Behavior has consequences
On September 30, 2011, the San Francisco Chronicle ran an op-ed penned by two California Nurses Association (C.N.A. and affiliated with the AFL-CIO) members. They were identified as Genel Morgan and Rita LaBarge, RNs at Mills-Peninsula Hospital and Alta Bates Summit Medical Center respectfully. They wrote this op-ed in response to what they viewed as a growing black lash against their public theatre held in the name of Judith Ming, a patient that died due to a nursing error that occurred at Alta Bates Summit Medical Center in the early morning hours after the C.N.A. organized one-day strike.
They begin their op-ed, entitled “C.N.A. members: Nurses protect patients”, with the following statement “To suggest that nurses who fight to provide safe care every minute of every day are using the death of one of our patients for our own gain is genuinely disturbing. One only has to view the video of the candlelight vigil held honoring Judith Ming to recognize the palpable grief in all our faces as we honored the life of a patient caught in the crosshairs of a system gone awry.”
This statement just about says it all when it comes to why so many nurses like myself and the public-at-large haven’t exactly been singing the C.N.A. praises about their behavior during the one-day strike and subsequent four-day lock out. A patient, a human being, died a tragic death and the C.N.A. nurses and their leadership
- First, call for an investigation via a press release,
- Second, hold a candlelight vigil in the name of the patient, announcing this “exhibition” of sorrow through yet another press release and then for good measure videotape and post it for all the world to see, and
- Third, begin a campaign to vilify the nurse that made the nursing error because we all know that “replacement” nurses aren’t real nurses just like substitute teachers aren’t real teachers, and doctors covering another doctor’s shift aren’t real doctors and so on.
Stay at the bedside long enough, and I have a couple of decades under my belt, and you see your share of nursing and medical mistakes. I’ve even stopped similar mistakes as the one reported to have occurred at Alta Bates Summit Medical Center. My readers may also recall the heparin overdoes that occurred in a number of pediatric patients not that long ago at Cedars-Sinai Medical Center. Then there was the nursing error at St. Mary’s Hospital in Madison, WI that lead to the death of a 16-year old mother who was at the hospital to deliver her child. In this case Nurse Thao, an experienced Labor & Delivery nurse, gave the mother an epidural anesthetic via IV causing the mother the have seizures and eventually die. Our nursing literature is rife with cautionary tales of nursing errors narrowly avoided or of those not caught that ended in tragic outcomes. Which is why, I found the C.N.A.’s crocodile tears about this tragic event so repugnant, because just when you think they can’t stoop any lower, they do. One must ask oneself have they no shame – apparently not!
Like falling dominos, the C.N.A. and their members set in motion a series of events when they walked away from their assignments to hold their one-day strike. They did so fully informed that should they hold their one-day strike those that didn’t report to work would face an additional four-day lockout so the hospital could meet its commitment to the 500 nurses that had been hired to cover the shifts of the striking nurses. Neither party was engage in any thing nefarious. The nurses, aggrieved with the state of the contract negotiations issued an intent to strike and when strides weren’t made (in their opinion) they held their strike – all legal and above board. Alta Bates Summit Medical Center in turn, unlike a grocery store or office couldn’t just close up shop and send the patients home for a day. Their only option was to hire registry/travel nurses to cover the one-day strike. However it’s not realistic that the hospital bring 500 nurses from across California and the country just for one-day so they did what most hospitals in the same situation would do, they gave these nurses a five-day contract. In turn they informed the nurses that walked away from their assigned shifts that they wouldn’t be allowed to return for an additional four-days, this rule didn’t apply to nurses that weren’t scheduled to work the day of the strike -- all legal and above board.
