NY Nurse: December 2021 by New York State Nurses Association

nurse New York

New york state edition | december 2021

Health Systems Must Do Their Fair Share, p. 5 charitable hospitals placed over 4,880 liens, p. 7

New York Nurse december 2021

Nurses Plan Rolling Actions to Highlight Dangerously Low Staffing Events Began Nov. 17 and Continued Through Mid-December

Matt Allen, RN, BSN matt.allen@nysna.org

cross the country, fellow nurses have spoken out about the challenges of providing care in a pandemic. In painstaking detail, we have described what it was like to work until our souls and physical bodies could take no more. We urged health systems to provide more resources to enable us to care for patients and ourselves, including hiring more nurses to address staffing shortages. Some nurses have even left the profession after experiencing burnout, poor working conditions, hostility from the very patients they were charged with caring for, and a sense that their employers viewed them as disposable. While we pleaded for more help, we watched our health systems hire travel nurses and pay them significantly more than us for doing the same job. That has led to a hemorrhaging of staff that was completely preventable. The question becomes: Where do we go from here?

Reginalt Atangan, RN reginalt.atangan@nysna.org

Nurses are Fighting Back

By Nancy Hagans, RN NYSNA President

Advocating for patients. Advancing the profession.SM Board of Directors President Nancy Hagans, RN, BSN, CCRN nancy.hagans@nysna.org First Vice President Judith Cutchin, RN, MSN judith.cutchin@nysna.org Second Vice President Marion Enright, RN marion.enright@nysna.org Secretary Nella Pineda-Marcon, RN, BC nella.pineda-marcon@nysna.org Treasurer Jayne L. Cammisa, RN, BSN jayne.cammisa@nysna.org Directors at Large

Marie Boyle, RN, BSN marie.boyle@nysna.org Seth B. Dressekie, RN, MSN, PMHNP, BC seth.dressekie@nysna.org Flandersia Jones, RN, BSN, MPH flandersia.jones@nysna.org Michelle Jones, RN, MSN, ANP-C michelle.jones@nysna.org Sonia M. Lawrence, RN, BSN sonia.lawrence@nysna.org Benny K. Mathew, RN, MS, CCRN, CEN, SCRN benny.mathew@nysna.org Ari Moma, RN, MSA ari.moma@nysna.org Jean Erica Padgett, RN jean.padgett@nysna.org Regional Directors Southeastern Bruce Lavalle, RN bruce.lavalle@nysna.org Southern Aretha Morgan, RN aretha.morgan@nysna.org Catherine Dawson,RN,CNOR,MSN Central catherine.dawson@nysna.org

Lower Hudson/NJ Cynthia Caruso, RN cynthia.caruso@nysna.org Western Steven Bailey, RN steven.bailey@nysna.org Eastern Bill Schneider, RN, CCRN bill.schneider@nysna.org Editor Jennifer R. Farmer Executive Editor Pat Kane, RN, CNOR Executive Director Editorial offices located at: 131 W 33rd St., New York, NY 10001 Phone: 212-785-0157 Email: communications@nysna.org Website: www.nysna.org Subscription rate: $33 per year ISSN (Print) 1934-7588/ISSN (Online) 1934-7596 ©2021, All rights reserved

Now many nurses are fighting back. For instance, health care workers from five different facilities, representing over 10,000 workers, have hosted a series of rolling actions to detail dangerously low staffing at some of New York’s most prominent care facilities. Our union siblings are noting that short staffing is a direct consequence of hospital systems failing to hire enough nurses, compensate them appropriately and improve overall working conditions. Nurses must now take our case to the communities that will be most impacted by understaffing. Our rolling actions began on November 17 and were detailed in a front-page story in the New York Daily News on Tuesday, November 16. My union colleague Noemi De Jesus-Aponte, who works at Presbyterian in Washington Heights, shared with the New York Daily News that NYSNA members and hospital systems “have known for 15 years that 2020 was going to be the largest retirement because

NYSNA President Nancy Hagans Fires up the Crowd at a Speak Out at New YorkPresbyterian Columbia Hospital

of the baby boomers. The retirees left, and hospital systems froze, and they didn’t fill those positions.” Because nurses enter the profession to help others, we are particularly distressed when short staffing compromises our ability to provide quality care. In a reported piece for The Atlantic, Ed Yong notes that “one in five health-care workers has left medicine since the pandemic started.” He cosigned my sentiment that “Health-care workers want to help their patients, and their inability to do so properly is hollowing them out.”

Asked to Do More with Less In hospital systems across the state, nurses are caring for far more patients with varying acuity than state law allows. What we are seeing is not a matter of fate — it is a matter of political will; and despite the rhetoric, many hospital systems lack the will to do what is right for caregivers and patients alike. In fact, they have played a sleight of hand, seducing the public to focus on vaccine mandates to shift the focus from where it needs to be: on hiring more nurses and investing in costlier measures (such as better ventilation and more research and

training on airborne transmission) to keep our communities safe. While the actions occurred at New York-Presbyterian Columbia, New York-Presbyterian Hudson Valley, Mount Sinai Morningside/West, Staten Island University Hospital/ Northwell, and Montefiore Bronx, this is an issue impacting all hospitals in New York. I believe more health systems will face increasing speak-outs and other actions by team members if they do not do more to improve conditions for nurses and other healthcare workers. For our part, NYSNA will become increasingly vocal about the need to preserve healthcare workers; doing so requires stronger contracts. As we conclude these rolling actions, we’ll head into the Dec. 6 bargaining conference, and continue to ramp up our work to prepare to renegotiate contracts that will give caregivers the chance to prioritize patients rather than be derailed by understaffing. Given the tens of thousands of workers who went on strike or narrowly averted a strike this fall, we know workers are serious, and we aim to fight for that which gives us and the people we serve a true shot at surviving and thriving.

We know workers are serious, and we aim to fight for that which gives us and the people we serve a true shot at surviving and thriving.

NEW YORK NURSE december 2021

Four Things That Will Shape 2022

he start of a new year brings anticipation. There is anticipation of what one hopes to accomplish personally and professionally. There is also trepidation about uncertainty for what the coming year may bring. While there is a lot we do not know, there are key things we are certain will greet us in 2022. As we round out 2021 and prepare to enter a new year, NYSNA is mindful that our work fighting for healthcare workers and patients is entering a new frontier. Below are four key things we are preparing for in the coming year.

