We Are Nurses: NYC H+H/Mayorals January 2019

JANUARY 2019

A NEWSLETTER FOR NYSNA RNs AT NYC HEALTH + HOSPITALS

Nurses Launch First H+H Bargaining Campaign Over 100 Bargaining Committee members and rank and file Contract Action Team (CAT) members turned out for the launch of the NYC H+H Bargaining campaign on January 5. NYSNA nurses brought their ideas and energy to the rainy Saturday session, crafting our vision and roadmap for a better H+H. After a morning of assessing our union’s victories in 2018, our strengths, and our challenges to come in negotiating a new contract, Judith Cutchin, RN and President of NYSNA’s NYC H+H/Mayorals Executive Council, led us all in a chant of “We are nurses, we are NYSNA!” H+H nurses got words of support and solidarity from private sector nurses of Montefiore and Mt. Sinai, who are in the midst of bargaining new contracts. They shared lessons in how they are building strong CATs and communications to strengthen their bargaining power during negotiations.

Labor leader Bill Fletcher, Jr. helped facilitate the all-day session, outlining the steps of a bargaining campaign, helping us analyze power, and emphasizing, “Nothing is more important than unity.”

“I want to make sure that all the nurses who are represented by NYSNA get a fair contract, and that our patients get the staffing, supplies, and everything that they need,” said Bargaining Committee member Valerie Bowers, RN,

Kings County Hospital. “Nurses are doing everything we can for the patients we are called on to serve, so the City of New York needs to compensate us accordingly.”

Participants discussed the theme of bargaining, Healthcare Justice for the Other New York, and what it would mean to win better working conditions for nurses and better treatment conditions for the vulnerable communities we serve.

Bargaining Committee member Yvonne Lam, RN, ACM, Woodhull Medical Center, explained: “It feels great that we’re getting ideas out to more members, so we can build a stronger campaign and do better for our patients.

I’m hoping that we can win better benefits, so we can retain nurses and attract more nurses to the city hospitals and agencies. Healthcare Justice for the Other New York means that everyone deserves equal care. All NYSNA nurses can get involved in helping us reach our goals!”

This is our first contract campaign in NYC’s public sector.

We need all H+H nurses to pitch in, shape the campaign, and help us win our demands. Turn in your bargaining survey. Wear a button on an upcoming button day. Join us at a big public kick-off of our campaign with a rally and press conference in Harlem on Tuesday, February 5.

For nurses unable to attend the kick-off, we are planning local actions in facilities throughout the system in February. Contact henry.rose@nysna.org to get involved.

WE ARE NURSES, WE ARE NYSNA!

Know Your Paycheck Nurses work hard. We deserve to be paid correctly.

H+H nurses often have questions about how to read their paycheck, and how to make sure they’re getting paid the correct amount.

Differentials If you receive a certification or education differential, it will be paid in every paycheck. Look for the code EDU or LCN in the earnings type on your paystub (see example below).

Night shift differential is paid every month, the last pay period of the month. The code SHD accompanies this pay.

Experience differentials are to be paid in the first pay

period of a new year. The code NEX will appear on your stub.

Review your paycheck for accuracy. The sooner you catch an error, the easier it is to correct it.

Retro Pay Retro payments are pensionable backpay and will show up as CLB on your paystub. NYSNA is in the process of requesting a complete accounting of each nurses’ retro payments—how much has been earned, how much has been paid out, and how much is owed—to be delivered to every NYSNA nurse.

For a history of your paystubs and a list of all earnings codes, log into your account from an H+H facility at: http://intranet.nychhc.org/Corporate_Comptroller/ Payroll_Your_Paycheck_Page6.html

A New Benefit for H+H Nurses NYSNA H+H members have a new benefit— free membership to the Children’s Museum of Manhattan!

Check your email and mail for more details on the many educational programs for children, and how you or your child’s caregivers can access the museum for free.

JANUARY 2019

A Newsletter for NYSNA RNs at NYC Health + Hospitals

Advocating for Our Patients On Wednesday, January 16, several coalition members testified before the City Council Committee on Hospitals. Anne Bové, RN and NYSNA Board Member, emphasized, “The money needs to follow the patient.”

