NY Nurse May 2017

New York

nurse New York City edition | may 2017

the official publication of the new york state nurses association

(left to right) Kyunghee Kim, RN and Carmella Liburd, RN (in traditional nurse uniforms), WendyAnne McGuire, RN, at nurses week celebration, The Brooklyn Hospital Center

Nurses Week: We are patient advocates

p. 11

In defense of NYC Public Hospitals, pp. 7-10

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New York Nurse may 2017

THE IRONY OF HEALTHCARE

‘Free market’ or meat market?

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By Judy SheridanGonzalez, RN NYSNA President

Advocating for patients. Advancing the profession.SM Board of Directors President Judy Sheridan-Gonzalez, RN, MSN, FNP First Vice President Marva Wade, RN Second Vice President Anthony Ciampa, RN Secretary Anne Bové, RN, MSN, BC, CCRN, ANP Treasurer Patricia Kane, RN Directors at Large Kevin Donovan, RN Jacqueline B. Gilbert, RN Nancy Hagans, RN Tracey Kavanagh, RN, BSN Lilia V. Marquez, RN Sean Petty, RN, CPEN Nella Pineda-Marcon, RN, BC Karine M. Raymond, RN, MSN Verginia Stewart, RN Mary Ellen Warden, RN Regional Directors Southeastern Yasmine Beausejour, RN Southern Seth B. Dressekie, RN, MSN, NP Central Ethel Mathis, RN Lower Hudson/NJ Jayne Cammisa, RN, BSN Western Sarah Annabelle Chmura, RN Eastern Martha Wilcox, RN Executive Editor Jill Furillo, RN, BSN, PHN Executive Director Editorial offices located at: 131 W 33rd St., New York, NY 10001 Phone: 212-785-0157 x 159 Email: communications@nysna.org Website: www.nysna.org Subscription rate: $33 per year ISSN (Print) 1934-7588/ISSN (Online) 1934-7596 ©2017, All rights reserved

hauled from one built around profit hile nurses across the for insurers, pharmaceuticals and state celebrated Nurses CEOs — based on insane reimburseWeek this year with ment formulas — to one built around food, conversation and social CARE. This is why we have put interaction in many of our faciliso much energy in the struggle for ties, there was a bittersweet sensa“Improved and Expanded Medicare tion permeating the atmosphere. for All,” embodied in the “NY The nursing profession is under Health Act,” one of our signature attack with attempts to chip away at our scope of practice in ways explicit pieces of legislation. We recognize the bankruptcy of the and implicit. Patient care is Federal Government’s being reduced to check lists initiatives and so are and codes. All of our facilifocused on what we ties are making cuts of one can do as a state. kind or another: RN staffAs a direct result ing, ancillary staffing, benof the current system efits reductions, access to over the years, the care for our communities, supports we need as essential services reductions. professionals have This leads to the obvious been removed or question: what exactly are Florence Nightingale altered. Education has we are celebrating? been reduced to on-line faux-learnThings to celebrate ing, with the time needed to learn We still can find something to feel classified as “non-productive time” and therefore frowned upon by our great about every day even in this penny-pinching management. challenging environment when we We have the power to fight every make a difference in one, two or many patients’ lives. I guarantee you one of these ill-conceived changes that NONE of these interactions are — on each unit, in each department, recorded in Press-Gainey surveys or in every facility and as a collective in patient satisfaction scores — they are our union. Our power derives from our ability to work together. too visceral, too REAL. Many of us still work in a team, History of nurse activism sometimes a phenomenal team, when we resuscitate a trauma vicLike all history of everyday peotim in the ER, negotiate a complex ple, we are often not taught about case in the OR, pull someone out of the battles of previous generations danger in the ICU, walk a difficult that struggled against the odds to patient out of a negative outcome in get us where we are today. Less than a med/surg unit, work with the out40 years ago, nurses’ salaries were at patient community to live healthier the bottom rung of salaries of most lives, send a sick child home — back service workers (less than sanitation to a family filled with hope and a workers, as one example). Through positive future. strikes, job actions and a mushWe have a union that, in the face of rooming of unionization, salaries the vicious attacks described above, QUADRUPLED over a short period serves as a tool to organize and win of time, pension benefits were won, small and large victories. We can’t health plans were introduced and lose sight of what we win, when we the infancy of the concept of staffwin, and what we PREVENT our ing ratios began to develop. employers from doing. NYSNA These gains were not generously nurses are luckier than the many handed to us by employers, governnurses who have no representation, ment agencies and hospital corpocannot bargain collectively and face rations. They were won after many repression with impunity. protracted battles, filled with sacOur health system in this counrifice, pain and the persistence of try is in total disarray. To reclaim committed caregivers — like many our profession and love our jobs, of you in the profession today. We the entire system needs to be overneed to rejuvenate that spirit if we

are to salvage our health care system and our profession.

