NY Nurse April [NYC]

New York

nurse New York City edition | march/april 2019

the official publication of the new york state nurses association

Nurses meet at Interregional, March 4

Focus on Brooklyn, Queens and Staten Island private sector bargaining Your POAs make a difference! pp. 7-10

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New York Nurse march/april 2019

Why do nurses and other professionals need a union?

Judy SheridanGonzalez, RN, NYSNA President

Advocating for patients. Advancing the profession.SM Board of Directors President Judy Sheridan-Gonzalez, RN, MSN, FNP judy.sheridan-gonzalez@nysna.org First Vice President Anthony Ciampa, RN anthony.ciampa@nysna.org Second Vice President Karine M. Raymond, RN, MSN karine.raymond@nysna.org Secretary Tracey Kavanagh, RN, BSN tracey.kavanagh@nysna.org Treasurer Patricia Kane, RN pat.kane@nysna.org Directors at Large Anne Bové, RN, MSN, BC, CCRN, ANP anne.bove@nysna.org Judith Cutchin, RN judith.cutchin@nysna.org Seth Dressekie, RN, MSN, NP seth.dressekie@nysna.org Jacqueline Gilbert, RN jackie.gilbert@nysna.org Nancy Hagans, RN nancy.hagans@nysna.org Robin Krinsky, RN robin.krinsky@nysna.org Lilia V. Marquez, RN lilia.marquez@nysna.org Nella Pineda-Marcon, RN, BC nella.pineda-marcon@nysna.org Verginia Stewart, RN verginia.stewart@nysna.org Marva Wade, RN marva.wade@nysna.org Regional Directors Southeastern Yasmine Beausejour, RN yasmine.beausejour@nysna.org Southern Sean Petty, RN sean.petty@nysna.org Central Marion Enright, RN marion.enright@nysna.org Lower Hudson/NJ Jayne Cammisa, RN, BSN jayne.cammisa@nysna.org Western Chiqkena Collins, RN chiqkena.collins@nysna.org Eastern Martha Wilcox, RN martha.wilcox@nysna.org Executive Editor Jill Furillo, RN, BSN, PHN 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 ©2018, All rights reserved

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n nursing school we’re taught that when we graduate, we earn the title registered “professional” nurse. But what is a professional? l A specialist, an expert, a skilled, proficient, qualified, licensed, certified, trained individual in an area of work or practice. l A person with a degree of autonomy and control over said field. l A n individual with a degree of decision-making authority.

After years of study, we do have much theoretical training and textbook knowledge. After a few years of practice we are on the road to proficiency, enhanced skills and the development of expertise. The term rings true on these levels.

But once we enter the factorylike atmosphere of a health facility, we discover that we have little autonomy to define our practice, nor do we have the authority to determine how our skills and knowledge can best be implemented. While we draw upon our skills to make clinical decisions every day, we don’t have control over the resources and supports required to deliver such care.

And, my colleagues, therein lies the rub.

The illusion of professional autonomy

It is this illusion of professional autonomy that many employers use to convince nurses that we don’t need to unionize in order to ensure that we have what we need to do our jobs. Schemes of so-called “shared governance” help to further this fantasy of control.

Non-managerial nurses do not determine budgets and resources.

Thus governance is never “shared.”

Our input can be sought, our brains can be picked, our clinical and practical knowledge can be [This is a reprint of a column that appeared in the April 2018 New York Nurse.]

“The labor movement was the principal force that transformed misery and despair into hope and progress.”

–Martin Luther King Jr. mined, but final decisions about what, how much and in what way resources are allocated are the purview of the bosses. And the bosses we see and meet with are not even the final decision-makers.

They have to answer to the CEOs, CFOs and COOs whom we never see or hear from—except for a cute letter sent out on Nurses Week or Christmas.

So what does a union do?

Throughout history, workers recognized the need to unite to deal with employers to improve working conditions, pay and other factors that improved their lots in life. This purposeful and organized unity led to the formation of unions.

Professional caregivers have the

same needs as other workers: to improve salary, benefits, hours, working conditions, respect for what we do, safety, fair treatment if accused of violations, etc. But Professionals have additional needs: to practice our profession as we see fit, based on our licensure, certification, education and autonomous judgment capability.

Thus, we have a GREATER need to be unified in an organized body to negotiate these terms. But the title “professional” has been used by employers to make us feel that we don’t need unions, that we are somehow “better” than less skilled workers and able to do fine on our own. Nothing is further from the truth.

Life in the United States would look very different were it not for the presence and serious sacrifices and struggles of union members and those trying to organize.

Why employers feel so threatened by unions

Union members have elaborate legal rights in both the private and public sectors (NLRA, PERA, etc.).

In addition, we have the ability to push the envelope beyond what is spelled out in statute.

Workers, together, can compel an employer to behave in ways they would not normally prefer to.