1. Implementation of the Safe Staffing Law One of the greatest surprises of adulthood is that one must defend what has already been earned. As a child, I thought victories were permanent. I thought civil rights leaders’ work would carry over perpetually. I believed societal gains could never be reversed. But in virtually every category of life, there are examples of things won years prior that later required protecting. Healthcare is no exception. Earlier this year, nurses and healthcare workers celebrated passage of the safe staffing law. They saw the law as one step toward ensuring better working conditions. They believed lawmakers were finally listening and responding to their needs. For years, healthcare workers have gone out of their way to detail the challenges with unsafe staffing. They have worked to ensure that both patients and caregivers have what they need. After securing an important victory, many are once again preparing to fight. Although nurses and other healthcare workers fought hard to ensure protections that enable them to do their jobs, employers and business interests are now seeking to roll back the clock. Under the guise of fallout from a pandemic, employers are saying they need more time to enforce staffing ratios. While they knew low staffing was mission critical, many employers refused to improve working conditions that would have allowed

them to better recruit and retain healthcare workers. Now, some health systems are saying do not have what they need to enforce the safe staffing law, a measure that will improve patient outcomes and protect nurses and healthcare workers. NYSNA must be clear: There is no justification for delaying the implementation of a law that will keep patients and caregivers alive and safe. Nurses and other healthcare workers have been beat down for years. Some faced mental healthcare breaks because of caring for so many patients and lacking sufficient resources. Many were counting on the implementation of that law to have some form of relief. Moreover, unless there is a clear law on the books (with enforcement provisions) to regulate staffing, some employers will cut corners, further endangering the people they’re in business to serve. In 2022, NYSNA will be fighting to ensure the implementation of a key measure. This is mission critical for the coming year.

are applying Band-Aids to deep, structural challenges. During bargaining, we want to push employers to be forward-looking rather than instituting knee-jerk solutions that have a long-term negative impact. As we prepare for this season, I’m asking you to stay close to your union siblings. We gain strength when we unite in solidarity. I am ready for this period, and I know you are too.

By Pat Kane, RN NYSNA Executive Director

3. Local, State and Congressional Elections The 2022 midterms will determine who sits in the governor’s

2. Bargaining Next year, NYSNA will also bargain a record number of contracts. Members across regions and systems will return to the table and negotiate for that which enables nurses to care for themselves, their families and their patients. From lived experience and years of research, NYSNA understands that nurses and patients are safer when caregivers have a voice on the job. Our union will wage an unrelenting fight to protect that voice and to ensure that healthcare workers have what they need to provide the high level of service they value. Some health systems will dig in their heels and plead distress. NYSNA will raise our voices, understanding that if we do not show up for us, no one will. One of the ways we’ll prepare for bargaining is via a host of bargaining conferences. The bargaining conferences present an opportunity for workers to unite across employers and regions to learn best practices and strategies to improve the likelihood of getting a fair contract. That is pivotal because employers

mansion in Albany. They will determine who represents nurses in Congress. They will also impact our local leaders such as sheriffs, judges, and prosecutors. All elections are important, and this cycle is no exception. Now is the time to ensure you are registered to vote. Now is the time to ensure you understand who will be on the ballot and what they stand for. Now may even be the time for you to consider whether you will run for office now or in the future. Now is also the time to engage your friends and family, ensuring they are registered to vote and dedicated to voting. We know that elections have consequences. But now is the time to ensure the consequences advantage us and not the people who oppose us.

4. COVID-19 The COVID-19 pandemic altered the way we live, work and commune with each other. Certainly, Continued on page 15

NYSNA nurses at Hudson Valley Hold Speak Out for Better Working Conditions

New York Nurse december 2021

Meet Your Board Members For the next several editions of New York Nurse Magazine, we will highlight NYSNA board members. In this installment, meet Jean Erica Padgett and Flandersia Jones.

Jean Erica Padgett “We all are or will age into a vulnerable population. Our NYSNA activity, participation and support will help protect us now and in the future.” Jean Erica Padgett, RN

Jean Erica Padgett, RN, is a Director at Large on NYSNA’s Board of Directors. She works in the pediatric emergency department at Morgan Stanley Children’s hospital of New York Presbyterian. She has said that her journey in nursing began with an associate degree from SUNY Farmingdale. From there, she studied at St. Joseph’s Patchouge campus for a Bachelor of Science in Nursing. She is finishing a Master’s in Public Health in health care policy and administration. What She Would Like You to Know: Jean Erica believes it is easy for nurses to care for others while neglecting themselves. She believes that being involved with NYSNA is a form of self-care. “The advice from the airline flight attendant has broad application: Put your mask on first BEFORE helping others. From the bedside to in-air travel, let’s secure our NYSNA union mask first so we can help ourselves and others. We all are or will age into a vulnerable population. Our NYSNA activity, participation and support will help protect us now and in the future.”

Flandersia Jones Flandersia Jones, RN, BSN, MPH, is a Director at Large on NYSNA’s Board of Directors. For over 16 years, she has worked at BronxCare Health System as a telemetry nurse. Flandersia was born in the Gambia and migrated to the U.S. in 1993. She started her nursing career as a Licensed Practical Nurse from the Gambia in 1983, earned her associate degree from Helene Fuld in 2001, graduated with a Bachelor of Science in Nursing from the College of New Rochelle in 2008, and a Master in Public Health from Monroe College in 2015. She is pursuing a doctorate in public health from Capella University. What she would like you to know: Flandersia has spent her entire career as an active, well-rounded nurse rendering service in the Bronx. She understands that health care is a human right and not a privilege. Flandersia believes that health disparities and racial inequality must end. “For decades, nurses have enjoyed consistent recognition as among the most trusted professional. As a result, we have a unique opportunity to use our voices on health system reform, regulatory changes, care coordination, and health information technology. The COVID‐19 pandemic has presented an opportunity to hear nurses’ voices on ways to improve staffing and patient care.” Although she is passionate about nursing, Flandersia says her most important role will always be wife, mother to Harriet, Isaac, and Arthur, and grandchildren Flandersia, Stephen, and Victoria. She is looking forward to serving as a member of the board of directors and advocating for every member. She is passionate about helping the union grow more robust and united.