These Cuts Would Be Hard to Heal The NYC Health + Hospitals system takes care of a disproportionate number of low-income patients—approximately 70% of our patients are uninsured or Medicaid patients. The federal and state governments provide “charity care” funding to subsidize the losses that public and safety net hospitals face, but this funding is both inadequate and unfairly targeted. As of now, the hospitals providing the majority of care to uninsured and underinsured people do not receive the majority of the funding to do so.

Threats to Funding To make matters worse, the federal government will likely cut money from the Disproportionate Share Hospital (DSH) funds, which will hit H+H first and hardest.

That’s why NYSNA is joining with patient, community and hospital advocates to demand a fix for hospital funding. We are advocating for increases in state Indigent Care Pool (ICP) funds, increases in Medicaid reimbursements, and a change to the funding formula, so that the hospitals that care for the most disadvantaged patients receive a fair share of the funding. As part of the H+H Community Coalition, we put forward a detailed proposal to #FixHospitalFunding. Learn more at http://bit.ly/fixhospfundwebinar

NYC H+H President and CEO Dr. Mitchell Katz said, “If everyone gets a little funding, that to my mind is not “disproportionate.”

Disproportionate should mean that those hospitals that are caring for most of the uninsured and Medicaid patients should get the largest portion of the funding.”

Anthony Feliciano of Commission on the Public’s Health System (CPHS) said, “Powerful political influences have tilted funding towards wealthy private hospital systems, to the detriment of the public system.” He provided examples of big, profitable hospital systems that provide very little charity care, but receive lots of charity care funding. “We still have hospitals that do not provide information about their charity care, but continue to receive funding,” he added.

Carlina Rivera, Chair of the New York City Council Hospital Committee, said, “Medicaid funding hasn’t been revisited thoughtfully in a decade, and our hospitals have suffered.” She affirmed her belief that healthcare is a human right, and made a commitment to advocate with us on behalf of H+H and safety net hospitals.

What’s Next Watch your email for ways that you can help the effort to support our public hospitals and underserved New Yorkers. As state budget negotiations begin in Albany, it is critical that we act to fix hospital funding. Anne Bové, RN, testified along with Carmen Charles, President of AFSCME Local 420

WE ARE NURSES, WE ARE NYSNA!

at night after the pharmacy is closed, or the young woman who is busy working but wants to make sure she gets a Pap smear.

I don’t think that everybody understands that they have a right to healthcare. People just move here from places where there’s no public health infrastructure.

They just assume that, “Oh, well, I can’t go to the doctor. I can’t see a nurse. I can’t afford that.” And so now, we have both the attention and the financial resources to be able to teach people. I’ve spent my whole career as a public health doctor, and to me, empowering people is very important. It’s not sufficient to give care if it means making people feel that they have to beg for care. If you’re in our program NYC Care that will mean that you’re entitled to a prompt primary care appointment, specialty care appointment if you need it, laboratory, X-ray, and hospitalization, and pharmacy, and mental health services, and addiction services. Even though it’s not insurance, the experience of getting the care should be like what someone would experience with insurance. And we can do that because in the end, it’s not insurance that makes people healthier—it’s the relationship with doctors and nurses and other healthcare professionals. Insurance is just a way of paying for the care, but insurance is not a loving nurse.

Q & A with Dr. Katz Q: To say that we’re 100% supportive of the New York City Care proposal that the Mayor put forward is probably an underestimate. What were your reactions when you first heard this proposal?

A: Well, I was incredibly excited. I love being at

Health + Hospitals, and Health + Hospitals does many things really well, especially trauma care and emergency room care, hospitalization. But where Health + Hospitals has really lacked the infrastructure is around outpatient care, being able to guarantee prompt appointments both for primary care and specialty care, being able to have a good customer service experience. Now we will have enough money to be able to provide a 24-hour, 7-day-a-week customer service line—not an information line, but something that would really help the patient who has an infection late

Q: Right now, we have many patients who seek

primary care in our emergency rooms at H+H. One of the hopes of this program is that those folks who had been using the emergency room for primary care will be seeking more care outside of the ERs, in some of the outpatient clinics that are being planned. And there are a lot of private outpatient clinics that are popping up around the public hospitals. So how do we manage people’s health better? How do we keep them as patients in H+H?

