Ebola opens up health workforce rift

For many nurses, the emergence of the Ebola virus in America has confirmed a sense of hospital leadership's underinvestment and underappreciation. Executives focus on frontline staff cost-containment, but spend millions on computer systems and executive compensation.

Now they’re protesting and striking, including at some large hospitals that usually receive great regards from patients and clinicians.

Across the world, some 100,000 nurses affiliated with the National Nurses Union are protesting and striking what they call “eroding patient care standards in the U.S. and globally.” In California, 20,000 registered nurses are striking for two days at 21 Kaiser Permanente hospitals and 65 clinics, Sutter Health’s Tracy Community Hospital and a 100-bed hospital owned by Community Health Systems.

It’s about Ebola, and also far more than just the virus, the union argues — from staffing ratios to electronic health records to Medicare’s “two-midnight rule.”

[See also: Kaiser's California nurses raise Ebola issue in contract talks.]

In its protests, vigils and public outreach campaigns, the National Nurses Union is trying to convince government agencies and hospital leaders to ensure that clinicians treating Ebola patients have full-body hazmat suits that meet international standard for blood and viral penetration, leave no skin exposed and have powered air purifying respirators.

The National Nurses Union is also using the debate around Ebola preparations to critique the business of American healthcare more generally and petition for more investment in nurses and more involvement in health system decisions.

“The lack of concern for nurses and patients in a world where corporations have taken over our community healthcare has been magnified during this deadly Ebola crisis,” said National Nurses Union executive director Rose Ann DeMoro. “Hospitals should be forced to spend the money on patient safety that they spend on public relations.”

The strikes highlight a growing distrust among frontline caregivers of hospital management in some parts of the country.

“Our computers on wheels are ten years old. They break down, they drop connections and they cause delays in care,” said Doris Plumer, a unionized medical and surgical nurse at the Mount Desert Island Hospital in Bar Harbor, Maine, where union nurses are holding a vigil after months of working without a contract. “The hospital administration then replaced these devices with a model that nurses had recommended against for the same shortcomings. We want the right to meaningful input on this issue.”

In California, the nurses want to set a contract with Kaiser, Sutter and Community Health Systems, seeking changes in 35 different operational areas.

At Kaiser Permanente’s Northern California facilities, the 18,000 striking nurses are trying to raises concerns about Ebola preparedness and a number of issues they allege have gone unresolved, including “sharp restrictions on admitting patients” at certain facilities, pressure to discharge patients early, and some 2,000 nursing positions going unfilled.

[See also: Texas Health Presbyterian takes financial hit after Ebola crisis.]

At KP’s 213-bed Redwood City Medical Center, the emergency department is “holding patients who should be admitted to the hospital,” said Sheila Rowe, a nurse affiliated with the California Nurses Association. “These elderly patients are kept on uncomfortable gurneys for many hours, unable to rest or sleep because of the noise and influx of patients."

Although some scheduled elective procedures may be delayed, Kaiser Permanente leaders said all the affected hospitals will remain open (thanks in part to 2,800 nurses hired as temps, at a cost that could reach $40 million.)

“At Kaiser Permanente, our members and patients come first, so we are prepared to deliver the care our patients need during the two-day walkout called by the union,” the health system said in a statement.

KP leaders, though, say there are perplexed at being a target for the strike, given the investment in Ebola and infectious disease preparedness and staffing levels that “often exceed” state-required ratios.

“We believe, and our nurses know, that Kaiser Permanente is one of the best-staffed health care systems in California and the nation,” KP leaders said. “We have responded to all of the union’s negotiating proposals, and we look forward to more bargaining sessions. We are absolutely committed to keeping Kaiser Permanente the best place for our nurses to work, and we have assured them of that commitment.”