New York
nurse Westchester/LoWer hudson VaLLey edition | may 2019
the official publication of the new york state nurses association
Hudson Valley Hospital nurses stick together.
Peekskill City Council supports safe staffing, p. 3 MEDICARE FOR ALL IS THE CURE, PP. 7-10
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NEW YORK NURSE MAY 2019
Toward a more perfect union
I Judy SheridanGonzalez, RN, NYSNA President
Advocating for patients. Advancing the profession.SM BOARD OF DIRECTORS President Judy Sheridan-Gonzalez, RN, MSN, FNP judy.sheridan-gonzalez@nysna.org First Vice President Anthony Ciampa, RN anthony.ciampa@nysna.org Second Vice President Karine M. Raymond, RN, MSN karine.raymond@nysna.org Secretary Tracey Kavanagh, RN, BSN tracey.kavanagh@nysna.org Treasurer Patricia Kane, RN pat.kane@nysna.org Directors at Large Anne Bové, RN, MSN, BC, CCRN, ANP anne.bove@nysna.org Judith Cutchin, RN judith.cutchin@nysna.org Seth Dressekie, RN, MSN, NP seth.dressekie@nysna.org Jacqueline Gilbert, RN jackie.gilbert@nysna.org Nancy Hagans, RN nancy.hagans@nysna.org Robin Krinsky, RN robin.krinsky@nysna.org Lilia V. Marquez, RN lilia.marquez@nysna.org Nella Pineda-Marcon, RN, BC nella.pineda-marcon@nysna.org Verginia Stewart, RN verginia.stewart@nysna.org Marva Wade, RN marva.wade@nysna.org Regional Directors Southeastern
Yasmine Beausejour, RN yasmine.beausejour@nysna.org
Southern
Sean Petty, RN sean.petty@nysna.org
Central
Marion Enright, RN marion.enright@nysna.org
Lower Hudson/NJ Jayne Cammisa, RN, BSN jayne.cammisa@nysna.org Western
Chiqkena Collins, RN chiqkena.collins@nysna.org
Eastern
Martha Wilcox, RN martha.wilcox@nysna.org
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 Email: communications@nysna.org Website: www.nysna.org Subscription rate: $33 per year ISSN (Print) 1934-7588/ISSN (Online) 1934-7596 ©2019, All rights reserved
f you’ve been a member of NYSNA for fewer than eight years, you may not know our unique history. In 2011, an insurgent slate won a majority of seats on the Board of Directors. This revolution, led by a Rank and File Caucus, NY Nurses United, finally gave staff nurses a voice after 100 years of being silenced. We drew inspiration from a small, low-budget organization: the Association for Union Democracy (AUD) and its amazing cofounder, Herman Benson (who is now over 100 years old). We learned about rank-and-file unionism and social justice unions through our contacts in Labor Notes and their “Troublemakers” conferences, where we met longtime activists from Teamsters for a Democratic Union and the Chicago Teachers Union, among many others. 2012 a turning point
We looked at models of unions that developed structures and fought against the odds, from California (National Union of Healthcare Workers) to Puerto Rico (Puerto Rico Teachers Federation). We received solidarity and critical support from progressive nurses unions, especially National Nurses United and the Massachusetts Nurses Association. On May 17, 2012, we assembled the largest gathering ever, at the Javitz Center in New York City, changing our bylaws so that nurse managers could no longer dominate our union. Later that year our convention voted to withdraw from the American Nurses Association (who had already suspended us, unhappy with our electoral success), freeing up over a million dollars that we could instead spend on supporting staff nurses across the state in their struggles. As the healthcare crisis escalated, we fought hospital closings, budget cuts aimed at the poor, marginalization of the uninsured and underinsured, and fought to save public health institutions, as well as for universal healthcare and safe staffing ratios in the legislature. We expanded our advocacy to include the struggles to alleviate the social determinants of health: poverty,
NYSNA nurses, 2012 all-union meeting
poor housing, environmental injustice, lack of access to care, food insecurity, racism and all forms of discrimination. We created a rigorous program of shop steward training, educating over 2,000 nurses in a few short years. We began the complex transformation from a union that focused on service (not necessarily quality service) by staff reps to one that educated members to fight directly with the boss. We fought for and won superior contract agreements and we organized new bargaining units. We formed coalitions with labor and community to unite around common goals. We reached beyond our comfort zones, embracing the Climate Justice movement, recognizing the deleterious effects of Global Warming on our planet and its people. And we developed a volunteer disaster network to intervene in times of crisis among populations affected by extreme weather events, motivated by our historic dedication to such victims in our own regions. A vision of democratic inclusion
Our vision to become a union that embraces democratic inclusion of all members, allows for both autonomy of local units and collective functioning, and that fights relentlessly against oppression on the job and within the broader community has been met with fits and starts along the way. While we can all agree on a broad mission statement, implementation of that vision can be a rocky road.