Single payer and safe staffing=inseparable

The concept of the “Free” Market in health care is the mantra for the pushers of the American Health Care Act (AHCA) today. But that concept is a misnomer. Nothing is free — that’s for sure. And the thinking that people must pick and choose from lists to obtain care; that providers have to do the same to offer care; vulgarizes the science and art of healthcare. Such a system relegates all of us to factorylike working conditions and the dehumanization of what must be the most intimate and humane of all social interactions — what we do as caregivers. It’s an obscenity.

Even if we win staffing ratios, we don’t want more of us so that we can fill in boxes and check lists and codes — we want more of us so that we can treat our patients. We want to be able to mentor new nurses and “give back” what we have learned to the next generation. We want to be able to thrive in our workplaces and have the supports we need to love what we do, every day.

We cannot do that in a marketbased system, where patients are seen as non-entities, as a diagnosis with prescribed length of stays and regimens, as pieces of meat to be moved through the system with callous indifference. Only a single payer system creates a baseline (not a panacea but a beginning) from which to heal our broken system.

Nurses Day on Florence Nightingale’s birthday in her homeland

Every year on May 12, there is a service held at Westminster Abbey in London wherein a lamp is passed along a line of nurses, one by one, to symbolize the passage of knowledge from one nurse to another. The last nurse places that lamp on a high alter. We can best honor our ancestor nurses and ensure our legacy by sharing our knowledge with one another and placing our humanitarian values on a high alter, continuing the fight for a healthcare system that truly embodies the reality that “Every patient is a VIP.”

calling on congress

NEW YORK NURSE

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may 2017

Taking on the AHCA

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he terms set forth in the U.S. House bill HR 1628, the American Health Care Act, pose a profound threat to the public’s health here in New York State and throughout the nation.

The Congressional Budget Office, whose estimates accompany legislation as required by law, issued estimates staggering in their ramifications on healthcare in this country.

The CBO says that the bill would increase the number of uninsured by 14 million by 2018 and 23 million by 2026 — including millions in New York alone. In a decade, the CBO estimates, 51 million Americans will be without healthcare should the bill become law.

The AHCA would gut Medicaid, cutting funding by nearly half over the next decade, a whopping $831 billion reduction over 10 years. The New York State budget would be hit hard in loss of Medicaid dollars, by lack of federal funds and county funds at the same time.

The bill would also allow states to let insurance companies charge more for people with pre-existing conditions, effectively taking away insurance for this most vulnerable patient population, unlikely to be able to afford sky-high premiums.

Age-based subsidies would be permitted, as well, giving insurers a green light to charge older people five times as much as younger ones, according to the CBO. And those essential benefits, such as maternity care, mental health care and more? These would be up to the states and what insurers want to offer.

Outraged constituents

But this significant threat is being met head on by NYSNA members, other unions, public health advocates and other community organizations. After passing the AHCA, members of Congress who voted YES returned to their districts to find outraged constituents, including our nurses and others.

At a May 8 forum in Plattsburgh, Congresswoman Elise Stefanik (R-21) heard heated comments from audience of one hundred constituents, furious in their demands

House Hall of Shame Rep. Chris Collins, R-27 Rep. John J. Faso, R-19 Rep. Peter T. King, R-2 Rep. Tom Reed, R-23 Rep. Elise Stefanik, R-21 New Yorkers with mock tombstones protest GOP House votes for AHCA

for an explanation of her vote. Her comments fell flat, invoking heckling at one point.

At a Town Hall in Busti, Congressman Tom Reed (R-23) encountered incensed constituents and numerous boos.

Town Halls targeted

In Whitesboro, Congresswoman Claudia Tenney (R-22), at a meeting with local realtors to discuss the housing market, was greeted by 40 demonstrators expressing their opposition to Tenney’s support for the House’s AHCA. Congressman John Faso (R-19) has been particularly beset by backlash for his vote for the AHCA, as he conspicuously avoided a Town Hall. On the day of the vote, Faso received more than 3,000 tweets denouncing his support for the bill.

At the Schoharie County Republican Committee’s Lincoln Dinner, he was met by more than 150 angry constituents. At a University Club in Albany event, dozens of people protested his healthcare vote. And in Amenia, demonstrators held a diein at the Hudson River Healthcare Health Center to protest the Faso’s visit to the facility because of his vote. One sign read, “Died waiting for a Town Hall.”

Faso was not alone. Out of 238 House Republicans — 217 of whom voted for the AHCA — only 17 held town halls during the recess following the vote.

The groundswell of opposition extends all the way to Albany, with both Governor Andrew

Cuomo and Attorney General Eric Schneiderman joining the fight for the future of health care.

