By  |  March 29, 2011 | 

I fondly remember attending the Local 17 insulators union hall meetings with my dad when I was a young boy. The scene was similar to what one might expect: a smokey, comfortably packed, dimly lit and musty room in a small red brick building in Chicago’s “Back of the Yards” neighborhood.  My father  introduced every “Brother” to me as “Mr. Jones, or Mr. Murphy, etc…” My dad seemed very comfortable in that environment as did I.  Those memories validate a sense of feeling very safe and very welcomed… taken care of, if you will.

Later in life, I worked  my way through college and medical school by removing the same asbestos insulation that my father and his Brethren of Local 17 installed decades earlier. (Local 17 ironically boomed in the 80’s during the asbestos abatement era). I frequently heard that many of those “Misters” I had met in my youth had died terrible deaths due to occupational lung disease and/or Mesothelioma.  Every other week my dad recounted another one of his Asbestos Worker Brethren dying in “this or that” hospital, and how he had “so many” kids in school, and “could I go to the benefit with him to help out the family.” He always attended those benefit gatherings and made sure that others did as well. Maybe it was his outright  altruism or maybe it was his belief in Karma that led him to do this. Whatever the case, my now-retired-father,  disabled from lung disease and dependent on oxygen, receives a pension and health benefits from Local 17–he is being taken care of.  Even though his “Cadillac health plan” is not enough to cover his medical expenses and he must obtain his medications at a discount  from the VA hospital, he is appreciative, and so am I.

Organized Labor in the United States has a rich and poignant history; one that is far too often taken for granted by the average citizen.  Were it not for the Labor Unions, I would not have been able to earn a Medical Degree. Were it not for the Labor Unions, my father would not have been employed after returning home from Vietnam with a wife and baby to support.

Were it not for Chicago’s Haymarket riots and the organized labor movement at the turn of the last century (which codified the 40 hour work-week, child labor laws, and workers’ wages) the world as we know it would look much different, and, in my humble opinion, very bleak.

I now struggle with the current national debate on organized labor. Not only because of the events that have taken place in Madison, but also as it relates to the recent and impending direct actions by the National Nurses Union (NNU).

In Washington DC, the recent one-day nurses strike at Washington Medical Center, incurred a cost of over a million dollars in replacement workers’ salaries. This April, a nurses strike at a potential five Massachusetts hospitals threatens to bring hospital operations at those facilities to a stand still. And, at a time when hospital margins are already lean, direct action has the potential to bankrupt these facilities. The most concerning aspect of these strikes is the impact on patient care. Hospitals in Massachusetts are scrambling to implement contingency plans, recruit replacement nurses, and modify elective surgery schedules. Replacement nurse salaries come at a premium and will drain the already depleted operational reserves. The down stream financial impact could be catastrophic. If you are a hospital employed doc, your salary could be at risk.

Yet, the major issue the NNU is fighting over is NOT wages. The major issue on the bargaining table is nurse to patient staffing ratios. That’s right. The NNU’s platform is patient safety.

Those of you who read my posts understand my passion for appropriate Hospitalist:patient ratios.  And so, I am at a crossroads. Do I support the NNU in their fight to improve patient safety or do I support the hospital’s efforts to manage costs in an already austere marketplace? A win for the NNU would have dramatic implications for patient safety on a grand scale, yet potentially a very negative economic impact at the local level.

And so, my Hospitalist Brethren, when the nurses union at your hospital decides to strike, what will be your position? Patient Safety, or Patient Safety?

I welcome your opinions and a spirited debate.





  1. Laurie Bankston March 29, 2011 at 5:53 pm - Reply

    Thanks for such an interesting perspective. At a time when we are working for value-based purchasing targets and patient safety goals, one has to think that staffing ratios are a huge piece of the puzzle. And as one who would not have been able to attend college or medical school or have had health insurance as a child without unions (teachers’–), I have to say it’s not an easy call.

  2. Kim March 29, 2011 at 6:28 pm - Reply

    As a nurse practitioner who works for a hospitalist service, with previous experience as as a nurse in the ER and ICU, as well as med-surg floors, I can say that patient safety must come first. Adding one or two nurses to each shift would dramatically improve patient safety and save costs by cutting down on length of stay (because so many things get missed due to oversight from busy nurses). The costs to me seem so minimal in the large scheme of things. By cutting length of stay, everyone wins.


  4. Mark March 30, 2011 at 12:31 pm - Reply

    Are there data to support specific nurse to patient staffing ratios? If there are, then it would seem any reputable hospital (and Medicare and commercial insurers, for that matter) could be persuaded for both moral and economic reasons to support these ratios without the nurses having to resort to a strike(i.e. abandoning the vulnerable patients whose safety they purport to protect).
    I don’t come from a union family, but have worked at hospitals with union nurses. Some were good, most weren’t. Nevertheless, I’m skeptical patient safety is the real goal of the nurses. The union, afterall, works for the nurses to advance their interests, not the patients.

    • Mike Radzienda March 30, 2011 at 2:36 pm - Reply

      Great comments Laurie, Kim and Mark.
      There is a large base of literature on nursing ratios and patient safety.
      California law mandates that hospitals staff to strict ratios and many state nursing organizations reference the CA precedent.
      I agree that the NNU acts in the best interests of their constituents, and tacitly, in the best interest of patients.
      From my reading, the direct actions are planned well in advance and by law, the union must give significant notice to the state if they intend to strike. This policy mitigates the “patient abandonment” issue and provides ample opportunity for employers to find replacement workers.
      I would like to hear the experiences of any providers out there who have lived through a nusrses strike.

  5. Rachel Lovins April 19, 2011 at 11:17 pm - Reply

    Mike, great post. I recently read about the 100th anniversary of the Triangle Shirtwaist Factory fire, where management locked the doors of a workshop and caused the death of about 130 people, mostly immigrant girls and young women, 14-23, which forced the issue of protecting workers rights. I’m a total supporter of labor rights, for nurses, for immigrants in the meat packing industry, for secretaries, for hospitalists. But unions today no longer focus only on labor rights. The goals are not always clean or clear. It’s a complicated issue. Thank you for addressing it.

  6. Mike Radzienda April 20, 2011 at 1:32 pm - Reply

    Thanks Rachel.
    I agree, unions are not what they used to be.
    Who will look out for the front- line healthcare workers as profit driven corporations devour the healthcare pie?

  7. […] I wrote in my previous post, organized nurses in Massachusetts, Washington DC, Minnesota, New York, California, and Illinois […]

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