against medical advice 386 371 -4% Temporary solution - refused the assignment 553 657 19% Unqualified staff - wrong skill mix 616 667 8% Total CFSS Forms Submitted* 3469 3769
*Several CFSS forms cited multiple categories of staffing concerns, causing the total number of forms submitted to be fewer than the combined total of concerns raised by nurses within the reports. Please contact Carrie Mortrud, RN, Nurse Staffing Specialist, with any questions at (651) 252-5451 or carrie.mortrud@mnnurses.org
Nursing in Minnesota in 2020 and even into 2021 will leave scars on our nurses for years to come. The anguish that nurses feel when they cannot treat and care for patients is causing moral distress, a phenomenon which occurs when nurses find themselves experiencing failure to rescue and realize they are unintentionally causing harm because they do not have the resources to treat the patients in their care.
Nurses work in an environment that is disrespectful and demanding, physically dangerous and emotionally taxing, and unforgiving in its expectations from administrators and regulators who have zero interest in reversing irresponsible and reckless implementation but rather relish in blaming the individual nurse who only wants to help care and treat patients in their most vulnerable time.
Nurses wonder, when is enough pain and suffering enough? It is time for change and to fully hold decision makers accountable. #safestaffingsaveslives
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Get involved! 2021 Municipal Elections
Decisions made at the local level impact hospitals, healthcare providers, and the welfare of the community. Whether it’s hospital and unit closures or public health decisions made at city hall, the voices of nurses have a tremendous impact on the public health of your community and the working conditions inside hospitals. What does it mean for elected officials to stand alongside nurses to hold hospitals accountable? How can we hold elected officials accountable in ensuring quality care is provided for our communities? Every election cycle, hospitals are getting involved— talking with elected officials, giving candidate contributions, and sharing their narrative on what’s going on inside hospitals—and so are we. MNA nurses are getting involved by participating in screenings, door knocks and phonebanks; talking to candidates; and sharing their stories of working conditions in hospitals. Join in and make your voice heard. Learn more about MNA’s endorsed candidates at mnnurses.org/endorsements. Get involved in Duluth’s 2021 municipal elections by contacting Zach Sias, MNA Political Organizer, at zach.sias@mnnurses.org or (651) 242-4352, and in Saint Paul’s municipal elections by contacting Cameron Fure, MNA Political Organizer, at cameron.fure@mnnurses.org or (651) 252-5028.
MNA Nurses endorse candidates for Saint Paul Mayoral and Duluth City Council races
The MNA Board of Directors announced the endorsement of candidates running for election this fall in Saint Paul and Duluth. MNA nurses have chosen to endorse Melvin Carter for St. Paul Mayor, and the following candidates for Duluth City Council: Mike Mayou for District 2, Renee Van Nett for District 4, and Terese Tomanek and Joe Macor for the two At-Large seats. The endorsement process included candidate questionnaires and an interview with candidates by local screening committees of nurse members who live and work in St. Paul and Duluth, respectively. Those nurses made a recommendation to the nurse-elected MNA Board for the endorsement of the candidates. “Nurses are proud to stand strong with Melvin Carter for Mayor of St. Paul,” said MNA President Mary C. Turner, RN. “His continued commitment to supporting nurses’ and worker’s rights, and his determination to find more equitable public health solutions that will improve the lives of patients and the entire St. Paul community, shows he is on the side of nurses and families.” “Mayou, Van Nett, Tomanek and Macor each demonstrated a strong commitment to building relationships with MNA members, holding hospitals accountable, and identifying and partnering on public health initiatives in the future,” said Chris Rubesch, MNA First Vice President. “Nurses are proud to stand with these candidates for Duluth City Council.” AllMNAcandidateendorsementscan be found here: https://mnnurses.org/ issues-advocacy/elections/mna-candidate-endorsements/
Melvin Carter St. Paul Mayor
Mike Mayou Duluth City Council District 2
Renee Van Nett Duluth City Council District 4
Terese Tomanek Duluth City Council At-Large Seat
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CARn Corner
By Cynthia Barnes, retired RN, BSN Living History