A lone worker does not have that power. In fact, the “power playing field” is dramatically altered when a union is present and the workers are engaged. The possibilities are limitless.

This is why corporations and their government accomplices have been so anxious throughout history to destabilize, decertify and destroy unions and the power that workers can aspire to.

Finally, a union is not a “third party” as the union-busting literature likes to describe it. The union is us. We have the ability to craft it in the way that serves our interests and our patients’ needs. Nurses and our patients are the two entities among which the work takes place.

The Employer is the real third party, more often than not, getting in our way and placing obstacles in our path.

new york city

NEW YORK NURSE/NYC

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march/april 2019

Moving forward in Brooklyn, Queens and on Staten Island

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egotiations are underway at hospitals in Brooklyn and at one facility in Queens. Staffing is an issue throughout, and an interregional brought out hundreds of members.

At the Brooklyn Hospital Center, as we go to press, 26 sessions have been convened so far, with some major progress on retiree health and language issues. Still, a gulf exists on staffing levels and enforcement language. While the administration is willing to fill all of the vacancies and post some new ful-time equivalent (FTE) positions, this offer falls short. Nurses are looking for wage increases on par with NYC, full 60-65 health coverage, and a wellfunded VEBA (voluntary employees' beneficiary association) for postMedicare benefits.

Members’ determination

Fifteen sessions so far have been held at Maimonides Medical Center, with negotiations continuing on the major issue: tangible changes to the staffing grid. Maimonides has a unique grid, which already includes nurse-to-patient ratios and free charge nurses. But the grid needs updating, with many units looking for better ratios. Maimonides wants several economic takeaways, such as the elimination of the long-term disability plan and funding rates for the VEBA retiree health plan. The hospital made over $10 million in profit in 2018.

“The determination of the members remains strong. We will not settle for anything that does not allow us to protect our patients and provide safe, quality care for them,” said Nancy Hagans, RN, NYSNA board member and chair of the Executive Committee.

Multiple packages have been exchanged in the hopes of resolving the contract at Flushing Hospital Medical Center. The employer has agreed to post 28 vacancies and convert 19 LPNs into RN positions.

The fight remains on hiring new nurses and improving the grid numbers. Additionally, retiree health is a very important issue that remains unaddressed by the employer. Our

Tracey Kavanagh, RN, NYSNA Secretary and Member, NYSNA's Flushing Negotiating Committee

negotiators put forward a proposal of NYSNA health insurance for members ages 60-65 and a VEBA for post-Medicare coverage. Lastly, compensation is the lowest in NYC at Flushing. The offer as of this time would still keep Flushing Hospital RNs the lowest paid in the city. We will work hard to close the pay gap.

Seeking a pattern

“We work very hard, and yet our compensation does not reflect that commitment. That is wrong.

So one effort has been to address the inequality in pay. We must also see improvement in the grids. They must also meet the needs of our patients, to keep them safe,” said Tracey Kavanagh, RN, NYSNA

secretary and member of the Negotiating Committee.

At Interfaith Medical Center and Kingsbrook Hospital, two constituent members of One Brooklyn Health, months were devoted to working on blending the two contracts’ work rules into one agreement. This effort was considered very worthwhile in terms of the future of the One Brooklyn Health system, but state funding for the final merger has not been completed, so the actual merger and construction process has yet to take place. Still, the committees are taking note of terms reached at other Brooklyn facilities where NYSNA is negotiating. so that a pattern can be set that serves patients, nurses and communities.

Nancy Hagans, RN, NYSNA Board Member and Chair, NYSNA’s Maimonides Executive Committee

More than 85% of RUMC nurses participated in a 36-hour blitz to sign the “We’re Fed Up” petition.

RUMC nurses are fed up with unsafe staffing ratios on every unit. The petition, along with 1,000 POAs and a new staffing ratio proposal, went to management.

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New York Nurse march/april 2019

In the battle for Medicare for All

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By Jill Furillo, RN, NYSNA Executive Director

“The issue is health care as a human right under social insurance or as a privilege for those who can afford to pay for it.”

ith the 2020 presidential campaign underway and Medicare for All once again a possibility, NYSNA has lost a dedicated ally and friend in the long fight for affordable healthcare. At the time of his death, on April 19, Max William Fine, the last surviving member of JFK’s Medicare Task Force, considered nothing more pressing than bringing care to a nation.

At his core, Fine knew instinctively what nurses know firsthand: health is almost unachievable without access to quality healthcare.

Fine had no doubt. Healthcare is a right not a privilege. In 1978, he told the Boston Globe: The question in the United States is whether we should continue to build a private health insurance system that uses such devices to limit its own liabilities without controlling overall costs, or whether we should move on to social insurance with everyone covered on an equitable basis, with no exclusions and strong cost controls. The issue is healthcare as a human right under social insurance or as a privilege for those who can afford to pay for it.