“We have a unique opportunity to use our voices on health system reform, regulatory changes, care coordination, and health information technology. ” Flandersia Jones, RN

Safe Staffing

NEW YORK NURSE december 2021

Health Systems Must Do Their Fair Share By Peppur Chambers

n September 2021, Gov. Kathy Hochul declared a statewide disaster emergency due to healthcare staffing shortages. Even before her declaration, many in the media drummed up a false narrative that the shortage was due to nurses who were fired or resigned in protest over the vaccine mandate. NYSNA believes every New Yorker should be vaccinated. However, mandatory vaccination programs have resulted in very few dismissals of RNs within NYSNA. More importantly, this narrative allowed health systems to evade accountability. The truth is that the people most responsible for understaffing are the people charged with running healthcare facilities - hospital and health systems administrators. “For instance, last year many hospitals implemented a hiring freeze, which left RNs out of work and forced to seek employment elsewhere,” said NYSNA President Pat Kane. “Without detailing a clear plan, many nurses had little information on when they would return or if they could return to work. This caused some to leave the healthcare industry altogether.”

Baby Boomers Are Aging What’s more, for years administrators have known that the aging of Baby Boomers would impose unique challenges on the healthcare system. They did little to stave off what most knew was coming. At this point, if we do not hold health systems accountable, patients and caregivers will perish. I spoke with several RNs who detailed why. “Understaffing of RNs is felt in many units in the facilities, including ERs, Labor & Delivery and ICUs,” said Nancy Hagans, RN, and President of NYSNA. “This is true for both private and public hospitals in NYC where NYSNA nurses work.” We know that nurses across the state, and country for that matter, are struggling to navigate chronic understaffing. But hearing directly from so many impacted people is sobering. Dawn Cardello, RN and

New York-Presbyterian Columbia Hospital Nurses at Speak Out

Co-President of the LBU at Staten Island University Hospital, said “SIUH nurses cannot continue to work in these horrendous conditions caring for 7-10 patients. Although they do their best, nurses cannot provide safe quality care when spread so thin. I have never seen it so bad in my 34-year career here.” Other healthcare professionals with NYSNA underscore that chronic understaffing impacts public health and deserves collective attention. “Inadequate staffing is a public health concern for NYC residents,” said Board Member Benny Mathew, RN and Emergency Department nurse at Montefiore Moses Hospital. “Overcrowding and nurses are assigned to higher number of patients is recipe for disastrous outcomes which occurs on daily basis. The community and the nurses are the victims because the hospitals fail to recruit and retain nurses.”

At Capacity According to an analysis, one in six ICUs have at least 95% capacity, yet there are not enough nurses to handle the crushing surge of patients nor is there enough staff to cover the hemorrhage of nurses leaving the profession in record numbers. With understaffing reaching a tipping point, patients and healthcare workers are at risk. It is important to note, that staffing shortages will not go away without intentional effort. There are reportedly 4 million nurses in the U.S., and most of them work in hospitals. Given the earlier point about

Baby Boomers, we know there will be a greater need for nurses in the coming years. The question becomes what are health systems doing now to plan for the future?

If we do not hold health systems accountable, patients and caregivers will perish.

This Catastrophe Has Consequences In a pre-COVID 2020 study carried out by Linda Aiken, Founding Director of the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, there is evidence a much lower ratio of nurse-topatient quota is imperative to quality patient care and saving lives: The Safe Staffing for Quality Care Act (S.1032/ A.2954) calls for nurses to care for no more than 4 patients each on adult medical and surgical units. Our findings show that on average, hospital nurse staffing is significantly worse than the proposed standard. Across all hospitals in the state, nurses care for on average 6.3 patients each. Nurse staffing was worst in New York City where nurses cared for an average of 6.9 patients each. A hospital isn’t a McDonalds. The consequences of understaffing are more severe than a meal being delayed. When low staffing impacts quality care, lives are impacted both the patients and the nurses providing care. Understaffing is a catastrophe that has consequences. Aretha Morgan, RN, who has worked in the Pediatric Emergency Department for 11 years, lamented “I have never seen staffing like. It Continued on page 14

Aretha Morgan, RN, NYSNA Board Member

New York Nurse december 2021

The Federal Government Has a Role to Play in Improving Maternal Health Outcomes By Jennifer R. Farmer

H Unfortunately, for women of color, especially Black women, ushering a new child into the world is rarely stress-free.

aving a child can be one of the most exciting times in an individual’s or family’s life. A new child can bring fresh possibilities and renewed hope for the future. There are a host of important milestones and rituals to celebrate the new addition or additions in the case of multiple babies. From the baby shower to the birth itself to the introduction to family and friends to the first birthday and other occasions, a new child brings new reasons to celebrate. But celebration is easier when women have healthy pregnancies and safe delivery experiences. Unfortunately, for women of color, especially Black women, ushering a new child into the world is rarely stress-free. There have always been rumors from Black women who have said their medical team did not immediately listen to them or take their concerns seriously. There has also been such considerable focus on infants that a mother’s own health has not been properly centered. Yet, when Black royalty such as Beyonce, Serena Williams and Keisha Knight Pulliam shared their own accounts of not being heard during the birthing process, many people began to take note. Those and other high-profile Black women’s accounts of having challenges during their pregnancy, delivery or postpartum underscored that this is a collective issue.

At Risk

SOURCES https://www.npr. org/2018/08/10/637614646/ even-famous-and-successful-blackwomen-can-encounter-seriouspregnancy-complicat https://www.beckershospitalreview. com/patient-safety-outcomes/ us-government-should-standardizedmaternal-care-practices-acrosshospitals-to-reduce-disparities-newreport-says.html

Even when one controls for socioeconomics, underlying health conditions and education level, Black women from all walks of life are at immense risk before, during and following pregnancy. For Black and Native women, maternal health — the period from preconception to 12 months postdelivery — can be rife with challenges. Incidentally, there is a growing body of research that supports this point. A new report by the U.S. Commission on Civil Rights found that: 1. B lack women in the U.S. are three to four times more likely to die

from pregnancy-related complications than white women in the U.S. ative American women are 2. N more than two times more likely to die from pregnancy-related complications than white women in the U.S. he above disparities have 3. T become more severe over the last 30 years. Referencing research from the Centers for Disease Control and Prevention, Nina Martin of ProPublica and Renee Montagne of NPR noted that “… a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 per-

cent more likely to die from pregnancy- or childbirth-related causes.”

