Internal Bleeding

St. John's Mercy Medical Center alienated their RNs when they turned to less experienced caregivers to save money. Now they're paying for it.

In short, the nurses want a voice, and they want answers when they speak. "You can fill out quality-improvement forms until you are blue in the face," sighs Prade, "and they will say, 'We are looking into that.' If they say anything at all."

Crain says there are "multiple examples where their concerns and suggestions have been acted upon. There was a request that full-time status be 72 hours instead of 80 hours; that change was made last summer. We have rooftop parking on the garage, and they asked if on the weekends that could be used, so we changed that and they can certainly park on top. In terms of clinical examples, there was an identified need to standardize the pediatric emergency carts. And the nurses on one of the areas identified a need for more telemetry. There are many avenues where we have demonstrated that we do listen."

She offers the Nurse Executive Council -- established during the MONA campaign -- as an example of RNs participating, voluntarily and influentially, in decision-making. But Prade -- the only union supporter on the council -- says members are handpicked by their managers, and she was only invited to serve after she pointed out that no one was representing her unit. "Rather than dealing with staffing issues, they are arguing about how crash carts should be set up," she says. "When someone from human resources came to talk to us, I did ask a question about the (freshly eliminated) career ladder. At the start of the next meeting someone said, 'I was really ashamed of our behavior last time -- we had guests.'"

Frustrated by politesse, martyrdom and new name tags that blurred any distinction between RNs and PCAs, nurses from St. John's successfully lobbied the state Legislature for a bill stipulating that RNs' credentials be prominently displayed on their name tags. On Oct. 26, 1996, a hospital Q&A promised that "in the near future, the name badge format will be changed to enlarge the RN credential." Then MONA went away. And the next time the nurses asked about changing the name tags, they were told that the new law made "no mention of the type size of the credentials. We have always displayed credentials in the name badge and will continue to do so."

Recently the badges were redone yet again -- this time removing any job specification from the PCA badge and wiping out any extra credentials of registered nurses (such as "B.S.N.," indicating a full four-year nursing degree). The informal, stewardessy first name stayed bold; no chance of a respectful "Ms." or "Mrs." or "Nurse Jones." The "RN" ... stayed small.

As for uniforms, administrators say the nurses wanted scrubs. "Sure we did," agrees Marge Herbert, who's worked in gynecology for 15 years. "That was before they went into patient-focused care. And at first, nurses were going to wear certain colors of scrubs, so you could still tell the difference."

Administrators purchased "nursing recognition pins" to quiet the clamor. And just recently, when hospital executives wrote to warn nurses that the union could have a negative effect on St. John's, the salutation was quite distinct: "Dear Professional Registered Nurse."

After professionalism, which appears and vanishes like a hologram on a cheap ring, comes the grievance policy, written in lemon juice and visible only under heat. According to Herbert, "They stopped distributing employee manuals to people years ago, and the grievance procedure is certainly not publicly known."

Asked whether there's an employee manual that outlines a nurse's grievance rights, Crain repeats the question, softly puzzled. "We have a human-resources manual, in which the grievance policy is clearly outlined. Each of the managers has it. (Nurses) can access it through the HR department." They'd better watch their timing, though. "If some nurse who is overwrought happens to blow up and use a four-letter word, she's fired," says Crafton, referring to a specific termination of a 17-year employee. "This woman knew about the grievance policy because she'd been a supervisor in the past, but when she wanted to exercise her rights, they said, 'You cannot, because you have been terminated.'"

The policies that are clear to all parties are the ones removing benefits. With patient-focused care, the hospital stopped offering shift differentials (higher pay as an incentive to work evenings or nights), as well as long-term-service days and two paid days a year for continuing education. Crain points out "newly identified sources of funds" for such education: The hospital donated its cut of Life Uniform sales, and the physicians offered money from their own research fund.

"The reason we got upset was nursing care," says Prade. "But as they continue to take away and take away and they put out anti-union literature saying, 'What can the union promise you?' it's real hard to sit and listen. They claim they are losing money because of managed care, but they are a not-for-profit institution that makes millions in profit every year. And they constantly redecorate. The new admitting area has Corian countertops, wood-paneled walls -- it's gorgeous. They told us they built a new corporate building for Unity -- with a fountain and a running track, yet -- with a $40 million surplus from cash reserves. And then they say there's no money to improve staffing."

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