By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist
We all knew big insurers would benefit as more individuals sign up for health insurance under the provisions of the Affordable Care Act. What is surprising to me, at least, is just how much Minnesota hospitals are profiting as well.
In the latest sign of sickness in the corporate healthcare world, the Minnesota Department of Health reports that our hospitals have reduced the amount of charity care they provide to our sickest and poorest citizens by 22.4 percent.
Much of this decrease is driven by a sharp increase in the number of patients with health insurance across the state — up to 94.1 percent, an all-time high.
Hospitals, as they reduce their charitable care, should pass those cost savings on to their patients and communities. They should allow more patients to qualify for charitable care. They should increase the quality of care they provide through appropriate nurse staffing. They should engage their communities in public health outreach.
Instead, our non-profit hospitals are pocketing the money, giving it out as bonuses, spending it on advertising and branding, building the latest and greatest waterfall in the lobby. Enough is enough.
Charitable care forms the backbone of our societal contract with our non-profit hospitals — we grant them tax exemptions, and in return, we expect that they will strive to help the sickest and poorest among us in a charitable manner. It might be time to re-examine that contract.
Listen to MNA Executive Director Rose Roach talk about nursing and health care on @AWomansPlaceMN @AM950Radio. http://ow.ly/SFgr5 Or listen below. mp3 player required.
What did we learn from the controversy around The View and Miss America contestant Kelley Johnson? That #nursesunite, and they mean business.
By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist
In yet another sign that Minnesota Hospitals are using the myth of a Minnesota “nursing shortage” in order to avoid appropriate nurse staffing, the Star Tribune recently reported that our 10 largest hospital systems “saw operating income jump by 38 percent in fiscal 2014 compared with the previous year.”
These healthcare systems reported sparking income growth by “putting the brakes on hiring.”
In particular, North Memorial Medical Center saw its highest net profit margin since 2006 (and yet is currently laying off RNs); the Mayo system reported a 1 percent decline in salary and benefit costs while experiencing a 36 percent increase in revenue (complaining of a nursing shortage and cutting pensions the whole time); Sanford reported eliminating positions through attrition (while also reportedly purposefully staffing 10 percent under grid in order to cut costs); and HCMC, a 472-bed facility, added the equivalent of only 38 full-time positions.
Meanwhile, nurses continue to report unsafe nurse staffing in record numbers.
Since August of last year, MNA nurses have submitted 2,802 Concern for Safe Staffing forms, indicating situations in which staffing is so bad patient safety is at risk.
Minnesota Hospitals: bragging about enormous jumps in profit obtained through unsafe staffing all the while jeopardizing the safety of our patients.
The time for a Safe Patient Standard law is now.
By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist
“If you don’t stay and work extra, who will take the admission that’s coming? There’s no one else.”
If you’ve been told by your nurse manager that you must work “mandatory” overtime, don’t buy it! Under Minnesota state law, nurses cannot be disciplined for refusing overtime if, in the nurse’s judgment, it would be unsafe for the patient.
Study after study show that unplanned overtime assignments have a high potential to be unsafe. Working more than 10 hours in a given day, when unplanned, results in lower quality of care, higher RN burnout, decreased patient satisfaction, and increased errors.
Whether the overtime is planned or unplanned does make a difference: we plan to get extra sleep, bring an extra meal, and mentally prepare when we know overtime is coming; when it’s not, we’re caught between pleasing our supervisor and doing what’s best for the patient.
What happens if your nurse manager tells you that if you do not accept an overtime assignment, you are abandoning your patients? Again, don’t buy it!
Generally speaking, patient abandonment occurs when a nurse leaves a patient without handing off that patient’s care to another nurse. If you refuse mandatory overtime for the purposes of protecting your patients, you will need to hand off the care of your patients to another RN, which can include your nurse manager (i.e. give report). Remember that under the language of the overtime law, healthcare facilities are forbidden from reporting nurses who refuse mandatory overtime to the Board of Nursing.