As I was working on this article, I turned on CNN and there it was: Kabul had fallen and people were fleeing, the airport was overrun. I was immediately transported back to Vietnam with my brother and other people in my life. One of those people is Kay Bauer, retired RN, U.S. Navy Commander, CARn and long-time MNA member who went to Vietnam as a nurse officer to set up a local hospital for surgery. Many are surprised that a Navy officer spent a tour of duty ‘in country’ in that war. As we are now, we were a divided country then over support for that war. As the guest speaker at CARn’s August meeting, Kay shared her experiences living and working in a war zone, including exploding bombs and close calls. Nurses cared for the local people as well as for our wounded soldiers. She told us about carrying messages home for those who remained in Vietnam when many Americans went home. Kay was treated well on her trip home, unlike many others who were spit on when they got off the plane and called disgusting names. Her troubles came later when she became a recruiter. On her day off, the building in which she worked in downtown Minneapolis was blown up. Then the house next door was burned down, and the residents died. She was told it was probably a mistaken address and was likely meant for her. Kay married and raised a family, and while she was done with active duty, she continued to be very involved as inactive. If you have seen the nurse statue near the Vietnam Memorial in Washington D.C., Kay was one of the group members leading the efforts for a memorial for the military women. She also worked to have PTSD recognized at the Department of Veterans Affairs (VA). Later, Kay worked many years as a staff nurse at United Hospital where I worked with her in the ICU. I have always admired Kay and called her “Admiral”, as that would have been her next rank had she stayed on active duty. I also attended her retirement from the Navy, and remember the women were so elegant in their formal uniforms of long skirts and white jackets. Coming up on the CARn agenda in November is a presentation by Senator Erin Murphy, an MNA member; a former lobbyist, MNA staff member and MNA Executive Director; and a staff nurse in the OR, I believe. Having known Erin a long time (I remember her pregnant with twins), I have seen her many amazing accomplishments. We share her dedication to fair and just government. We first met when she was a member of MNA staff and a lobbyist. When I was co-chair of our Political Action Committee (then ‘MN PIN’) and meeting with the chair of the Governmental Affairs Commission, we all crossed paths frequently. All of us were so proud when Erin ran for office the first time—one of the first nurses to run for office. Many of us worked on or donated to her campaign. She was a part of us. Erin Murphy’s campaign for Governor of Minnesota was exciting, especially for nurses. Her continued meetings with people all over the state make her one of the most knowledgeable office-seekers anywhere. CARn members are awaiting her presentation with great interest. Please join us! The next CARn meeting, including Senator Erin Murphy’s presentation, will take place on November 10 at 10:00 a.m.
Remember your MNA Quick Reference Staffing Card!
Know what to do in the moment and what to do after the fact to hold administration accountable for their poor and unsafe staffing conditions. Need a new card? Ask your MNA Steward or bargaining unit chair.
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Nurses leading the Medicare for All movement By Jean Forman, RN
Nurses are leading the movement for Medicare for All in our country. I am so proud to be part of this call for sweeping change to our broken healthcare system. It gives me purpose and hope to make healthcare better now and for future generations. I got involved just around the edges after the Metro Strike in 2010. Threats from the employer to tinker with our wonderful healthcare plans that had been foundational for economic security had me worried how anyone would be able to afford basics like prescription meds and cancer treatments. Luckily, we negotiated to keep our plans! I started asking if there was a better way to have healthcare because, although we didn’t lose our benefits, I wasn’t sure that we wouldn’t in the future. I attended some informational sessions at MNA and tried to learn more about single-payer healthcare. Then in 2016, Allina went after our plans again, and this time we were not successful at keeping our plans despite a seven week-long strike. As one nurse shared with me, “Now I understand how our patients wait until they need the ICU before going to the doctor”. We were now in the same situation, ‘having skin in the game’ and because we had negotiated salary increases below cost of living (COL) over the years, we were not in a good place.