Bias Persists That is not always a function of poor health, lack of medical care or lower education levels. Many Black women said they were discriminated against when seeking medical care or had their concerns ignored. The Commission noted that the federal government has a role to play in improving access to quality maternity care for women, standardizing care to reduce racial disparities and collecting data to track the scope of the problem and progress. Maternal health is not just the burden of women of color; it is a shared responsibility.

medical debt

NEW YORK NURSE

december 2021

Charitable Hospitals in New York Placed 4,880 Liens By Jennifer R. Farmer

uring times of difficulty, many people naturally look to faith or religious institutions for assistance. But several hospital systems, including those owned by religious charities, appeared to betray that trust by placing liens on the homes of people who fell on hard times and were unable to satisfy medical debt. According to the November 2021 report, “Discharged into Debt: Nonprofit Hospitals File Liens on Patients’ Homes” by the Community Service Society, charitable hospitals in New York imposed 4,880 liens on the homes of patients with outstanding medical bills. Many of these same institutions received taxpayer money to defray medical debt. For instance, the report noted the hospitals collected over $442 million from the state’s Indigent Care Pool to help alleviate uncompensated care. These institutions accepted state funds and then aggressively pushed indigent patients into physical and financial ruin.

Discharged in Debt The Discharged into Debt report, which is part of a broader series on medical debt, detailed the adverse impact of liens: “A judgment lien clouds title to property and can prevent the homeowner from refinancing or obtaining an additional loan, including a home equity loan. As a result, a judgment lien can reduce the value of what is, for most people, their main asset and source of future economic security.” To understand the significance of this, one must appreciate that many people delay seeking medical attention due to the high cost of medical care. The report found that over half of New Yorkers struggle with healthcare affordability. For persons in this category, they may only seek care when they are desperate but even then, many worry about the repercussions of being unable to pay. They have reason to worry as over half (58 percent) of all collection actions are for medical debt

according to the U.S. Consumer Financial Protection Bureau. “Former Vice President Hubert Humphrey famously said, ‘The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped,’” said Nancy Hagans, President, NYSNA. “If there is truth to that sentiment, then the treatment of persons who are both ill and poor is shameful and casts a weighty cloud over those that consider themselves charitable institutions.” According to the Community Services Society’s report, “Nearly 80 percent of the liens occur in counties with median incomes that are below 300 percent of poverty for a family of four. For residents in these counties, home ownership is crucial to their family’s economic security and physical health.” How does one recover if they are constantly worried about whether they’ll have a home to recover in, or whether their wages will be garnished due to medical debt.

Mocking Their Mission Equally troubling, these health systems allegedly entered the industry to provide compassionate care. They have not only made a mockery of their mission, but they have also complicated life for scores of people. We know that home ownership is a way to not only build wealth, but to transfer wealth from one generation to another. Placing liens on a person’s home therefore impacts not only the homeowner

and their family, but future generations. Additionally, the people most impacted are those who lack significant resources to begin with and many are people of color.

Things Will Get Worse If 2017 through 2018 is par for the course in terms of the behavior of charitable hospital systems in New York, one shudders to think of the toll the pandemic will have on persons who became sick, lost their jobs, buried loved ones, and fell behind on medical debt. Of all institutions, hospital systems understand uniquely the strain that the pandemic placed on the nation. They watched their caregivers, including doctors and nurses succumb to COVID-19, experience burnout, or struggle to work under the strain of an unrelenting virus. They also treated untold sums of people. And while hospital systems should be compensated, it is unfair to accept state resources and then engage in predatory behavior of those least able to pay. This report helps explain NYSNA’s belief in and advocacy for single-payer, universal healthcare. It also speaks to the need for policymakers to hold accountable, health systems that simultaneously accept state funds and then aggressively pursue sick patients. We do not need to watch more people lose their home, struggle to recover from illness, or be unable to transfer wealth to their children and grandchildren to know that placing liens for medical debt is immoral and wrong. Hopefully, state elected officials will put a stop to this awful practice.

They have not only made a mockery of their mission, but they have also complicated life for scores of people

SOURCE https://www.cssny.org/publications/ entry/discharged-into-debt-nonprofithospitals-file-liens-on-patients-homes

around our union

New York Nurse december 2021

NYSNA Honored at Erase Racism’s 20th Anniversary Celebration and Benefit Dinner

n Wednesday, November 17, Erase Racism New York honored the New York State Nurses Association for the union’s work championing racial justice. NYSNA member Yasmine Boursejour, RN, accepted the award on the organization’s behalf. In her acceptance speech, Boursejour, said, “As a union of mostly women, mostly marginalized people, mostly caregivers, we understand that the fight for justice is a perpetual. As a union with a significant number of nurses who come from immigrant families, we understand the danger of xenophobia and racism. We work for racial justice then, not just because it is the right thing to do; but because our own survival depends on it.”

Yasmine Boursejour, RN, (at right) from LIJ Valley Stream Northwell Health accepted the award on behalf of NYSNA.

NYSNA Sends Delegation to COP26 in Glasgow, Scotland

he United States is the second largest emitter of greenhouse gases even though we are a small portion of the world’s population. The growing climate emergency is causing catastrophic natural disas-

ters and more frequent weather emergencies. Amid this escalating climate emergency, NYSNA nurse Nella Pineda-Marcon traveled to Glasgow, Scotland, to participate in the United Nations’ COP26 convening.

Pineda-Marcon has previously noted that healthcare workers are at bedsides treating patients with respiratory infections and other ailments influenced by the climate crisis. In Glasgow, she joined others in urging parties to the COP26 to work to meet the commitments they made at prior conventions. While in Glasgow, Pineda-Marcon also joined a Global March urging action on the climate crisis and delivered remarks on a Nov. 8 panel entitled “Working Class Struggles Against Climate Change: Union Stories From the Frontlines.” In reflecting on the convening, Pineda-Marcon shared: “Climate change poses a national security threat as well as a public health threat. Inaction is not an option.”

Recommitting to Action

NYSNA’s flag flies in Glasgow, Scotland.

NYSNA Board Member Nella Pineda-Marcon represents union at COP26.

The conference was an opportunity to affirm prior commitments to meet the urgent demands of the climate crisis. More than 100 countries agreed to reduce methane emissions by 2030, which is the fastest way to limit warming. Other countries promised to stop or curtail deforestation. All of those things will impact the world that we live in and the one we pass to our children.

