September 2011 Submission:
 
I have this friend in the Union.   He tells me, at this one VA facility, in which he works, staff on one of the units had been asking for a good long time to be able to go to 12 hour shifts.   They wanted to do this for a variety of reasons, some of which were:
 
* Personal Preference – would allow for more time at home and with family
* Increased Job Productivity – studies done have consistently shown greater productivity by those folks doing compressed schedules
* Increased Job Satisfaction – studies also show a markedly greater job satisfaction enjoyed by folks doing 12 hour shifts as compared to those doing 8’s.
* Other units within this particular VA had been, for years, doing 12 hour shifts, effectively.
* Within the SAME BUILDING in which this staff worked, indeed, on the very SAME FLOOR of that SAME BUILDING, a similar but separate unit, had been working 12 hour shifts for YEARS, again, very effectively.   
 
So, with all of the above, one would think, given the proper proposal and plan for back up, the request from staff to management that the staff transition to 12 hour shifts would have been a slam dunk.   Yeah…..one WOULD think !    
 
However, in this particular VA facility, some in the management staff, including the nurse manager, did not particularly care for the 12 hour shifts.   The reasons for this were never very fully articulated, particularly when compared to what was happening, successfully, on other units within that same VA.    Some of it was the holding onto the old-school thinking of 12 hour shifts being more expensive ( proven otherwise ) or being more difficult to cover ( also debunked by other experiences ).   Still…..management continued to say “ NO ” !
 
Enter, the Union.    Union reps and staff met to go over what had taken place.   The next step entailed a formal meeting amongst the Union, staff and management.    Management made their position known, staff had their input, and the Union, speaking on behalf of its membership, stated what appeared to be a reasonable resolution of the problem. The solution was turned down by management.   The Union, acting for its membership, then went to the grievance route.    It took months ( much longer, actually, than we would have liked from both staff and the Union vantage point ) but, my friend in the Union is happy to report that, this unit, which for so long had wanted to be working 12 hour shifts, now, with the help of its Union, has a date of this coming month to start working 12’s !!!
 
Union…. it WORKS !
 
 
 
 

  So….. this friend of mine in the Union…..he’s been watching the “ stuff ” going on in some of the states….as well as what is going on in his own shop….a Federal Health care facility.    He’s been watching state governor after state governor go after the Unions, attacking the Unions, taking away Hard-Won benefits secured over the years by other Union Members’ efforts... and he’s been watching the American public, by and large a

“silent” public, sit by do next to nothing to protest the events !   

 

   “Oh, sure”, my friend will tell ya…. “Some of the States have seen some protests …… mostly by those affected Union members, or other Union members who have seen the handwriting on the wall… ( “ First them….then they’re coming after me !” ) but for the most part, little-to-no ‘general population’ outcry against these blatant ‘power-grabs’ by these governors !

 

     And….my friend sits there and scratches his head ….. wondering “ Why ? ”     My friend wonders if the general public, long-since lulled into the false security that one’s working “rights” are secure just because they have been told by their employers that they are ( secure ) …..and thus, truly believe there is no need for Unions in this day and age” ?

My friend wonders if the general public fails to recognize that, what they can do to the Unions, they ( management ) can do also to the general non-union worker.    The TRUTH is, they can do it to them much more easily, more readily, because there is no Union to stand up for them ?   My friend wonders if they ( the general population ) have truly forgotten the past ?   What is the saying…..?   “ Those who forget the past, are destined to repeat it !”    How sad !   How terribly, terribly sad !

 

    Jane Schweitzer, RN,  Nurse, Nursing Leader, and Author,  tells her colleagues in

TEARS and RAGE:  The Nursing Crisis in America.  1996, that we MUST be aware:

 

              “ The Big Groan:  Political Awareness and /or Involvement.

        It is crucial that during these turbulent ( albeit exciting) times, we maintain

        an acute comprehension of all that is going on around us.  Legislation is

        presented on an ongoing basis that is bound to have  a profound effect on

        the ways we practice our craft – direct reimbursement of nursing services

        rendered, scope of practice laws, etc.” …. pg. 141

 

    Yeah, I have this friend in the Union…..and today….while he KNOWS “ Union Works”…… today he is scratching his head…..and today….he is also a bit sad !

 

    HOWEVER…..that said, my friend is also hopeful.   He knows, increasingly, while it may not be the public as a whole, he knows that nurses are listening, especially to other nurse leaders and shakers in the field, such as Ms. Schweitzer, RN, above.   He knows they are,  listening, getting involved, and collectively, taking action !

 

UNION…..it WORKS !

 

 

 

I have this friend in the Union ………

I have this friend in the Union. Tells me an unbelievable tale which I still to this day find hard to believe! But it’s true!!!

It seems some documentation was going missing / not being done, by some of the nurses in the hospital. Of particular interest was a situation where-in the administrative status of a patient only was being changed, but not recorded in a nursing note.

A patient would have his or her status changed, from acute to sub-acute (sustained)yet NOTHING else changed…… and…

Here is what would happen. For ADMINISTATION purposes
only, a patient’s status would be changed, yet the patient

 -- Remained on the same floor
 -- Remained with the same treatment team
 -- Had no essential change in the level or type of care……

And because some staff failed to record the change in the pt. status in their notes (disregarding the fact that there was no set note nor standard to be used to document this change) ……… the administration of this facility decided that:

 A FULL DISCHARGE / TRANSFER NOTE would have to be completed
 PLUS
 A FULL ASSESSMENT / REASSESSMENT NOTE would ALSO have to be
completed………

simply because an administrative change had been made!