Whether what happened at Alta Bates Summit Medical Center was a case of catheter confusion, some other nursing oversight, human error, or negligence we’ll have to wait for the conclusions of the various investigations that are ongoing. The C.N.A. instead of vilifying the hospital or offending nurse should be actually asking how they can help ensure that nursing errors such as the one that occurred never happen again. Instead they chose to publish op-eds about their anguish, or issue quotes about “if only I had been allowed to return to work my shift the day after the walk-out, and posting videos of candlelight vigils to the web, giving lip service to patient advocacy. I think it’s important to note that this is the same group that has reportedly held 100 strikes over the past three years. Which makes it all the more important to remind the C.N.A. and their nurse members that behavior has consequences.
What’s going on at Henry Mayo Newhall Memorial Hospital?
It would appear that the California Nurses Association (C.N.A.) has set its “sights” on Henry Mayo Newhall Memorial Hospital. Now by setting their “sights” on Henry Mayo Newhall, I don’t mean that they’re planning to try and unionize the hospital, because the C.N.A. already represents the RNs at Henry Mayo Newhall. What I mean is that I think they’re laying the groundwork for some serious arm-twisting in advance of the next contract negations. What? Pray tell would lead me to think such a thing. Simply put, an article that I believe the C.N.A. had planted in The Signal, the area’s local paper this past March.
The article was entitled “Nurses challenge staffing” laid out for all to read that the C.N.A.-represented nurses were accusing the hospital for failing to meet our state mandate nurse-patient ratio and this action as reported in the paper “poses a danger to patients”. Oh my! I find it interesting that nursing unions always seem to be quick to cry “poses a danger to patients” whenever they want to get in the paper or on TV and this cry makes sense because everyone’s ears perks up when they hear that something or someone “poses a danger to patients”.
As I read the paper I began to suspect a more choreographed press release rather than an article for several reasons.
- The first being that the reporter incorrectly reported that RN’s receive a college degree in Registered Nursing, and when I reported this error to the paper’s editor there appeared no attempt to correct the error, didn’t publish my letter to the editor dealing with the error and the reporter (for whom I left several messages) never responded to my phone call.
- The second, and perhaps most interesting, was the statement that the RNs came to The Signal to discuss what they “saw as the dangers of team nursing” on the condition on anonymity but brought along their C.N.A. representative to vouch for their credentials. Why did they need the C.N.A. representative to vouch for their credentials, since all they needed to produce was their valid California RN license and their Henry Mayo Newhall identification, and if necessary proof they were C.N.A. members. I think that the C.N.A. representative was there to ensure that the nurses stuck to the script, and The Signal fell for it hook, line, and sinker.
All in all, the article painted a grim picture of brave and overworked nurses struggling to do their job and provide appropriate care for their patients. However as a nurse with almost four decades of experience under my belt I found it hard to buy some of their “poor me” stories. Such as the one “Helen” tells of “I don’t know any of the meds my patient got today. Because all the thousands of medications we give to patients each day.” Really? Thousands of medications each day – how many patients does she have each day? 100? I’m a NICU/PCIU nurse and in some cases I’ve had to deliver complicated medication regimes and in my entire career I’ve never had to administer thousands of medications to my patients every day – come on! And even if a nurse did have to deliver thousands of medications to their patients every day no one would expect them to remember, but they would be expected to be able to report from the patient’s medical records what had been administered during their shift. This is why we record our actions in the patient’s medical chart, and in some of the more technologically up to date hospitals we simply scan the medication barcode and the patient’s id barcode and the computer updates the record.
In all likelihood there are underlying nursing management issues at Henry Mayo Newhall, especially when I learned that Mr. Larry Kidd, RN was the Chief Nursing Officer (CNO) and Vice-President for Patient Care Services. He was brought in by the Camden Group as their CNO in their failed attempt to help the Los Angeles County Department of Health Services to turn around and save King/Drew Medical Center (KDMC) – and we all know how that story ended. So I wouldn’t be surprised if competent and experienced nurses had issues with his management of the nursing department. Even I had issues with his management of the nursing department during the failed turn-around of KDMC, so no surprise there. I can also empathize with their dislike of team nursing, because I’ve never been a fan of team nursing. I’ve always found that team-nursing without clear lines of communication and strong management often devolved into chaos with no nurse stepping up to take leadership responsibility and everyone pointing to the other with the explanation that I thought it was their job?