Private insurance remains unfettered and caregivers on the frontlines are intimately familiar with its toll—skyrocketing healthcare costs that negatively impact care.

Today, the United States spends $3.5 trillion on healthcare.

While industry titans accumulate billions in profits, 34 million Americans still do not have health insurance. Our maternal mortality rates are the highest among all developed nations, according to the World Health Organization, and our longevity ranks 31st in the industrial world.

A national imperative

Like Fine, nurses know that, now more than ever, Medicare for All should be a national imperative.

However, the fight remains an uphill battle, as it was for Medicare under JFK. What Max Fine helped teach us is to stay the course, that with a firm resolve we can and will prevail.

In 1963, when President John F. Kennedy tapped Fine to help shape the legislation that would assure

NYSNA nurses, joined by NNU/VA hospital RNs, at Lobby Day for Medicare for All in Washington, D.C., April 30 affordable healthcare to America’s seniors, the prohibitive cost of health insurance was driving many elderly who needed hospitalization into bankruptcy. Even so, public support for Medicare was hardly a given.

When JFK made Medicare a key part of his bid for the presidency, the legislation came immediately under fire in the form of medical association and insurance industry attack ads. Richard Nixon, JFK’s opponent, sounded the alarm that Medicare was socialism.

Just a beginning

Medicare survived them all— political opponents, the insurance companies, the medical establishment, and the Madison Avenue advertisers. On July 30, 1965, thanks to the commitment and determination of people like Max Fine, the Medicare Act was signed into law by President Lyndon Johnson, who ushered it through after JFK’s assassination.

That law, Fine said, was a beginning, but not enough. JFK and others had intended to extend it to all Americans: Medicare for All. Labor’s central role

Fine understood that to advance a program of this breadth and significance labor should play a central role. Who better to speak to the needs of working people?

In 1968, with the financial backing of the UAW and key support from other unions, Fine founded the Committee for National Health Insurance. The committee grew as medical and health insurance costs continued to rise, drawing on support from a coalition of

religious organizations, consumer groups and public health experts.

A decade later, the Committee dissolved, a temporary setback but not defeat. Fine simply shifted gears, worked with friendly members of Congress to keep Medicare for All a part of the dialogue.

Traveling to public forums, he continued to extol the message of healthcare as a human right.

More relevant than ever

Today that message is more relevant than ever. Forty-two percent of new cancer patients lose their entire life savings within two years, the American Journal of Medicine reported in October 2018. Fiftyeight percent of adults have delayed or foregone medical or dental care because of high costs, a recent survey found, and 31 percent of respondents said they did this “often.”

Fine continued to underscore the key role labor must play in the policy and advocacy of todays’ fight for guaranteed healthcare, and we couldn’t agree more! We thank him for citing NYSNA and other nurses’ unions for their leadership on the issue and recognise the essential central role the entire labor movement must have to ensure success.

Fine’s optimism has proved wellfounded. This January, the Kaiser Family Foundation reported that 56 percent of Americans are in favor of Medicare for All, and those numbers may well be conservative. According to Reuters/Ipsos, support for singlepayer has reached 70 percent.

“It was always our intention to extend the guarantees of Medicare to all Americans,” Fine said. Max Fine was 92 when he died.

NEW YORK NURSE

public health

march/april 2019

Measles makes a comeback

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n the year 2000, measles was completely eliminated in the United States. As one of the most contagious pathogens in existence, the elimination of measles was a public health triumph decades in the making. Unfortunately, this victory has not lasted.

In 2019 alone, this country has seen over 700 measles cases. The majority have occurred in New York State. Complacency due to the lack of measles cases in the United States coupled with the recent anti-vaccine movement, has created a new public health problem. As fewer parents choose to vaccinate their children, the protection to which we have all become accustomed is eroding.

link between the MMR vaccine and autism.

Yet myths persist about vaccine safety that have led to decreased rates of vaccination in some communities. Parents believed their children would be safe because “herd immunity� from the rest of the population would keep measles from reappearing in the United States. Unfortunately, as

experience more severe infection, however, complications can include permanent hearing loss, encephalitis, pneumonia, serious pregnancy complications and death.

numbers of unvaccinated persons has increased, herd immunity has decreased. This can have tragic consequences for those who, for medical reasons or because of age, cannot be vaccinated.

months and the second between the ages of 4-6 years. Adults who have only received one dose of the MMR should speak with their physician about getting a second booster vaccination. Adults vaccinated between the years 1963-1968 received the inactivated virus, which is considered significantly less protective over the long term than the attenuated live vaccine that has been in use since 1968. It is recommended that adults who were vaccinated during this period receive a second vaccination or have titers checked for immunity.

Adults who were born prior to 1957 may be considered immune due to likely exposure to measles in childhood. It is recommended that they either get vaccinated now or have titers taken to measure immunity.

