CRITICAL UPDATE September 2021

SAFE STAFFING SAVES LIVES • SAFE STAFFING SAVES LIVES

CRITICAL UPDATE Pennsylvania Association of Staff Nurses & Allied Professionals

INSIDE! I Interview with nursing living legend and fierce safe staffing advocate Linda Aiken, Ph.D., R.N.

“This shortage of nursing care during COVID? It’s the result of hospitals employing too few nurses for decades! And hospital industry representatives will do everything they can to keep it that way.”

—Linda Aiken, Ph.D., R.N.

September 2021

PASNAP Safe Staffing Lobby Day!

For a year and a half, the pandemic has ravaged our hospitals, our communities and our physical and emotional health. It has also intensified the biggest problem we face at work—chronic, even dangerous shortstaffing. On September 28th, we fight back, we tell our story.

On Tuesday, Sept. 28, we’re bringing the fight for safe staffing to the halls of power in Harrisburg! Our state senators and representatives must be told about the staffing crisis in our hospitals and urged to pass the Patient Safety Act (House Bill 106 and Senate Bill 240), which would mandate safe staffing ratios in all Pennsylvania hospitals. Please join us! Your legislators need to hear directly from you!

For more info on Lobby Day— what it is, what’s involved— head to page 6 I

We Deserve Better Her research has led to so many fundamental changes in health policy and nursing practice over her lifetime that she was recently designated a “Living Legend.” Now she wants to help fix nurse short-staffing.

Wouldn’t that be legendary? A PASNAP exclusive interview with Linda Aiken, Ph.D., R.N.

“Nurses Deserve Better, So Do Their Patients” is the title of a guest essay by Linda Aiken, Ph.D., R.N., that appeared in The New York Times on August 12th.

In those seven words, the longtime professor of nursing and sociology, and founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, neatly summed up nursing’s eons-long struggle with short staffing in a perfect, commercial-worthy slogan.

However, her evidence-based essay— required reading for every frontline RN— just got better from there.

This is Dr. Aiken’s lane. A year ago, she was honored as a “Living Legend” by the American Academy of Nursing—it’s highest honor—for her extraordinary contributions to the nursing profession, largely due to her pioneering research on the impact of safe-nurse staffing on saving lives while reducing costs and the need for positive clinical working environments to improve nurse retention. She knows firsthand the toll the pandemic has taken on frontline caregivers. And she knows what we must do to help improve our work environments, both for our patients and ourselves.

“The Covid-19 pandemic exposed strengths in the nation’s health care system—one of the greatest being our awesome nurses,” Dr. Aiken begins.

“But it also exposed many weaknesses, foremost among them being chronic nurse understaffing in hospitals, nursing homes and schools.”

Ahead of our Safe Staffing Lobby Day on September 28, PASNAP talked to Dr. Aiken about her career, the push for safe staffing legislation and playing hardball.

PASNAP CRITICAL UPDATE

PASNAP: When did you become interested in nurse short-staffing and

nurses’ wellbeing as a factor in patient safety?

DR. AIKEN: “It was actually on my very first night as an R.N., in 1965. I was one of only two nurses assigned to a 24-bed surgical unit of burn patients and thoracic surgery patients in a good teaching hospital that’s now a magnet hospital. I said to myself, ‘There’s something really wrong with this.

I’ve always wanted to be a nurse in this hospital, but I was given this impossible thing to do on my very first day as a nurse.

Something is really, really wrong here.’ The longer I worked in hospitals, the more I saw this unfolding, and I just could not let it stand.

“Thoracic surgery was my area of interest and I noticed, at the time, patients who had open heart surgery would be totally psychotic, pulling out their chest tubes, when they came back from surgery, and no one knew why. I asked a psychologist to partner with me on a study for a nursing

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“I said to myself, ‘There’s something really wrong with this.’” intervention to tackle the disorientation open heart surgical patients experienced.

It was my first study, and it was published in Nursing Research.

“I wanted to change things. I came to realize that I could help patients one by one at the bedside but that by doing research, I could help millions. It’s why I went back to school to get my Ph.D. I wanted to look at what is and advocate for what could be.”

PASNAP: You have long advocated for safe staffing ratios in nursing, yet nurses are still short-staffed.

DR. AIKEN: “Sometimes I feel like things haven’t changed all that much since 1965.

Many hospitals are caught in another era. There’s no other industry I can think of that’s so lacking in modern human relations policies. They’re still treating nurses as though they’re expendable, and then they wonder why nurses have no employer loyalty? Please. It’s obvious.”