Challenges toward forming “a more perfect union” are persistent. First and foremost is our orientation to organization. We are raised and educated in a system that promotes self-interest and personal power. Worker organizations like unions cannot thrive if members are unable to embrace the concept of “the collective” as opposed to individual gain. NYSNA members—and particularly NYSNA leaders—have to constantly reflect upon our motives and actions: Are we functioning for the greater good? Are we accepting the rights of members to express all opinions, even unpopular ones? How do we determine what takes priority? Are we sacrificing democracy for the sake of expediency? Or are we losing focus, distracted by multiple interests and concerns? There is no blueprint that allows us to follow a smooth path that confronts these contradictions effectively. Even the best plans can go awry. Rank and file avenues for input, honest self-examination, a commitment to educate ourselves beyond our own circles, and, ultimately, respect for the richness and variety of views our members bring to the table—these are among the values that allow any structure to nourish itself and grow. We welcome your ideas about how to become better at what we do. Write to the NYSNA Board via Jeremy.markman@nysna.org. Indicate in the subject, “To the Board of Directors.”
NEW YORK NURSE/WLHV
WLHV
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MAY 2019
Peekskill endorses safe staffing
D
onna Shore, RN, who works in the pre-admission testing center at New York-Presbyterian Hudson Valley Hospital (HVH), has been a nurse for 36 years. Earlier this month she saw something she never thought would be possible. In a sign that support for staffing ratios is making headway, she watched with pride as the Peekskill City Council unanimously passed a resolution in support of the Safe Staffing for Quality Care Act. “Change is absolutely necessary in this environment, and this is a great start to bringing this issue to the forefront,” declared Shore.
A no-brainer
Copies of the resolution were sent to Governor Andrew Cuomo and the State Senate Health Committee. The action by the City Council comes as pressure continues to build around implementing staffing ratios in hospitals and nursing homes at the state level. “It affects everybody because at some point everyone is going to have a loved one in the hospital,” said Shore. “Nobody should be worried their loved one is not getting the proper care because of a lack of nurses or because nurses are overwhelmed with patients.” Joanne Boniello, RN, works in
Joanne Boniello, RN
Nurses at Peekskill City Council meeting
the Trauma 3-South Surgical unit at HVH and attended the council hearing, too. She was born and raised in Peekskill. “I’m involved in the community, and I try to attend all the local meetings that I can. Passing the resolution was a no-brainer,” she said. “You don’t want nurses overwhelmed with patients because then anything can happen.” Boniello continued, “The proposed safe staffing law has ratios that are one nurse per four patients. I have seen one to six, sometimes one to eight.”
ing of support in our community,” she said. Both nurses say showing solidarity is the key to making lasting improvements. “The more municipalities that get on board, the more we can show the state how many people want and need this,” said Boniello. “We are united in this fight.” “I believe we can do great things, but we need to be participating,” Shore stressed. “Just being at the vote was empowering. You see the support we have. It shows you that a nurse can make a change.” The two women are certainly are practicing what they preach. “I’m on my way right now to another event to recognize nurses for Nurses Week,” Shore said. And with that, she was gone.
United in the fight
Shore sees the resolution as an important step forward. “People don’t even know what the role of a nurse is, and it has changed a lot. So, it’s so good to see the outpour-
Donna Shore, RN, middle right, and fellow HVH nurses
“
Just being at the vote was empowering. You see the support we have.” –Donna Shore, RN, New York-Presbyterian Hudson Valley Hospital.
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NEW YORK NURSE MAY 2019
Meeting the future of nursing
N By Jill Furillo, RN, NYSNA Executive Director
Our union actively promotes the funding of public universities and community colleges so that these exceptional young people will have educational opportunities and join our ranks. And as the graduates enter the workforce, NYSNA focuses on their needs going forward.
ursing has been a leader in job growth in New York State—both RNs and NPs are in demand. Between 2014 and 2024, the NYS Department of Health projects job growth for nursing to the tune of 7,500 annual openings. This year, as in past years, hundreds of nursing students attended Lobby Day with the help of NYSNA. Our union actively promotes the funding of public universities and community colleges so that these exceptional young people will have educational opportunities and join our ranks. And as the graduates enter the workforce, NYSNA focuses on their needs going forward. One fundamental need: safe staffing. Lobby Day’s focus on quality and safe care for patients through safe staffing helps ensure that the work conditions for these young nurses—and all nurses—are good conditions. That is the fight for our profession, our patients and their families. In New York, RNs who are 55 and older grew by almost 6 percent between 2005 and 2014, with nearly two-thirds of actively practicing nurses over the age of 50. According to the U.S. Department of Commerce, the U.S. population is projected to increase by almost 100 million from 2012 to 2060. By 2030, more than 20 percent of U.S. residents are projected to be age 65 and over, compared with 13 percent in 2010.
