The Cranberry Scoop

Inside this issue…

• The Chair’s Message
• Spring 2011 CE Program & Fall 2011 Preview
• Save The Dates, etc…
• Around The Region: What’s The Scoop?
• NEW! FAQs from the bedside…
• Things You Should Know—Scholarships!
• Download original pdf

The Chair’s Message
Stephanie Stevens, RN

Spring has arrived and with the longer days, warmer weather, and budding trees and flowers comes a time of renewal. It’s a good time to examine our past and plan to act instead of react to our future in Nursing and Health Care.

If you were able to attend the recent Labor Leader Summit given by MNA in Westborough, you heard about “Six Sigma and Lean Staffing: What it Means for Nurses” by Charley Richardson, “Overview of Healthcare Financing and Hospital Networks” by Julie Pinkham, MNA Executive Director, and were able to participate in lots of networking and planning with nurses throughout the state in all areas of practice. It was a very powerful experience. Please check out the MNA WEB site for more info on these subjects.

Some of what I learned:

• In the 1980’s DRGs (Diagnosis Related Groups) were developed and reimbursed by the insurance industry in an attempt to maximize profits. Ancillary services were cut, nurses left the profession, and hospitals increased profits. The Diagnosis Related Groups (DRG) were developed for the Health Care Financing Administration as a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its case mix) to the costs incurred by the hospital. While all patients are unique, groups of patients have common demographic, diagnostic and therapeutic attributes that determine their resource needs. The DRGs form a manageable, clinically coherent set of patient classes that relate a hospital’s case mix to the resource demands and associated costs experienced by the hospital. Each discharge in the UHDDB was assigned into a DRG based on the principal diagnosis, secondary diagnoses, surgical procedures, age, sex, and discharge status of the patient.*
• Governor Dukakis changed healthcare in Massachusetts. **
• Governor Weld undid these changes. **
• ‘I favor putting the scorpions in the same bottle . . . and letting them fight it out,’ said Democrat Edward L. Burke, then cochairman of the Legislature’s healthcare committee.( 1992)1

  About 30 hospitals closed and there was a nursing shortage and double digit raises for nurses (supply and demand).

• The insurance industry developed capitation, which became a perverse incentive not to admit patients to the hospital. Capitation is a fixed payment remitted at regular intervals to a medical provider by a managed care organization for an enrolled patient. 2
• Hospitals developed networks to develop clout with the insurance industry and now we have ACOs (Accountable Care Organizations) where these systems are incentivized to have control over the person’s usage. ACOs would make providers jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work they’d have to seamlessly share information. (Note: Think there is another reason for computerized documentation?) Those that save money while also meeting quality targets would keep a portion of the savings. But some providers could also be at risk of losing money..

  HHS estimates that ACOs could save Medicare up to $960 million in the first three years. That’s far less than one percent of Medicare spending during that period. If the program is successful, it can be expanded by the Secretary of Health and Human Services.3

  $960 million and that is just Medicare… when it is applied to private insurers, the projected profits skyrocket. Many of us, as patients, have experienced this “control” already in the form of restrictions on covered treatments and doctors. Many of us, as bargaining unit members, have sat across the bargaining table and been told that, basically, it wasn’t that the hospital didn’t have the money; it was just that the hospital did not want to spend it on the nurses. However, there doesn’t seem to be any end to the consultants we see and we still don’t have Nurse/Patient Ratios (Safe Staffing)….

So, we can react to all this or we can ACT.

1. We know collaboration/networking by nurses works. The politicians know it too or they wouldn’t be trying to take collective bargaining rights away from workers.
2. Do not lose your standards… if it is wrong, it is wrong! Hiding from the issue is wrong and a problem. Face the issue… embrace the issue and network… you are not alone!
3. Dovetailing of seniority must happen. Seniority is a basic union principle but, it needs to be union seniority, not individual unit seniority. Bargaining units are going to be developed into networks…if it hasn’t happened to you yet, it will. We are one… and we are stronger that way.
4. No concession approach to bargaining… give nothing back and do not be ashamed of your benefits… you work darned hard! The middle class is disappearing and we need not to go quietly!
5. Shore up your contract language on successorship, Kentucky River, and “In House” meetings. MNA is developing “Best Contract Language” on these things so, if you don’t know what it is, ask. If you don’t know who to ask, call 508.888.5774 and talk to our Region 3 Office Manager, Pat, and she will get you to the right person.