I became even more determined to learn about and advocate for Medicare for All. Thanks to MNA, I have had so many opportunities to attend forums and seminars, meet other activists, and really grow my voice to work on this important movement. I am determined to make this law real, and guarantee better futures for my children, grandchildren, neighbors, and community. Surprisingly, opponents are found in all conversations, many of whom are not fully informed. Even other union members are not on board. Imagine having your negotiation team work on better pay, better education, and other important benefits! Union members from all types of work are losing on the insurance issue, and it’s time to unite outside of our contracts to make Medicare for All real! Healthcare is a human right, not a clause in a contract. It should not be tied to a person’s employment status, it should be no cost at point of care and it can be paid for progressively. How many times are you finding yourself answering health questions from family and friends about if they need to see a doctor? While your advice is probably sound, it’s sad that folks are weighing a medical bill they maybe can’t afford against just asking their nurse friend. How many GoFundMe requests do you see for medical help? Even full-time employed people can’t afford an unexpected medical bill. Nurses, we know we can do better, we see it each day whether you are an ED nurse, a case management nurse, an ICU nurse, or OBS unit nurse. The unfairness of the current broken system highlights shortfalls, inequalities, and to be honest, the cruelness of the healthcare and insurance industries. I encourage you to get involved by first learning more about Medicare for All—there is room in the movement for any amount of time that you can give. Most importantly, the question should not be “How can we afford this?”, but rather, “How can we not afford to make these important changes?” Please be on the lookout on the MNA website for educational sessions, and days of action; it will take nurses’ leadership to accomplish Medicare for All.
MNA welcomes new staff
• Marakah Mancini, Researcher/Labor Relations Specialist. Marakah has over 15 years of experience in communications and research. Most recently, Marakah served as Director of Communications and Strategy for Co-op Cincy. Prior to that, Marakah was a Senior Field Communicator for SEIU International. • Megan Duevel, Nursing Education Specialist. Prior to coming to MNA, Megan was an Emergency Department nurse at Abbott Northwestern Hospital and a Neuroscience and Cardiac Stepdown nurse at United. She has also served as a member of the MNA Health and Safety Committee. Before becoming a nurse, Megan held positions responsible for patient safety, quality measurement, and performance improvement in several organizations. • Travis Thibodeau, Organizing Manager. Previously an MNA Organizer and Senior External Organizer, Travis is transitioning into the position of Organizing Manager.
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Children’s nurses make strides in staffing and continue the fight
By Doreen McIntyre, RN
With the ongoing pandemic changing the landscape of healthcare, Children’s management used it as the perfect excuse to make changes in both Minneapolis and Saint Paul. Initially, non-essential surgeries were canceled in both hospitals and many nurses went on furlough. Once the hospitals began scheduling surgeries again, nurses knew and explained to management that there would soon be a short staffing problem. The hospital was slow to call nurses back from furlough and we had to deal with inadequate staffing. Unit by unit, nurses responded and participated in mass emailing campaigns to the Chief Executives and Directors asking to call back nurses in response to the increasing census. Meanwhile, the hospital started restructuring in Saint Paul, with the intent to move high acuity services to Minneapolis and keep lower acuity in Saint Paul. Nurses believe that we need to maintain all services in Saint Paul. Many RNs left the hospital and both hospitals had to lay-off nurses. The census started to explode, creating inadequate staffing levels. All the units began a Concern for Safe Staffing (CFSS) form blitz. Nurses’ names were removed from the forms and they were sent to the hospitals’ CNOs, CEOs, Directors and HR departments every 24 hours. We have had frequent all-nurse meetings, we have done petitions, we have marched on the CNO and CEO, and in June, we held informational pickets at both campuses. Thousands of unsafe staffing forms were and continue to be filled out. In the months since the pickets, Children’s executive management has apologized and taken responsibility for the mess they created. They have committed to: • Numerous pre-scheduled Incentive Bonus and Just In Time Bonus programs, with increasing dollar amounts • Starting a Children’s-wide behavioral health program that is reviewed in System Labor Management Committee • Hiring nurse 100 FTEs in the next two years and hiring 300 employees by December • A six-month Flexible Schedule FTE Incentive Bonus of $6,500 for every .1 increase in FTE for 8 hour shifts and $9,750 for every .15 for 12 hour shifts to aid in staffing while the hospital hires and orients nurses • Opening more med/surg beds to address the ED inpatient crisis • Recalling nurses from the previous layoffs back to their original units While Children’s has addressed some staffing concerns, we know the fight is long from over. But we also know that our collective actions have helped put pressure on the hospital resulting in change.