Areas of RN growth
Nurse students at graduation, Bellevue Hospital Center
We know that the elderly population typically has a high acuity level, underscoring the need for nurses with knowledge, skill and expertise, especially in the inpatient setting. All acute patients rightly expect quality care in their hospitals, with highly skilled nurses. In the primary and preventive care setting there is a growing demand for nurses in the field of chronic disease management. There is already a shortage of primary care providers in New York State and around the country. For example, hospitals and federally qualified health centers are experiencing
Nursing students at Lobby Day, 2019
difficulty in hiring psychiatric nurse practitioners NYSNA’s attention to issues of recruitment and retention of nurses is central to all our campaigns. Who else can mentor the young nurses we encourage and support? NYSNA’s specific efforts
Here is a short list of some of the specific efforts undertaken by NYSNA to help meet nursing demand and advance nurses’ skills. NYSNA: ● applied for and received NYS DOH Health Workforce Retraining Initiative (HWRI) grant funding and undertook a program in 2017-18 to train nurses to work in an outpatient psychiatric mental health setting to become board certified in psychiatric mental health nursing, culminating in close to 100 nurses certified through these efforts. ● applied for and received grant funding through the NYS DOH HWRI for nurses to become psychiatric mental health NPs and adult gerontology NPs in 2019 – 20 in order to address the shortage of nurses in New York City in these fields. NYSNA plans to continue this program. ● received grant funding through NYS DOH HWRI for nurses to receive BSNs. This grant spans 2019 – 2020. NYSNA plans to broaden this program. ● provides to its members certification review courses in over 25
nursing specialties in order to help prepare nurses to become board certified in the specialty areas in which they work. These programs are free to NYSNA members. ● negotiated collective bargaining agreements that include differentials for higher education and board certification. Collective bargaining agreements have tuition and continuing education course reimbursement to offset the cost of tuition and continuing education. ● has also negotiated paid time off in many of their CBAs in order for nurses to attend continuing education programs and higher education courses. ● provides additional continuing education programs for nurses and nurse practitioners in order to meet patient needs. ● negotiated collective bargaining agreements with recruitment and retention of nurses in mind in all healthcare settings. ● awards the Secor Scholarship for a family member of a NYSNA member to become a nurse or for NYSNA members to advance their degrees. More than anything, NYSNA works with members to best advocate for patients from issues on their units to community outreach, to understanding the social determinants of health. NYSNA nurses will be present, engaged and active.
NEW YORK NURSE
LOBBY DAY
MAY 2019
A strong showing in Albany
O
n May 6, NYSNA nurses gathered in Albany to participate in their annual Lobby Day. The Safe Staffing for Quality Care Act topped the list of priorities. Nearly 20 elected members of the Assembly and Senate spoke at the luncheon, including Assembly Member Aileen Gunther, RN, sponsor of the Safe Staffing for Quality Care Act. “This is a matter of life and death,” she said. “Nurses have not received justice.” Cathy Dawson, RN, works in the OR at Ellis Hospital, Schenectady. “When staff is short cases are delayed or put off for the next day,” she said. “Emergency cases are sometimes delayed.” Psych patients in need
At Kings County Hospital Center, Crystal Hall, RN, works the psych unit. “Many do not have insurance,” she said. “For psych patients they need after-care—meds, visits, follow-ups. It is imperative that we have funding for these programs.”
Thumbs-up from Assembly Member Karines Reyes, RN, Montefiore Medical Center Among the programs offered at this year’s Lobby Day: Workers and Patients at Risk: Active Shooter Incidents in Healthcare; Extent &
Causes of High Maternal Mortality Rates among Black Women—What Nurses Need to Know.
Cathy Dawson, RN
CONTINUED ON PAGE 6
Crystal Hall, RN
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NEW YORK NURSE MAY 2019
Lobby Day, 2019 CONTINUED FROM PAGE 5
Lobbying with the Long Island contingent
“
It’s blatant disregard for the safety of patients and the nurses caring for them.” –Emily Wood, RN, St. Charles Hospital
(L-R) RNs Emily Wood (St. Charles), Rose Jackson (St. Charles), Sherry Bloom (Plainview), Tracy Kosciuk (St. Charles), Kris Micelli (Plainview), Toni Ann Giaquinto (St. Charles) and Rob Baron (St. Charles)
N
urses from Catholic Health Services of Long Island, St. Charles Hospital and Plainview Hospital visited with Assembly Member Steve Stern (right). A sponsor of the Safe Staffing for Quality Care Act, Stern plays an important role in spreading the word about safe staffing. Emily Wood (top right), RN, said, “More often than not we have staffing issues. It’s blatant disregard for the safety of patients and the nurses caring for them. I believe that without legislation, the only thing that will open their eyes is a tragedy and subsequent lawsuit.”
