The Cranberry Scoop - Massachusetts Nurses Association

Inside this issue:

The Chair’s Message
Stephanie Stevens, RN

“A truck system is an arrangement in which employees are paid in commodities or some currency substitute (referred to as scrip), rather than with standard money. This limits employees’ ability to choose how to spend their earnings—generally to the benefit of the employer. As an example, script might be usable only for the purchase of goods at a ’company store’ where prices are set artificially high.

While this system had long existed in many parts of the world, it became widespread in the eighteenth and nineteenth centuries, as industrialization left many poor, unskilled workers without other means to support themselves and their families. The practice has been widely criticized as exploitative and similar in effect to slavery and has been outlawed in many parts of the world. Variations of the truck system have existed worldwide, and are known by various names.

The practice is ostensibly one of a free and legal exchange, whereby an employer would offer something of value (typically goods, food or housing) in exchange for labor, with the result being the same as if the laborer had been paid money and then spent the money on these necessities. The word truck came into the English language within this context, from the French troquer, meaning ‘exchange’ or ‘barter.’ A truck system differs from this kind of open barter or payment in kind system by creating or taking advantage of a closed economic system in which workers have little or no opportunity to choose other work arrangements, and can easily become so indebted to their employers that they are unable to leave the system legally. The popular song Sixteen Tons dramatizes this scenario, with the narrator telling Saint Peter (who would welcome him into Heaven upon his death) ‘…I can’t go; I owe my soul to the company store.’

Truck systems came under increasing criticism, and laws were passed in many jurisdictions that made it illegal for payment to be made other than in lawful money, and to specify how or where employees spent their pay.

Origin of the saying ’I’ll have no truck with that’ to mean ‘I will have nothing to do with that system.’ ” **

I know many of us are currently in contract negotiations and many of the proposals are related to Health Care Benefits. Some of the proposals may include increasing co-pays and deductibles unless the services were received at the specified institution… sort of like The Company Store. I don’t have a position pro or con on this but I think it is important to remember history when we make our decisions on these questions.

In Unity,
Stephanie Stevens RN,
Chairperson, Regional Council Three

** http://en.wikipedia.org/wiki/Company_store

Region 3 2011 Council Meeting Schedule

(Meeting are generally held on the fourth Tuesday of the month—no meetings July and August)

January 25, 2011
February 22, 2011
March 22, 2011
April 26, 2011
May 24, 2011
June 28, 2011
September 27, 2011
October 25, 2011
November 29, 2011
December 29, 2011 (Thursday)

Start time is 6 p.m. at the Region 3 office. Members are welcome to attend— please notify the Region 3 office.

2010 – 11 Regional Council Three Members & Staff

*Chair – Stephanie Stevens: Sandwich, Jordan Hospital

*Vice-Chair – Peggy Kilroy: Centerville, Cape Cod Hospital

Treasurer – Rick Lambos: Edgartown, Martha’s Vineyard Hospital Chair

*Secretary – Rosemary O’Brien: Harwich, MNA Board of Directors

Louise Bombardieri: Pembroke, Brockton VNA Co-Chair

Deb Caruso: Brewster, Cape Cod VNA Chair

*Trudy Crowley: East Falmouth, Falmouth Hospital

Janet DeMoranville: Lakeville, Morton Hospital Chair Designee

*Donna Dudik: Weymouth, Boston Medical Center

Patricia (Karen) Duffy: Marshfield, Brockton Hospital Chair Co-Designee

Ellen Farley: Middleboro, Unit 7 Chair Designee

Joanne Kingsley: Duxbury, Brockton Hospital Chair Co-Designee

Jean Lessard: Brockton, Brockton VNA Co-Chair

Kathy Metzger: Taunton, Brockton Hospital Chair, MNA Board of Directors

Joanne Murphy: West Wareham, Jordan Hospital Chair

Nicky Powderly: Forestdale, Falmouth Hospital Chair

Shannon Sherman: Yarmouth Port, Cape Cod Hospital Chair

* elected/appointed

Barbara ‘Cookie’ Cooke: Community Organizer

Pat Conway: Office Manager

We’d love to hear from you!

The Cranberry Scoop is published four times per year by Regional Council 3. It is a publication made available to MNA Region 3 members as a means of communicating information and topics of interest relative to our region and we invite members to submit writings to the newsletter, especially through the editorial voice.

