National Nurses United

Unit Closures_REV 2 6/30/11 12:55 PM Page 10 Cutting to the Bone Nurses across the country are fighting closures of critical units by hospitals. Learn what works and what's needed to keep these services open. A STAFF REPORT A bout two years ago, the registered nurses who worked at Kaiser Permanente's urgent care clinic in Fremont, Calif. received news that their employer intended to basically gut afterhours services by closing the clinic at 5 p.m. on weekdays, cut hours in half on Sundays, and funnel more patients into telephone consultations with physicians. The plan, they thought, was a total disaster. Many of their patients were modest-income, working families who could not afford to take time off from their jobs to attend appointments during the day. For them, the evening urgent care clinic was their go-to place for that bad cough that's stuck around for two months, or the fever of a child that's high enough to have the parents worried, but not high enough to justify the emergency room. If Kaiser killed after-hours appointments and the ability to just walk in, the nurses feared that serious health problems would not be treated early enough to prevent full-blown medical emergencies. But the urgent care nurses didn't just get mad. They got organized. Under the leadership of Michelle Gutierrez-Vo, an urgent care charge RN who's also head of the professional practice committee and a California Nurses Association board member, the RNs waged a campaign to save after-hours urgent care. They started collecting all kinds of data to show how the proposed cutbacks would hurt patients—everything from the types of appointments people were booking, to the volume of appointments, to how much more people were paying when they had to use the emergency room versus urgent care. They monitored all the workflows so they knew exactly what was going on in their department. Nurses filled out assignment despite objection 10 N AT I O N A L N U R S E forms at every opportunity, and also kept notes in their own journals. They presented that data to Kaiser at meeting after meeting, they used it to garner the support of their local elected officials against the closure, and they showed it to the media to support their position. The campaign culminated in a major picket of nearly 300 RNs, complete with speeches by concerned politicians and TV cameras capturing all the action. That same day, management announced that there would be no reductions to urgent care clinic hours and that, no, they never planned to close at 5 p.m.! "It pays for nurses to really take ownership of their work and collect the data," said Gutierrez-Vo. "You need to paint a picture of what happens to the patients when these cuts are made. Focus on the patient. Where does the patient go and what kind of hardship does it pose for them?" Gutierrez-Vo's advice is needed now more than ever, as hospitals across the country are shutting down units that they simply don't feel are worth the money to run anymore. The desire by hospitals to slash costs during this poor economy has simply accelerated the closures. Often, healthcare management consultants are telling hospitals that they can save money and increase efficiency by "streamlining" their operations. Sometimes the units are money losers, and sometimes the units still operate in the black, but at not a high-enough profit margin to please their corporate owners. Often such closures are part of a healthcare trend of hospitals consolidating or regionalizing services at one of their campuses. In California, many hospitals are building new facilities to comply with seismic safety requirements and using the construction as an opportunity to drop units and services that they no longer want to operate. 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 JUNE 2011

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