Why are these people trying to distract us when our “job” is to save lives? Why do they treat us as if we are “bad” when we are MNA/NNU members? Because they fear us and what we do… do not apologize, embrace it! That and our unity will defend our patients… and make no mistake, it is very powerful!

In Unity,

Stephanie Stevens, RN, CNOR
Chairperson MNA Region 3

Sources:
*http://health.utah.gov/opha/IBIShelp/codes/DRGCode.htm
**Policy in Politics and Nursing by Diana J. Mason, Judith Kline Leavitt, Mary W. Chaffee, pg.410
1http://hcrenewal.blogspot.com/2009/01/scorpions-in-bottle-shook-handssecret.html
2http://medical-dictionary.thefreedictionary.com/capitation
3http://www.kaiserhealthnews.org/Stories/2011/January/13/ACO-accountablecare- organization-FAQ.aspx?gclid=COXwzJrxhagCFQVy5Qodm0_lrQ

Spring/Fall 2011
Region 3 Continuing Education Programs

Contact Hours will be provided. To successfully complete a program and receive contact hours, you must: 1) sign in, 2) be present for the entire time period of the session and 3) complete and submit the evaluation.

Chemical Sensitivity: Scents may trigger responses in those with chemical sensitivities. Men and women are requested to avoid wearing scented personal products when attending this meeting/program.

Disability Help: Please contact the MNA Regional Council Office with any questions about special needs accessibility.

Program Cancellation: MNA reserves the right to change speakers/cancel programs for extenuating circumstances. Registration fees will be returned for all cancelled programs.

Region 3 CE Registration Form 5/5/11 Current Trends in Orthopedics

Name __________________________________________________________________â–¡

RN â–¡ LPN â–¡ APN Other (specify) ___________

Email Address___________________________________________________________

Adress:___________________________________________________City______________________State______Zip___________

Phone: Daytime______________________________Evening_______________________________Cell_______________________________

Place of Employment _________________________________________________________________________

Member Fee (by check only):

Please include a $25 check (a separate check for each program you wish to attend) which is a placeholder fee and will be returned to you upon attendance at the program.
Non-members $95 non-refundable.
Make your check payable to MNA Region 3, and mail to:
MNA Region Council 3, Post Office Box 1363, Sandwich, MA 02563

Save the Dates, etc…

May 5 CE—Current Trends in Orthopedic Surgery
Canal Club, Bourne MA

May 13 Clinical Conference

June 1 MNF Scholarship
Application Deadline

June 5-7 NNU Staff Nurse Assembly
Washington, DC

July 18 Rosemary Smith Memorial Golf Tournament
Lakeville MA

Sept 20 Public Health Committee Hearing

Oct 5—7 MNA Convention,
Burlington MA

***********************

SPECIAL ANNOUNCEMENT

The Deb Walsh Memorial OB/GYN Program will not be offered this year

Unfortunately, the Education Coordinator from Women & Infants Hospital recently notified us that, due to restructuring at W&I, they would be unable to provide content/speakers for our program this year.

Given the time constraints, it was not possible for the MNA Nursing Division to complete the necessary accreditation process for a program that would provide contact hours towards relicensure.

We have asked the Nursing division to work with us as we make every effort to resume this important program in 2012.

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, MNA Board of Directors
Patricia (Karen) Duffy: Marshfield, Brockton Hospital Chair Co-Designee
Ellen Farley: Middleboro, Unit 7 Chair Designee
*Karen Gavigan, Berkley, Steward Good Samaritan Hospital Chair, MNA Board of Directors
Joanne Kingsley: Duxbury, Brockton Hospital Chair Co-Designee
Jean Lessard: Brockton, Brockton VNA Co-Chair
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, RN: Community Organizer
Pat Conway: Office Manager

Region Three 2011
Council Meeting Schedule

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.