This went on for MONTHS !!!

Well, the Union got involved. The Union felt that this might just be a bit ( ? ) of overkill, a bit like swatting a mosquito with a sledge hammer ! Soooo…… the Union got involved !

Know what? Staff NO LONGER waste their time doing a
FULL DISCHARGE / TRANSFER NOTE together with a FULL ASSESSMENT / REASSESSMENT NOTE each and every time a patient has his status changed.
Shortly after the Union got involved, what should have been put in place from the beginning, was finally put in place.

Staff now, when a patient’s administrative status changes, simply make that notation in a one paragraph notation in the patient’s chart,
indicating that, for administrative purposes only, the patient’s status has been changed from acute to sustained status, with location, treatment team and care remaining the same. The note reflects that the VANA and the care plan of the patient have been reviewed, and that no change(or the appropriate changes) have been made. 99 % of the time, since it IS JUST an administrative change, no changes in the VANA nor care plan are
required.
Total time spent in this ( new ) notation ? Perhaps all of five or six minutes.

This,
vs
a FULL DISCHARGE / TRANSFER NOTE
together with
a FULL ASSESSMENT / REASSESSMENT NOTE !

Yeah…… I have this friend in the Union……..

Union ! It works !

I have this friend in the Union….

She tells me that she LOVES working with our nation’s warriors, “ her vets “ as she

so protectively refers to them. However, increasingly, she tells me that the work

is much more difficult, oftentimes driven by onerous and duplicative documentation.

Case in point:

Everyone involved in patient care is aware that pain and pain issues for

our vets are vitally important factors to be considered in the care of the

vet. The powers that be, both nationally, and also from the local V.A.

administrative hierarchy, have deemed it so….and RIGHTFULLY so !

These powers that be, maintain that these pain and pain issues must

at all times be addressed. And again, RIGHTFULLY so

Well….. ya know what ? Being the great nurse and ferocious veteran advocate that

my friend in the Union is…..she WHOLEHEARTEDLY AGREES ! My friend would NEVER

want to see “ her “ vets go hurting, especially if she could make a difference !

PAIN, within the VA system, is documented in a number of ways. Upon admission, a

detailed note is written, formatted, and included in what is known as the Nursing VANA.

Subsequent to this, if a vet reports pain, there is a template and a note which follows,

detailing EXTENSIVELY:

location,

duration,

quality,

and

intensity

of that pain.

This template and note is utilized, each and every time the vet is assessed as being in

pain. It takes a bit of time to fill it out, but again, it IS the RIGHT thing to be doing for

the vet, and for his or her pain.

On the other hand, in order to save time, should a vet NOT have any pain, a simple

zero ( reflecting, you guessed it, NO pain ) is entered in the vital signs area, FOR ALL

TO SEE, each and every time the vet is assessed and reports no pain ! This too, makes

sense…..and again, IS the RIGHT thing to do !

However….. my friend also tells me, should she have a vet, as she often does, who

has NO pain, and has NOT had pain, even for days and days, that IN ADDITION to the

pain score of ZERO being entered into the vital signs area ( again, FOR ALL TO SEE )

she must ALSO, IN ADDITION take additional and valuable time ( time taken away

from being with “ her vets “ providing EXTRA, and DUPLICATED and what she sees

as UNNECESSARY documentation, reiterating, each and every shift, that the veteran

has no pain ! Again, mind you, this is done, DESPITE the fact that this same

information is first also entered into documentation in the form of the simple zero in

the vital signs tab !

“ What a waste of valuable time “… my friend in the Union was overheard to say one

day.

Well, fortunately, that “ overhearing “ was overhead by one of her Union reps. The

issue is now ( and has been for awhile ) before the nursing administration of her V.A.

facility, and the Union is awaiting word back on the administration’s “ official “ take

on this one instance of needless duplication of efforts and documentation.

Stay tuned. More to follow !

Yeah, I have this friend in the Union……..

Union ! It works !

I have this friend in the Union….

He tells me that he was asked if he could take some time out of his busy

schedule last week to go downtown and help show some support for

some local Nursing and Health Care Workers Union Organizing Activities.

My buddy really didn’t feel like breaking up his day and heading back into

the city on his day off. But….he KNOWS what he has with the backing of

his Union ( NAGE in the VA ) so…..

…..he broke up his day

…..he took the drive into the city

and….with what seemed

to be numbers in the hundreds

….he saw to it ( by his presence and

that of his Union brothers and sisters

in NAGE) that those colleagues of his,

other Nurses and Heath Techs, and

other Health Care Workers throughout

Maryland who do NOT have the benefit

of representation,

SAW THE NUMBERS, FELT THE SUPPORT,

as they demonstrated for the simple right

of representation in the work place.

I have this friend in the Union….

He really DIDN’T want to give up a portion of his day last week to go

Downtown….. but went anyway….. and came back home, a few

hours later….. KNOWING he’d done the RIGHT thing !

The struggle continues ….. !

Wow – I just saw a position announcement for an in house position that I and many others would love to have……  However, wait before you spend hours updating that resume and submit your paperwork to be considered.   Wow, sources close to the top tell US that “they” already have someone in mind;   AND guess what?  That information has proven to be correct on every occasion, especially for the Monday through Friday higher paid positions, high profile positions.

Is it me or is nursing spending more and more time chasing the Perception of Doing Well than we are addressing Nursing Care issues and point of care problems?

I have been a Nurse for --------- Let’s just say for close to a very, very, very long time.