Even those who have previously had measles may still be at risk of infection and should consider getting vaccinated or having titers taken to confirm immunity.

Vaccination recommendations

The CDC recommends that children receive two doses of the MMR or MMRV vaccine—the first between the ages of 12-15

State of emergency

NYC Mayor Bill de Blasio recently declared a public health emergency covering certain parts of Brooklyn, where the outbreak has been most severe. It bans unvaccinated students from going to school and fines unvaccinated individuals for not having themselves or their children vaccinated.

As of April 25, 2019, Rockland County, where another large outbreak has taken place, issued a 30-day state of emergency that excludes persons diagnosed with the measles or exposed to a person diagnosed with the measles from indoor and outdoor places of public assembly. The order also requires all students attending school to be vaccinated or have a medical or religious exemption on file with the school. The state of New York is currently considering a measure to prohibit any nonmedical vaccine exemptions.

Safety myths drive drop in vaccination rates

While there is always a risk of allergic or other negative reaction to any vaccine or medication, the measles, MMR and MMRV vaccines are considered to be extremely safe. One study a number of years ago linked the MMR vaccine to autism; however, that study was discredited and retracted due to data misrepresentation. Numerous studies conducted prior to and after that study have shown no

One of the most contagious pathogens

According to the CDC, measles is so contagious that if one person has it, up to 90 percent of the people close to that person who are not immune will also become infected.

Infected people can spread measles to others from four days before through four days after the rash appears. Measles transmission has been documented to have occurred even after a contagious person has left the room up to two hours before a susceptible person enters the room.

For many, measles infection means several days of high fever, cough, runny nose, rash and conjunctivitis. For those who

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NYC H+H Mayorals

New York Nurse March/April 2019

NYC H+H/Mayorals nurses on the move!

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n facilities, the boroughs and citywide, NYC H+H/Mayorals nurses are on the move. NYSNA nurses are getting organized and demanding respect from hospital administrators and the City.

Getting active locally

Woodhull Sticker Day

Main Contract Proposals 1 Protect the working conditions of nurses and other care givers and maintain equal access to quality care for patients and communities

2 Better recruitment and retention of nurses

3 Democratize the decisionmaking process for the delivery of health services

Jacobi, NCB, and Lincoln RNs turn up the heat at the NYC H+H Annual Board Meeting in the Bronx

At Woodhull and Harlem hospitals, nurses participated in a sticker day action to send the message that they appreciate management’s efforts during Nurses Week, but they would appreciate safe staffing every day of the year much more!

Nurses throughout Queens Hospital took action on Tuesday, April 23, in response to chronic short staffing and disrespect on the job. Walking into the administrative office unannounced, nurses told hospital management personal stories that dramatized the need for a contract that guarantees safe staffing. Chief Operating Officer Dean Mihaltses responded that he fully supports NYSNA nurses’ campaign for a fair contract, but Queens RNs intend to keep up the pressure until he signs onto our demands and increases staffing levels.

Making our voices heard in the boroughs NYSNA nurses began making their voices heard at H+H annual board meetings in the boroughs.

Dozens of nurses who serve the communities of the Bronx packed the room at Jacobi Medical Center on the evening of April 30 to speak out for safe staffing and respect. Nurses from Jacobi, North Central Bronx and Lincoln spoke passionately about the unacceptable staffing levels that leave them feeling like they are abandoning their patients.

Thomas Riley, RN, from Jacobi’s ED said, “On most shifts, the

Harlem Sticker Day AuBonPain cafe at Jacobi has more staff making sandwiches than we have in the ER. The admin knows about the safety issues and their response to the nurses has been anything from lukewarm to negligent.”

Dr. Katz and the NYC H+H Board listened attentively throughout the meeting, and when NYSNA nurses approached the front of the room with a pledge to support the H+H/ Mayorals contract campaign, Dr. Katz and two other board members signed it enthusiastically.

Nurses plan to continue speaking out at the H+H annual board meetings—May 7 at Elmhurst Hospital in Queens, and June 18 at Woodhull Hospital in Brooklyn. Contact your rep if you would like to testify at an upcoming board meeting.

Building citywide support Citywide, H+H nurses are building community and political support before they begin bargaining with the city. In April, nurses met with key city council members to inform them of their challenges and what they would like to accomplish at the bargaining table. In separate meetings, Councilmember Mark

Levine, Health Committee Chair, and Councilmember Diana Ayala, Chair of the Committee on Mental Health, Disabilities, and Addictions, both expressed their strong support for public sector nurses. In May, nurses are scheduled to meet with the Chair of the Hospitals Committee, Councilmember Carlina Rivera, who has previously met with Bellevue Hospital nurses and pledged to advocate for fair funding for NYC H+H hospitals.

