National Nurses United

National Nurse magazine April-May-June 2021

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conditions, viewing workers as robots. Is that the future nurses want for themselves? TG: I think we both know the answer to that, it is unacceptable. I mean we are seeing "hospitals at home." What a concept, right? You are too sick to be home without care, but they don't want to put you in the hospital, so we'll hook up a bunch of gizmos and have some people talk to you from somewhere in a room. TeleICU, it makes me cringe, the thought of needing that level of care, and not having someone there to provide it for you. Post-operative surgical site eval- uations, with a telephone?! These are just a few examples of telehealth. Again, placing nurses farther and farther away from patients and caring. Nurses are then unable to develop these nurse- patient-family partnerships in their care. Cathy, you set this up perfectly for the next bad trend that we're resisting, and that is compact licensure. Massive use of telehealth goes hand in hand with compact licensure, because if the industry is going to farm out nursing work hundreds or thousands of miles away, the nurse must be allowed to practice where the patient is located. CK: Now, Trish, remind us again why compact licensure sounds nice, but is one of those wolves in sheep's clothing situations again? TG: Okay, for anyone not familiar, there are certain forces within corporate health care that have been pushing for a long time for nurses to have license "reciprocity" in other states. So if you get licensed in, say, Texas, you can go practice in Arizona without reapp- lying for a license there. So all the states that participate in this system are called compact states. It sounds great, right? But for whom is it great? Not for the nurses. The problem is that, again, for reasons motivated by money, the compact states do not adopt the highest standard among the states for their nursing licensure requirements; they adopt the lowest. So, for example, states that have high bars for school accreditation, clin- ical hours, and continuing education, such as New York, California, Illinois, and Massachusetts, would essentially have their standards watered down. Not to mention the states boards of nursing and the autonomy of nursing practice of state CK: I heard rumors that they eventually want nurses to just hold a national license. Is that true? TG: It is true. This would certainly benefit the health care corpo- rations. But this is really problematic for a number of reasons. Again, it's not just an evolution of the nursing profession or chang- ing times. This isn't progress, these are the stated goals of the health care industry to maximize profits. Prior to compact licensing states, each state previously had control over how nursing is practiced. Some states have much higher standards and stronger nursing prac- tice acts, some states much lower. So with a national body determining essentially who does and who does not get to practice nursing, whose standards do you think will win out? And I want to add we should not rely on nurses practicing out- side of their state in times of emergency or predictable flu season but as a matter of public health policy that we should plan for adequate staffing and workforce needs at all times, not "just in time." CK: Well, this is certainly eye opening, Trish. It sounds really good at first, really flexible, but I wasn't totally aware of how it would play out in reality. TG: I know. When you look at the supporters of the compact state system, it's all these big health care corporations. Why do you think that is? It goes back to money. Being able to move around nursing staff across state lines means that they will be able to outsource nursing work to areas of the country where the labor pool is cheapest and regu- lations most lax, and it will also make it much easier to bring in nurses from other states to strike break when union nurses take a stand. CK: When you look at everything in totality, it seems like nursing is really at a crossroads, and Covid has accelerated that. In one direc- tion, you have nursing provided as an essential sector of a caring economy, where hands-on nursing care is valued and respected. And in another direction, you have nursing as we know it basically disap- pear. We are reduced and replaced by other personnel, apps, video cameras, and robots. TG: I think that's exactly right, Cathy. Nursing is at a crossroads. So the question now is what to do about it, and I think you and I both know the answer to that question. CK: Well, it seems to me that we need to keep working to trans- form our entire health care system away from a money-driven toward a care-driven system. But in the meantime, we nurses need to fight like hell to protect the integrity of our profession. We need to put our foot down, draw a line in the sand, and say, "Absolutely not." The only effective way to do this is together, collectively, through our union. It's too risky and less effective doing it alone and easier for management to ignore, harass, discipline, or fire one nurse; much harder when the entire unit marches on the boss with a peti- tion demanding change! TG: You said it, Cathy. I think looking back over this year, every victory we've had to win protections for ourselves and our patients only happened through our union activism. The government and our employers did nothing on their own. It was always our collective action that forced the improvements. And as we mentioned before, Covid really opened nurses' eyes about how little their employers valued them. So nurses are pissed, and rightfully so. CK: Well, I know a good way to channel that anger into some- thing more constructive would be to unionize! TG: Yes, that's exactly what some nurses did. The Mission Hospi- tal nurses in North Carolina unionized in the middle of Covid. And we want to take this opportunity to congratulate the nurses of Maine Medical Center on their union victory April 30. They are a perfect example of nurses showing solidarity to improve their work lives and their communities for the better. CK: Organizing ourselves to build nurse power is really the only way forward. As we discussed earlier, our employers have com- pletely different interests and goals than we do. To support and protect our ability to do what we do as nurses, to care for people, we must collectively advocate for our profession: in our workplaces, our state capitals, in Washington, D.C., and even across the globe—since nurses worldwide are facing the same challenges. A P R I L | M AY | J U N E 2 0 2 1 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 23 "We nurses need to fight like hell to protect the integrity of our profession. We need to put our foot down, draw a line in the sand, and say, 'Absolutely not.' The only effective way to do this is together, collectively, through our union."

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