National Nurses United

RNs fight Kaiser over restructuring CALIFORNIA bout a year ago, Jennifer, an emergency room RN for Kaiser Permanente, noticed that her facility seemed to have quietly changed its procedure for treating patients with blood clots in the legs, or deep vein thrombosis. Previously, when patients came in with such a diagnosis, they were usually admitted to the hospital, given blood thinners, monitored by the nursing staff until their clotting levels were safe and to make sure the clot had not migrated to the heart or lungs, then discharged. Now, the physician orders for such patients instruct Jennifer to give the patient an initial shot of a fast-acting blood thinner, and to teach the patient or patient's family members how to give the patient subsequent injections at home. Instead of entering the hospital, the patients are sent home with the drugs, told to watch for symptoms like shortness of breath or chest pain that might indicate the clot has moved, and asked to come back to the hospital lab each day to undergo blood tests to monitor their clotting levels. The patient is then responsible for continuing to take his or her injections and, later, moving to an oral blood thinner medication until the problem is resolved. "I am essentially teaching the family member how to give injections and care for their family member at home, and sending them home, where we used to admit these patients and monitor them until their [blood clotting] levels were ok and we knew the clot wasn't moving," said Jennifer, who preferred that her last name not be used. Jennifer's story is just one example of the many ways that Kaiser Permanente, the huge "nonprofit" integrated health insurance and provider corporation, is prioritizing profits before the safety and health of patients, say Kaiser registered nurses. The California Nurses Association represents about 17,000 nurses working for some 21 different Northern California Kaiser facilities. The business press has reported that Kaiser posted about $2.6 billion in net income in 2012. A JUNE 2013 Kaiser, the nurses say, is using healthcare changes brought about by implementation of the Affordable Care Act as an opportunity to restructure the type and quality of care it provides, the setting in which it is provided, and the roles and jobs of the people who are providing it. Not only is Kaiser currently understaffing its hospitals, say RNs, Kaiser wants to ultimately shift as many patients as it can away from the inpatient hospital W W W. N AT I O N A L N U R S E S U N I T E D . O R G setting to the outpatient clinic setting where care is less regulated, the staff is usually lesser skilled and paid, and profit margins are higher. Like with the example of how blood clot patients now must treat themselves at home, Kaiser also seeks to shift the burden of care onto patients and their family members. All of this translates into fewer nurses to care for patients, and that is exactly what Kaiser is now proposing in the middle of a contract term. Almost 200 Kaiser nurses met on June 27 to discuss and bargain with Kaiser management a recent proposal by Kaiser to eliminate about 586 full-time positions and to eliminate the nurses' decades-old contract provision establishing a "no cancellation" policy that ensures work stability and safe staffing. Nurses vehemently disputed Kaiser's claims that hospitals were overstaffed. When asked how many of them had been called just that morning to work extra shifts, dozens of nurses stood up. When asked how many of them had been called that week to work extra shifts, almost every single nurse in the room was standing. RNs also reported that some units were heavily staffed by traveler nurses, a sure sign that a unit needs more regular staff. Holding signs reading, "Kaiser, our patients need more nurses, not less," RNs at the bargaining session held fast to their position. The nurses said Kaiser should post much-needed training positions and bargain locally over safe staffing levels, a proposal Kaiser rejected. RNs are determined to keep fighting these cuts and changes. The nurses also used their lunch break to put some public pressure on Kaiser, since the corporation's headquarters were located just blocks from where they were meeting in downtown Oakland. Hundreds of RNs dressed in red, shouting, "Chop, chop, chop from the top!" marched to one of Kaiser's main office buildings and staged a "die in," where RNs drew crime scenestyle chalk outlines of themselves on the sidewalk outside and wrote messages to Kaiser. "Kaiser sent me home too early," read one body. "Sent home from ER too soon. No nurse to care," read another one. —Staff report N AT I O N A L N U R S E 9

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