Building unity through our contract campaign NYC H+H/Mayorals nurses from all across the city are also coming together and organizing themselves through the Negotiations Committee and Contract Action Teams (CATs).

Dozens of NYC H+H nurses gave up their Saturdays to participate in daylong strategy sessions on March 16 and 23. Through open dialogue and debate, the Negotiations Committee and CAT members began crafting a list of proposals to inform our bargaining. See the main proposals coming out of these sessions on the left side of this page. To join a CAT, signup at http://bit.ly/hhvol.

New York

nurse special edition | march/april 2019

the official publication of the new york state nurses association

e k a m s A O P Your ! e c n e r e iff ad

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New York Nurse march/april 2019

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The critical role played by he Protests of Assignment are a serious matter. Attested to by NYSNA members, these documents serve as evidence of unacceptable conditions on the Units.

Last year, there were a total of 22,657 POAs with 80,631 nurse signatures affixed, i.e., an average of close to four signatures per POA. That speaks volumes to both our unity and the magnitude of problems on the Units.

More than 80 percent of POAs relate to understaffing. Most come from Med/Surg Units, followed by Stepdown/Telemetry, then the Emergency Departments, Maternity (L&D), and CCU/ICU/ MICU. A copy of each POA is sent to management and is submitted to NYSNA staff, which enters it into the union database. An analysis is compiled by “specialty unit”, “shift”, and “reason(s)”. A report is prepared in terms of unit, shift and reason.

At this juncture, a hospital report card is prepared, or what we call the “Patient Care Chronicle.”

Jayne Cammisa, RN and NYSNA Board Member, with one of more than 3,000 POAs nurses filed at Westchester Medical Center in 2013

(See p. 10 for a sample page from a current Patient Care Chronicle.)

The Patient Care Chronicles have many purposes. They are used at: l Negotiations l Lobbying l Meetings with legislators l A rbitrations They are also integral to the filing of complaints at

l Department of Health l Joint Commission l Department of Labor The data is statistically valid and reliable to show corporate negligence and to demonstrate what’s required under the laws that registered nurses serve.

Continued on pages 9-10

POAs in the news “...the union presented documented reports of 3,800 “Protests of Assignment” signed by over 20,000 nurses...” http://amsterdamnews.com/news/ “At Staten Island University Hospital alone, 1,815 POAs have 2019/mar/28/nysna-making-inroadsbeen filed over the last three years that include complaints contract-push/ from over 8,600 nurses...”

"In 2017, at hospitals where our nurses provide care, tens of thousands of nurses signed POAs and the vast majority of them pertained to understaffing. From 2015 to 2017, in hospitals serviced by NYSNA nurses, over 69,000 POAs were submitted with signatures from over 280,000 nurses. More than 80 percent of those were because of safe staffing issues." https://www.silive.com/news/2018/06/staten_island_university_hospi_29.html

“Already short staffed and admissions keep coming (ER quickly filling up) with no imminent increase in staffing. Patients arriving every 5-10 minutes,” “Unsafe staffing in both nurseries. No NAs in both nurseries and acuity is high. Same situation on both fifth floor and sixth floor” and “Not enough RNs to admit and discharge patients …RNs not able to check on patients every 1-2 hours.” https://www.silive.com/news/2018/06/staten_island_nurses_rally_for.html

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march/april 2019

y Protests of Assignment

2018: PROTESTS OF ASSIGNMENT POAs = 22,657 SIGNATURES = 80,631 Staten Island University Hospital's campaign featured an enlarged POA signed by members and delivered to parent Northwell Health's offices on Long Island.

BECKER’S

April 2019

Vol. 2019 No. 4

HOSPITAL REVIEW The Metrics Healthcare Leaders Check Daily p. 59 IN THIS ISSUE: EXECUTIVE EXCLUSIVES: • Nurses Sue CHI Over "Insufficient space, hallway patients, patients stacked in rows, “...more than 2,500

MOST INNOVATIVE Know p. 16 unable to access5patients in a timely manner, temp in ED 76 HOSPITALS, According to • Hospitals, Not Physicians, degrees on west side, air conditioning not workingDrive onUpEast side Children's Health p. 106 Healthcare Costs for Privately Insured p. 20 300+ Hospital Leaders p.

44 and area is very hot and uncomfortable, inadequate ventilation, Saria Saccocio, MD • $89B: The Annual Price Greenville Health System unable to comply with appropriate infection control.

Patients Tag of Healthcare Wait, p. 107 Financial Updates Travel Times p. 37 waiting days to get a bed and aggressive to staff."