A:

Those clinics are sprouting up and people are going to them because there’s a need. This program will allow Health + Hospitals to develop a robust outpatient system so that people don’t have to go to the emergency room. People have to get the experience that they’re looking for if they’re going to go to primary care. That’s why it upsets me when people talk about how uninsured people go to the ED for things

JANUARY 2019

that are not urgent. It may not be urgent, but how else are they going to get their care? The usual reason people go to the emergency room, whether they’re insured or not insured, is because their next option is to be seen in a month, and they know it can’t wait a month. So NYC Care will enable us to have the capacity to really meet people’s needs.

Q: The City Council meeting here today is about fair share funding. We’ve seen from the federal government attacks on the social safety net, on funding for healthcare, and on immigrants. Do you feel like the NYC Care proposal is taking steps to address some of those challenges?

A: I think yes. It’s filling the void in leadership at the

federal level by making sure that, at least in New York City, people who are low-income are getting appropriate services and that the safety net system is funded at a level that we can maintain a positive experience for our patients.

Q: How does NYC Care compare to the MetroPlus program?

A Newsletter for NYSNA RNs at NYC Health + Hospitals

Q: How do you see the roll out of NYC Care? How do you see the role of nurses and of NPs?

A: I’m a big believer that good care requires a whole

team. And nurses working at the top of their licenses can add so much to patients’ care experiences. We’re going to hire more nurse practitioners who can serve as independent practitioners. We’re going to hire more nurse case managers/ care managers. There are people who have multiple chronic diseases, such as diabetes, elevated lipids, hypertension, who really benefit from having a nurse work with them around their self-management tools, around getting the care that they need. And registered nurses in clinics can do much of the age-based, cancer, mental health and other screening and education. Those things could be done before seeing a physician or a nurse practitioner, thereby, making the time with the physician or nurse practitioner more efficient, so then that doctor or nurse practitioner can see more patients. And nurses are really good. I mean, those are core functions of nurses to focus on health promotion and preventive behavior, more so, actually, than physicians. More nurses are part of the plan. We’ll be hiring more nurses as we expand.

A: MetroPlus is true insurance for people who have Q: Compared to what you did in California with exMedicaid or Medicare, or they have commercial insurance. For those people who are eligible for receiving insurance with a subsidy from the federal government, we want them to do so. We’re going to take some steps to make it easier for them to do so, to make the experience in enrolling into MetroPlus easier. NYC Care is needed because there are people who are not eligible, either because of their immigration status, or it’s simply unaffordable. The coverage that they can get through MetroPlus on the exchange is too high a percentage of their income, and so they can’t afford it. But we see them very much as dual strategies: that 600,000 uninsured people in New York City; 300,000, who we believe are not eligible for insurance under the exchange but need healthcare; and 300,000 who are eligible, but are not enrolled. And our job on that group is to improve the process, so they go into MetroPlus.

panding universal care in San Francisco, or looking at housing and other social determinants of health in Los Angeles, how do you envision NYC Care moving us towards a more universal system of care and improving the health of all New Yorkers?

A: NYC Care will be the largest, most comprehen-

sive health coverage program in the US. The Healthy San Francisco program, which I’m very proud of, at its peak, had 72,000 people, and it currently has under 20,000, because the ACA began covering many people. But San Francisco is a population of 700,000 people. New York City has a population of 8.6 million, and a large number of people who don’t qualify for insurance. So to me, what you always want to do is produce a system that provides people the care that they deserve. I’m very excited to be able to do that.

* Interview edited for length

WE ARE NURSES, WE ARE NYSNA!

Sharing in Decisions that Impact Nurses and Our Patients many ICU beds. The patients are happy, nurses are happy—it’s helped every discipline.”

On Wednesday, January 9, NYSNA nurses came together with management throughout the NYC H+H system to discuss progress on our shared governance initiatives.

Enhanced and improved in our last contract, a systemwide Nurse Practice Council and individual facility Nurse Practice Councils (NPCs) began a collaborative process to address issues related to nursing practice, nurse recruitment and retention, and patient safety and outcomes. The Councils and Subcommittees, comprised of an equal number of nurses and managers, soon began meeting on a monthly basis.

The annual meeting brought together teams from different facilities throughout the H+H/Mayorals system.