We reserve the right to edit all submissions for brevity, content and clarity. Include a daytime and evening telephone number.

Email to region3@mnarn.org or please sign your submission and mail to:
MNA Region 3
P O Box 1363
Sandwich, MA 02563

Winter / Spring 2011 Region 3 Continuing Education Programs

A Social Networking Media: Implications for the Nurse
Current Trends in Bariatric Surgery
Current Trends in Orthopedics

Visit Events Section

Save the Dates, etc…

March 15 CE—Social Networking Media Canal Club, Bourne MA
March 30-31 Labor Leader Summit Doubletree, Westborough MA
April 7 CE—Current Trends in Bariatric Surgery Canal Club, Bourne MA
May 5 CE—Current Trends in Orthopedic Surgery Canal Club, Bourne MA
June 5-7 NNU Staff Nurse Assembly Washington, DC
Oct 5-7 MNA Convention Burlington MA

Around The Region: What’s the Scoop?

Morton Hospital– Negotiations have been reopened on the issue of pension. We have had one meeting so far where we exchanged our proposals, our next meeting is scheduled for December 8. The hospital continues to look for "a clinical and economic partner" to buy us and has been touring the facility with several potential candidates. Many units are still struggling with poor staffing levels and management has been very strict about the use of incidental overtime.

Respectfully submitted,
Janet DeMoranville,
Unit Chair Designee

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Martha’s Vineyard Hospital— Contract negotiations continue slowly with no progress toward a settlement at this time. Our contract officially expired on September 11, 2010 but has been extended until further notice keeping all benefits and rights intact while the Nurses Committee attempts to negotiate a new agreement. Discussions with management continue over security issues and a grievance has been filed in the ER contesting a recent change in working conditions.

Respectfully submitted:
Rick Lambos RN
MNA Unit Chair

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Caritas Good Samaritan Hospital— Good Samaritan had its first labor management meeting with new director Allison Zimmerman as Cindy McManus left MNA. There were many issues addressed with follow up needed. A few are: the pharmacists are going to new shifts, 7 days on 7 days off which is done at other facilities (the kinks need to be worked out). After we reduced beds on one of the floors and staff the census has been up so we need to hire 2 float RN positions. Our interim PeriOp director is leaving to be closer to home and Nancy Spirko (from Cape Cod) is arriving soon. Very busy discussion and many issues to be followed up with next meeting!

Respectfully submitted,
Karen Gavigan, RN
MNA Unit Chair

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Cape Cod Hospital— Currently at Cape Cod Hospital negotiations have been slow to progress. It truly seems like the hospital is not willing to negotiate with its dedicated nursing staff. After eight sessions, the negotiating committee has readdressed several of its original proposals in an effort to work with the hospital to reach a fair and respectful contract. Our continued efforts have been unanswered by hospital management despite its reporting in several media outlets of having a $31 million dollar budget surplus. We may leave these meetings discouraged and feeling disrespected but we remain committed to being unified and focused on our ultimate goal of safe patient care and keeping a strong contract WITHOUT CONCESSIONS! I personally cannot thank my membership enough for their show of force at our last session. About 50 RN’s attended negotiations which helps to send an important message to the management – we will not be ashamed of our "mature" contract and we will not be swayed. The nurses at this hospital are a strong, fair and reasonable group of professionals and the negotiating committee looks forward to everyone’s increased involvement in the near future – not only within our facility but along side with the Falmouth nurses as well.

Respectfully submitted,
Shannon Sherman BS-RN
MNA Unit Chair

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Falmouth Hospital—Negotiations have been frustrating as management refuses to effectively address our proposals while continually addressing their own proposed "takeaways". This is despite the fact that CCHC is fiscally sound and making money. They have asked for mediation from day one, perhaps in hope of convincing a third party that their "doom and gloom" scenario for the future actually justifies their "package" of preposterous proposals. We have met with the Cape Cod Hospital negotiating committee to ensure a united front and a strong response to CCHC’s attempt at concessionary bargaining and hope to move forward as a single voice.