Bonnie Clipper, DNP, RN Ed Kopetsky

On-Call Pay: 4 Things to

Lucile Packard Children's Hospital Stanford, Stanford

on Ascension, • Healthcare Leaders 155+ https://www.beckershospitalreview.com/human-capital-and-risk/new-york-cityAmerican Nurses Association Share Practices for Snaring CHI, CHS, p. 108 Top Talent p. 54 nurses-prepare-for-day-of-protest-over-staffing.html STORIES Dignity, Daniel Barchi • Your Hospital May FEATURED Kaiser Benefit From a Chief NewYork-Presbyterian Purpose Officer — Here's INSIDE THE ISSUE Hospital p. 109 Permanente, Why p. 58

complaints, known as protests of assignment, from nurses at the three health systems.” https://www.crainsnewyork.com/ health-care/nurses-plan-strike-ifstaffing-ratio-demands-arent-met

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New York Nurse march/april 2019 Continued from page 9

A page out of a patient care chronicle Figure 3: Most Frequent Reason for Protest of Assignment The 1,445 hospital-wide POAs filed at Maimonides Medical Center between January 1, 2018 and December 31, 2018 documents the following perceived inadequacies and unsafe conditions:

l Nurses are protesting their assignments because of the inability to adequately address the patient acuity, given the staffing assignment. Higher patient acuity comprises over 73% of the protests filed throughout the hospital. l Nurses are protesting their assignments because of the inadequate numbers of qualified staff needed to address the acuity, admission volume, discharges, and caseloads. Inadequate numbers of qualified staff comprises over 85% of the protests filed throughout the hospital. l Nurses are protesting their assignments because the numbers of patients assigned to the nurse impedes safe delivery of care. The unsafe nurse-to-patient ratio comprises over 85% of the protests filed throughout the hospital. l Nurses are protesting their assignments because the volume of admissions and discharges (51% of the protests) and patient caseload (81% of the protests) leave them with inadequate time for documentation. Inadequate time for documentation comprises over 83% of the protests filed throughout the hospital. l In addition to the reasons noted above, nurses have identified “other” reasons for the filing of the POA in 29% of the protests filed throughout the hospital (See Table 1).

“In 2018, 20,000 nurses ... signed protests of assignment for unsafe conditions, including a six-hour wait time for pediatric patients in the emergency department, unsafe staffing in the neonatal intensive care unit and patients stacked on stretchers in hallways for days waiting for an available room.”

https://pix11.com/2019/03/18/strikeaffecting-10000-new-york-city-nursesto-begin-april-2/

NYC CONTRACTS

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March/April 2019

Big win at Alliance Hospitals

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n May 1, the ratification of a four-year agreement with Mount Sinai, Montefiore and New York-Presbyterian hospital systems was completed.

The new contract expires on December 31, 2022.

The agreement includes staffing ratio language calling for the initial hiring of 1,500 new nurses. The initial hires will include nurses to fill current vacancies, and will also include an additional $100 million dollars to hire nurses for newly added full-time positions. Registered nurse staffing will be based on safe staffing ratios that will be included in the collective bargaining agreements, and enforced by an independent neutral party. The language includes a mandate to maintain and improve the ratios.

enough nurses to safely care for our patients. With this contract, we’ve come a long way to resolving the critical under-staffing at the three hospital systems. That’s been our priority throughout. ‘Safe staffing saves lives’ is our reality and with this contract we have made tremendous gains that will help us provide safe, quality care to our patients,” said Anthony Ciampa, RN, NYSNA First Vice President and President, New York-Presbyterian Executive Committee.

Staffing enforceability

“We have made significant strides based on these contracts: Front line Registered Nurses, Nurse Practitioners, Nurse Anesthetists, Case Managers, and Midwives will now have effective input in establishing nurse-to-patient grids that

will ensure that our #1 priority, safe staffing, will be achieved. Most importantly, for the first time ever, we now have transparent, enforcement mechanisms that hold all parties accountable in achieving this goal. The combination of staffinggrids, enforceability, and transparency is the winning trifecta for both our patients and our nurses,” said Robin Krinsky, RN, NYSNA Board Member and President, Mt. Sinai Hospital Executive Committee.

“It was the unity and determination of frontline nurses who fought hard to improve conditions for nurses and additional staffing for patients. Our commitment to our patients was the driving force behind this contract,” said Bernita Stewart, RN and Member, Montefiore Medical Center Executive Committee.

Strong provisions

The contract also includes across the board wage increases of 3 percent in each year of the contract and full retro-pay. For all facilities, the contract calls for millions of dollars for retiree health benefits, tuition reimbursement as well as other monetary benefits. The contract strengthens worker protections including new guidelines to stop workplace violence, a process to improve safe patient handling, and language allowing nurses to aid victims of disasters inside or outside the United States.

“Everyone in these negotiations recognized that there are not

Progress at BronxCare Negotiations at BronxCare are progressing on provisions covering disaster relief, safe patient handling and workplace violence. The priorities continue to be staffing and retiree health.