Facility teams presented on their progress in the areas of nurse retention, alcohol withdrawal treatment, NP practice, and behavioral health.

Queens Hospital has one of the most well-established shared governance structures. Nurses there started a steering committee in 2005, working jointly on retention issues. Today, nurses from every division and nearly every unit are released to attend monthly meetings of the different Councils, including Nurse Practice, Education, Retention, Research, Policy and Procedure, and Peer Review.

Queens Hospital LBU President, Lindella Artman, RN, explained, “Nurses provide so much of the care at the hospital, so nurses should be a large part of making the decisions.”

Queens Hospital nurses presented on their progress at the annual meeting, including Med-Surg nurse Toni Hylton, RN: “The Council discussed and approved a recommendation that nurses assess and administer meds at the bedside. Now we’re able to better treat the patients in withdrawal, there aren’t delays, and we don’t use as

Kings County Hospital started unit-based shared governance around 2013, and the concept has grown throughout the hospital. This year, staff and leadership started a new service-based shared governance program, which has been embraced as a part of the model of care. At the annual meeting, nurses from Behavioral Health and Med-Surg presented on their progress. Kings County Nurse Practitioners Suzette Williams, MSN, FNPBC, CDE, and Kisha Carrington, MSN, FNP-BC, presented about standardizing practices to ensure high quality, consistent care throughout the H+H system.

Curlean Duncan-Britton, HN in Ambulatory Care and Kings County Hospital LBU President, has seen concrete results from shared governance, including installation of panic buttons on computer desktops and improvement to the overhead paging system in Ambulatory Care.

“With shared governance, nurses bring resolutions, not just burning concerns,” said Curlean. “Nurses are the experts of our profession, and shared governance empowers us to make decisions based on evidence and research that will enhance our patients’ care.”

Some facilities with less established shared governance programs are now forming committees and selecting leaders. Harlem Hospital LBU Secretary and NYSNA Board Member Jacqueline Gilbert, BSN, RNC, said, “We have research that supports how frontline staff input creates a better work environment. This process really emphasizes how everyone has a stake in the success of H+H.” Harlem has an active NPC Steering Committee, as well as a Recruitment, Retention and Reward subcommittee, which grew out of nurses’ Daisy Award practices. The Steering Committee is now discussing how to build out more committees and more nurse leaders to represent their units.

“For the facilities with less established committees, I would say there’s always a beginning—it’s never too late to start,” said Michelle Webb, RN and Release Time Representative at Jacobi Medical Center.

To get involved in a shared governance initiative or Nurse Practice Council in your facility, contact your NYSNA Representative.

JANUARY 2019

A Newsletter for NYSNA RNs at NYC Health + Hospitals

time to attend trainings and conferences, and then by claiming we were only entitled to two education days per year. We filed a grievance and won, then re-emphasized our rights at the Labor Relations meeting.

Evaluations had become a big problem. Administrators with no medical background and no connection to our work were evaluating nurses. We won a change to evaluations, so that moving forward a doctor or direct supervisor will complete one part of our evaluation, and an administrator will complete the time and attendance portion of the evaluation.

Progress at the PD Working within NYC H+H Mayorals can present challenges. When nurses are spread out at different locations, it can be hard to come together to solve the common problems we face.

That was the case in the medical department of the NYPD, where several issues had been brewing for years.

After gaining little ground in dealing with NYPD management, and encountering a series of meeting cancellations, NYSNA nurses were finally able to schedule a meeting with the head of NYC H+H’s Labor Relations in November, where many of our outstanding issues were redressed.

“It seems like we were working on some of these issues for a long time, and we finally are seeing some changes,” said Lynne Sanderson-Burgess, RN and NYPD LBU President.

The recent accomplishments include unlimited nurse education time, a better evaluation process, improved vacation and mobilization policy, and respect for nursing protocols.

Turning the Tide Our contract does not limit the amount of education time nurses use to keep current in our practice and certifications. However, management started trying to limit our education time—first by making nurses use vacation

Management also changed our vacation scheduling practice—lumping all nurses from different units and locations into the same pool for float and mobilization purposes. We fought back because this change limited when nurses could take vacation. It also treated nurses the same as uniformed officers for purposes of mobilization, even though nurses don’t have unlimited sick time and the same level of disability and pension benefits as uniformed officers. From our experience in mobilizing immediately after 911, we know how dangerous it can be to mobilize. During the meeting, NYC H+H agreed it was unfair to mobilize NYPD nurses and expose them to the same risks as uniformed officers.

