Unhealthy Debate

There's a new and nasty labor-management war. Health care is the battlefield. San Francisco is the front line.

"I don't see the timing as relative," says California Pacific's Kelley. "I see the behavior as relative."

But union representative Andrea Staples says that VNH has never disciplined anyone in a similar scenario and calls the suspension retribution.

Standing in the bed of a pickup truck holding a microphone in front of the Kaiser Medical Center in Oakland, Nancy Cosazza is obviously a bit uncomfortable and definitely unrehearsed. Maybe it's the hospital uniform and the white sweater, her hair pulled back into a bun ... there's just something wrong with this picture.

Cosazza has cared for the sick and wounded for 30 years, some of them as an Air Force flight nurse, the last decade as a registered nurse at Kaiser. Usually, if she's at the Oakland Medical Center, she's working in the emergency room.

Nurses didn't go on strike when Cosazza started in this profession. As a matter of fact, it wasn't until 1968 that the American Nurses Association lifted its official no-strike policy. Yet during the past year alone, the California Nurses Association has organized members in five Northern California hospitals. This is the kind of organized labor movement that many nurses considered unprofessional not long ago, and there is a reason for the general shift in attitude. It is a reason that relates directly to the societal shift to corporate health care, the merger of health organizations and the rise of the HMO.

Being a nurse has changed since Cosazza began her career, and most of that change, she says, has occurred during the past five years.

"There was this guy in his 20s, who fell off a scaffolding and had 14 broken bones in his arms and legs," she explains matter-of-factly. "I picked up the chart and it said, 'crutches and splint and send home.'

"OK, he had a splint on one arm. The other wrist was sprained. He had a broken ankle and his other leg broken ... there's no way this guy could walk on crutches. Plus, he's in and out of consciousness because of the [pain] medication.

"This guy was going to go home in the back of a pickup truck with his friend. He had to have a bedpan and a urinal and a hospital bed.

"I told the ER doctor, who fortunately agreed with me. I heard him on the phone saying, 'Just how many broken bones does it take to get somebody admitted nowadays?' "

And, of course, there is no such thing as a routine day in the emergency room.

"If I'm in triage starting at 3 p.m., I might not have a second [nurse] until 6 p.m. If there are four or five people waiting ... and here comes an ambulance in with a heart attack patient. I have to go to the heart attack patient. And I have to go get the charge nurse to help out, and I have to get the most stable patients out of there and into another room. There might be 10 people in line.

"It's my responsibility to keep an eye on that line and see if there's anyone who is really sick or bleeding from the head or what have you. I've got to take them in order of their condition," Cosazza explains.

"And somebody is in the ambulance entrance saying, 'Can you help me to go to the bathroom?' What am I going to do as a responsible nurse? I'm going to have to tell them, 'I can't help you right now.' And sometimes I don't even have time to tell them that. It's perceived as inattention and rudeness, and people think we don't care."

In business theory, this predicament is known as the "speedup effect." Fewer workers must do more things. In health care, though, the speedup effect is not theory but reality, and it's challenging the professional practice of nursing. Registered nurses are required by state law to advocate for patients and to exercise independent clinical judgment. It's part of their license as nurses. This charge makes nurses officially sanctioned whistle-blowers, a status that is particularly annoying if you're a health care conglomerate and want to admit fewer patients and assign more and more routine tasks to unlicensed staff.

The more health care corporations restructure, the more nurses are squeezed by the push for profit. And so, three decades after becoming a nurse, Nancy Cosazza spends her time speaking at legislative hearings, and handing out leaflets to strangers. And standing in the bed of a pickup truck outside a hospital with a microphone, saying,

"Do we know why we're out here and not in there where we should be?
"Corporate tyranny."

Throughout the first few months of this year, the residents of Castro Valley were inundated with television commercials about the caring world of the Sutter/CHS Corp. They received brochures in the mail telling them that Sutter could "save" their community's Eden Medical Center -- a publicly owned hospital governed by an elected board of directors -- from fiscal pressures that were jeopardizing its very existence.

Because Eden is owned by a hospital district, and hence the public, Sutter's bid to purchase it required a vote of the people. The proposed purchase also required Sutter to overwhelm opposition from unions, specifically, the Service Employees International Union. Sutter and the SEIU are archenemies. There is a history of bitter labor fights at other Sutter facilities. The SEIU was not about to let Sutter take over management of another hospital where the union represented employees without a fight.

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