Schneiderman and Cuomo, along with California Attorney General Xavier Becerra, are leading a national coalition that is intervening in a lawsuit brought by House Republicans to block billions of dollars in required Affordable Care Act subsidies that reduce out-ofpocket healthcare costs for millions of low-income Americans.

Rep. Claudia Tenney, R-22 Rep. Lee Zeldin, R-1

Assault on our practice

Schneiderman has also threatened another lawsuit, calling the AHCA “unconstitutional” and vowing to “challenge it in court.”

“It’s bad public policy,” Schneiderman said. “It’ll cost millions of people healthcare.”

Governor Cuomo slammed the House vote, calling the healthcare bill “an assault on women and an assault on New York.”

“Ultraconservatives in Washington have pushed through the House an unconscionable piece of legislation that threatens to tear apart our health care system,” said Cuomo.

Bracing for a version from the U.S. Senate likely to be little different from that of the House, NYSNA members will keep up the pressure. “The AHCA is an assault on our practice and on the patients we serve,” said NYSNA President Judy Sheridan-Gonzalez, RN. “Communities are rising up against this backward legislation and nurses are with them.”

Pat Kane, RN and NYSNA Treasurer, speaking at a Town Hall on single payer on Staten Island, May 20. Calls for single payer are growing, as details of the AHCA were released. This month the NYS Assembly passed the New York Health Act, again, a single payer plan for the state. Millions would lose healthcare, hospitals closed and jobs lost under the AHCA. Even special coverage for children is threatened.

Pressure is shifting to the U.S. Senate to stop the ACA repeal.

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New York Nurse may 2017

ICE raids are making us sick

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By Jill Furillo, RN, NYSNA Executive Director

he current increase in immigration raids in communities across the country is having a devastating impact on public health – one that could get even worse if there were an outbreak in Zika or other highly contagious illness. The White House’s current immigration policy is causing fear to spread in immigrant communities and studies show these policies are causing toxic stress among children and leading undocumented immigrants to delay seeking medical care.

There are an estimated 11 million people living in the United States without legal documents. The White House has vowed to crack down on undocumented immigrants and has conducted unprecedented sweeps,

rounding up and deporting people, regardless of whether they have criminal records. The White House is now considering using up to 100,000 National Guard troops to round up even more undocumented immigrants.

Round ups

Some of those who have been rounded up include young adults who were brought to the U.S. as children and who had received deferred status under President Obama. Others are parents with pending asylum cases based on claims of violence in their home countries. Still others are people who have never missed an appointment with Immigration and Customs Enforcement (ICE) agents who are working on their immigration statuses – several of whom

have been arrested when they arrived for their scheduled appointments. Only a small percentage of those who have been deported this year had violent criminal records.

ICE raids spread fear like wildfire. In recent months, immigrant communities have been on high alert with rumors spreading about raids on subways, in schools, on city buses. In early May, immigration agents appeared at a New York City elementary school inquiring about an enrolled child. Many parents have stopped dropping their children off at school out of fear that they will be detained on their way home.

Toxic stress

A pediatrician in North Carolina told The Atlantic magazine that she had treated young patients who were suffering from panic attacks, headaches, and other stress-related symptoms since the White House began its crackdown. Children come to school crying and asking whether their parents will be deported. The pediatrician determined that these kids were suffering from toxic stress due to current immigration policies.

Toxic stress has been found to cause myriad health problems and interfere with childhood development by flooding the body with inflammatory chemicals that interfere with the cardiovascular system and the metabolism.

More adverse childhood experiences are linked to higher chances of permanent disability, chronic illness like diabetes and hypertension, mood disorders, and early death.

Further, toxic stress can impair academic performance and brain processing.

Studies show that this toxic stress is not limited to undocumented immigrants. Rather it impacts all Latinos, even citizens. Raids create fear and stress in entire communities that worry for the safety of their loved ones.

A recent University of Michigan study showed that ICE raids have a devastating impact on the health of Latino immigrants – even those who are not at risk of deportation.

A 2008 raid at an Iowa factory conducted by 900 ICE officers armed

with military-grade weapons and a black hawk helicopter resulted in the detention of nearly 400 workers. News of the raid spread rapidly throughout immigrant communities in Iowa. According to the study, in the 37 weeks following the raid there was a spike in Hispanic babies born with low birth weight – an outcome associated with stress in mothers. Birth weights in babies born to white mothers remained stable.

Fear keeps them from care

According to the National Institutes of Health, raids also decrease the likelihood that immigrants will seek medical care – again, whether they have their documents or not. This result was determined by a study conducted after changes were made to immigration enforcement laws in Alabama.

According to another study, undocumented patients are more than four times more likely to delay seeking care for tuberculosis.