New York
nurse speCial editioN | may 2019
the official publication of the new york state nurses association
Jennifer Bejo, RN, Albany Medical Center, before the New York State Legislature 2019 Joint Public Hearing on the New York Health Act
Medicare for All is the cure
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NEW YORK NURSE MAY 2019
Medicare for All is the cure
T . . . 52 percent of adults in New York State experienced healthcare affordability burdens in the past year, foregoing rent and food, and racking up credit card debt.
he reality about healthcare is simple: it’s so expensive that millions of Americans go without care, causing them to put their finances and even their lives at risk. Here in New York conditions are alarming. A survey from the Campaign for New York Health reports that 50 percent of insured New Yorkers skipped or delayed care in recent years because they could not afford it. They did not get basic care due to cost, foregoing regular checkups, diagnostic testing, dental care and prescription drugs. Another recent survey by Altarum’s Healthcare Value Hub in partnership with the Community Service Society found that 52 percent of adults in New York State experienced healthcare affordability burdens in the past year, foregoing rent and food and racking up credit card debt. And more than 75 percent of New Yorkers—with insurance—worried about what care will cost them in the future.
Priced out of care
(Below) Attendees at the New York State Legislature 2019 Joint Public Hearing on the New York Health Act, Albany, May 28, 2019
New Yorkers are not alone. The Commonwealth Fund reports that approximately one in three Americans with insurance does not go to the doctor when ill or fill a prescription when needed—because they cannot afford to. A newly diagnosed cancer patient will use up a life saving within two years, according to a recent study in the American Journal of Medicine. Another sad reality is that healthcare denied, or postponed, means that patients get sicker. That’s exact-
ly what nurses see: high acuities indicate a lack of care. Conditions that could otherwise be managed go undetected or untreated until emergency care is required. That helps explain why New York has 3.7 million potentially preventable emergency room visits each year. First-ever hearings
An increasing numbers of members of Congress see Medicare for All as the solution. Rep. Pramila Jayapal (D-WA) is sponsor of the Medicare for All Act, H.R. 1384. On April 30 Congress held its firstever hearing on Medicare for All. “Democrats in Congress have been writing bills that would bring the country closer to a single-payer system,” reported the New York Times. “In that system, Americans would be covered by the same government insurer for a wide range of medical benefits, without the need to make any payments to doctors or hospitals when they receive health care.” On May 28 the New York State Senate and Assembly held their first-ever Joint Public Hearing on the New York Health Act. The Campaign for New York Health (NYHA), a leading organization in the fight for Medicare for All in New York, helped organize participants who shared the view that it’s time for Albany to listen about what is really happening and issue the right prescription for the ailing healthcare system. Medicare for All would cover the one million New Yorkers who have no insurance and it would eliminate the pernicious issue of medical debt for everyone else.
The room of 500 was filled to capacity, as testimony was presented during a marathon 13-hour session. Among those giving testimony was Jennifer Bejo, RN, Albany Medical Center (see her remarks, p. 9). “Every New Yorker should get the healthcare they need without facing financial obstacles or hardships to get it,” said Assembly Health Committee Chair Richard Gottfried in his statement. “No one says they disagree. And the New York Health Act is the only plan that achieves that goal. Our 2014-2015 Assembly hearings were very helpful in collecting stakeholder input, informing our bill drafting, and educating both the public about the bill and our members about public concerns. These hearings will help build on that.” A thorough study
In her prepared statement, State Senator Jen Metzger shared these remarks: “Insurance and prescription drug costs are out of control. People aren’t getting the care they need and our small businesses can’t keep up with rising health costs. New York residents and businesses need and deserve an affordable healthcare system that provides comprehensive, universal health coverage for everyone. These hearings are an important opportunity to get input from key stakeholders as the State Legislature considers this important legislation to create a healthcare system that works for all New Yorkers.” So why not adopt Medicare for All? That question resonated among attendees on May 28. The powerful healthcare industry— insurance companies, hospitals and other providers—claims that Medicare for All is just too expensive, without offering any meaningful solutions to our nation’s healthcare affordability crisis. A thorough study prepared by the Rand Corporation in 2018 considered the issue of cost to consumers under the New York Health Act. It found that “. . . payments for healthcare (premiums, out-of-pocket payments and tax payments supporting healthcare) would decline among lower-income residents under the NYHA, and would rise substantially among the highest-income CONTINUED ON PAGE 10
NEW YORK NURSE MAY 2019
TESTIMONY OF JENNIFER BEJO, RN, Albany Medical Center before the New York State Legislature 2019 Joint Public Hearing on the New York Health Act Good morning! My name is Jennifer Bejo, a proud member of the New York State Nurses Association. I am a registered nurse working in the Intensive Care Unit at Albany Medical Center Hospital. Healthcare is an issue affecting the well being of millions of New Yorkers. If you ask each one of them to prioritize their concern: healthcare will come out on top of their list. And if this issue proves to be a problem in a regular US household who are facing financial obstacles to get the healthcare coverage they need…think about the nightmares that
tracheostomy procedure. Her debilitating condition and chronic dependence on the ventilator require her to wait until the social worker is able to find a facility that will either accept her insurance or would cover her long term care and rehab. She also had to overstay in the ICU pending insurance approval allowing her to be in a vent facility closer to her family. Situation like this places our patients in a vulnerable position. By delaying appropriate disposition of care, it predisposes our patient to multi drug resistant pathogens in the ICU. And if ever some of them find a facility
Jennifer Bejo, RN, testifies, as 1199SEIU Vice President Helen Schaub looks on.