PASNAP: Do you think the pandemic has changed people’s understanding of the staffing problem?

DR. AIKEN: “Yes. There’s a more accurate media portrayal of what nurses do and so the public now understands why nurses are so important to patient outcomes.

That’s why I firmly believe that now is the time for nurses to act to get better care for patients.”

PASNAP: Do you have any advice for nurses looking to get involved?

DR. AIKEN: “Nurses are the glue that holds the whole healthcare system together. No matter how bad their working conditions are, they still provide care, they still act as the glue. That very fact gives nurses tremendous power that we shouldn’t be afraid to use. We have to speak truth to power and we have to do it now, while the pandemic continues and the public and the media are on our side. We have to let the public know what we’re up against, and we have to play hardball. This shortage of nursing care during COVID? It’s the result of hospitals employing too few nurses for decades!

And hospital industry representatives will do everything they can to keep it that way.”

PASNAP: That’s why you’ve long advocated for legislative fixes like the PA Patient Safety Act. DR. AIKEN: “Most hospitals won’t do it themselves. They aren’t offering enough permanent positions or paying at a market rate, and the working conditions for frontline caregivers inside too many hospitals are really poor. All these things can be fixed, but the problems have existed for decades. The US has some exemplary hospitals that invest in their nurses, but not nearly enough.

Interestingly, hospitals that invest in their nurses are doing just fine financially.

“Here’s a question: If hospital care costs so much, where is all the money going if it’s not going to employ enough nurses?

That’s a question that should resonate with the public.”

Conclusion from an American study published in BMJ, the British Medical Journal, in August 2020: “The needed nursing care surge required to treat patients with COVID-19 is being created from a deficit status quo in which the nurse workforce was already emotionally depleted prior to the surge in patients with COVID-19.

[And] our findings are consistent with what much of past research has shown, namely that chronic nurse understaffing has persisted in a significant share of U.S. hospitals for decades and poses significant risk to patients even without the presence of a pandemic.”

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“Many hospitals are caught in another era. There’s no other industry I can think of that’s so lacking in modern human relations policies. They’re still treating nurses as though they’re expendable, and then they wonder why nurses have no employer loyalty? Please. It’s obvious.”

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Message from PASNAP President Maureen May, RN Dear PASNAP members, In the early summer edition of Critical Update, I wrote to you about the Patient Safety Act (see page 6) and the critical need for safe staffing in our hospitals.

I said we are doing everything we can from the bedside, but we need help from Harrisburg. “Now is the time for nurses to stand together and lead,” I wrote. “Our patients’ lives depend on it, but frankly, so does the health and viability of our profession.”

I wrote that in May, prior to that issue’s publication in June. At the time, our COVID numbers were falling, not one but three versions of the vaccine were widely available for those who wanted it, and there was every reason to hope for a reprieve from this deadly pandemic and the soul-draining experience of working as caregivers on its front lines.

Now, as I write this, our COVID numbers are rising due to a ruthless, hypercontagious variant, we are even more exhausted, if that’s possible, and our ranks have further thinned. The system that’s supposed to support nurses, and therefore patients, is in crisis. Our workloads and stress-loads have shot through the roof while our staff numbers have dwindled due to burnout and

bottom-line decisions made by executives worlds away from the bedside. This cannot continue.

Our hospitals cannot be counted on to prioritize excellence in patient care with appropriate nurse staffing. We need our legislators to stand up for their constituents with mandated staffing ratios.

We need the Patient Safety Act, and we need it now. That’s largely what this edition of Critical Update is all about. I hope you join us in this fight, in whatever way you can.

On another note, close as we are to Labor Day, I want to recognize the often backbreaking and heartbreaking labor you do and the passion and fight and commitment you bring to it every single shift.

This is the second Labor Day we have celebrated since the pandemic laid siege to our hospitals, our communities and, in many ways, our professions. We have lost patients—so many patients. And we have also lost colleagues—to COVID, to retirement and, in some cases, to hopelessness and despair. Yet we have fought for our patients and for each other.

We have fought for excellence in care and in working conditions and against management and policies that would seek

to limit those things. And we have fought for better staffing, for better contracts and for a better future for the nurses and allied health professionals just joining us out of school.

We have done this every day, and we have done it well.