Without treatment TB can be fatal, and as nurses we know that TB can be highly contagious when it affects the lungs and becomes airborne.

Many avoid going to the hospital for any reason for fear that they will be deported or asked about immigration status upon arrival.

Public health risks skyrocket

Imagine an outbreak of Zika virus or other communicable disease with a large swath of those affected going untreated because they are too scared to go to the hospital. We need to ensure that people feel safe enough to seek the care they need to stop the spread of illnesses that could spread like wildfire if left untreated. We also need to make sure that children can feel safe in their schools and in their homes.

The vast majority of those impacted by current immigration policies work hard and pay taxes – and many of them are children who cannot be held responsible for their parents’ actions. As nurses, it is our duty to support humane immigration policies that don’t put the public health of our nation at risk or make children sick.

multi-union lobby day

NEW YORK NURSE may 2017

Unions stand up for safe staffing

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hey came from across the state to call attention to healthcare in New York State, with safe staffing at the top of the agenda. This year’s Multi-Union Lobby Day drew union members by the hundreds from NYSNA as well as from 1199SEIU, New York State United Teachers (NYSUT), Public Employees Federation (PEF), Communications Workers of America (CWA) and the New York Statewide Senior Action Council.

Other supporters were there, too, as well as elected officials.

A vast gathering at the luncheon heard speakers from the array of unions speak in support of the Safe Staffing for Quality Care Act. “Floor vote, now!”

NYSNA President Judy SheridanGonzalez, RN, spoke, acknowledging the union solidarity on the issue of safe staffing. “The time has come,” said Sheridan-Gonzalez, “for legal protection of our patients. We can no longer allow

NYSNA President Judy SheridanGonzalez, RN

patients to come to the hospital only encounter shortages of RNs and other caregivers needed to provide the care that is out duty. Safe staffing now!”

Signs read: “FLOOR VOTE, NOW!”.

Continued on page 6

An impromptu march line of attendees snaked through the Convention Center.

Assemblymember Shelley Mayer spoke in support for safe staffing.

Statewide Senior Action Network attendee Kitty Vetter, RN

Lobby Day attendees from across organizations gave an enthusiastic welcome to luncheon speakers.

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Unions stand up for safe staffing Continued from page 5

StateWide Senior Action Network President Maria Alvarez welcomed attendees.

President Sheridan-Gonzalez,RN, was joined by Wayne Spence, PEF President, Debbie Hayes, head of the RN unit of CWA, Anne Goldman of NYSUT’s Health Care Professionals Council, Norma Amsterdam, Executive Vice President, 1199 SEIU, and Maria Alvarez of New York StateWide Senior Action Network.

When hospitals save money by using fewer nurses, “the patient

doesn’t get a discount,” said Howard Sandau of NYSUT. “Enough is enough,” he said. Utica nurse Marianne Reardon, RN, displayed protests of assignment.

“Plain and simple, safe staffing saves lives,” said Andy Pallota, NYSUT Executive Vice President.

Passing the safe staffing act, “should be an end-of-the-session priority.”

Assembly Health Committee Chair Richard Gottfried, stalwart of the safe staffing in NYS, was present, as was State Senator Andrea Stewart-Cousins, D-Yonkers and Senate Democratic Leader.

Strong showing

It was a very strong showing at this year’s Multi-Union Lobby Day, as NYSNA was joined by other unions whose commitment to safe staffing was resounding. Elected officials joined this chorus.

New York’s patients have the support of union nurses and caregivers from across the state and from the many unions who give care with devoted professionalism.

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It is essential for us to be able to provide excellent care for our patient.”

Edna Stachurski, RN Orange Regional Medical Center and member, 1199SEIU

NYSNA Members from the Westchester region applauded elected leaders and officials.

New York

nurse special edition | may 2017

the official publication of the new york state nurses association

In defense of NYC Public Hospitals

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New York Nurse

NYC H+H

may 2017

More than 8,500 NYSNA nurses work in this system, providing care to one in five New Yorkers annually. No matter their financial condition or immigration status, the doors to these outstanding institutions remain open. These public hospitals truly distinguish this city in terms of public health and human compassion.

Forces opposed to full support of the public hospitals cite a fiscal deficit as reason to make cuts to

this system of essential care, much of which serves the underserved.

Below is an excerpt of the Executive Summary of a White Paper commissioned by NYSNA and prepared under the union’s supervision. The White Paper is critical to understanding the false premises of the opposition and argues forcefully and persuasively of the critical necessity of a fully funded public system.

On restructuring NYC Health + Hospitals: Preserving and expanding access to care for all New Yorkers June 2017

EXECUTIVE SUMMARY The New York City Health + Hospitals system is the crown jewel of public health in NYC. No other American city even approaches its size, scope and level of commitment.