Nurses are seeker greater transparencies over the budgeted FTEs per unit and want a more expedited mechanism to enforce ratios, already in the contract.

BronxCare members at informational picket, February 13

“It was the unity and determination of frontline nurses who fought hard to improve conditions for nurses and additional staffing for patients.”

–Bernita Steward, RN, Montefiore Medical Center

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steward’s corner

New York Nurse march/april 2019

Bargaining chronicle

By Julia Symborski, RN, a rankand-file nurse at New YorkPresbyterian Hospital and a member of the bargaining team

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Mount Sinai Hospital

n late fall of 2018, nurses from five private hospitals in three competing hospital systems in New York City delivered their contract proposals to management. Born from a protracted gestation of surveying democratic priorities and tracking experiences with the previous contract, a triumphant mood presided at the presentation of the proposals. But no one expected smooth sailing from these hospitals, notorious for their union busting and connections to dark money.

The New York State Nurses Association (NYSNA), the union belonging to these nurses, is an independent nursing union representing nearly 43,000 nurses statewide and it actively encourages member ownership. December’s annual statewide convention was the union’s first where peer-elected delegates voted on their union’s strategic goals and direction; it was also notable for a vote to advocate for the repeal of the no-strike clause of the Taylor Law, which has stunted the public sector in New York State (including the NYSNA nurses who work in the NYC Health and Hospitals system, the largest public health system in the United States).

“Management will not agree to ratios under any circumstance, at any time,” said the Alliance lead counsel on January 3. This statement followed months of heartrending firsthand accounts of the extreme dangers, both to patients and to caregivers in their working conditions, caused by short staffing—a chronic condition to which the hospitals refused to admit, clinging instead to their “flexible staffing plans.” One chief nursing officer, ostensibly proud of her past experience in bedside care, claimed that nothing was really wrong with staffing as it was being allocated by Alliance hospitals—just that “the nurses call out sick too often.”

Public health at risk

After 22 negotiating sessions with nothing more than insults for progress, NYSNA nurses coordinated informational picketing at 13 sites across the city in February and rapidly proceeded to a strike authorization vote. The outcome alone should have grabbed the Alliance’s attention: It was a 97% authorization to strike across all five hospitals with historic levels of turnout.

Instead, the Alliance pulled a new trick from its bag: pleading indigence, they claimed that their reimbursement rates from lowincome patients were at risk for imminent state budget cuts. They offered negotiations contingent

First-hand accounts by RNs

The roughly 13,000 of NYSNA’s 43,000 nurses represented in the New York City private-sector negotiations are still only a fraction of the city’s private healthcare sector.

Labor and negotiating veteran Jerry Brown joined forces with NYSNA to face off against anti-labor legal experts, sitting rich in their plush Manhattan offices. The employers at the table who hired them, Montefiore, Mount Sinai, and New York-Presbyterian (jointly named “The Hospital Alliance”), represent three out of four of the largest corporate healthcare entities in the New York City region. Despite retaining nonprofit status, they amass multiple millions in annual net income.

New York-Presbyterian Allen Hospital

on the elimination of these cuts, but NYSNA teams wisely refused such terms. No one was fooled, although NYSNA continued to advocate against the cuts on the same grounds one of the Alliance CEOs himself had earlier stated on the record: It was not private hospitals put at risk by these cuts, but rather the public health safety net system, which would—and could not afford to—suffer.

14-day strike notice

In a stroke of magnificent strategy, NYSNA negotiating teams responded by issuing a 14-day strike notice on March 18, four days longer than the legal minimum of 10 for healthcare strikes.

This simultaneously maximized the remaining scheduled bargaining sessions under the threat of an impending strike, while counting down the clock to the expected delivery of the New York State budget. Had the teams chosen to rush into a strike before the budget could be finalized, the Alliance could have co-opted the nurses’ strike threat, using it as a pawn in their budgetary crisis. Worse yet, the nurses’ crystal clear “safe staffing or strike” message could have been mistaken as a thinly veiled tantrum to fundraise for their own contract.

The 14-day notice strategy became crucial again at 10 days out, the day on which a legally

NEW YORK NURSE March/april 2019

Montefiore Medical Center

minimum notice would otherwise have been served. Travel nursing agencies that source scab nurses typically demand a hefty down payment at the 10-day mark.

Despite the presence of two federal mediators since early January, very little progress had been established up to this moment, and the ideological gulf between the parties remained as broad as ever. With a new mediator on the scene, the nurses received an offer they had hardly hoped to expect: in exchange for their lifting the strike notice, in addition to the Alliance meeting several other key nurse demands, the ungodly sum of money destined for scab nursing contracts would be put toward externally enforceable staffing through ratios and grids, and the nurses would retain their right to strike. Nothing had been sacrificed.

The ideological barrier was broken: nurses would have a say in their staffing at last.