Just in the last year, PASNAP members have won no fewer than 18 transformative new contracts and inspired nurses and allied professionals at Delaware County Memorial Hospital, Taylor Hospital and Jefferson Frankford Hospital to pitch their own battles in an attempt to join us and our fight.

It’s what the labor movement as a whole is all about, really—coming together in solidarity to fight to lift up our communities, both worker and patient. And even in the midst of a deadly and dangerous pandemic—one that has changed our hearts and our minds forever—we have done exactly that, using our voices and our agency to lead in our fields and to improve both patient care and our professions.

Photos of Carlos Aviles, PASNAP Executive Board Member and president of TAP, and Tracy Pack, a nurse at Jefferson Frankford Hospital and one of the leaders in the effort to unionize there, were featured in an editorial in The New York Times celebrating workers and union members just before Labor Day. Through the photos, Carlos and Tracy hold hands with other union members, underscoring the title, “The Power in Numbers.”

They are two of only three healthcare professionals featured in the story.

Today, I reach out my hand to you and thank you, PASNAP sisters and brothers, for all that you do.

In solidarity, Maureen May, RN

The Ladies in Red: At the AFL-CIO Labor Day 2021 march in Philadelphia; with me from the left, PASNAP Executive Board Member Selena Hodge (TAP) and Marty Harrison and Mary Adamson, Vice-President and President of TUHNA.

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What’s the Patient Safety Act?

Picnicking with politicians: Prime Patient Safety Act sponsors state Rep. K.C. Tomlinson (standing, fifth from left) and state Sen. Maria Collett (standing, seventh from left) attended a St. Mary membership picnic in Core Creek Park on June 30.

The Patient Safety Act (PA House Bill 106 and PA Senate Bill 240) is a bill that would mandate, through legislation, safe staffing standards in hospitals across the state--something our hospitals have never done, don’t do now and can’t be counted on to do in the future. Those of us at the bedside are doing all we can to protect our patients. We’re now asking legislators to do their part to protect their communities—by passing the Patient Safety Act.

Bill Basics There are two identical versions of the Patient Safety Act—the bill introduced in the House and the bill introduced in the Senate. Both will limit the number of patients a nurse can be assigned depending on the level of care the patient requires. Because the limits were set by nurses, both bills ensure a minimum standard of care that every Pennsylvanian deserves. PASNAP, the Pennsylvania State Nurses Association, Nurses of Pennsylvania and SEIU Healthcare Pennsylvania all support this legislation.

PASNAP CRITICAL UPDATE

“This legislation is an important part of keeping hospital patients safe and ensuring they receive the best care possible. In addition, the Patient Safety Act represents an excellent way for hospitals to make an investment in patient care that will pay dividends in overall savings.”

When a bill is introduced in the Pennsylvania legislature, whether it’s in the House or the Senate, it’s automatically referred to a committee, based on its subject matter.

Both Patient Safety Act bills were referred to the —From the introductory Health Committees in their respective chambers. In order memorandum attached to both for the bills to be debated bills and voted on, the chairs of each committee must bring the bills up for discussion; House Bill 106 if the chairs, for whatever reason, choose not to do this, the bills will languish in Introduced in February by prime committee. They will never be discussed, cosponsors Reps. Thomas L. Mehaffie III never receive a vote and never move to (R) and Kathleen C. Tomlinson (R), serving the House or Senate floor for a hearing.

Bucks County.

Because Republicans are the majority party in the Pennsylvania House and Senate Bill 240 Senate, the Health Committee chairs are Introduced in August by prime cosponsor both Republican. Even though House Bill Sen. Maria Collett (D), serving parts of 106 was introduced in February and its Bucks and Montgomery Counties and a prime cosponsors are both Republican, nurse herself. it has yet to be brought up for debate in the House Health Committee.

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What’s a Lobby Day? A lobby day is simple, really: It’s a day of face-to-face visits with lawmakers, whom you are trying to convince to support you and your issues. At PASNAP’s Safe Staffing Lobby Day on September 28th, we’ll be spreading our message that safe nurse staffing is critical for patient safety and optimal patient care, and that our hospitals aren’t staffing appropriately and cannot be counted on to do so in the future, which is why we need legislators from both parties (safe staffing should not be a partisan issue) to support the Patient Safety Act and to pass it.

What’s Our Plan for the 28th?

PASNAP had hoped to charter some buses to take us to and from Harrisburg.

But due to an uptick of COVID cases due to the Delta variant, we feel it would be safer to plan to travel in smaller groups.