my patients face trying to get care in a system that is broken, inadequate and inaccessible to them. Today I am here to tell you about those nightmares… In as much as I want to provide the best care and treatment plan for my patients, I have seen how our broken healthcare system creates challenges and insurmountable barriers for them to get quality healthcare. Whether it is the high cost or out of pocket network coverage, inadequate or no insurance coverage, restrictive provider network or lack of availability of services…patients are suffering in New York State unnecessarily! I took care of a patient in the ICU. She has cerebral palsy and was admitted from St. Margaret’s after a cardiac arrest due to seizure. She was intubated and failed to be weaned from the ventilator that soon after she underwent
in their insurance network, it is usually far from their residence and family, so they lose out on the personal support system when they move in the institution. These are never good for patient outcomes! A year ago, a newly admitted female patient went into a cardiac arrest upon arrival in the ICU. Despite our attempt to revive her, our efforts were futile. She was newly diagnosed with leukemia and underwent a few rounds of chemo. However her therapy was cut short because one of her medicine was no longer accessible under her insurance network. Now it’s hard to say whether this what caused her early demise. I don’t have the exact data for that and would prefer not to speculate. But one thing I know—interruptions in medical care due to denial of coverage that is unjustified resulting to delays in seeking
appropriate treatment until they are in “dire circumstances”— adding into it the amount of time fighting with insurance company to get the medication or medical equipment or home care needs or worrying about expensive cost of care creates so much stress on the patient and family that it impacts their overall physical, social and mental health status and even their quality of life. And how about the 28 year old who was brain dead after a cardiac arrest due to heroin overdose? The patient being poor and destitute had no insurance. No insurance means no means to find a rehab facility to cure the addiction. Even the family could not afford a proper funeral. I strongly believe that people should not be making decisions about their health based on their finances or the amount of money they have in their bank account. Healthcare should be a RIGHT that is guaranteed to all and not a privilege by those that can afford it. Or perhaps a patient who had to postpone a cataract surgery until she went home to have it done in the Philippines where it is cheaper... because his insurance wouldn’t cover all the expenses. Insurance companies make it harder to get quality care because of this kind of delays…delays on seeking pre approval for procedures and test. Insurance companies limit care by forcing people to get referrals and prior authorization before seeing specialist or undergoing procedure. This is unacceptable. As well as network restrictions not being allowed because health care decisions should solely be left between patients and doctors…NOT insurance companies! When we pass the NY Health Act, it will improve access to a comprehensive, affordable and quality health care services for all. It will reduce, if not eradicate, incidents of needless disability or death due to lack of health coverage or delays of care. No one should worry about high premiums, deductibles and copays…or even the threat of using up a lifetime worth of savings for long term or home health care. It will be guaranteed to all because it will prioritize people getting healthcare where needs will be met and treatment and preventative care will be emphasized before it becomes acute and difficult to manage, therefore decreasing the incidence of hospitalization and further financial burden to patients and families. Thank you!
State Senator Gustavo Rivera, New York Health Act sponsor
Assembly Member Richard Gottfired, New York Health Act sponsor
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NEW YORK NURSE MAY 2019
Nurses know the human costs of care. That’s why many want ‘Medicare for All.’ By Jeneen Interlandi
R Critics say
universal healthcare will penalize providers the most. These
nurses are undeterred.