The New York City public hospital system may be facing the most profound challenge in its 48-year history. Even before the new administration’s threat of devastating changes in Medicaid funding and unraveling of the ACA, the City was projecting a $1.6 billion deficit by 2019, rising to $1.8 billion in 2020. This deficit — nearly one-fourth of its operating expenses — is expected even though the City has raised its total annual level of financial support to New York City Health + Hospitals (NYCHH) from $1.3 billion in 2013 to $1.8 billion this year and to a planned $1.9 billion in 2020.

In April 2016, the Mayor released his reconfiguration plan One New York: Health Care for Our Neighborhoods, then convened a blue-ribbon Commission on Health Care for Our Neighborhoods.

Meanwhile, the New York City Health + Hospitals’ (NYCHH) Board authorized its own study and instituted a series of revenue raising and cost-containment actions to deal with the fiscal difficulties. A year in, the deficit is still expected to reach $1.8 billion and many observers doubt that substantial new federal revenues are likely to materialize.

The Commission recently released Recommendations on NYC Health + Hospitals’ Transformation along with three issue briefs that provide more detail on the system’s clinical infrastructure and challenges.

These latest documents, however, continue to misconstrue the relevant NYCHH operating cost data and fail to situate NYCHH’s challenges

Judith Cutchin, RN, Woodhull Hospital and President, NYSNA’s NYC H+H Executive Council (center)

in the broader context of New York City’s overall health care system which is 70 percent publicly-funded, and in which the private hospitals heavily rely on the public system.

Within the broader hospital sector, public funding covers more than two-thirds of expenditures.

Cutbacks no answer

NYCHH’s fiscal problems cannot be fixed by closing hospitals, laying off staff, and cutting services. Nor can the solution be increased reliance on and payments to the costlier and less responsive private hospital system.

Unfortunately, given the current alignment of reimbursement policies, it is very unlikely that NYCHH hospitals will be reimbursed adequately for the cost and quality of services it provides.

Fiscal relief can come, in part, from other sources. The private health care system needs to be made more accountable for the care of all New Yorkers – regardless of

ability to pay or medical problem.

The hospital system in New York City is a single system with multiple managements. The voluntary sector is making money, the public sector is not, but not because it is highcost or provides poor quality. No solution to NYCHH’s fiscal woes will succeed without acknowledging NYCHH’s interaction with the city’s broader health care system.

Nor without recognition that the burden of caring for the neediest and most vulnerable should be more equitably distributed.

In the following report, we reach several conclusions.

1. NYCHH’s structural deficit is not an expense problem.

It’s a revenue problem.

NYCHH spends more for care than it is reimbursed. This is because of its role and function within the broader healthcare delivery system in New York City, and not because it is failing as a system.

NYCHH provides the bulk of under-financed medical care to the city’s uninsured, Medicaid patients with poorly-reimbursed health

NEW YORK NURSE may 2017

Kings County Hospital Center nurses

conditions (substance abuse and psychiatric disorders), and Level one emergency trauma care. It is not adequately compensated for the care it provides that the private hospitals do not provide.

2. The NYCHH System’s cost structure is efficient and its care of good quality NYCHH testimony before the City Council Health Committee this spring and the recently released

Blue Ribbon Commission Report are both premised on the argument that NYCHH has an unsupportable and high cost structure. This assumption is directly related to the unstated premise that public hospitals (like the common perception of government services) are less efficient, costlier and of lower quality than private sector service providers.

These spoken and unspoken premises are not supported by the

Bellevue Hospital Center

facts. NYCHH costs for treating patients are comparable to or lower than those of voluntary hospitals.

As a group, NYCHH hospitals are among the lower cost NYC hospitals. The majority have payroll expenses per adjusted discharge (a widely used standard) in the lower half of NYC hospital costs. 1 Nor is the quality of care inferior to that provided by private hospitals, particularly the large academContinued on page 10

NYCHH costs for treating patients are comparable or lower than those of voluntary hospitals.

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New York Nurse may 2017

On restructuring Continued from page 9

It is, in part, the very existence of NYCHH that enable the large private hospital networks to operate with huge surpluses.

ic medical centers. For example, surveys by the Leapfrog Group, which is a national hospital industry quality measure organization that rates hospitals on a set range of patient safety metrics, have consistently found that NYCHH hospitals as a group provide higher than average quality. According to the Leapfrog report issued in November of 2016, the only hospitals to receive a grade of “A” or “B” were five NYCHH institutions. In the March 2017 report, only seven NYC hospitals were rated “B” and six of the seven were NYCHH. (There were no “A”s.)

