National Nurses United

J A N U A R Y | F E B R U A R Y 2 0 1 5 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 7 We continue our explorations of the life and career of Kay McVay, a longtime intensive care unit RN at Kaiser Permanente and pres- ident emeritus of the California Nurses Asso- ciation. In this installment, McVay recounts the long but victorious struggle of CNA to win the first safe staffing ratios in the nation, and to defend against the hospital industry's attempts to overturn and undermine them. When did the nurses first propose the idea of passing a law setting the maximum number of patients that could be assigned to one RN? CNA first tried in 1992, but we had been talking about it forever. We started working really hard to cut down the number of patients on the floors in the 1980s because it was very bad, really very bad. Before the ratio law came in, on my medical floor it would not be unusual for a nurse to have 10, 15, even 20 patients. You just couldn't cover everything that you were supposed to be covering. You couldn't get to the patients when they needed you. And I was working on a cancer floor and you'd have 30-some patients. And on night shift, you were it. Is there any particular shift that sticks out in your mind as your motivation to fight for ratios? Oh yes. As I said, I was working nights on oncology. One shift, we had three deaths that night. And these are patients you have seen over and over because of the cancer. They come in frequently. I felt very badly about not being able to do more for the patients, giving them more attention, getting them medication that would help them not hurt as bad while they were going through this. They could have passed in a better way. And I felt bad that I couldn't spend more time with the families, helping them, comforting them. As a nurse, you treat the family, too, because they are going through a lot of hell. That night was just too much for me. I called in the next morning and said I needed to take the day off. It really did hit me very, very hard. I don't know if nurses realize that it took CNA seven years and multiple tries to pass the ratios law. That took perseverance! You bet. Of course, the hospital industry hated the idea of ratios and fought it tooth and nail. As I said, first we tried in 1992. Didn't pass. Then we tried to package it with healthcare insurance protections for consumers in Proposition 216, which was a ballot initiative. That didn't pass either. Then we actually got another bill through the Legislature, but Gov. Pete Wilson vetoed it. Each time we lost, I was just madder than hell that people couldn't look beyond themselves at what we were really trying to do. It was to help the patients, for crying out loud. Then in 1999, we finally passed AB 394, but we didn't think the governor would sign it. Obviously nurses were putting intense pressure on Davis to sign. But there was also a little-known story about a personal contact that may have tipped him over the edge. Can you tell it? Well, Davis was hemming and hawing and we heard through our government relations staff that he really wasn't going to sign it. But it turned out his chief of staff had a family member that was in the hospital during that time, and she saw first hand everything we had pointed out and said was the problem and why we needed to have this particular bill. She experienced how it was so important to have that RN at the bedside. Well, she came back and told Gray Davis to sign it, and he did. Do you remember where you were or what you were doing when you got the good news? I was at home cooking, actually, I think. And I got a telephone call. I can't remember the exact person who called. She said, "Kay, you won't believe it. He signed it." I was in Seventh Heaven. I hung up the phone and started yelling, "Yahoo!" I was so excited. But that wasn't the end, right? Then the nurses had to fight against the industry to convince the Department of Health Servic- es to set a numerical ratio that was safe and reasonable. Oh yes. The California Hospital Association fought and fought. They tried to make the ratios nonbinding. They tried to allow hospitals to average out the staffing. They tried to make the ratios not apply during meals and breaks. On and on. We overcame all of that, organizing huge rallies in Sacra- mento and meeting with the state and going over the issues and numbers with them so that they would understand what it was like working on the floors. When they released the actual numbers, I thought it was still too many. How did you feel when Gov. Schwarzenegger tried to mess with the ratios in 2004, making them not apply to emergency departments and delaying the better med-surg ratios? I was furious, but I was already furious with him anyway. The whole atmosphere he creat- ed when he took office was just so arrogant. But we taught him a lesson! We protested everywhere he showed his face—I think it was hundreds of protests in just 12 months, which works out to like one almost every other day. And we won. From talking to nurses, have ratios made a difference? Oh yes. The nurses who were already work- ing before ratios went into effect say it makes a huge difference. They appreciate it. I think it's important for the younger nurses who entered the profession after ratios were already in place to understand what it was like before and to realize that if we don't defend, advance, and enforce the ratios, that we could lose them. Ratios was not some regulation that our government thought was a good idea and implemented. It was the nurses' idea and we fought to make it happen. "Conversations with Kay" appears in each issue of National Nurse. Through McVay's stories, we docu- ment the origins of the modern staff RN movement as well as the changing practice and culture of nurs- ing and healthcare. Conversations with Kay

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