Excerpted from the New York Times, May 28, 2019
enelsa Caudill, a Washington, D.C.-area cardiac nurse, remembers being forced to pull a cardiac patient out of the CT scanner before the procedure was complete. The woman had suffered a heart attack earlier that year and was having chest pains. The doctor wanted the scan to help him decide if she needed a potentially risky catheterization, but the woman’s insurance, inexplicably, had refused to cover the test. Melissa Johnson-Camacho, an oncology nurse in Northern California, remembers a mother who had to ration the special bags that were helping to keep her daughter’s lungs clear. The bags were supposed to be changed every day, so that the daughter did not drown in her own fluids, but they cost $550 each. And Karla Diederich, also from California, remembers saying a final goodbye to her friend and fellow intensive care nurse Nelly Yap in their hospital’s parking lot. Ms. Yap was dying of metastatic cancer. She was scheduled for another round of chemotherapy, but the hospital had changed owners while she was on sick leave and she’d lost her job—and insurance—as a result. “Nelly spent most of her life taking care of other people,” Ms. Diederich says. “And when she needed that care herself, it was not there.”
The women say that their professional experiences have led them to an inescapable conclusion: The motives of gargantuan for-profit health care industries—hospitals, pharmaceuticals, insurance—are incompatible with those of health care itself. They argue that a singlepayer system, run by the federal government and available to all United States residents regardless of income or employment status, is the only way to fully eliminate the obstacles that routinely prevent doctors and nurses from doing their jobs. Several proposals now working their way through Congress would aim to create just such a system. The nurses’ support for such proposals—the union has endorsed a bill put forth by Representative Pramila Jayapal of Washington— is somewhat surprising, because the zero-sum nature of American health policy tends to place them on the losing end of any major system overhaul. The money it will take to provide many more services to
Medicare for All is the cure CONTINUED FROM PAGE 8
residents. Among New Yorkers with household compensation below the ninetieth percentile under the status quo in 2022 (average household compensation $105,300), average healthcare payments would decrease by about $2,800 per person, which is a decrease from 23 percent of compensation per person to 16 percent.” (p. xi) No surprise that consumers are catching on. They understand only too well that the healthcare industry is not really worried about
its patients’ financial health: 69 percent say insurance companies charge too much; 69 percent say hospitals charge too much; and, 68 percent say drug companies charge too much. And they are right. Healthcare spending as a percentage of household income is on an inexorable march upward. For all we spend on healthcare in this country—$3.5 trillion in 2017, more than any other nation— we aren’t any healthier for it. Americans don’t live as long as our counterparts in other industrialized
many more patients will have to come from somewhere, the thinking goes. And the paychecks of doctors and nurses are a likely source. That calculus has not deterred the nurses. Perhaps that’s because they see so much time and money wasted by the bureaucracy of the current system. By most estimates, the administrative costs of American health care surpass those of any other developed nation. Or maybe it’s because of the innumerable avoidable medical crises they constantly find themselves confronting. Or maybe they just know that a steady job with decent health benefits does not exempt anyone from the arbitrary agonies of our current system. Ms. JohnsonCamacho recalls having to discharge a patient without essential chemotherapy—not because the patient was uninsured but because his insurer refused to cover the drug that had been prescribed. “I had just finished explaining to him how important it was to take this medication faithfully,” she says. “I told him, ‘Every day you skip it is a day that the cancer has to potentially spread.’ And then we had to send him home without it.” Proponents who want to persuade those skeptics would do well to have nurses make the case. “People say they are scared to have the government take control of their health care,” Ms. Diederich says. “But they should be scared of the people who are in control now.” countries with universal healthcare systems. As we get sicker, we spend more when we finally get the care we need—if we get it at all. New Yorkers are ready for reform. Only 32 percent of New Yorkers say the U.S. healthcare system is great, while 72 percent say it needs to change, according to the Altarum survey. It’s time for New Yorkers—and all Americans—to communicate loud and clear that we simply cannot afford to keep this ailing healthcare system. We urge lawmakers in Albany and Washington to act in their constituents’ best interest by adopting Medicare for All.