NEW YORK NURSE

december 2021

NYSNA Wins Legal Victory at Champlain Valley

YSNA won a significant legal victory at Champlain Valley Physicians Hospitals, a member of the University of Vermont Health Network. The union brought five different grievances and an unfair labor practice charge, which resulted from Champlain Valley Physicians Hospital’s decision to restructure

13 hospital units within its operation in summer 2020. The employer notified the union that it intended to restructure its operations violation of the collective bargaining agreement. It implemented a restructure over a 15-day period without first bargaining in good faith with the union. The employer also required NYSNA members to bid for new positions

in their respective units, and if they failed to comply, it threatened them with a loss of employment. Additionally, although employees were strongly encouraged to complete their bidding in person and on-site at the hospital, many NYSNA members who adhered to that directive were not paid in full or at all for the hours spent waiting to bid and actually bidding.

THE

JOURNAL of the New York State Nurses Association

VOLUME 48, NUMBER 2

n E ditorial: Roles

by Anne Bové, MSN, RN-BC, CCRN, ANP; Audrey Graham-O’Gilvie, DNP, ACNS-BC; Meredith King-Jensen, PhD, MSN; Alsacia L. Sepulveda-Pacsi, PhD, DNS, RN, FNP, CCRN, CEN; and Coreen Simmons, PhD-c, DNP, MSN, MPH, RN

n Nursing Students’ Experiences on NCLEX-RN Preparation by Susan Joseph, PhD, RN, CNE

Healthcare Workers at Kaiser Narrowly Avert a Strike

daptation to Motherhood for Rural Women With Newborn(s) in the Neonatal Intensive n ACare Unit

by Donna Tomasulo West, PhD, RN, FNP-BC; Pamela Stewart Fahs, PhD, RN; Geraldine R. Britton, PhD, RN, FNP; and Carolyn Pierce, PhD, RN

n What’s New in Healthcare Literature Activities: Nursing Students’ Experiences on NCLEX-RN Preparation; Nurses Unions Can Help n CE Reduce Stress, Burnout, Depression, and Compassion Fatigue During the COVID-19 Pandemic,

Part 4: Promoting Quality Nursing Care Through Better Self-Care Pilot Study Results; Adaptation to Motherhood for Rural Women With Newborn(s) in the Neonatal Intensive Care Unit

Journal of the New York State Nurses Association Seeks Articles for Publication

SEIU-UHW

o many workers went on strike this fall that October was temporarily renamed Striketober. But a massive strike was averted after healthcare workers reached a new agreement with Kaiser Permanente. Mother Jones previously reported that in addition to the 20,000 workers already on strike in October, more than 30,000 healthcare workers at Kaiser Permanente sent a 10-day notice, permitting them to go on strike on Nov. 15 if negotiations with the hospital system did not improve. The local nurses and health workers’ contract expired on Sept. 30. A strike was ultimately averted when the Alliance of Health Care Unions, a collective of unions representing 52,000 Kaiser workers in Oregon and Southwest Washington, reached a new, a 4-year contract with Kaiser The Kaiser announcement comes on the heels of a newly ratified contract between CWA and Catholic Health’s Mercy Hospital

Kaiser employees in Oakland, California

in Buffalo, New York. NYSNA members had expressed a show of solidarity with the CWA workers, visiting the picket line and donating to the strike fund. NYSNA President Nancy Hagans, RN, noted: “NYSNA understands the significance of staffing ratios and applauds CWA for winning staffing

ratios in their contract. NYSNA will continue to fight for staffing ratios for our members.” For more information, see this article in Mother Jones: https://www. motherjones.com/politics/2021/11/ kaiser-permanente-strike-two-tierstriketober/.

Update: NYS DOL Adopts COVID Healthcare ETS for Public Sector Healthcare Workers

Nurses Unions Can Help Reduce Stress, Burnout, Depression, and Compassion Fatigue During the COVID-19 Pandemic, Part 4: Promoting Quality Nursing Care Through Better Self-Care Pilot Study Results by Carol Lynn Esposito, EdD, JD, MS, RN-BC, NPD; Lucille Contreras Sollazzo, MSN, RN-BC, NPD; and Christina Singh DeGaray, MPH, RN-BC

fter months of pressure from NYSNA and other public sector unions, the New York State (NYS) Public Employee Safety and Health Bureau (PESH) has finally extended the Occupational Safety and Health Administration (OSHA) COVID Emergency Temporary Standard (ETS) to public sector healthcare workers in the state. Now both private and public sector healthcare workers are protected by the OSHA ETS. The latest standard was adopted on October 21 and is now published in the state Register, https://dos.ny.gov/system/ files/documents/2021/11/111021.pdf. This NYS regulation will be in place until January 18, 2022. If the ETS is not renewed, NYSNA will fight to ensure the New York HERO Act stan-

dards protect all healthcare workplaces. Check out NYSNA’s fact sheet in the COVID-19 ETS safety requirements for healthcare.

he Journal of the New York State Nurses Association is currently seeking articles for publication. Authors are invited to submit scholarly papers, research studies, brief reports on clinical or educational innovations, and articles of opinion on subjects important to RNs. The journal is especially interested in papers addressing direct care issues. New authors are encouraged to submit manuscripts for publication. For author guidelines, read more here https://www.nysna.org/ nursing-practice/journal-new-yorkstate-nurses-association# or write to journal@nysna.org.

public policy

New York Nurse december 2021

NYSNA’s Director of Public Policy Testifies before New York State Assembly’s Standing Committee on Health On Nov. 1, NYSNA’s Director of Public Policy Leon Bell testified before the New York State Assembly’s Standing Committee on Health during a hearing titled “Medicaid Program Efficacy and Sustainability.” He spoke on behalf of NYSNA’s 40,000 registered nurses and the communities they represent. Bell shared our union’s perspective on key problems in the structure and funding of New York’s Medicaid program. Medicaid ensures health care for more than 7 million New Yorkers, or about one third of the state’s population. It is also the predominant form of health coverage for persons with low-wealth, and therefore an essential component of the state’s health care system. He offered several recommendations for remedying the two-tier medical system including policymakers passing universal, single payer health care. You can read his speech below:

“Medicaid is a major component of the health care system and is the primary source of health care for about 35% of New Yorkers.” Leon Bell

y name is Leon Bell, and I am the Director of Public Policy at the New York State Nurses Association (NYSNA). NYSNA represents more than 40,000 registered nurses across New York State for collective bargaining and is a leading proponent of universal, high quality and equal health coverage for all, regardless of race, ethnicity, gender identity, disability, socio-economic status, or ability to pay. On behalf of NYSNA, I thank the Committee for the opportunity to offer our perspective on some key problems in the structure and funding of New York’s Medicaid program. I am going to focus our comments on the issues of inadequate funding for Medicaid and what we consider to be serious structural problems in the way that this funding is distributed, with a focus on inequalities in access to and quality of care. Medicaid provides health care for more than 7 million New Yorkers, or about one third of our population. It is also the predominant form of health coverage for

lower income populations, and thus plays an essential role in the state’s health care system. Eliminate the Medicaid Global Cap — Fund Medicaid in accordance with the needs of New Yorkers, not based on artificial budgetary caps As noted above, Medicaid is a major component of the health care system and is the primary source of health care for about 35% of New Yorkers, with current enrollment of more than 7.1 million. As a safety-net program, Medicaid plays a vital role in providing coverage to low-income communities that could not otherwise afford to access care. Medicaid funding is also essential to the operation of hospitals and other providers, particularly those that provide services to lowincome populations. In addition to its function as a vital safety net for low-income communities, the program also plays a vital role as an economic stabilizer. When the state economy is doing well, more people are working and can get their health

care from employer sponsored health plans. When, on the other hand, the state economy is in recession or crisis, employment levels drop, and people lose their income and their health care coverage. During the COVID pandemic and the resulting economic crisis, this dynamic was particularly acute — Medicaid enrollment went up from 6.1 million in December 2019 to almost 7.2 million in August of 2021, or about 15%. If the 2020 federal elections had played out differently, the absence of substantial federal aid to state and local governments would have had devastating effects on state Medicaid services. Social and economic “stabilizer” programs (like Medicaid and unemployment insurance) should be expanded during periods of recession or crisis, not artificially capped. Finally, it should be noted that Medicaid is a federal matching program — for every $1 that the state spends, it gets an additional $1 or more in federal funding. By cutting or limiting the growth of state Medicaid spending, the well-known imbalance between what New York pays into the federal government in taxes and what it receives in federal funding is worsened. Given the importance of health care in the state economy, the limits on state spending adversely effect the broader economy — less economic activity, lower growth, and fewer state tax revenues. The last thing New York should be doing is reducing its share of federal funding and reducing the availability of needed health services. The Medicaid Global Cap was instituted as a purely budgetary measure to limit the growth of state Medicaid spending and to restrict the program for purely fiscal reasons.

To read the rest of the testimony, visit the blog on the NYSNA website

https://bit.ly/nov1testimony

members speak

NEW YORK NURSE december 2021

Celebrate Nurse Practitioner Week by Making the Nurse Modernization Act Permanent By Kristle Simms-Murphy, FNP and NYSNA member

very day, nurse practitioners (NPs) save lives and improve the health of our friends and family. The worldwide COVID-19 pandemic has demonstrated that NPs are essential to our healthcare system. To honor their heroic efforts, communities nationwide are recognizing the critical role of NPs as part of the annual National Nurse Practitioner Week (NP Week) celebration, held November 7-13. This year, the NP Week theme is “NPs: Going the Extra Mile.”

Nurse Practitioners Improve Care NPs provide a wide range of care to America’s patients in more than 1 billion visits annually. As clinicians who blend clinical expertise with an added emphasis on disease prevention and health management, NPs are the healthcare provider of choice for millions of Americans. They practice in clinics, hospitals, emergency rooms, urgent care centers, nursing homes, homes and private practices across the country — wherever patients are in need. During the COVID-19 pandemic, nurse practitioners went the extra mile. They were redeployed where they were needed most, including in intensive care and critical care units and at mobile COVID-19 diagnostic, testing and vaccination sites. NPs were able to step up and help save New York because of the 2015 Nurse Practitioner Modernization Act (NPMA), which expanded the scope of NPs’ independent practice and their collaboration with medical doctors (MDs). Soon, New York’s elected officials will have the opportunity to once again support NPs and patients. Along with my union, the New York State Nurses Association, I support state legislation (A1535/S3056) to make the NPMA permanent and further expand the role of NPs by allowing experienced NPs with 3,600 practice hours or more to work independently of MDs and less experienced NPs to work under either an NP or an MD.

Nurse practitioners improve health outcomes for all.

In New York state, 32,750 licensed NPs are practicing, providing timely, culturally relevant care and education to patients throughout the state. Whether serving in rural areas where healthcare access is poor or in the public health system of our nation’s largest city, NPs improve access to quality care and improve patient outcomes.

Higher Satisfaction with NPs According to the National Association of Nurse Practitioners, research finds that patients under the care of NPs have higher satisfaction ratings and fewer unnecessary hospital readmissions, preventable hospitalizations and unnecessary emergency room visits than patients under physicians’ care. In my own practice at NYC Health + Hospitals/Jacobi in the Bronx, New York, I’ve seen the results firsthand. As an oncology NP, I care for cancer patients every day, including patients who remember me from 14 years ago when I

began my career in healthcare as a patient care associate in the emergency department. I know that to best serve the community that I love, I need to be able to continue to practice at this advanced level.

Soon, New York’s elected officials will have the opportunity to once again support NPs and patients.

We’ve Come a Long Way Nurse practitioners have come a long way since our title was developed in the 1960s and our role in New York’s healthcare system was officially recognized in 1988. Since that time, we have seen our scope of practice grow and modernize to meet patients’ needs. One of my NP mentors at Jacobi, who has been an NP for 40 years, remembers the time when NPs existed in a gray area and had to battle for respect. She says it makes no sense to turn back the hands of time and fight those same battles again. Patients appreciate NPs because, like nurses, we listen to what our patients have to say. Nurse Practitioner Week is a perfect time for lawmakers to listen too.

Nurse Practitioners see over 1 billion patients annually.

Source https://www.aanp.org/advocacy/ advocacy-resource/positionstatements/quality-of-nursepractitioner-practice

New York Nurse december 2021

NYSNA Nurses at Montefiore Deliver Testimony to the Health and Human Services Committee of Community Board 7 Oct. 19, 2021 To the Members of the Health and Human Services Committee of CB7

n behalf of the emergency department (ED) nurses at Montefiore on Gunhill Road, we are here today to bring attention to the critically unsafe staffing and environmental conditions present in our EDs. In the adult emergency room, we often care for 15 to more than 20 patients, when a safe number would be closer to five or six. In the pediatric emergency room, we sometimes have only one RN at 7 a.m. staffing the entire internal ED. The hospital has generated draconian staffing cuts, both professional and assistive, over the past few years, creating conditions that make it impossible for us to properly care for our community. That has led to an unprecedented exodus of committed, experienced staff who, exhausted and demoralized, have left to work in other facilities or programs with far superior conditions for patients and staff and with higher salaries.