3. Private hospital networks prosper at the expense of the public hospitals The fact of the matter is that NYCHH increasingly picks up the costs of a wide range of services and populations that private sector providers can avoid precisely because NYCHH is there to assume this load. NYC’s private hospital systems have been shifting the burden of caring for the uninsured and for people with psychiatric and substance abuse diseases to the public system. Even as the

NYSNA H+H nurses featured in a bus shelter ad.

number of uninsured New Yorkers declines, NYCH+H’s share grows.

It is, in part, the very existence of NYCHH that enables the large private hospital networks to operate with huge surpluses. In 2016, the five major private systems reported net operating revenues (profits) totaling $877 million while NYCHH has faced recurring and mounting losses. These ‘non-profit’ entities have been recording significant operating surpluses while enjoying substantial tax exemption benefits, excessive payments from State and Federal indigent care pools not proportionate to the amount of charity care they provide, and while paying generous compensation to scores of executives.

Unity of public and private nurses, conference, May, 2017

This year might mark a unique moment in the history of New York City’s hospital system. A fiscal crisis in the public hospital and safety net care systems, an uncertain future for full federal support of Medicaid and insurance for the uninsured converge with a near universal recognition that U.S. health care system is failing to provide the care we need at a price we can afford. Both the Mayor and the Governor have committed very significant resources to the continued support of NYC’s necessary safety net institutions.

We need to take advantage of this confluence of factors to re-shape the system for the 21st century.

NEW YORK NURSE/NYC

nurses week

may 2017

Celebrating patient advocates

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his year, National Nurses Week, May 6-12, brought NYSNA nurses together to acknowledge our work at the hospitals in a celebration of dedication and accomplishment.

Community recognition of our special role was apparent, too, as expressions of gratitude were many.

Day after day, nurses deal with critical issues, and these acts form a bond between us.

So during this time devoted to our professionalism, we embrace that bond with pride. We are, more than anything, patient advocates, and that role is embraced by us and acknowledged by our patients and their families.

We thank the communities for putting their trust in us. We are here to provide quality care to all patients and it is that unwavering commitment to caring no matter the circumstance that forms that special RN bond.

Flushing Hospital

On Nurses Week we are reminded to heal ourselves — heal our sorrow, challenges — so we can return to work and be the light our patients need to have hope that their suffering will soon end. In order to be resilient in these challenging times we need to celebrate each other.

Wyckoff Medical Center

Xenia Greene, rn, Montefiore Hospital

Kings County Hospital

Queens Hospital

Parker Jewish Institute

New York Presbyterian Hospital

NYC H+H/McKinney

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stewards corner

New York Nurse may 2017

Critical win at Jacobi

By Sean Petty, RN

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remember the exact moment when we decided to start this campaign.

My thoughts were racing after a labor management meeting in January that left us reeling.

Changes were coming throughout the hospital. A global hiring cap of five staff members per month for non-medical staff was announced by the CNO, and the hospital

Jacobi Medical Center, Spring, 2014: a new tradition of advocacy

would be counting attrition at the rate of 20 staff per month through retirements and resignations.

The news of the hiring cap was shocking enough. But then the CNO dropped the bombshell.

A matter of outreach

They were going to be officially changing our Pediatric Intensive Care Unit to a “Step-Down” unit — no patients with ventilators, vasopressors or other conditions that require the care of a roundthe-clock intensivist.

In the course of the meeting we raised our many concerns about the profound impact of these changes on the health services in our community, but management was unmoved.

When the meeting ended, we tried to get our thoughts in order. Generally, we felt overwhelmed.

But some of us had been down this road before. In August of 2013, NYC H+H shut down Labor and Delivery services at North Central Bronx Hospital without warning. Immediately, nurses, NYSNA

Executive Council leaders, Leticia James and community organizations came together and waged an inspiring and successful campaign to restore those services. Outreach would be essential.

Critical services threatened

This time we quickly understood that issues were interconnected.

One critical fact: while there were some days where the census was down, management’s claim of overall underutilization — which underpinned their plan to shut us down — was clearly false.

But more importantly, we learned that if the PICU were to become a step-down unit, it would let loose a severe ripple effect throughout the hospital. Jacobi is one of the few Pediatric Trauma Centers in the entire region — designated by the NYS Department of Health as a Level 1 Pediatric Trauma Center. That meant that one of Jacobi’s critical services for the entirety of the Bronx and southern Westchester would be eliminated.

We also knew that the private sector would not pick up the slack.

All the major private facilities in the Bronx had refused to apply for pediatric trauma accreditation because it’s not as profitable as other services.

We built an email list of nurses in pediatric and emergency departments and sent regular updates, including community and management meetings as well as other opportunities to advocate and organize. Nurses started to express optimism as the plan to challenge the decision took shape.

We appeared at a “Stakeholders Forum” held by newly appointed NYC H+H CEO Stanley Brezenoff.

Jacobi and NCB nurses spoke in powerful terms about protecting critical public services in the Bronx.

