National Nurses United

It's 2 a.m. and your two-month-old baby is wailing with a 102 fever. You've tried everything and are on the verge of panic. Should you take him to the ER now? Should you wait until the morning? Are you overreacting? But what if it's something serious? Kaiser Permanente members, however, need not face these health quandaries alone. As a Kaiser patient, you can call 24 hours a day, seven days a week, for any reason and speak to an advice nurse over the telephone who can help you assess the problem, determine what course of action to take, and access medical services. Speaking as a Kaiser member who has called the advice line on a number of occasions (And, yes, once for our toddler who would not stop vomit- ing!), the advice nurses are a godsend and a trusted, professional resource that is not only much appreciated among Kaiser patients, but considered one of the unique benefits of being a Kaiser member. That is, if you ever actually get to talk to an advice nurse. The ugly truth is that Kaiser's entire care model depends on restricting, as much as possible, member access to advice nurses through the use of unlicensed teleservice representatives (TSRs) who act as gatekeepers to nurses by interacting with patients via conversation scripts. For nurses who actually do get connected to patients, Kaiser pushes them to work as quickly and intensely as they are humanly capable through common call center management techniques that nurses say are wholly inappropriate when applied to their profession of caring for and ensuring the safety of live human beings: patients. These methods include heavy micromanagement, timing for efficiency every segment of the process, and counseling and discipline for performance that doesn't meet their benchmarks. Under these onerous working conditions, approximately 950 regis- tered nurses who work at Kaiser's three major Northern California call centers struggle and fight to provide the best patient care they possibly can. The numbers tell the story: Out of nearly 14 million calls Kaiser received in 2015, only close to 3.5 million—about a quarter—were referred to registered nurses, according to Kaiser's own statistics as presented via video monitors at the Vallejo call center. Kaiser claims that the 75 percent of calls the Appointment and Advice Call Center, often referred to by nurses as the AACC, receives that don't get rout- ed to a registered nurse are "routine," non-urgent calls for appoint- ments and other administrative needs, but the RNs aren't buying it. "That's totally not true. They're getting stopped at the teleservice representative," said Mary Magtanong-Sigua, RN and chair of the professional practice committee for the call center located in Vallejo, Calif. "And we know the people calling are sicker and sicker than ever before." Multiple nurses noted that Kaiser hospitals are dis- charging patients too soon, earlier and faster than ever, meaning that patients are developing serious complications at home and turning to the advice nurses for help by phone. "We end up with those calls." As Mary Roth, an 18-year call center RN who also holds one of two Kaiser Quality Liaison positions representing the call centers, notes, "The people who are not that sick, who have means, who know how to navigate the system, they're all going to go online [to Kaiser's website]. The ones who are sickest, who are elderly, who may have English as a second language, are going to call us." In other words, the call center fields inquiries from the most vulnerable of patients. While nurses say there have always been issues with the way Kaiser's call centers operated, the problems have accelerated and compounded within the last five years. To protect their patients, call center nurses are fighting for reforms that they say are desperately needed to keep members safe and ensure they receive the care they deserve and are paying for. To protect their profession and their practice, call center nurs- es are also championing changes needed to improve their working conditions, safeguard nursing judgment and the assessment process, prevent injuries among call center RNs, and attract and retain experienced call center nurses. They demanded improve- ments as part of this current round of 2017-2018 bargaining for the master contract covering 19,000 Kaiser Permanente regis- tered nurses and nurse practitioners. (Please see the article on page 8 about Kaiser RNs' and NPs' recent settlement for more information.) "All registered nurses should understand and care about what we call center nurses are facing because our experience foreshadows what to expect in nursing and healthcare in the years to come as corporate J A N U A R Y | F E B R U A R Y 2 0 1 8 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 25 We've all been there.

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