Hugo L. González

In the pediatric ED, we have behavioral/mental health patients who need specific care that we do not have the training, space nor equipment to provide. Consequently, they can spend days, weeks and even months stuck in the ED, in near prison-like conditions, without a permanent bed and adequate care, leading in many cases to their deterioration. In the adult ED, patients with mental illness overwhelm the medical areas because the specific psychiatric ED can only house five patients. Sometimes there are 10, 15, 20 or more “Psych Overflow” patients housed proximal to patients with heart attacks, strokes, post-cardiac arrest. They are inches from those patients who are actually occupying critical care-monitored settings, pushing intensive care unit patients into the hallways, without appropriate monitoring. Day after day, we continue to file formal “Protest of Assignment” documents to alert managers of

Day after day, we continue to file formal “Protest of Assignment” documents to alert managers of unsafe patient conditions. unsafe patient conditions. We even created a cross-campus ED working group to meet with Montefiore upper leadership to create a working plan to fill the dozens of vacancies and support nurses in the interim. Yet, after two meetings, leadership has refused to continue to meet with us in this setting. Instead, Montefiore has closed an inpatient unit on the adult side despite the overflow of patients in the ED who can languish on stretchers, in hallways, for days at a time, desperately waiting to be admitted to in-patient units on the floors. What was Montefiore thinking to close a fully functional, expertly staffed in-patient unit, resulting in such intolerable conditions for our sick patients? Exacerbating that issue, patients inside the ED are not permitted family visitation at any time due to COVID-19. Visitation is allowed on the in-patient units — another reason rapid admission and transport are so critical. Even in the face of the pandemic, patients positive for COVID-19 are not segregated properly, nor is there adequate infection control support for such diagnosed and suspected infected individuals. The space and environment are totally inadequate to care for adults, children, and psychiatric/behavioral patients of all ages. We have reached the cusp of the dreaded outcome of chronic understaffing: Few nurses wish to work here, especially those with postCOVID-19 trauma. Throughout the Medical Center, there remain dozens of unfilled vacancies, coupled with a recent exodus of over 30 nurses from the Moses adult ED. And in the pediatric ED, hiring cannot keep up with resignations. Unsanitary and inadequate conditions abound with bathrooms,

food distribution processes, equipment maintenance, total physical plant areas, infection control, trash and other receptacles, broken or absent stretchers (uncleaned between patients), linen shortages, and overcrowding with patients forced to sit or even stand due to lack of space, stretchers and chairs. These are sick people! Our community deserves so much more! The frustrations and unacceptable conditions often lead to verbal and physical violence visited upon helpless staff who are victims ourselves of these horrendous conditions. The hospital refuses to negotiate with us as peers, and our offers of collaborative problemsolving are ignored, leading to only very modest improvements that are often unsustainable and only when we exert enormous pressure to get these things accomplished. We are distraught that our community is not getting the quality care it deserves. Many of our patients are chronically ill and poor; they do not have the strength or courage that accompanies access to social capital, nor the resources to demand changes. Hence, we are requesting the Community Board be their voice and insist Montefiore stop this inferior treatment and ensure better health care outcomes in the community. We ask the Health and Human Services Committee to share these concerns at the general CB7 meeting and draft a letter to Montefiore demanding community, caregiver, and administrative collaboration to develop real plans to serve our patients with the dignity, respect, and quality they deserve. Sincerely, The Montefiore NYSNA All ED Working Group of RNs

(CB7 Catchment Area includes Moses and CHAM Emergency Departments)

NEW YORK NURSE

NYRN

december 2021

Medical Missions, Congresses & Educational Events Healthcare is a Human right In these trying times, the work of NYRN and its volunteers is more important than ever. NYRN, through its medical missions, seeks to affirm that access to quality healthcare is a human right. NYRN is excited to announce its 2022 Medical Missions Calendar. These

upcoming missions will give our volunteers the opportunity to provide much-needed medical care to underserved populations and to learn from and work alongside host organizations across the globe. Contact Rony Curvelo for more information at rony.curvelo@nysna.org.

2022 CALENDAR OF UPCOMING EVENTS

JANUARY

JUNE

SEPTEMBER, cont.

DOMINICAN REPUBLIC

EL SALVADOR

NEPAL

JAN 12-16 (5 Days) Medical Mission

JUN 8-13 (6 Days) Medical Mission

SEP 14-20 (7 Days Nepal ONLY) Medical Mission

Accommodation: Single: $1,650.00 / Double $1,250.00

Accommodation: Single: $1,400.00 / Double: $1,100.00

Accommodation: Single: $2,100.00 / Double: $1,940.00

INDIA

FEBRUARY

JULY

THAILAND – Chiang Mai

MEXICO – Matamoros

FEB 10-18 (9 Days ) Medical Mission

JUL 6-10 (5 Days) Medical Mission

Accommodation: Single: $2,300.00 / Double: $2,000.00

Accommodation: Single $2,900.00 / Double $2,500.00

Accommodation: Single: $1,350.00 / Double: $1,050.00

OCTOBER

MARCH

AUGUST

MEXICO – Tijuana

EGYPT

MAR 10-14 (5 Days ) Medical Mission

AUG 21-29 (9 Days) Medical & Educational Mission

Accommodation: Single $1,365.00 / Double $1,050.00

Accommodation: Single: $2.200.00 / Double: $1,800.00

APRIL

SEPTEMBER

CUBA

INDIA & NEPAL

APR 7-11 (6 Days) Educational

SEP 14-28 (15 Days) Medical Mission

Accommodation: Single: $1,300.00 / Double: $1,100.00

Accommodation: Single: $3,270.00 / Double: $2,440.00

GHANA APR 21-29 (9 Days) Medical Mission Accommodation: Single $3,071.00 / Double: $2,515.00

MAY PERU MAY 11-18 (8 Days) Medical Mission Accommodation: Single: $1,630.00 / Double: $1,500.00