Around the Region

Morton Hospital – The nurses and healthcare professionals have managed to keep their defined benefit pension plan intact! At our last negotiation session, management came to the table and withdrew their proposal to change the benefit to a defined contribution plan, with the understanding that we would withdraw our proposal for the multiemployer Taft Hartley plan set up by the MNA. This means our defined benefit plan is safe until December 31, 2011. It has been announced that Steward is the buyer for the hospital. No doubt we will be back at negotiations with them at the reopener at the end of this year. Stay tuned for more info!

Respectfully submitted,
Janet DeMoranville, RN
Unit Chair Designee

Caritas Good Samaritan Hospital— We have our next meeting April 6 at 4 p.m. at Nocera’s in Stoughton. Nothing much new except Allison and I did meet with Steve Enright (from Steward health care and main person at HR) and he wants to set up some dates to address all the issues. We are hopeful that this will occur. At Good Sam, we are dealing with grievances and staffing issues.

Respectfully submitted,
Karen Gavigan, RN
MNA Unit Chair

VNA of Cape Cod— Preparations for negotiations are in the works. The committee is taking into consideration the nurses ‘wish’ lists and data from the nurses survey that was done last year to assist us in our proposals. We will keep you posted. There have been some disciplines recently and a couple of grievances in process in regard to these disciplines. Please be sure to review you VNA employee handbook, as well as your MNA contract periodically, to make sure you understand the policies to be followed and the rights you have. If you have questions, or something appears to be in conflict, please contact your VNA bargaining unit rep, or our MNA rep., Tom Breslin, to assist you in getting the correct answer. Do not let management interpret your contract! That said, please fill in your time sheets accurately with starting and stop times to reflect the time you are actually working . Do not falsify your time sheets because someone tells you they don’t want to see any overtime. If you worked it, you earned it, and have a responsibility to documentit. You can be held liable if the time sheets are not accurate w/your starting and stop times. One of our nurses has found this out the hard way and suffered serious consequences. The next OPEN Bargaining Unit meeting is Wednesday, May 11 in the Dennis Conference Rm. at 5 p.m.

Respectfully submitted,
Deb Caruso, RN
MNA Unit Chair

Falmouth Hospital— Negotiations continue and, despite profits of 30 million dollars over the last 18 months, Cape Cod Healthcare still refuses to give nurses an across the board raise. They also refuse to accept any limits on mandatory OT, instead wanting to form a committee to study the issue. They refuse to update staffing language to meet the current needs of the hospital but were willing to change the date on the side letter so it would look like we updated the language. Needless to say, we are now taking our concerns to the public. We have been leafleting and have been received supportively by the community. Mike Lauf, president of CCHC, mailed each of the nurses a letter explaining how reasonable CCHC’s offer is and attached was an inflated summery of how much that nurse costs the hospital in wages and benefits. It even included our own retirement contributions as part of the benefit provided by the hospital, not to mention SSI, FICA and workman’s comp that ALL employers are required by the government to carry on ALL their employees! We hope Mr. Lauf enjoys our reply which is coming in the form of a press release. United we stand!

Respectfully submitted,
Nicky Powderly, RN
MNA Unit Chair

Boston Medical Center— We held elections for bargaining committee officers. Karen Higgins is the new Chair, Lisa Sawtell is vice chair and I am Secretary/Treasurer. There has been a "proposal" to: 1) transfer the 6 EICU MICU to the other side, 2) move the trauma SICU (city side) and decrease it 2 beds, 3) move the step down MICU on the (old city side) and make a 22 bed MICU/stepdown. This would consolidate beds but they would be on the SEIU side. Would we get the jobs, for it is a transfer and there is language for that, or will SEIU get them? There is an intervental cardiology 6N unit that is closing. They are switching the surgical step down on the MNA side to another floor and making it Medical/ surgical stepdown and no one is quite sure if they are switching staffs or what is happening. The 6N has over 30 nurses and 6EICU has 30 nurses so this could be a major RIF. We are trying to get information and bring some of the issues to the table. Meanwhile, we are opening the Shapiro building and we don’t know if that building will be MNA or SEIU. It has already been sent to the labor board for clarification.