When employers ask for or “mandate” overtime, it means the hospital is desperately short of staff. Accepting overtime assignments enables and perpetuates this unsafe staffing by allowing hospital administration to get away with not hiring enough nurses. So, the next time you’re asked to take on mandatory overtime, just say no.
National Nurses United this week endorsed the U.S. Presidential candidate who agrees with nurses’ values and is an ardent advocate for issues important to the nursing profession, like expanding Medicare, the Robin Hood Tax to ensure Wall Street pays its fair share, and proper safety and protections from infectious diseases for nurses and patients.
National Nurses United announced on August 10 the endorsement of Vermont Senator Bernie Sanders for President at a “Conversation with Bernie” at NNU’s national offices in California. Hundreds of RNs cheered Sanders on at the California event, and thousands more watched on live stream at 34 watch parties in 14 states, including Minnesota.
“I have spent my career fighting for something that I consider to be a human right,” Sanders told the crowd. “That human right is health care.”
He said it’s time for a Medicare for All single-payer health care program in the U.S.
“We have got to move toward a health care system which is based on providing quality care to all of our people rather than worrying about the profits of the insurance companies,” he said. “We have got to move toward a health care system which ends the absurdity of Americans paying, by far, the highest price for prescription drugs in the world.”
MNA President Linda Hamilton had the honor of being one of the NNU members introducing Senator Sanders. Hamilton said the members she represents are looking forward to issue-based discussions in the campaign. She said Senator Sanders will address the real problems that patients and the country face.
According to NNU Executive Director RoseAnn DeMoro, NNU has adopted a call to Vote Nurses Values – Caring, Compassion, Community.
“Nurses take the pulse of America, and have to care for the fallout of every social and economic problem – malnutrition, homelessness, un-payable medical bills, the stress and mental disorders from joblessness, higher asthma rates, cancer, heart ailments and birth defects from environmental pollution and the climate crisis,” she said. “Bernie Sanders’s prescription best represents the humanity and the values nurses embrace.”
Last fall, my grandmother was admitted to the hospital after a TIA that left her oriented only x1. Or, more correctly, we thought she was admitted. As it turns out, she was in the hospital for several days in an outpatient status, known in Medicare parlance as “observation status.”
Unfortunately, what “observation status” meant for Grandma was that she did not meet the Medicare requirement for a 3-day inpatient stay at the hospital in order to qualify for discharge to a skilled nursing facility. Thus, despite the fact that Grandma was certainly not in any shape to discharge home; and despite the fact that she had entered the hospital from a nursing home, she was not able to go back to the nursing home.
Such situations occur more frequently than you might think: according to a 2014 report by the Medicare Payment Advisory Commission, 1.8 million observation claims were submitted in 2012, an 88 percent increase from six years earlier. While observation status was originally implemented to allow hospitalists to determine whether or not patients should be admitted, it has grown into a kind of purgatory that allows hospitals to reduce penalties from the Hospital Readmission Reduction Program (since observation status patients are not technically readmitted) and shift services to more profitable outpatient areas of the hospital.
On top of not counting toward the 3-day requirement for discharge to a skilled nursing facility, observation status stays are charged on an outpatient basis (i.e. under Medicare Part B). This can often mean higher out-of-pocket costs for Medicare beneficiaries—for example, Medicare Part B services have a deductible and 80/20 cost sharing (80 percent Medicare/20 percent beneficiary) that is applied to all services provided and does not cover the cost of pharmaceutical drugs used in the hospital.
So what can nurses do? The first step is to advocate for our patients. Ask the hard questions – why are our patients in the hospital being charged for services if the physician is unsure whether or not a hospital admission is medically necessary? Equally important is communicating with the patient. Our patients deserve to know whether or not they are on observation status. Furthermore, they absolutely must understand what “observation status” entails: they will be charged for services under Medicare Part B (80/20 cost sharing and a deductible), the cost of medications will not be covered, and the patient’s time in the hospital will not count toward the 3-day requirement for discharge to a skilled nursing facility.
As of July 1, such communication with a patient is in fact required under state law — but in order to properly communicate with and advocate for our patients under observation status, we must first understand it ourselves. Read more about the issues with observation status here or here.