After the meeting we approach Mr. Brezenoff who said he would “look into the details”.

We also understood that we had to take this fight into the community.

So we reached out to proven allies, like the Commission on Public Health Services and the Northwest Bronx Community and Clergy Coalition.

We met with NYSNA’s NYC H+H Executive Council leadership and political/community organizers to plan our outreach to the community. We kept the entire executive council fully informed to raise awareness among all public hospital nurses in NYC about our fight and to hear their ideas.

We went to the Health Committee meeting of Community Board 11 in early February and, while not on the agenda, the members of the committee graciously gave us time to present.

What they heard shocked them.

One CB member remarked, “We had been hearing about problems at Einstein, but we thought Jacobi was okay.” At the CB11 general meeting later that month, a motion to stop the PICU closing was passed and a letter was sent to Jacobi administration.

Victory achieved

Meanwhile, our PICU was transferring patients to Montefiore and other private hospitals. Families were traveling farther to visit their critically ill children. The risk of complications during these transfers was omnipresent. In that time, we continued to press the case at Labor Management meetings and speak out at Community Board meetings. Politicians that attended CB meetings or contacted directly were listening.

Many of our attending physicians in the Pediatric ED and on other Units, members of Doctor’s Council/SEIU, were steadfast and vocal in support of saving the PICU. They pressed the case internally with Jacobi and NYC H+H medical and nursing leadership.

Then, on May 16, it all came together. We learned that we had won! NYC H+H had officially committed to restoring the PICU at Jacobi! What a great win!

A successful fight to save Labor and Delivery at NCB, the fight to stop dialysis privatization, and now our victory at Jacobi’s PICU show that NYSNA nurses, along with our fellow healthcare workers, community advocates and supportive elected officials have the power to win when we advocate and organize.

NEW YORK NURSE

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may 2017

Beware: bloodborne pathogen exposure still a risk

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ithout a doubt, Bloodborne Pathogens (BBP) pose a very serious risk to nurses.

Here’s some important background: Before OSHA’s BBP Standard was promulgated in 1991, healthcare workers were frequently exposed to bloodborne pathogens through needlesticks, cuts, splashes, etc. Healthcare unions knew that there were measures that could provide protection to these workers, but healthcare employers for years fought to prevent protective regulations. Finally, after many years of struggle, the BBP Standard was put into place.

With implementation of the standard, the rate of BBP exposures dropped dramatically. In particular, Hepatitis B infections plummeted because the standard required employers to provide Hepatitis B vaccines to all workers who were at risk of occupational exposure.

However, the CDC estimates that there are still almost 400,000 needlesticks each year in the hospital setting, and almost twice that amount when all types of workplaces are measured (home care,

If you experience a bloodborne pathogen exposure by, for example, a needlestick or splash to a mucus membrane, time is of the essence.

Studies have shown that, for prophylaxis to be most effective, it should begin within 2 hours of the exposure. Take the following steps: 1. W ash needlestick injuries and cuts with soap and water.

2. F lush splashes to nose, mouth, or skin with water.

long-term care, etc.). The numbers are likely far higher when underreporting is taken into consideration.

If you suffer a bloodborne pathogen exposure, it is vital that you receive treatment immediately. See box, right for steps to take if you’ve been exposed.

Not inevitable

Many healthcare workers consider needlestick injuries and other forms of BBP exposure to be inevitable. “The patient jerked when I inserted the needle,” or, “I wasn’t paying attention,” or, “I was working too fast.” But it is the

employer’s responsibility to ensure a safe working environment for employees. Human beings make mistakes. It is vital that measures be put in place that recognize the risks and try to prevent them if possible. The BBP Standard requires that employers investigate each exposure incident and take corrective actions to prevent similar incidents in the future.

Being a nurse shouldn’t put you at risk of becoming a patient. For more information or for assistance, contact the NYSNA occupational health and safety staff at healthandsafety@nysna.org.

OSHA’S BLOODBORNE PATHOGENS STANDARD WHAT YOU NEED TO KNOW

The BBP Standard requires employers to protect workers who are likely to come into contact with blood or other potentially infectious materials (OPIM).

Employers must: l Establish an exposure control

plan to eliminate or minimize occupational exposure to BBPs. The plan must include all job classifications and tasks that may put workers at risk for exposure. The plan must be updated annually. l I dentify, evaluate and implement

effective engineering controls (e.g., safer needle devices, needless systems, sharps disposal containers) with frontline worker input.