Respectfully submitted,
Donna Dudik RN
Unit Chair Designee

Signature Healthcare Brockton Hospital— I have just returned from the Leadership summit and, as always, it was a wealth of information. I was particularly interested in the talk given by Charley Richardson on Lean and Six Sigma: Yet another round of plans by management to increase control and profitability, and to undermine the collective voice. Have no fear, we are again in a battle to do our jobs safely and to give our patients the care they deserve. We hear it everyday about customer satisfaction, doing more with less. Using the Toyota method of fast and efficient production. There’s only one problem with this model. Toyota can do a recall if they fail. Can hospitals? We see corporate America now oozing their way into healthcare, the next money maker. Make no mistake they are here to turn a profit quickly and will do whatever it takes to achieve this goal. But with MNA, and now our national NNU, we have a very loud voice to stand up for our patients. We just need to come together in solidarity and use it. We see hospitals laying off, not filling positions as nurses leave and not hiring new nurses to train to replenish the profession. Here we go again; back to where we were in the 90’s. It didn’t work then and it won’t work now. The head of the Hospital Association had a scathing article in the Boston Globe the other day stating that the MNA and the NNU were pushing their agenda by threatening coordinated strikes in four facilities. Well, we are the MNA and the NNU and our agenda is SAFE PATIENT CARE. It’s not safe to care for three critically ill patients in ICU. It’s not safe to care for eight patients on a med surg unit and as nurses we know this. I also make no apologies for having a decent wage and benefits and I will not give up my right to collective bargaining. It was collective bargaining that allows the fat cats on Wall Street to take a day off to go golfing. Many of our sisters and brothers are in battles now: Tufts, St. Vincents, BMC and Berkshire Medical Center. Steward just agreed to buy Morton Hospital. One thing we discussed at the Summit was forming networks with other hospitals in our area. We would be in the Southeast network, working with Tufts and several Cape hospitals. We felt this was a great idea to network with others since our problems are the same and, with strength in numbers, we would have more power at the table. It is an exciting time for MNA and NNU members. We are one of the first unions in years to develop a national voice for our patients and our profession. NOW we just have to use it. Corporate America is coming for all of us and we need to work together and protect our patients and our profession and not choose profits over safe patient care. We will be heading towards negotiations very soon and the battles that others are in now will soon be ours. If you take on one of us you take on all of us should be our daily chant. Stand together and let your voice be heard. We want safe patient ratios NOW.

In solidarity,
Kathy Metzger RN, MNA Unit Chair

Jordan Hospital— Happy Spring to all our members! On Feb 17, 2011 our contract was ratified by the membership, effective for one year from 2/27/2011— 2/26/2012.
The committee strongly urges all members to have their own liability insurance. Please contact MNA headquarters Membership division for further information.
RIF in MNA positions occurred in March. The bad news: There was a RIF (reduction in force) in our bargaining unit. The good news: Everyone got a position. No one went out the door. It began when the hospital decided to RIF a 40 hour day position in MSTA. That nurse bumped into 40 hours in the Wound Clinic. The nurse from the Wound Clinic bumped into 40 hours in Cardiac Rehab. The nurse from Cardiac Rehab bumped into 40 hours in PACU. The nurse from PACU took a 20 hour vacant position, thus ending the bumping and ending the impact of the RIF.
Five members attended the Labor Leader Summit on March 30. Joanne Murphy, Kathy Moody, Deb Gonsalves (Committee members), Stephanie Stevens and Colette Kopke (former committee members) were in attendance. Networking and group discussion with nurses from all over the state was inspiring and informative as we plan our strategy for our next contract.
TEN Unsafe Staffing complaints were given to management over a 2 week period in the ER, one from 3 South. These will be discussed at Labor Management meeting, April 5 at 1530.