Respectfully submitted
Nicky Powderly, RN
MNA Unit Chair

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Signature Healthcare Brockton Hospital— I would like to remind my members and all nurses of the importance of carrying your own malpractice insurance. We unfortunately are seeing a campaign by the National Council of State Boards of Nursing giving instructions on how to file a complaint against your nurse. MNA is researching who is financing this campaign. They are airing television ads and are sending mailings to both nurses and consumers. I have copies of these flyers. There are many untruths regarding malpractice, such as the ‘you’re more likely to be sued if you have i.e. deep pockets theory.’ This is so false; no one is able to find out whether you have it or not. The second is ‘if you feel you need it then you must be a bad nurse.’ Seriously – come on. You have car insurance; doesn’t mean you’re a bad driver. It’s insurance in case something happens. Your malpractice insurance protects you and, more importantly, your license— that little piece of paper which allows you to WORK. It is as easy as an anonymous phone call to start an investigation by the Board and no one should go in front of the Board without legal council. Your malpractice will pay for that council, your hospital will not. So please, I urge you to get or keep up your malpractice insurance—it is not that expensive. There are a few companies that offer this insurance. The most popular is NSO – it is 108 dollars a year and it is the best money you will ever spend. Just ask yourself how much is my license worth??

Respectfully submitted Kathy Metzger, RN
MNA Unit Chair

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VNA of Cape Cod—VNA is undergoing some restructuring with this dismantling of our new in-house case manager positions. We continue to meet with management to strategize on how to continue to provide quality patient care while management is telling us to speed up and not ‘solve world hunger.’ Despite the winter weather, our patient numbers remain high. Our case managers are managing more patients and our floats are traveling farther and farther every day. Negotiations will be right around the corner so, we ask everyone to give some thought to returning their ‘wish lists’. Next open bargaining unit meeting will be on January 25 at 5 p.m. in the Dennis office. We have a lot of new and younger nurses and hope to see them at the meeting and look forward to some new ideas to make our bargaining unit even stronger.

Respectfully submitted
Deb Caruso, RN
MNA Unit Chair

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Jordan Hospital— On November 22, 2010 the MNA nurses at Jordan Hospital voted no and rejected the tentative agreement. The MNA Committee will move forward and continue to work towards the goal of a satisfactory agreement for the bargaining unit we represent. We thank our members for their support . Wishing all our members and their families a happy and healthy new year!

Respectfully submitted,
Joanne Murphy RN, MNA Chair
Kristine Kenyon, RN Co-Chair
Jordan Hospital Bargaining Committee

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Unit 7 Commonwealth – The Executive Board reached a tentative agreement at the end of October and has ratified the agreement. The agreement includes a 7% salary increase over the three-year agreement. The sense of change in governor leadership was an impetus to close out the agreement with some favorable economics for the members and there is a committee to address MOT. The expectation is that they will have to mount a campaign on MOT and other intransient issues again in subsequent bargaining.

Respectfully submitted
Ellen Farley, RN
Unit Chair Designee

MNA membership dues deductibility for 2010

Federal law allows you to deduct 95% of the amount of your membership dues paid in 2010. The law disallows the portion of dues used for lobbying expenses (5%).

Medication Administration
Are You Taking a Risk?

We all remember the “Rights” of medication administration drilled into us back in our nursing school days. In the real world, faced with the fast-paced and hectic environment, RNs find themselves taking short cuts when administering medications and are putting their license and patients at risk. Below is a chart of some common risky behaviors. Read through and check to see if you are taking any of these risky short cuts. The MNA strongly encourages every RN to obtain liability insurance (see info box). Table adapted from: http://www.massnurses.org/files/file/intranet/pdfs/NurseAdviseERR201009.pdf