WHAT TO DO IF YOU’RE EXPOSED

l I dentify and use work practice

controls (i.e., procedures for handling contaminated sharps, specimens, laundry; cleaning contaminated surfaces; etc.) with frontline worker input. lM aintain a sharps injury log. l I mplement universal precautions. lP rovide appropriate PPE

(including gloves, gowns, eye protection, masks, etc.). lM ake available hepatitis B

vaccinations free of charge. lM ake available post-exposure

evaluation, prophylaxis and follow up at no cost to employee.

lR equest that the source of

exposure be tested for BBPs if the source’s BBP status is not known (if the individual agrees to testing, the results may allow prophylaxis to be stopped early). lU se labels and signs to

communicate hazards. lP rovide information and training

to workers on initial assignment and at least annually thereafter with a trainer available to answer questions. lM aintain worker medical and

training records.

To review the OSHA Bloodborne Pathogens Standard, go to www.osha.gov.

3. I rrigate eyes with clean water, saline, or sterile wash.

4. G o to your facility’s employee health unit or the emergency department, depending on your facility’s post-exposure protocols.

5. It is very important to begin prophylactic treatment within 2 hours of when the exposure occurred. Make sure the healthcare workers treating you understand that you must be seen as quickly as possible to meet that timeline.

6. Request medication for potential side effects of prophylaxis such as nausea.

7. T here may be a special prophylaxis protocol to follow based on factors such as pregnancy. Make sure to discuss this with your treating physician.

8. As stipulated by the OSHA Bloodborne Pathogens standard, there should be no out of pocket cost for your medical care.

9. T he employer should make every effort to obtain consent for testing from the source patient.

10. F ile for workers’ compensation in case you miss work due to the injury or treatment.

11. N otify your supervisor and union representative so that the NYSNA Health & Safety Department can follow up on the potentially hazardous conditions that led to the exposure incident.

14

New York Nurse/NYC

NYC

may 2017

Anne Bové, RN, honored at Bellevue

B

ellevue Hospital Center, the nation’s oldest hospital, has distinguished itself in so many significant ways: on the cutting edge of healthcare innovation and excellence, and for its commitment to keeping its doors open to all seeking care, no matter ability to pay or immigration status. No one embodies the spirit of Bellevue more than Anne Bové, RN, Secretary of NYSNA’s Board of Directors, who started her illustrious nursing career at Bellevue.

Anne has also stood out for her teaching of nursing students at the hospital.

During Bellevue’s Nurses Week celebration, Anne was honored with the prestigious, international Daisy Award, which recognizes nurses who provide extraordinary

compassion and skillful care every day. We share in the many congratulations for Anne.

This year, Bellevue created its own award to honor commitment to and excellence in teaching : the

first annual Anne Bové Nursing Preceptor Award. Its first recipient is Genebel Caratao, RN, Bellevue Hospital Center, pictured above receiving the award. Our congratulations to Anne and Genebel!

Key partners and stakeholders in their Accountable Care Organization, the six nurse practitioners in the Kings Primary Care Team,(from right to left) Suzette Willliams, NP, Vanishree Sooppersaud, NP, Denise Romney, NP, Geraldine Haughton, NP, Sylvia Ayoko, NP, Amisal Cecile, NP, were honored in May. Their roles in promoting wellness and providing excellent quality primary care in 2016 were acknowledged with $1,000 grants per individual to be used towards continuing education. Many congratulations!

City Councilmember Jumaane Williams spoke out in behalf of Haiti’s community and the Temporary Protected Status its members received after a devastating 2010 earthquake. Washington threatened to end the status and send tens of thousand of Haitians back. NYSNA Secretary Anne Bové, RN, spoke in behalf of the hundreds of Haitian nurses in NYSNA, joining other unions, immigration advocates and supporters at a Foley Square press conference on May 16.

Later that week, the special status was extended six month

A public hearing on Coney Island Hospital heard NYSNA members testify on conditions at the facility. They spoke of increase of patients at in patient and outpatient services. Successfully meeting the needs of the influx of new patients to Coney Island reflects on the facility’s outstanding care. Coney Island is maintaining its reputation for serving patients in the community.

Nurses also described the implementation of the EPIC system on the Units, accomplished with the help of leadership of nurses, medical and ancillary staff.

around the state

long island – Nurses Week: We

NEW YORK NURSE/NYC may 2017

westchester /hudson valley –

are patient advocates

Nyack RNs focused and ready

capital /north country –

central region – Saluting our

Spreading the word in Albany

nurses week

western region – ECMC nurses

staten island – Nurses Week: We

beat the data hackers

are patient advocates

Nurses from all the regions celebrated Nurses Week in May. Some had campaigns and projects that needed attention, too.

15

NEW YORK NURSE

Non-Profit US Postage Paid NYSNA

May 2017

131 West 33rd Street, 4th Floor New York, NY 10001 6 NYC

INSIDE

Taking on the AHCA, p. 3

Bloodborne pathogens still a risk, p. 13

Contact your nysna delegate or rep for more information.