In Unity,
Joanne Murphy RN, MNA Chair
Kristine Kenyon, RN Co-Chair
Jordan Hospital Bargaining Committee

Martha’s Vineyard Hospital—Contract Negotiations: A mediation session has been scheduled for May 13. The contract that expired Sept 12, 2010 has been extended until further notice with all rights and benefits in effect until another agreement is reached.
Grievances: The ER Security grievance is presently being held in abeyance because of management’s cooperation in securing the ambulance bay and progress toward providing card swipe for access to the core ER.
The ER Per Diem Utilization grievance is also being held in abeyance pending management’s review of a pilot program for staffing in the ER. Other grievances concerning Non Professional Duties & Unreasonable Assignments are still on going with arbitrations to follow.

Respectfully submitted
Rick Lambos RN
MNA Unit Chair

FAQs…from the bedside

Q. I recently attended an MNA CE program and noticed that the certificate of completion I received that evening indicates a 2.2 contact hour value but, in the fine print, 2.7 contact hours is mentioned. Which is it?

A. The numerical value for a contact hour as defined by the American Nurses Credentialing Center’s Commission on Accreditation differs from the value defined by the Massachusetts Board of Registration in Nursing. The Number of contact hours for that educational activity which can be applied toward relicensure in Massachusetts is 2.7 hours. For relicensure in other states, the lower amount may apply.

Q. After completing my scheduled 8-hour shift, my manager told me that she was short-staffed and asked me to stay. When I said that I could not, she told me that “someone needs to stay and it’s your turn. If you leave, I will charge you with abandonment.” Is this a valid threat?

A. Not if your manager is implying that his/her intent is to report you to the Board of Registration in Nursing (BORN). When the Board evaluates a complaint of patient abandonment, in general, the Board would not consider that patient abandonment has occurred when a nurse is asked to work beyond the nurse’s established work schedule and informs the employer that he or she is unable to do so.

However, be prepared to ask your manager to more clearly define her intentions. If the manager says that you would be charged with abandonment with BORN, you can be confident that the charge would have no merit. However, if the manager is actually threatening internal (your facility) discipline, then you should carefully consider your options and the consequences. In this case, you will find that the publication Accepting, Rejecting and Delegating A Work Assignment: A Guide For Nurses*, which was developed by the MNA Congress on Nursing Practice, will be most helpful to you in your decision-making process. The Decision-Making Guide outlines the steps you should take to properly reject a work assignment.

Prior to rejecting the work assignment you could negotiate it and accept the assignment with modifications (i.e. agree to work X more hours). If you cannot negotiate a satisfactory arrangement, you may either reject the assignment or accept the assignment under protest . If you choose to reject the assignment, immediately 1) Notify your supervisor, 2) Prepare for consequences and document ALL events, and 3) Complete an MNA Objection Form) Objection and Documentation of Unsafe Staffing/Unsatisfactory Patient Care form). If you choose to accept the assignment under protest, immediately 1) Prepare for consequences and document ALL events, 2) Complete an MNA Objection Form, and 3) Notify your supervisor.

Be sure to check off Forced Overtime on the form!
*See http://www.massnurses.org/nursing-resources

Q. I keep hearing how important it is to complete MNA Objection and Documentation of Unsafe Staffing /Unsatisfactory Patient Care (also referred to as Unsafe Staffing Forms ). Why so important? What are they used for? Where do I get one? Where do I file/submit it?

A. They are an important form of documentation used to substantiate staffing problems in bargaining units and are used by your union representatives in meetings with management as an essential tool to demonstrate and resolve staffing problems. Reporting incidents or unsafe conditions resulting from 1) floating to another unit 2) forced overtime 3) inadequate staffing with typical patient census and 4) heightened patient acuity, in writing, is the only method that can be used effectively; verbal claims draw little response from employers.

