Overall cut in pay adds to nurses' outrage

(Katherine Frey)
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By Lena H. Sun
Washington Post Staff Writer
Thursday, October 7, 2010

It was bad when Washington Hospital Center fired 18 nurses during last winter's snowstorms. It got worse when the nurses' union and management failed to agree on a new contract over the summer. Then, last week, the hospital effectively cut take-home pay for most nurses. As WHC nurses voted overwhelmingly Tuesday night to join the largest nurses' union in the nation, labor relations at the area's biggest hospital were tense.

"People are really angry," said one veteran nurse, referring to how hospital officials forced through a plan that increases base pay but cuts shift pay for working evenings, nights and weekends. The hospital said it took that action only after more than 100 proposals and counterproposals and two months of silence from the union.

The labor dispute reflects growing rancor across the country when the role nurses play in the country's evolving health-care system is about to become more critical then ever: The success of the sweeping health-care legislation will depend heavily on primary-care givers, such as nurses, whom President Obama has called "the beating heart of health care."

The country's more than 3 million nurses already make up the largest segment of the health-care workforce. Millions more will be needed to take care of the 32 million additional people who are estimated to get health insurance coverage in 2014. The quality of care nurses provide will also be crucial as hospitals will increasingly be paid for how well they take care of patients rather than how many procedures and tests they perform. Better nurse staffing and work environments are linked to fewer hospital readmissions, hospital-acquired infections and bedsores, experts say.

"Our research has shown that nurses are the single most important factor in how satisfied patients are with hospital care," said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania.

But during a recession, with their salaries being targeted, nurses across the country are unhappy: In Minnesota, 12,000 nurses from 14 hospitals narrowly averted the biggest nursing strike in U.S. history in July after a dispute over staffing and benefits. In Philadelphia, 1,500 nurses and health-care workers had a 28-day work stoppage at Temple University Hospital in April over benefit cuts. And in Oakland, Calif., nurses at Children's Hospital Oakland voted last month to authorize a strike to protest efforts to reduce their health-care coverage.

Challenges increasing

For nurses, changes in the delivery of and payment for care are occurring at the same time that patients are sicker than before and the use of sophisticated technology is increasing. Coupled with chronic understaffing and high turnover, the pressures on nurses are enormous.

In the WHC pulmonary step-down unit ,where many patients go after leaving intensive care, one nurse often has to care for four patients on respirators, said nurse Blondina Mays. That's double what it was when she started at the hospital 11 years ago.

In labor and delivery, two nurses are supposed to be in attendance for every delivery, but "we do it when we can - it just depends," said one veteran nurse who did not want to be identified for fear of retaliation.

Many teenagers having babies for the first time need teaching and support, but nurses often have time only to do the minimum, taking vital signs and checking medications.

"I feel like I'm not doing the job I want to do," said the nurse, who has more than 20 years of experience in labor and delivery. "I'm not doing a good job of taking care of them, of meeting the emotional needs."

That can be as simple as holding a patient's hand or helping brush her teeth. When she squeezes that in, patients are so grateful. "It just breaks my heart," she said.

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