PASNAP will reimburse for parking, tolls and mileage; carpooling is encouraged.

If you plan to join us, you’ll need to plan to leave early in the morning on Tuesday,

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September 28th, so that you are parked and in the Capitol no later than 9 AM; you should be home by late afternoon.

We’ll meet just inside the entrance to the Capitol to go over plans and to divide into groups. Pre-scheduled meetings with legislators will begin at 10 AM; each group will be assigned a series of meetings. In those meetings, you’ll tell the state senator or representative in your own words, based on your own experience, why the Patient Safety Act is desperately needed at your hospital and hospitals statewide.

If you have a personal story about why safe staffing is so important, this is the time to tell it. You’ll be given a folder you can leave behind with the legislator about the Patient Safety Act—what it is, why it’s important. And before you leave, you’ll ask for that legislator’s support to get the bill passed. Your group will then head to your next scheduled meeting.

At noon, we’ll meet at a reserved area of the Capitol for lunch (box lunches will be provided) and to trade notes; at 1 PM, we’ll hold a safe staffing rally on the Capitol

steps. You should be free to head home by midafternoon.

We hope you’ll join us—the bigger our presence in Harrisburg, the larger our collective voices. We’ll have signs and buttons. We’ll meet with our legislators.

And we’ll do excellent work, advocating for our patients and our profession. Don’t miss it!

LOOK OUT, LAWMAKERS— HERE WE COME! If you plan to attend—and we hope you will—PASNAP’s Safe Staffing Lobby Day on Tuesday, September 28th at 9 a.m., click on the link below and sign up! Or, email PASNAP Political Organizer Steve Morris at smorris@pasnap.com ASAP. Feel free to share your questions and concerns.

SIGN UP HERE PASNAP CRITICAL UPDATE

What Should I Wear?

The PASNAP Lobby Day uniform is a red PASNAP tee; black pants or a skirt; and comfy shoes (the historic Moravian tile Capitol floors are beautiful to look at but hard on feet). You’ll be given buttons, signs and masks (which you will be required to wear) when you arrive at the Capitol.

It’s a Good Day to Fight the System!

Alexandra Shungudzo Govere, better known as Shungudzo, is a Zimbabwean-American philanthropist, record producer, gymnast, journalist and reality television personality. She also writes and sings a really good song. Listen to “It’s a Good Day to Fight the System!” on the drive to Harrisburg.

HAVE TWO MINUTES RIGHT NOW?

Tell your legislators to pass safe staffing!

“It’s incredibly easy!

I flooded my representative’s office with letters—so many that his staff reached out to me! That’s what it’s all about, right?”

—Angie Cleghorn, president, Jeanes Nurses United

If the last year and a half have shown us anything, it’s that we have to take staffing decisions out of the hands of hospital administrators.

Here’s something you can do right now, in just 2 minutes: Click on the link below, enter your contact information and send a quick, prewritten email to your state senators and representatives, urging them to pass the Patient Safety Act.

SEND EMAIL HERE

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CONTRACT UPDATES United and Bargaining Hard at ACMH Like many of our hospitals, Armstrong County Memorial Hospital is in the midst of a critical nursing shortage and isn’t rehiring fast enough. The nurses, who had had three bargaining sessions at the time we went to press, are looking for wage increases to attract and retain nurses.

They had just presented a unity petition on staffing and wages. A whopping 93% of the nurses signed.

ACMH Bargaining Committee, including Cassie Wood, Sandy Harrison, Jerry Dunn, Bethany Dunn, Mary Kilgore, Brian Wimer and Christen Rearick.

Focused on Staffing and Retention at Warren The contract for Warren General Hospital Professional Employees’ Association expires at the end of the month, and bargaining dates are scheduled through September. As we went to press, the nurses had some TAs, but since management has proposed a wage freeze and eliminating contributions to members’ retirement, it will come down to staffing and economics. The committee is laser focused: They know what they want and why they want it.

Facing Off Against Tower at Pottstown The nurses at Pottstown Hospital are currently negotiating with a boss— Tower Health--with fierce anti-union animus. Negotiations had just begun as we went to press, with a vital, engaged Bargaining Committee. “We have some new young nurses on the committee,” said Pottstown Hospital Nurses United President Lori Domin— “one person has only been here for three months!” They have session dates scheduled every two weeks through mid-December.

“We’re so short staffed we can’t get bargaining committee members to daytime bargaining.

We requested evening sessions and Fred—Tower’s lawyer—said he gets cranky in the evenings.

