National Nurses United

Unit Closures_REV 2 6/30/11 12:57 PM Page 11 According to reports from NNU nurses, the most popular units for the chopping block include psychiatric, skilled nursing, acute rehabilitation, hospice, and home care. As a result of lower birth rates due to the lousy economy, labor and delivery units have also been targeted in this trend of closures. In the outpatient area, clinics are often shut down or have had their hours of operation radically reduced. And, of course, when units are shut down, registered nurses and other staff are often at risk of losing their jobs. When NNU nurses across the country fight aggressively against closures, however, they have been successful at stopping them— particularly those at public or district hospitals where RNs can put pressure on elected officials. In this way, years-long campaigns led by nurses have kept two much-needed hospitals in the San Francisco Bay Area, San Leandro Hospital and St. Luke's Hospital, open when Sutter Health wanted to shutter them. "We really scared them," said Gutierrez-Vo about their fight against Kaiser. "They backed off, but that was because we really fought them. We were all really opposed to it and took it very seriously." F or some hospitals, the unit closures and cutbacks are part of a concerted strategy, often touted by management consultants, to reorganize the way healthcare is delivered in order to maximize the return out of every dollar spent. One of the most popular schemes goes by the name "Lean Six Sigma" and is modeled after a variety of programs implemented in manufacturing industries in the 1980s and 1990s to eliminate variability in the work process, eliminate defective products, and, of course, save money by cutting waste. Business consultants soon began applying Lean Six Sigma to other industries, and registered nurses are now dealing with its use in hospitals. NNU RNs and other critics argue that these types of management consulting strategies are inappropriate for use in healthcare settings. Nursing very sick patients back to health is not the same as producing a car bumper or microchip, and never will be. People are extremely complex and variable. A person's physical health can even be heavily influenced by their psychological or emotional state. Nevertheless, hospitals eager to maximize profit have rushed to adopt these management consulting practices, which are often characterized by making deep cuts in all areas—staffing, inventory, units, even whole hospital campuses—and shifting the problems those cuts create onto employees and patients. After such programs are enacted, employees often find themselves working faster, harder, and longer to pick up the slack; that's where the employer often realizes the promised "efficiencies." Patients suffer without needed services. Such is the case at UMass Memorial Medical Center in Worcester, Mass., where interventional radiology RN Colleen Wolfe works. Last September, management announced that census was down from the year before and it would be closing an entire floor of 28 medical-surgical beds. "I couldn't believe it," said Wolfe. "It was the exact opposite of what I expected to hear." Wolfe had assumed that her facility would be expanding beds. After all, the central Massachusetts hospital was packed full with patients every day and not enough places to put them. There were now so many patients in the hallways that staff had to start referring to them as located not only in "Hallway 18" or "Hallway 19," but also in "Hallway 18½." Some patients were being held so long JUNE 2011 in the hospital's busy emergency department and operating rooms that administration started issuing "Code Help" calls, which means that every department has to speed up work in order to discharge patients from the floors as fast as possible to make room for ER patients. And just a month before, the hospital had been so overwhelmed with patients and not enough staff that management called a "Phase 2" disaster, normally reserved for natural catastrophes and actual emergencies, which meant that none of the nurses could go home. "The nurses and physicians told management that this is going to create even more chaos than there already is," said Wolfe, who is co-chair of her bargaining team and a MNA board member. "This is a disaster waiting to happen. It's not fair to the patients or the staff." Now Wolfe said the hospital is calling Code Helps nearly every day. In the case of UMass Memorial, Wolfe believes that the unit closure was part of the hospital's "Lean Six Sigma" initiative. Why pay the money to staff an entire floor when you can simply squeeze multiple patients into hallways, stash ER patients in the recovery room, and make surgical patients recover in the operating room? "This is not a hospital," said Wolfe. "We're just warehousing people." To protest the closure, Wolfe and her colleagues have staged pickets and spoken out to the public through the news media about how overcrowded and dangerous conditions are at the hospital. Though the RNs are determined to ultimately bring back all the beds that were eliminated, the hospital in the short term has agreed to restore about 10 of the beds that were lost. The unit closure is still a contentious issue that RNs plan to make a focal point of bargaining talks. F ighting unit closures is hard work, but nurses report that what seems to work best is an organized campaign, led by dedicated and motivated RNs, that puts nonstop pressure on hospital executives through a combination of media coverage, well-attended actions like pickets or candlelight vigils, support of elected officials, alliances with the public and concerned community groups, and data to back up the nurses' warnings. The proposed closure of Kaiser Permanente's pediatrics department in Hayward, Calif. is a perfect example of how nurses must get creative and organized in pushing back against such cuts. Last June, nurses learned that after Kaiser moves its services in 2014 to a new facility in nearby San Leandro, that it would no longer house a pediatrics department. Members would have to drive their sick children 20 to 30 miles farther to access the nearest Kaiser pediatric unit, a huge burden for parents—especially those that depend on public transit. Pediatric nurses immediately geared up against the planned closure by educating families of patients and collecting signed cards, securing letters of support from local politicians, waging a sticker campaign when they knew a Kaiser executive was visiting their hospital, crashing an upper-level management meeting to protest the closure, and even picketing the groundbreaking ceremony for the new hospital. The nurses also plan to write letters to the editor and notify the Kaiser membership of the planned closure. Once school starts in the fall, Richter said nurses will leaflet the pediatric clinics and start visiting local PTAs. "Our goal is to educate as many people as we can," said Kristine Richter, a pediatric RN for nearly 35 years. "I'm really proud of our peds nurses for sticking together. Not one nurse has gone looking for another job. Hopefully we'll get enough public outcry to make them rethink their decision." W W W. N A T I O N A L N U R S E S U N I T E D . 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