AUG 20-28 (8 days India ONLY) Medical Mission

PUERTO RICO OCT 12-16 (5 days) Medical Mission Accommodation: Single: $1,000.00 / Double: $800.00

NOVEMBER BRAZIL NOV 10-19 (9 days) Medical Mission Accommodation: Single: $2,400.00 / Double $2,000.00

DECEMBER TBA

(above and below) 2020 Medical Mission to Thailand

New York Nurse december 2021

Health Systems Must Do Their Fair Share Continued from page 5

is devastating. Patients are suffering. Instead of hiring, management froze positions. How is that safe?” Echoing that point, Noemia Dejesus-Aponte, RN at New York Presbyterian said, “In the ER, patients can be ignored for hours and hours. It is a shame!” DejesusAponte continued, “The Obstetrics unit needs nurses. We cannot safely care for newborns, high risk babies with this staffing. Newborn hospitalizations are 1-2 days when it should be a week. Understaffing compromises patient safety.” At Maimonides Medical Center in Brooklyn, where Hagans has worked for 31 years, management allegedly froze positions all over the state. “It’s time to hire nurses,” Hagans said. “Once they hired, management must work on retention. One thing that is clear is that relying on travel nurses is an unsustainable band-aid.”

Declaring the Emergency This is not care; this is not what many nurses signed up for when they entered the profession. Hospital administrators and health system leaders must do their fair share. It is wholly inappropriate to leave the entire burden of caring for those who are ill to nurses. Faced with physical, emotional, and ethical challenges, nurses are ringing the alarm. Many kicked off a series of rolling actions to detail dangerous understaffing at some of the state’s most prominent

Nurses at Hudson Valley rally for safe staffing.

care facilities. The New YorkPresbyterian Columbia Hospital November 17th Day of Action & Speak Out was the first. Another occurred on November 23rd, with more to follow. Nurses and other healthcare workers appreciate that

LINKS https://www.governor.ny.gov/ executive-order/no-4-declaringstatewide-disaster-emergencydue-healthcare-staffingshortages-state

New York State Senator Robert Jackson attended the November 17 New YorkPresbyterian Columbia Hospital Speak Out.

the best way to push back is to unite together and demand change. They understand that understaffing is not isolated to one facility, but rather a systemwide challenge.

Perceptions Must Shift New York State Senator Robert Jackson attended the Nov. 17 New York-Presbyterian Columbia Hospital (Presby) Speak Out and proclaimed, “Thirty-to-one is absolutely crazy!” Anthony Feliciano, Director of the Commission on the Public’s Health System added, “Safe staffing saves lives, is the reality.” Across the country, and certainly in New York, more and more nurses are noting that the public must shift how we think about caregiving. It is not just the responsibility of nurses and other healthcare workers to support those who are sick. Hospital systems too have a responsibility and must be held accountable for staffing shortages and other workplace challenges.

NEW YORK NURSE

giving back

december 2021

Retired NYSNA Members Work Alongside Student Nurses By Jennifer R. Farmer

or every season of our life, there is work for us to do. This was the conclusion of several retired nurses who recently teamed up with student nurses from Mercy College to collect and sort PPE supplies at an AFYA Foundation warehouse in Yonkers, NY. The AFYA Foundation collects medical supplies and distributes them to people who need them in New York and across the world. They rely on retired nurses and nursing students, who help the nonprofit sort, pack and ship products to medicallyunderserved communities in New York and 79 countries. “Last year many retirees wanted to help but we didn’t want to go back to the bedside,” said retiree Marva Wade, RN. “Even though I had a lot of fear about going back to work, I wanted to do something

to support my colleagues and the people in the communities we all serve. Retirees had the opportunity to volunteer to go to AFYA to sort, package, and ship PPE. The nursing students go to AFYA twice per week and we work together. We work alongside and help them learn how things work when nurses not under stress. It’s a good experience for them and for us. I also had the opportunity to speak with students about joining NYSNA, even as a student. I explained to them that its good for them to know about the industry they’re entering.”

NYSNA Nurses Partner with Student Nurses In addition to Marva Wade, registered nurses Pat Devaney, Jeannesse Byers and Moonia Awad all visit the AFYA warehouse weekly and work alongside student nurses and the students’ instructor. In addition to learning, the students had an oppor-

tunity to hear about the benefits of joining a union, specifically NYSNA. The partnership is beneficial for students, retirees as well as AFYA. Wade, who has been a member of NYSNA for 45 years, said she really enjoyed working with nursing students: “You want to know there is another group of people in the pipeline wanting to take care of us, all of us.” “If you live a life of service, you gravitate to service,” Wade added. “That is what nursing is. And to do something for your colleagues is a blessing, but we are able to help all over the world and that is a great thing to do.” In addition to encouraging retirees to volunteer, NYSNA also arranges lunch for volunteers. If you or a retired NYSNA member you know is interested in community health and volunteering, please contact Mary Grace Pagaduan at marygrace. pagaduan@afyafoundation.org.

NYSNA nurses (in red) volunteer with student nurses in an Afya warehouse stuffing and shipping PPE.

Four Things That Will Shape 2022 Continued from page 3

the health crisis impacted us all, but it was uniquely felt by nurses and other healthcare workers. From working around the clock, to watching colleagues as well as friends and family fall ill from the virus, to lacking basic supplies to keep themselves and patients safe, the pandemic was akin to a nightmare. It wasn’t that nurses don’t enjoy their calling; it was that they

lacked the resources to provide the level of care they were accustomed to providing. Although the height of the crisis has abated, nurses are now left to pick up the pieces, albeit with fewer staff. Therefore, every report about an impending surge or a new variant is cause for concern. The announcement of DELTA and now Omicron, is triggering panic and anxiety. As we enter 2022, the fallout of the pandemic will occupy

our hearts and minds. As a union, we will continue to advocate for our professions, and fight to ensure that healthcare workers receive the level of support necessary to continue providing care. We know 2022 is a big year. But we also know that everything we’ve been through over the past several years has prepared us for this moment. We are therefore greeting this moment confident in the power of our unity.

“If you live a life of service, you gravitate to service.” Marva Wade, RN

NEW YORK NURSE december 2021

131 West 33rd Street, 4th Floor New York, NY 10001

INSIDE

Nurses Plan Rolling Actions, p. 2

Four Things That Will Shape 2022, p. 3

Non-Profit US Postage Paid NYSNA