Most importantly, these forms are for your protection and have been used when an error or injury has occurred that has harmed a patient. When you complete an Unsafe Staffing Form you expressly “decline to accept any legal responsibility for any untoward events that may occur as a result of unsafe staffing by the hospital/agency/facility.”

In the contract fights for safe staffing at Tufts and St. Vincent’s, the use of the stacks of hundreds of Unsafe Staffing forms that the nurses have filed has made a dramatic impact.

Your bargaining unit officers or floor reps. can provide forms or you can easily download a form at http://www.massnurses.org/files/UnsafeStaffingForm.pdf

There should be three (3) copies filed; 1) MNA Bargaining Unit 2) VP Nursing/DON/Administrator and 3) Keep a copy for yourself.

If you have any questions or particular topics you would like to have addressed in future issues, please email the region office at

region3@mnarn.org or mail to
MNA Region 3,
POB 1363

Things you should know…
Scholarships are available!

2011 MNF SCHOLARSHIP ANNOUNCEMENT
Application Deadline: June 1, 2011

The Massachusetts Nurses Foundation is a non-profit organization, established in 1981, whose mission is to support scholarship and research in nursing and healthcare professions. The primary goal of the MNF is to advance the profession of nursing and healthcare by supporting the education of nurses. The MNF raises funds and dispenses scholarships & grants to qualified recipients who have applied for assistance to further their careers or study clinical issues that are essential to the improvement of health care. The MNF awards numerous scholarships each year to MNA members. Some scholarships are even available to members’ children and spouses/partners.

• Rosemary Smith Memorial Scholarship for MNA members seeking advanced degree in nursing, labor studies or public health policy ($1,500)
• School Nurse Scholarships for MNA members enrolled in an accredited program related to school health issues ($1,500)
• Unit 7 Scholarship for RN pursuing higher education ($1,000)
• Unit 7 Scholarship for health care professional pursuing higher education ($1,000)
• Regional Council 3 Scholarship for MNA member pursuing BSN (3 available) ($2,000)
• Regional Council 3 Scholarship for MNA member pursuing MSN/PhD (3 available) ($2,000)
• Regional Council 3 Scholarship for MNA member’s child pursuing BSN (4 available) ($1,000)
• Carol Vigeant Scholarship for entry level nursing student in Worcester area ($2,000)
• Kate Maker Scholarship for entry level nursing student in Worcester area ($2,500)
• Annual Faulkner Hospital School of Nursing Alumnae Scholarship (2 available) ($1,000)
  1. An entry level scholarship for students pursuing and AD or BS degree. Preference for this scholarship will be given to applicants who are lineal descendants of alumnae of FHSON; second preference will be given to all others.
  2. The Connie Moore Award is for RN’s pursuing a BSN or MSN degree. First priority will be given to FHSON alumnae, then to lineal descendants, then to all other RN’s.

Additional scholarships are available in other regions for members of those regions. To download the application and criteria, go to http://www.massnurses.org/about-mna/mnf/scholarships. Any questions can be directed to the MNF voice mail at 781.830.5745 or email Cindy Messia at cmessia@mnarn.org.

A little history about nursing and education…

1903 – The Massachusetts State Nurses Association was founded during a meeting of 300 graduate nurses at Faneuil Hall on February 26 – one of the first of its kind in the nation. Its purpose is first, to secure legislation for the protection of the nursing profession for the benefit of the public, the physician and the nurse by creating a law requiring the registration of nurses; second, to formulate a code of ethics for the nurse of the state; and third, to work for higher standards of nursing practice and a uniform curriculum in nurses’ education.

1919 – The Massachusetts Nurse Practice Act is amended to provide for the registration of only graduates of nurse training programs and for a standardized curriculum for the nurse training schools in the state.

1938 – MNA helps pass legislation calling for compulsory registration for graduates of attendant schools of nurses, (later known as LPNs).

1948 – First bachelor’s degree program in nursing is established at Boston University.

“