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The truth about the Twin Cities’ healthcare bed shortage By Rui Pina, RN
We are witnessing another surge in healthcare hospital needs. The media is inundated with stories of ICU bed capacity issues with COVID-19 being the usual cause of this situation. However, it fails to shine a light on the responsibility that the corporate-driven healthcare industry bears. This crisis is greatly self-induced by poor business practices, and profit-driven policies and strategies that have significantly exacerbated the healthcare worker shortage. With the onset of COVID-19, healthcare employers in the Twin Cities instituted “COVID-19 staffing practices” to address years of chronic short staffing and unwillingness to staff appropriately for community needs. Hospitals have traditionally run with minimal staffing and at maximum capacity. ER waits and closures, due to lack of staffing, were not new with COVID-19. Those practices have been in place for several years before COVID-19 happened. Following last year’s COVID-19 wave, employers decided to continue and to compound such staffing practices by reviewing patient care ratios downwards with the justification that such changes, in order to address efficacy, were necessary to address COVID-19 related financial losses despite being recipients of emergency government COVID-19 funds. In St. Paul, the actual number of patient care beds was significantly diminished with a closure of one hospital and partial closure of another. In addition, one employer has implemented an electronic acuity tool that further contributes to patient assignment concerns. Nurses in the Twin Cities will consistently work full shifts without the ability to take time to eat a meal or take a break. The employer’s response—“Why don’t you find another nurse (equally overburdened) to take your assignment?” Despite an increasing labor market demand due to fatigue, healthcare workers leaving the profession, and poor working conditions, most employers have refused to address such issues or increase compensation in order to address demands. Healthcare benefits for healthcare workers have been on the decline for several decades and that is especially significant during a pandemic when professional hazards make the need for healthcare financial security a concern. Healthcare workers are now faced with the worry that a potential exposure can result in financial ruin. Some organizations have not only failed to recognize this, but have doubled down by refusing financial responsibility and by refusing to pay exposed workers for work-related quarantine time. Politicians in the Twin Cities, despite words of support for frontline workers, have turned a blind eye to the corporate healthcare misdeeds. Many, supported individually or collectively by such organizations, seem unwilling to “bite the hand that feeds them”, thus neglecting the duty to represent Minnesotans and their healthcare needs. As long as state elected officials continue to ignore their duty to address patient ratio concerns, healthcare delivery and availability will continue to deteriorate in the Twin Cities. Corporate healthcare’s sole priority is profitability and their drive to benchmark their practices with the rest of the country will result in a downward delivery of care. Minnesota will lose its renowned leading edge in healthcare delivery. As another wave occurs, we are now severely impacted by an overworked, demoralized, and exhausted healthcare workforce. Poorly led by corporate leadership who are unable to understand the dynamics of this shortage and their responsibility in its origin, it is easy to miss such development when leadership is remote, occurring in the relative safety of online venues such as Zoom or Microsoft Teams, far away from the bedside and unable to view the impact such decisions have on the very same frontline workers that many leaders claim to greatly honor and appreciate.