You can find a copy of The Signal article and my response LTE TS Henry Mayo
Did C.N.A.’s Demonstration at Whitman Home Result in a Federal Offense?
In this nurse’s opinion the California Nurses Association (C.N.A.) membership hit an all time low this afternoon in Atherton, California. You may wonder what could be worse than threatening opposition nurses, their children, and pets, or stalking opposition nurses, showing up at their relatives homes and calling family members at all hours of the night and day under the pretext of “convincing” the recalcitrant nurse that the C.N.A. is a great organization to join is low -- you weren’t in Atherton. Today, low behavior was when hundreds of C.N.A. members and supporters descended on this quiet neighborhood so they could hold a demonstration at the private residence of California gubernatorial candidate, Meg Whitman.
Of course this demonstration was accompanied by all the usual hyperbole and misrepresentations that are part of the C.N.A.’s usual arsenal. But to come to a person’s private home is truly above the pale. I’m sure Ms. DeMoro, Nurse Burger and company wouldn’t appreciate say the S.E.I.U. coming to their private homes and demonstrating to illustrate how the C.N.A. has engaged in raiding their nursing unions. But common decency, and socially appropriate behavior seems to be lacking in the C.N.A. leadership DNA.
But what this nurse liked best was that in the C.N.A.’s attempt to garner media attention a nurse delivered a letter to Ms. Whitman by placing said letter in Whitman’s residential mailbox. In doing so this nurse may have engaged in a federal offense. What federal offense, why the law that states only authorized letter carriers may insert mail into a residential mailbox. Oh my! The rule making and rule toting C.N.A. broke a rule themselves – color me surprised! …. More to come.
Investigative reporting that often falls short — welcome to the Los Angeles Times
After reading this post, one might think that I have a bone to pick with the editors, and some reporters of the Los Times – and you’d be right!
For years, it has been my opinion that when it comes to nurses, nursing unions and the nursing profession the LA Times has been inconsistent and at times down right off in left field when it comes to nurses. My disagreement with the LA Times on this topic goes back many years, and started with an article they ran on nursing which reported, incorrectly, that the American Nurses Association (ANA), was some how representative of all California. When I read this article I quickly responded with a letter to the editor and provided them with data from the ANA itself showing that less then 11% of all active RNs were members of the organization nation wide . Did they run this letter, of course not, but they did run a very small correction in the Home section of the paper much later. The correction was so small it barely served as a correction at all since it was so small it was all but insignificant and surely hardly worth the ink that was used to print it. This episode would mark my first, but far from my last, run in with the LA Times Reader Advocate, Ms. Gold.
Over the years, I’ve been vigilant and responsive to articles that have run in the newspaper especially when those articles shed a bad light on nursing that was not deserved, or glossed over what were gross nursing mistakes because those nurses worked in some venerated institution. For far too long all forms of media have relied upon groups such as the ANA, California Nurses Association (C.N.A.) and other such ilk to provide them with data and information on all things nursing. I’ve nothing against the media citing these and other organizations as sources of information, they are after all groups that represent nurses and thus have some expertise in the nursing arena. What’s wrong is when the media blindly cite suspect facts from these organizations with little effort to fact check the organization’s statements. Such as when the ANA purports to represent the interests of the almost 3 million RNs; or when the C.N.A. labels itself the voice of the California RN – when neither of these facts are accurate, let alone true. When individuals such as myself take the time to educate the media and provide them with the correct statistics and facts the response is often the proverbial paternalistic pat on the head, as if we’re somehow ignorant but well-intentioned children.