Underlying truth

While many nurses back on the floors were skeptical that this breakthrough had truly been achieved, and a few others even seemed disappointed in their hopes to take part in the rising zeitgeist of work stoppages, the underlying truth remained the same: the real threat of over 10,000 nurses going on strike at once had caused a seismic shift in favor of worker power at these facilities. New YorkPresbyterian even agreed to cancel an expensive upcoming PR war against safe staffing, similar to the one waged by Massachusetts hos-

New York-Presbyterian Hospital

pitals leading up to the ballot measure in 2018. Just over two weeks after the strike was called off, all four negotiating teams endorsed a stunning and historic tentative agreement.

Transparency established

What the Alliance had once sternly denied the nurses had been won. Transparency was established regarding current vacancies, which would have to be filled following ratification. A staffing allocation team would be created immediately, giving nurses a voice in safe staffing levels for each unit. These levels would then become an enforceable part of the contract, eliminating the unilateral management right to a staffing shell game through attrition or even sick call outs or leaves of absence. Furthermore, these newly enforceable grids and ratios would be subject to several levels of enforcement, including expedited arbitration terms above and beyond those of the rest of the contract: under no circumstance would any violation of staffing be protracted in its enforcement.

While these historic landmark wins and the immense sums of money allotted to the hiring of new staff in these facilities is what earned this tentative agreement its own article in the New York Times shortly thereafter, they were not the only gains made across the hospitals involved. Other wins included fully retroactive wage increases throughout the four-year contract, pension and healthcare contributions continuing untouched, retirement health benefit improvements

both before and after 65, improvements in language for addressing safe patient handling and workplace violence (an enormous, daily risk for healthcare workers), ability to donate sick time to coworkers in need, contractual recognition for those choosing to take leave to participate in disaster relief missions, and management agreement not to retaliate against nurses when filing for pay for their missed breaks or meals, along with a technological tool to be developed to help track such occurrences. Still more wins were made which were specific to each hospital, as each facility continues with a distinct contract.

Ratification is currently underway, and when ratified, this agreement stands to set a liberating precedent for nurses across the country (outside of California, where safe staffing limits are law), who are eager for safer working conditions for themselves and for their patients.

Other bargaining

Several other New York City private hospitals in Brooklyn where nurses are represented by NYSNA still remain at the bargaining table. The public NYC Health and Hospitals system nurses (whose negotiating catchphrase is aptly “healthcare justice for the other New York”) are also in bargaining, and may experience distinct challenges in their contract campaign.

All of these facilities continue to appreciate support; the Facebook page “We Stand with NYC Nurses & Patients” is one way to share messages of solidarity.

Thank you in advance!

The Alliance contract was ratified on May 1 by a margin of 70 percent.

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New York Nurse/NYC March/april 2019

A journey to Mexico NYSNA

nurses are always on the frontlines of healthcare, whether at our hospitals, providing relief in the aftermath of a devastating hurricane, or on the Mexican border witnessing first-hand the impacts of a humanitarian crisis.

In late February, NYSNA traveled to Tijuana, Mexico, to join area organizations in providing essential healthcare services to Central Americans fleeing violence

in their homelands. The Northern Triangle of Central America is a place of serious deprivation, and currently one of the most dangerous regions in the world.

A passion for service

NYSNA’s team included nine nurses and one doctor, with three local volunteers assisting with interpretation. Over three days, the group provided nearly 200 medical consultations to patients from five countries in 10 area shelters, including pregnant women,

teenagers and families traveling with children.

The migrants had traveled north to the border, sleeping on floors for weeks, many of them walking more than 1,000 miles. The hazardous journey along the migration route exposed them to numerous health risks and still more violence. They then faced the precarious challenges of living in shelters.

Providing care to these refugees was both gratifying and humbling.

For the nurses, the passion for service knows no boundaries.

NEW YORK NURSE march/april 2019

long island

– Across Long Island, nurses achieved

monumental bargaining wins, including in Lindenhurst School District and the Parker Jewish Institute.

westchester/hudson valley – After months

of negotiations, NYSNA nurses at Putnam Hospital Center voted overwhelmingly for a tentative first contract agreement.

Around the state 9

capital /north country

– Albany Medical

Center nurses are banning together with displays of unity to make continued progress in their negotiations.

western region

– Olean nurses are demanding

safe staffing ratios to make sure their patients get the quality care they deserve.

central region

– Samaritan RNs traveled to

Albany for Lobby Day where they advocated for safe staffing and discussed the issue with Assemblyman Mark Walczyk.

staten island

– As Staten’s Island only safety net

hospital, RUMC nurses are on the frontlines fighting for their patients and safe staffing.

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NEW YORK NURSE march/april 2019

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Congratulations to the NY Nurse for winning the award for General Excellence for print publications from the Metro NY Labor Communicators Council

For more information contact: rony.curvelo@nysna.org