National Nurses United

e system that covers everybody from by everyone's tax dollars. That's how untries have set up their healthcare t run healthcare as a business or view arena in which to make profit. other hand, continues to let healthcare s. That's why, when we examine the was crafted with the help of companies nd Pfizer, we see a law that does not at of healthcare corporations and actually ke money by enabling the least, cheap- quality" and "increase value" by sup- oordination between doctors, hospitals, merging them into one entity; relying chnology to limit care options by ensur- based care;" and encouraging institu- outside of the hospital (cheaper and skilled providers (cheaper labor). l goals that the healthcare industry had me of these aspirations, turning them tled around healthcare reform, corpora- orts and accelerating the race to the across the country are adapting and mselves in a way that takes full financial tem. Sometimes it means merging with sometimes it means buying up those s. But, increasingly, it also means that g their employers venturing into activi- are clinics around town and setting up their own insurance plans—on top of continuing to make the relent- less cuts to services, staffing, equipment, and supplies that they always have. Here at National Nurses United, we often refer to all of these changes as healthcare "restructuring." In this article, we will list the top five trends RNs must know about this restructuring. Since the bottom line of all this reorganiza- tion is always to make more money, a goal that is typically in conflict with our role as patient advocates, registered nurses must work together at the unit level, facility level, and organizational level to fight any changes that would harm our patients or our practice. But, as always, the first step is education, so read up. Hospitals will use the Affordable Care Act as an excuse for anything and everything horrible they want to do it's like the 2014 hospital version of "The dog ate my homework." Want to cut benefits for part-time RNs? It's because of the ACA. Want to make layoffs? Blame the ACA. Want to reduce the hours for per diem nurses? The ACA made us do it. As soon as it was signed into law in 2010, hospitals started using the law and the "uncertainty" and "ambiguity" it supposedly created to justify all types of changes, mainly cuts to services and staffing. The ACA has been invoked at multiple bargaining tables, including Sutter Health and Kaiser Permanente, usually as the basis for some type of argument that the hospital will collect less revenue through drops in reimburse- ment. Hospitals never seem to anticipate that their revenue will rise due to the increased number of people eligible for Medicaid and who will now carry health insurance. 1 Hospitals are trying to shift patients who need to be in the hospital out of the hospital yes, hospital care can be expensive, but that's large- ly because hospitals charge so much (See page 6 for report on excessive hospital charges), plus money gets siphoned away to fund million-dollar executive pay packages, advertising and marketing campaigns, and profits to shareholders. To rein in spend- ing, the ACA encourages care to be provided in non-hospital set- tings. This means several things, including figuring out ways to move patients through the hospital faster, discharge patients early, or never admitting them into the hospital in the first place. In the Kaiser Permanente system, nurses are seeing patients held under "observation" status without formal admission for up to 24 hours before being sent home, and also changes in treatment protocols that shift care to outpatient settings or the patient's home. There, the burden of care is put on sometimes very ill patients themselves or on their family members. For example, a Kaiser facility in Califor- nia's Central Valley used to admit patients with deep vein thrombo- sis so that providers could administer blood thinners and monitor patients to make sure their clots did not cause more problems, but Kaiser protocols have changed in the past couple of years so that RNs are told to teach patients or their relatives how to inject them- selves and to return every day for testing of clotting levels. Clinic care does have its role in the healthcare system, agree RNs, but patients who legitimately require the type of round-the-clock observation and care RNs can provide in a hospital should not be shunted into a 15-minute clinic visit. Not surprisingly, some hospitals are rapidly building new clinics. Kaiser is apparently experimenting in constructing clinics with pre- fabricated walls, with the first such building in Kona, Hawaii. According to a June 2013 West Hawaii Today article, a team manag- er for Kaiser's National Facilities Services described the Kona clinic as a "pilot project" and that "national Kaiser officials wanted to find a way to make building clinics 'faster, better (and) cheaper.'" RNs point out that clinics are often staffed by lesser-skilled and nonunion workers and more loosely regulated. For example, the mandatory RN-to-patients ratios law that sets a maximum number of patients per nurse does not yet apply to clinic settings. Everyone wants to violate your RN scope of practice you, my dear rn, are a highly educated, trained, and skilled healthcare provider. Your labor does not, and rightly should not, come cheap. But the healthcare industry, anticipating many millions more people accessing health- care, wants that care to be provided most "efficiently" (read: at the lowest cost possible). At the same time, industry-connected policy wonks complain about a lack of RNs and general practitioners to provide the primary and preventive care people need. Instead of investing in the education of more registered nurses, nurse practi- tioners, and medical doctors (many countries provide a free or heav- ily subsidized medical school education), they argue that healthcare should be delivered "in new ways." That's why, across the country, there is a huge push for all kinds of lower-skilled, unlicensed staff to assume registered nurs- ing duties and practice, and to dissect and break down the com- plex work that RNs do into discrete tasks to be parceled out to ancillary staff. 2 3 J A N U A R Y | F E B R U A R Y 2 0 1 4 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 13

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