I told him to eat a Snickers!”

—Lori Domin, Pottstown Hospital Nurses United President

Front row, from right: Bill Zoda, Jim Slinger (Treasurer), Joyce Fuerman (Bargaining Committee), Alison Campitelli, Kendra Barkasi (President), Emily Lennon, John Mason (Bargaining Committee), Jackie Strohl, Ken Adams, Debbie Tieck. Back row, from right: Jamie Yakscoe (Bargaining Committee), Liz Fiola (Bargaining Committee), Roslyn Rucker (Bargaining Committee), Jenn Lopez (Bargaining Committee), Ken Harner (Vice President), Michael De Rosa. Far back row, from right: Chris Betts (Bargaining Committee), Bernie Donnelly, Rob Haines (Grievance Co-Chair), C.J. Stemple (Executive Board Member).

Fists in the Air at Eagleville’s Third Bargaining Session!

Eagleville Hospital Nurses and Techs United’s contract expires on September 30th, and they had had a trio of bargaining sessions with management as we went to press. The union had proposed changes in the grievance procedures and advocated for the sameThePTO Photo by Monica Herndon, staff photographer, Philadelphia Inquirer.

Published March 2021. for techs and nurses. They had also proposed adding a 12-hour shift, a Baylor program for the weekends, wage and step10,increases, parity between nurses and techs on differentials, and language around Just Culture. Staffing and retention are the union’s priorities.

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PASNAP CRITICAL UPDATE

ORGANIZING UPDATE Angry and Organizing: Nurses at Jefferson Frankford Hospital Early this year, nurses at Jefferson Frankford Hospital began meeting with one another to discuss the state of their hospital and issues that were standing in the way of providing safe, excellent patient care. Nurses reported critical issues with staff turnover and departures, leaving many units across the hospital understaffed and with heavy patient loads, forcing the nurses who remained to attempt to do more with less and putting patients at risk.

This was, of course, after a devastating year, where nurses and other frontline healthcare professionals worked tirelessly during the COVID-19 pandemic at great personal risk to themselves. Jefferson Health responded to their nurses’ heroism by announcing that the hospital was cancelling their scheduled 401k contributions. This news came after Jefferson pulled in $394,943,000 in profits during the pandemic.

The nurses decided to organize. Jefferson decided to hire a notorious union-busting firm--Healthcare Labor Solutions, the same consultants hired by Jersey Shore Medical Center in New Jersey when the nurses there tried to organize last year.

The nurses at Jersey Shore filed 12 Unfair Labor Practice charges against Healthcare

Jefferson Frankford nurse Kevin Diamond, R.N., kicks off the August 13th press conference.

Labor Solutions and the hospital for the same type of illegal actions they are engaging in now at Jefferson Frankford.

The Jeff Frankford nurses have also filed numerous ULP charges with the National Labor Relations Board.

“Not only is union busting a disgrace,” said Philadelphia City Councilmember Helen Gym. “It’s illegal, it’s unconstitutional, and we will fight it with every ounce that we have. We will be there with you every step of the way.”

On August 13th, outside the hospital, the nurses stood up for their patients and for each other. With them on the sidewalk and in their fight were fellow PASNAP members and city, state and federal-level government officials or their representatives, including US Congressman Brendan Boyle; state Sens. Nikil Saval, Sharif Street and Tina Tartaglione; state Representatives Jason Dawkins, Joe Hohenstein and Danilo Burgos; and Philadelphia City Councilmembers Helen Gym, María QuiñonesSánchez, Kendra Brooks and Isaiah Thomas. The officials pledged their support for the nurses, demanding that a quality healthcare system value the people who drive it.

State Sen. Sharif Street added: “Just like we look to these folks, the nurses, to make sure our loved ones are cared for, we’re looking to you, Jefferson, to make sure they’re cared for. We demand nothing less.”

“We’ve been understaffed for a number of years. We’re unable to retain nurses, for various reasons, including lower pay.

We want a seat at the table. We want to help facilitate better care and treatment of our patients—and for ourselves,” Kevin Diamond, a Jefferson Frankford nurse, told WHYY at the press conference.

“It’s about fairness,” said Jeff Frankford ICU nurse Lola Morgan, BSN, RN, CCRN, CHPN. “Last year, a coworker said, ‘The bigger Jefferson becomes, the smaller we become.’ That comment has been on my mind this entire journey. It’s time to make our voices heard!”

They have.

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