Equally frustrating is when the media soft peddles the mistakes or bad deeds of an organization or institution they consider venerable. Not that long ago the LA Times and various other media outlets barraged us with the numerous medical and nursing misdeeds of the now defunct King-Drew Medical Center (KDMC). Now granted there were many serious medical/nursing and even management errors occurring in this institution, and the press would have been remiss if they failed to report the story aggressively. However, when two nurses at Cedars-Sinai nearly offed a handful of infants, including the Quaid twins, little was really covered. Oh yes, there was front-page article about the initial incident, then there was at least one or two “follow-up” articles. What I found striking about the handling of the nursing errors at both hospital was the way the articles were spun. Granted KDMC’s problem were nearly endemic, but the heparin incident at Cedars was also on a grand scale, but the article spun this serious nursing error and breech of nursing protocol as well there have been other heparin incidents and these are primarily due to the labels not being different enough between the adult and children dosages and the fault was much more a “labeling” issue and not really the fault of Cedars-employed nurses. As a RN I took issue with this redirection of blame, because as someone who had administered more than once dose of Heparin to infants during my career I knew precisely where the blame for this error lay, and it wasn’t with the labeling – it was squarely on the shoulder of the two nurses who failed to not only read the label, but to also implement the time honored and basic nurse practice of double checking of certain drugs (heparin being one of them). What is this double-checking I speak of, simple the first nurse checks the order, checks the medication, draws the ordered amount, then another nurse checks the order, inspects the bottle the medication was drawn from and then verifies that the appropriate amount has been drawn, as well as verifying that the correct patient is receiving the medication at the correct time and by the appropriate route all the while placing their initials at the appropriate stages and places (this describes a general overview of the procedure, some hospitals have even more detailed safety protocols in place). But why come down so hard, nurses are only human, and this was just a mistake. Perhaps, but Cedars is also a so-called Magnet hospital which is supposed to designate that they have a higher standard for nurses, and such a failure of basic nursing safety protocols is indicative of a hospital that is not worthy of claiming that its nurses are a “cut above”, since the heparin incident is not a “ordinary” nursing error, because as it turned out apparently the mistake happened not once but twice.
Which brings me to the ongoing LA Times investigative report about the California BRN and the handling of nurse licensure. In its December 27, 2009 - Inept nurses free to work in new locales (http://www.latimes.com/news/local/la-me-nurses27-2009dec27,0,2090185.story) the article took a detailed look at the licensing failures that occur because there’s no real national clearing house, i.e. national nurse license agency which can lead to nurses gaming the system and securing licenses in additional states when they have a suspended or revoked license in another state. This is a very real problem, since every state is solely responsible for the verification of a nurse who is applying for or renewing their license in that state. Some states have a better verification system then others, catching a nurse with an out-of-state suspended or revoked license then others (California falls into the not so successful verification system). As part of their research the LA Times reported interviewed the National Council of State Boards of Nursing (NCBSN), regarding this issue. The quote from NCSBN that really caught my attention was this one “Officials at the National Council of State Boards of Nursing said they don't tell nursing boards how often to consult their database.” But wait a minute the NCBSN is comprised of representatives (most of the Executive Director) from each of our Nation’s state board of nursing! So what does this quasi-governmental agency really do; I call it quasi-governmental and not non-profit since it appears that its board is comprised entirely of representatives of governmental agencies. In my opinion very little is done to truly protect the nursing profession and the patients we care for, since when the Philippine test stealing scandal broke in 2006 the NCBSN stayed relatively silent on the matter (I wonder if this had anything to do with the fact that the NCBSN was in the process of opening an NCLEX testing center in that country?), if not for the local Philippine Nursing Association, the Association of Nurse Executives and a handful of nurse activist such as myself very little would have been done to force a retest of the suspect exam period. The NCBSN finally took a stand after the fact, so much for serving as a watchdog.
Though I think that its important that the LA Times reveals failures of our system of checks and balances, I think it’s equally important that they aggressively investigate agencies such as the NCBSN, that our BRN pays fees to and on which the BRN executive director (in this case the interim executive director) is a member of – if it cannot aid its board members to be better advocates for the profession then does it serve a purpose. Or perhaps the purpose it serves is to continue to charge fees for tests once administered and collected by the individual states thus consolidating power and wealth in the quasi-governmental agency that presents itself as a non-profit?