Nurses throughout Minnesota know of instances of employers intimidating and retaliating against staff for a wide variety reasons, like reporting unsafe staffing, speaking up when they disagree with a program or pilot, reporting managerial unethical or illegal behavior, engaging in union activities, and many more.
These types of incidents can cause managers and administration some headaches, but they are all part of the ebb and flow of the employer-employee relationship. Unless, of course, the employee is punished for legal and ethical actions.
Unfortunately, retaliation in the workplace is all too commonplace – and not just in hospitals.
For nurses, the opportunities for retaliation are higher than in many other fields. In addition to issues with employers over the way they conduct business, nurses’ licenses require them to follow an additional set of rules that often contradict their employers. They are responsible for ensuring that every assignment they accept is safe for the patient, refusing overtime if they don’t feel safe, and reporting situations in which a patient is injured or in grave danger.
Because of that, the opportunities for “disappointing” the employer increase in the nursing field, as are the opportunities for retaliation.
Some recent examples show that retaliation in the healthcare field is not improving:
- The National Labor Relations Board issued a formal complaint last October against North Memorial Medical Center in Robbinsdale for harassing and intimidating staff for their participation in an informational picket calling for safe staffing levels. The hospital fired one employee, revoked work agreements and forced employees to work weekends, “repeatedly interrogated” staff about their union activities and falsely claimed that talking about union activities was prohibited.
- A nurse at another Metro hospital was recently targeted by management and her CNO for speaking up about a pilot project that she and many others thought was endangering patient safety. After her union colleagues protested, the nurse was asked to “review hospital policy” that she never violated in the first place.
- After a nurse filed a Concern for Safe Staffing form, she was called into the office and asked why she went to the union with her concerns. The nurse defended her actions, and said her union was the proper place to share concerns. The hospital attempted to terminate her a short time later, but MNA rose to her defense.
- A nurse who refused an unsafe assignment was berated in front of colleagues, pulled into a manager’s office and berated some more. Other nurses were so upset at the treatment, that they stood up and defended the member.
As you can see, hospitals have many ways to retaliate against nurses and other staff.
The good news is that nurses do not have to put up with this. The law and your union – your colleagues – are on your side.
It’s illegal for employers to retaliate against you for any concerted activity about the terms and conditions of employment, such as speech or other actions that don’t disrupt the workplace in a private or public facility; and it’s especially illegal for employers to retaliate against nurses for blowing the whistle on a situation that in the nurses’ professional judgment risks patient safety.
If you have experienced workplace retaliation, share you story with us.
Filing Concern for Safe Staffing Forms and speaking out about unsafe staffing do make a difference. Just ask Surgical/Trauma/Neuro RNs at Hennepin County Medical Center in Minneapolis.
Nurses mobilized and forced the hospital to end a pilot program in the STN unit that increased the number of patients a nurse cared for at one time.
The pilot was implemented in January 2015 without Nurses’ input. They knew from day one the pilot was endangering patient safety and stretching each nurse too thin.
The increased number of patients was “overwhelming” to the nurses and other staff.
“You can’t keep track of that many people,” said RN Sue Oberg. “The push was to work at the top of our licenses, which was ridiculous. You need so many other people to take care of a patient. It was also pulling nursing assistants out of their areas of practice.” They were put in a position of taking over at the bedside because RNs had so many patients they couldn’t spend the proper amount of time in each room.
The situation was so bad that the RNs were worried about their licenses.
The pilot took its toll on nurses mentally and physically.
Some nurses were ready to look for another job.
Patients noticed a problem when they wouldn’t see a nurse for hours.
The nurses stood up and fought the pilot. They spoke loudly and strongly about the damage the pilot was causing. They talked to managers one-on-one and at meetings – and filled out the Concern for Safe Staffing forms. The forms showed that this issue was a concern on days, nights, and afternoon shifts. MNA received 45 forms from HCMC between January and the middle of February.
Nurses also shared their concerns with physicians, who saw what was happening and supported nurses by signing letters.
HCMC backed off the pilot under the pressure.
*This post was updated on July 31, 2015 to clarify some minor details.