At Risk Behaviors	Examples	Actual Errors/Preventable Adverse Events
Bypassing pharmacy review of orders or dispensing of medications to give medications on time	Removing medications from an Automated Dispensing Cabinet (ADC) via override Borrowing medications	Incorrectly prepared IV infusion (improper dilution) on the unit so it could be administered on time because pharmacy had not yet dispensed it Pulled the wrong drug with a look-alike name via override from an ADC
Failing to check and verify new orders on the MAR to stay on schedule	Administering a medication before the MAR entry has been verified Not checking for new orders before drug administration	Administered discontinued medications Administered a drug to the wrong patient when a new medication order appeared on the eMAR and was not verified (pharmacy had entered the medication into the wrong patient’s profile)
Documenting administration at the scheduled time, but giving the medication early, or planning to administer it later	With a paper MAR, just initialing the entry, suggesting the drug was administered at the right time, even though it was given later or earlier With an eMAR, charting or back-charting drug administration at the scheduled time, not the actual administration time Bar-code scanning medications at the correct time to give the appearance of being compliant, but giving the medication later or earlier	After documenting an IV antibiotic as given at the correct time, forgot to go back to actually administer the drug Nurse administered the next dose of a high-alert medication very close to the prior dose which was given several hours late but was documented as being given at the correct time Nurse charted medication administration at the time scheduled but administered it later, which led to inaccurately timed collection of blood for a drug level and incorrect dosage adjustment
Altering the schedule to avoid late administration	Revising the scheduled administration time to coincide with the late administration time to show an “on time” administration	Pharmacy made a dosing error when re-entering a medication order after the scheduled time had been changed to accommodate late administration
Pre-pouring /gathering medications ahead of time for one or more patients to speed up the drug administration process	Pulling medications for several patients and carrying them in pocket until needed for administration.	Gathered two patients’ insulin pens and mixed them up, giving each patient the wrong type/dose
Unsecured medications and/or unobserved administration	Leaving medications in the room for the patient to take/parent to give at the right time Pulling medications ahead of time and leaving them in a cup on table outside patient’s room	Unattended medications left in patient’s room missing when nurse went back to administer them Nurse scanned medications at the scheduled administration time, left them in the patients’ room, but forgot to go back to administer them/li>
Having another RN remove meds from ADC for another RN/MD to give	RN attending to patient needs knowing that medication is due requests another RN to get them and delivers meds to room for RN to give Emergency requires medication and request for another RN to get medication	This practice has resulted in verbal counseling, suspensions and terminations citing poor documentation and diversion MA BORN has also ruled that, unless the Hospital has a written policy that covers these situations, this practice could result in RN license suspension or forfeit.
Administering medications to patients without patient assessment or adequate information about the drug	Administering medications without checking patient’s height, weight, allergy status, related lab/monitoring tests Not assuring that the medication makes sense for the patient based on indication and the patient’s condition	Medications were hurriedly scanned and administered to stay on time; an allergy alert was overridden Medications given without time for assessment or review of lab values; an electrolyte supplement and antihypertensive meds should have been held

Things You Should Know…

Personal Professional Liability Insurance

Why YOU need your own policy

For protection in the event that your patient facility or agency sues you.
For legal representation before the Board of Nursing, the agency with disciplinary authority over nurses. Most employer policies do not provide nurses with coverage for attorneys fees in discipline cases. Most individual liability policies do provide such coverage but, ask to be certain when obtaining coverage. (MNAendorsed NSO insurance provides this coverage up to $10k in legal expenses per proceeding)
For protection if you render nursing services to a neighbor or friend who sues you. In an emergency you might be covered under the Good Samaritan Act but, for actions or advice gone awry in a non-emergency, that protection would not apply.
For protection over and above the level that your facility or agency may provide (Have you seen a copy of their policy? Ask for one!).
To provide you with your own attorney in the event of a conflict of interest with your employer or fellow practitioners.
Because coverage is inexpensive. For most nurses, the cost is under $100/year and may be a tax deductible expense. More so, defense costs are provided outside the limit of liability. By comparison, attorneys fees generally begin at $200 per hour.

The MNA recommends NSO as a preferred provider of liability insurance. Go to www.nso.com or pick up an NSO application brochure at MNA, 340 Turnpike St, Canton MA 02021

AEDs For Life Campaign—Update

Regional Council Three has been privileged to assist three (3) non-profit entities in the region with the purchase of an AED through our AEDs For Life Campaign to date during fiscal year 2011. Funds have been granted to the Holy Family Church in East Taunton, the VNA of Cape Cod in Hyannis for their headquarter office and, most recently, the Blessed Kateri Church in Plymouth.

The Regional Council earmarks $4000 per year (fiscal) for grants to non-profit entities with 25 or more members who purchase an AED. Often, these entities initiate fund raising efforts to purchase the AED in anticipation of our help. Under the terms of this program, the region will reimburse the entity for half of the cost of the equipment, up to $800.

These grants total $2047, therefore, we would be able to help at least two (2) and possibly three (3) more entities during this fiscal year. If you know of a non-profit entity that might be interested, please ask them to contact Pat Conway at the region office via telephone 508-888-5774 or email region3@mnarn.org to learn about the qualification criteria and how to apply for this valuable benefit.

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