NEW YORK NURSE
PUBLIC HEALTH
MAY 2019
Killer fentanyl
T
he street names say it all — Goodfellas, Murder 8, Poison, Drop Dead, Serial Killer, TNT, among others. Fentanyl. It’s insidious and it’s a killer. In New York State, fentanyl has surpassed heroin as the drug of choice, leaving a trail of bodies from Suffolk to New York City, from Oneida to Erie. Identifying fentanyl abuse can be a matter of life and death. Nurses know the signs all too well. Fentyanyl users exhibit a false sense of well-being, feelings of euphoria and relaxation, extreme happiness that quickly dissolve into pinpoint pupils, difficulty thinking, speaking or walking, confusion, dizziness, slowed heart rate, difficulty breathing, coma and worse—all classic symptoms of a fentanyl overdose. Without immediate treatment by trained professionals, death comes swiftly—in minutes. A grain of salt
The body count is staggering. Between 2015 and 2016, according to the New York State Department of Health, fentanyl-related deaths rose by 124 percent (excluding New York City) and another 28.3 percent the following year. Those counties most affected are Suffolk, Erie, Monroe, Nassau, Onondauga, Orange, Dutchess, Westchester, Oneida and Niagara.
In New York City, where a lethal drug overdose occurs every six hours, fentanyl was responsible for 57 percent of drug-related deaths in 2017. Make no mistake. Fentanyl is toxic. “The dose you require is minuscule, like a grain of salt,” Dr. Nora Volkow, Director of NIH National Institute on Drug Abuse (NIDA) told Rolling Stone Magazine. “A tiny difference in your content can mean someone dying.” Stronger drugs, less money
Deadly and cheap, with some pills selling for as little as $10, street fentanyl often comes from Mexico and China and is made in labs. According to NIDA, it “is sold illegally as a powder, dropped onto blotter paper, put in eye droppers and nasal sprays, or made into pills that look like other prescription opioids.” It is often cut with heroin, cocaine, methamphetamine or MDMA. “Fentanyl is a problem because the dealers who supply heroin and off-market drugs keep lacing everything with it, thanks to the fact that it's both significantly cheaper and 50 to 100 times more potent than heroin. In short, it allows suppliers to make stronger drugs for less money. And the knock-on effects are drastic. The CDC reported that out of 5,152 opioid-related deaths in 10 states, fentanyl was a factor in
3,700 of them,” according to public TV station KQED. But despite its toxicity, nurses know that fentanyl—when administered properly—can provide a lifeenhancing service. It was first used in 1959 to bring pain relief to cancer patients post-surgery, and is prescribed today judiciously by medical professionals for end-of-life care and to those struggling with severe and unrelenting pain. Introduced by shot, patch or lozenge, pharmaceutical fentanyl such as Actiq, Duragesic and Sublimaze has been known to significantly relieve suffering and improve a patient’s quality of life. Death toll climbing
Even so, nurses know that fentanyl in all its forms is highly addictive and illegal fentanyl is the worst offender. It has surpassed heroin abuse not only in New York but nationwide. In 2017, according to NIDA, 59.8 percent of opioidrelated deaths involved fentanyl compared to 14.3 percent in 2010. The death toll is climbing, and by all indicators, will continue to climb. A kilo of fentanyl that wholesales for about $80,000 will bring nearly $1.6 million on the street, the DEA estimates, making fentanyl a go-go business on the black market. And for now, hospital emergency rooms remain the last line of defense for a growing number of users whose lives may one day hang in the balance.
Without immediate treatment by trained professionals, death comes swiftly–in minutes.
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RESCUE & RELIEF TK
NEW YORK NURSE MAY 2019
NYSNA heads to South America
I
Brazil trip – Benjamin Njoku, RN, Lincoln Hospital
n April, a team of passionate RNs traveled to Brazil for a medical mission, joining other organizations and volunteers in the area in providing essential healthcare services. Over 11 days, NYSNA members traversed the country, visiting Manaus, the Amazon Rainforest, Recife, Salvador and Bahia, bringing their expert care to Brazilians in need. Although healthcare is a guaranteed right in the country, many poor communities in remote locales lack access to healthcare professionals. “In the time we were there, we saw over 1,000 people, so I think we made a big impact,” said Karen Davis, RN of Erie County Medical Center. “Even giving residents someone to talk to and being able to listen to their medical needs contributed to our impact. We were providing medical care to those who wouldn’t otherwise have access to it.”
NYSNA volunteers traveled deep into the rainforest in Brazil.
ence learning about the culture, while treating different illnesses and conditions,” recalled Mount Sinai Hospital RN Erin Hogan. As NYSNA traveled to different areas, they shared ideas, discussed
the current healthcare system and engaged with community leaders. Along with student nurses and volunteers, members were fortunate to visit indigenous tribes and isolated communities deep in the rainforest.
An exchange of ideas
Nurses learned Brazil’s medical practices and protocols, as well as the ins and outs of the country’s universal healthcare program. Nurses fully immersed themselves in the culture, participating in both traditional and daily ceremonies. “It was a moving experi-
Adults and children alike received healthcare services in Peru.
