National Nurses United

system crashed in the middle of the day. TSRs were unable to trans- fer calls to advice nurses, so managers instructed the RNs to pick up their chairs and go sit next to TSRs and take over the headset if a patient called with emergent symptoms. "It's pathetic," said Roth. "They still have no backup plan for crashes." * * * When you consider the entirety of Kaiser's Appointment and Advice Call Centers—the way the workflow is improperly designed between TSRs and nurses; the organization's profit motive for relying on call centers; the mentality and mindset of managers who measure AACC employees against typical call center standards and work pacing in other industries; the lack of proper tools, equipment, and nurse staffing; and the enormous mental and physical stress the work puts on RNs, it's no wonder that many call center nurses are unhappy about their work environments and their ability to provide safe patient care. In 2016, CNA nurse leaders conducted a survey of RNs at Kaiser's three Northern California call centers. The results showed, among other things, that more than 66 percent felt pressure to avoid making appointments for patients in violation of their professional judgment; more than 50 percent felt they could not consistently apply the nursing process to their patients, give advice, or advocate; more than 85 percent of their patients believed that the TSR was a health professional; more than 66 percent of nurses had to revise actions or instructions given by a TSR; and almost 50 percent of RNs felt bullied in their monthly coaching sessions by managers. In other words, Kaiser prevents them from doing their jobs. "I like my job. I hate the environment," said Berry matter of factly. "Let people do their job. Stop super micromanaging." Of course, the call center nurses are organizing and fighting back. The quality liaisons and nurse leaders have been meeting regularly to discuss ways of addressing issues. One example of a solution to the problem of supervisors interrupting nurses while they are on the phone with patients was development of small placards reading, "Please do not distract me when I am providing patient care." that nurses can hold up. The reverse side includes some important phrases for advice nurses to use in establishing their role as RNs with patients. In addition, CNA's nursing education department last year hosted a series of well-attended continuing education courses focused solely on call center nurses' workplace and practice issues. The professional practice committees at the various call centers have also been occa- sionally successful in modifying TSR scripts to make them safer. And as part of recent contract negotiations, the call center nurses put three specific proposals on the table. The first was to be able to doc- ument and keep notes during their reviews of TSR scripts. The second was to reinstitute regional professional practice committee meetings among the three call centers so that nurses are able to share informa- tion and better understand AACC issues on a systemwide level—which they won. And the third was to establish a standing committee to exam- ine on a quarterly basis technology and its use at the call centers. The advice nurses are determined to win improvements so that they can do what they love best: take care of their patients. "I know I am an asset to Kaiser," said Berry. "I get satisfaction every day on a regular basis from patients who tell me, 'Thank you. You've calmed me down. You've helped me so much.' I'm there for the patients." Lucia Hwang is editor of National Nurse. Momo Chang contributed reporting to this story. 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 31

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