Count HealthPartners CEO Mary Brainerd as another healthcare official who neither buys the logic behind the nurses demand for set staffing levels, nor the union’s stated reason for embracing the issue as its rallying cry.
Brainerd is hardly a neutral expert. HealthPartners, based in Minneapolis, operates three hospitals, all of them non-union. Yet as leader of the largest, nonprofit health cooperative in the country, Brainerd’s voice deserves to be heard.
Speaking at the Minnesota High Tech Association’s CEO Briefing event Wednesday morning, Brainerd calls the labor spat between the Minnesota Nurses Association (MNA) and Twin Cities hospitals “a very tough situation.” But she argues politics is driving the union’s strategy that has already resulted in the nation’s largest nursing strike earlier this month and could lead to an indefinite one.
“A new union is trying to demonstrate greater value [to its members] than the previous union,” Brainerd said.
The MNA is an affiliate of the National Nurses Union (NNA), founded last year by nurses unhappy with the American Nurses Association. The new union has made mandatory limits on how many patients each nurse can see a top priority and argues that set ratios protect patient safety by boosting the time a nurse can spend on each patient.
Brainerd questioned the need for such requirements.
“Putting these [ratios] into labor agreements is a very expensive way to do it,” she said. “You can’t help but think of autoworkers. Locking in [these requirements] freezes any sort of productive change. We have not seen [set ratios] make a difference. I don’t see any examples of poor quality in Minnesota” because of staffing problems.
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I don’t agree with everything Brainerd said. There’s plenty of independent evidence to suggest establishing ratios boost patient outcomes.
“A higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients,” according to a 2002 study published in the New England Journal of Medicine.
“Our results suggest that the [1999] California hospital nurse staffing legislation [that sets patient ratios] represents a credible approach to reducing mortality and increasing nurse retention in hospital practice,” a 2002 study published in the Journal of the American Medical Association concluded. “Our major point is that there are detectable differences in risk-adjusted mortality and failure-to-rescue rates across hospitals with different registered nurse staffing ratios.”
Nevertheless, Brainerd makes some valid points. Writing set ratios into labor contracts seems outdated, especially when federal and state health reform laws require hospitals, doctors and nurses to be more innovative, flexible and efficient.
Like Brainerd, I too thought of American autoworkers. Globalization and the emergence of formidable foreign competition caught both American carmakers and the unions completely flat-footed. The dynamic changes to the stressed American healthcare system seems to demand all healthcare parties go with the flow. Hard to see how ratios mesh with that.
The nurses have legitimate beefs — tiny pay raises and pension reductions — with the hospitals. It’s just odd that the MNA has chosen patient ratios as its showpiece demand, a problem, as Brainerd noted, that might not even be a problem in Minnesota. The nurses whom I spoke to seem to prize the high quality of their work and no one claimed today’s patients are in any immediate danger.
Ironically, the MNA might even get more sympathy from its peers in healthcare if it stuck to the traditional grievances of wages and benefits. Read the following comments from a doctor in response to an earlier piece I wrote about the doctors union remaining neutral:
“The nurses I speak with, however, are very concerned with their pension benefits, and understandably,” the physician writes. “Ultimately, I support trying to come to an agreement with salvaging some sort of pension that doesn’t cripple the mission of these nonprofit organizations. I don’t support the NNU push for nurse staffing requirements as proposed and have yet to meet a physician who does. Unfortunately, the staffing requirement is the goal of the new union that MNA has aligned itself with.”
Winning sympathy of their peers may not be the MNA’s goal, but winning the general public certainly is. So in the end, maybe this conflict really is about wages and benefits. And there’s nothing wrong with that.
But let’s just be clear. Despite its rhetoric, the MNA’s threatened strike is not solely about patient safety. I don’t buy that argument from the union any more than I buy it from the hospitals.
In the end, labor conflicts of any kind always come down to one thing: money.
Cynical? Maybe. Realistic? You betcha.