Vacation scheduling also went back to unit-by-unit, with the understanding that nurses from one location do not float to cover nurses on vacation in another location.

Lastly, we discussed how long it takes for nurses’ voices to be heard to put the proper protocols in place to ensure safe patient care. Management would ask us to do new tasks, like administer oxygen, or test for TB, without putting in place the necessary protocols and doctors’ orders.

Lynne explained, “We are nurses and have our licenses to protect, but our first duty is to protect police officers.

Nurses have the expertise to implement safe protocols that protect patients, nurses, and the department—we need to be listened to immediately when we raise concerns.”

There are still some issues to resolve—especially around hiring and promotions,” she continued. “I hope this will be a turning point where management will be less dismissive of nurses’ concerns, and where advocating for your patients and your colleagues won’t be seen as making trouble.”

UPCOMING EVENTS

(For more information or to register, ask your NYSNA Rep or visit www.nysna.org/events)

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PHARMACOLOGY REVIEW

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MED-SURGE NURSING CERT. REVIEW

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PACU NURSING CERT. REVIEW

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CHARTING WITH A JURY IN MIND

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PAIN MNGMT NURSING CERT REVIEW

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MEDICAL MISSION & DISASTER RELIEF

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PSYCH MENTAL-HEALTH CERT REVIEW

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AMBULATORY CARE CERT. REVIEW

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MEDICAL MISSION & DISASTER RELIEF

February 4, NYSNA NYC Office February 14 & 15, NYSNA NYC Office March 7 & 8, NYSNA NYC Office March 14, NYSNA NYC Office March 25, NYSNA NYC Office March 27 - April 3, Guatamala March 27 - 29, NYSNA NYC Office April 4 & 5, NYSNA NYC Office April 23 - May 9, Brazil

SAVE THE DATE! Rally for the Other New York TUESDAY, FEBRUARY 5

NYC H+H & MAYORAL EXECUTIVE COUNCIL CHAIRS RNS: • Naomi Greene, Administration for Children’s Services • Todd Schultz, Bellevue Hospital Center • Jovana Woodley, Coler Specialty Hospital & Nursing Facility • Ray Briggs, Coney Island Hospital • Audrey Morgan, Correctional Health Services • Florence Exinor, Cumberland D & T Center • Keysha Morris, Department of Correction • Theresa Minarik, Department of Sanitation • Patricia Morris, Dr. Susan Smith McKinney Nursing & Rehab Ctr • Deborah Gatson, East NY D & T Center • Pauline Williams, Elmhurst Hospital Center • James Ambery, Fire Department • Kittie McGee, Harlem Hospital Center • Grace Lee, Gouverneur Healthcare Services • Peter Pacheco, Henry J. Carter Specialty Hosp. & Nursing Facility • Rivka Elyahu, HHC Health and Home Care • Yelena Levin, Human Resources Administration • Mary Simon, Jacobi Medical Center • Curlean Duncan, Kings County Hospital Center • Marsha Wilson, Lincoln Medical and Mental Health Center • Charles Mighty, Metropolitan Hospital Center • Nicole Smith Ferguson, Morrisania D & T Center • Lynne Sanderson Burgess, Police Department • Sharon Greenaway, North Central Bronx Hospital • Lindella Artman, Queens Hospital Center • Stephen Nartey, Renaissance Healthcare Network • Kimberly Yeo, Sea View Hospital Rehabilitation Center & Home • Natalie Solomon, Segundo Ruiz Belvis D&TC • Judith Cutchin, Woodhull Medical & Mental Health Center

GET ANSWERS/STAY IN TOUCH Dental benefit questions: www.Aetna.com, 877-238-6200 Prescription benefit questions: www.optumrx.com, 888-691-0130 For all other benefits: www.ASOnet.com, 888-692-7671 NYSNA NYC Office: www.nysna.org, 212 785 0157 NYSNA Board of Directors: www.nysna.org/board-directors

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