Brazil trip – Erin Hogan, RN, Mount Sinai Hospital
Members of NYSNA's team on the ground in Peru
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“One of the things that moved me the most was when we visited a tribe and the chief mentioned the consciousness of the environment,” said Benjamin Njoku, RN, of Lincoln Hospital. “As nurses, we should be aware that we are not just taking care of patients; we are taking care of the environment as well because a part of our health is our environment.” On to Peru
A month later, in the mountainous Cusco province in Peru, 14 NYSNA nurses had an equally enriching experience. Members traveled to the country on a medical mission organized in part by the local Andina University. The area is home to many farm workers who speak Quechua, a language indigenous to the Andes mountains and highlands of South America. Two translators were tapped to facilitate communication between patients and nurses, with one translating from Quechua into Spanish and a second translating from Spanish to English. With their support and the assistance of local doctors and approximately 50 volunteers, NYSNA’s team was able to provide care to nearly 200 patients in the impoverished communities of Ccorca and Collana. Members visited the university’s School of Nursing, where they participated in lectures and debates with students and faculty. The group also visited the regional hospital and met with the nurses’ union, encouraging
Nurses in Brazil provided medication to those in need.
them to advocate for themselves and their profession. In Peru, nurses earn a mere $7,000 a year. Gaining insights
These medical missions offer NYSNA nurses the chance to make a broader impact and get a glimpse of the needs and environments for
both patients and nurses beyond the United States. “As a nurse who has gone on two missions, it really gives you insight into what people need and the conditions that are out there that we are unaware of,” said Davis. “It truly reveals how much more we have as a country and the need to help others access basic medical care.”
RNs Karen Davis and Memuna Ali enjoying the beautiful views of Brazil.
“ NYSNA members at a hospital in Cusco, Peru
We were providing medical care to those who wouldn’t otherwise have access to it.” –Karen Davis, RN, Erie County Medical Center
NYSNA nurses and other volunteers at Andina University School of Nursing
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Upstate nurses are using their collective voices to stand up for patients and their rights.
CVPH RNs present member statements
Solidarity at CVPH
W
hen the quality of care for patients is in jeopardy, NYSNA nurses aren’t afraid to band together and fight for what’s right to ensure that every patient is treated like a VIP. At the University of Vermont Health Network, Champlain Valley Physicians Hospital (CVPH), NYSNA RNs are doing just that. Recently, nurses came together to fight cuts impacting ancillary staff on the Medical-Surgical and
Progressive Care Units. NYSNA nurses jumped at the opportunity to use their voices to take on administration directly, compiling dozens of statements from members providing feedback on the cuts and laying out their concerns. The power of collective action
The statements, which were presented to management, criticized the cuts and called on the administration to prioritize patients, not
the hospital’s profits. Moreover, the nurses shed light on the factory-like work environment that they have had to endure, which has negatively impacted both staff and patients alike, leading to high stress and low satisfaction across the board. Finally, members provided indepth, evidence-based research on the importance of safe staffing and its ability to increase the quality of care for patients. We stand in solidarity with the brave nurses at CVPH who are showing the power of collective action and speaking truth to power.
St. John’s nurses fight back
E
arlier this month, NYSNA nurses at St. John’s Riverside Hospital celebrated a well-
earned victory. The hospital’s administration had been directing nurses to float between the Yonkers and
Dobbs Ferry campuses in a clear violation of their contract and the stipulations of their appointed positions. subhead
The NYSNA executive committee at St. John's Riverside Hospital
Members had been in a battle with the administration over the issue; however, in typical NYSNA fashion, the nurses united to advocate for their rights. Nurses gathered and demanded to meet with management. After a well thought out, forceful presentation of the facts, management ultimately backed down and acquiesced to NYSNA’s demand that the practice come to an end. NYSNA applauds nurses at St. John’s Riverside Hospital for their grit and determination and for leveraging the power of their collective voice to create meaningful change and ensure nurses get the treatment they deserve.
NEW YORK NURSE MAY 2019
NYC – Nurses at The Brooklyn Hospital Center
achieve major wins for staffing and retiree health in their new contract.
STATEN ISLAND
– For RNs at RUMC, Nurses Week
is a reminder of the special relationship between them and their patients.
Around the state 9
CAPITAL /NORTH COUNTRY
– Nurses in the
CENTRAL REGION
– Nurses in Central New York
Capital-North Country region discuss the importance of celebrating Nurses Week.
celebrate Nurses Week by connecting with one another while engaging in fun activities.
WESTERN REGION – At ECMC, SANE nurses are going beyond the call of duty to make a difference.
LONG ISLAND
– Across Long Island, nurses were recognized for their dedication to their communities.
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NEW YORK NURSE MAY 2019
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INSIDE
Meeting the future of nursing, p. 4
Killer fentanyl, p. 11
Medicare for All is the cure