Care Package 

It's not a victory. It's just the right thing to do. That's how nurses at Fletcher Allen Health Care described the hospital's decision last week to reinstate Marley Skiff. The nine-year dialysis nurse was fired on April 18 for giving her union the names and telephone numbers of several of her co-workers. A well-respected RN with a spotless work history, Skiff also serves on the nurses' union bargaining team. That she was canned for a relatively minor infraction at a time when the hospital is already struggling with an acute nursing shortage raised howls of union-busting, a claim the administration denied. Some nurses saw Skiff's dismissal as a return to the climate of intimidation and fear that pervaded the hospital for decades but has been waning since the arrival of interim CEO Ed Colodny.

This week, nurses expressed relief and optimism over the administration's quick change of heart. But they also said that to focus on this one incident obscures the bigger picture; that not enough is being done to stop the flow of nurses who are leaving the profession. They remain troubled that the statewide hospital association continues to oppose legislation that would benefit nurses, patients and profits. And they're disappointed that more progress hasn't been made this year in the Legislature on a package of bills that could improve nurses' working conditions, cut down on preventable medical errors and protect whistleblowers who disclose unsafe or life-threatening practices.

Stephen Kimbell, chief lobbyist for Vermont's 14 community hospitals, argues that all these bills, though well-intentioned, are concerns to be addressed at the bargaining table, not by statute. "Issues like whistleblower and staffing ratios and overtime requirements need to be resolved as close as possible to the workplace, not in the halls of Montpelier," Kimbell says. "This is not the place to be enacting rules for a fluid workplace like a hospital."

Local nurses contend, however, that if the Legislature is willing to take on other issues involving rising health-care costs, it cannot afford to overlook the financial and human costs of the current nursing crisis. In short, cost-saving must go hand in hand with life-saving.

Consider the issue of patient-to-nurse ratios, a debate underway not only in Vermont but nationwide. As health expert and author Suzanne Gordon noted recently during a hearing in Montpelier, the United States spends $1.3 billion each year dealing with patient bedsores. Why? Because when hospitals and health-care facilities are understaffed, patients don't get turned in their beds.

More sobering is the death count. Numerous studies confirm what Vermont's nurses have been saying for years: The more patients a nurse has to attend, the more likely one will die under his or her care. A report in the Journal of the American Medical Association found that each additional patient assigned to a nurse increases the likelihood of a patient death by 7 percent. Another study found that as many as 20,000 deaths a year nationwide may be linked to inadequate staffing.

"We've been wearing stickers that say, 'I support safe staffing ratios,'" reports Jennifer Henry, a registered nurse at Fletcher Allen and union chairperson. "That's causing patients to say, 'Well, aren't they safe now?' Not really."

Better staffing ratios can also attract more people to the nursing profession and help retain those who are already there. California's Kaiser Permanente, the nation's largest not-for-profit HMO, launched a safe-staffing initiative last year that put caps on patient-to-nurse ratios. The result? Kaiser increased the number of nurses it hired by 71 percent and reduced the number who quit by 47 percent in just one year. Currently, two bills, H.335 and S.158, would address hospital staffing ratios in Vermont. Sponsors don't expect either measure to move this year.

Nurses are not only understaffed but overworked, and few professionals know better the effects of stress, fatigue and sleep deprivation on the human body. Yet Vermont nurses are routinely working 10- to 12-hour shifts, often longer. The situation is not only driving nurses away from the bedside in record numbers but also putting patients' lives at risk. A study by the Institute of Medicine estimated that as many as 98,000 people die each year from preventable medical errors -- about 268 per day. "Imagine if you had 10 days of jumbo jets crashing every day. Would that be an issue?" asks Henry.

"We accept that when a nurse comes in and has alcohol on her breath, she gets sent home, and rightly so, because we believe she is mentally and physically impaired," Sue Lucas, a registered nurse at Copley Hospital, said during her testimony in Montpelier. "Yet, you can be exhausted at the end of your shift, you can be sleep-deprived and you can be mentally and physically impaired, and your employer thinks it's OK to keep you. That just doesn't work."

Nurses warn that without improvements to their work environment, Vermont will continue to see its nurses moving to neighboring states in record numbers. A survey in February's Advance for Nurses, a nursing trade publication, found that Vermont RNs earn an average of $22.46 per hour, the lowest wage on the East Coast. In comparison, Connecticut nurses average $28 per hour. But proponents of an overtime ban say the real issue is not about money but about creating a work environment that keeps nurses -- and patients -- healthy and happy. "People are dying because of this and nurses carry that burden," says Henry. "No wonder they're leaving the profession."

Another pair of bills pending before the Legislature -- H.337 and S.157 -- would ban mandatory overtime, just as five other states have done. But Rep. Anne Donahue (R-Northfield), who sponsored H.337, says her bill will not be voted on before lawmakers leave this session. Still, she is optimistic the issue will be addressed in 2004. "We just had the new health commissioner in to meet with us last week and I think we were very impressed by him and his interest in hospital quality," Donahue says. "I think we're going to work well with him on this issue."

One concern of nurses that may be addressed this year is whistleblower protection for health-care workers. "It's very important that people feel free to talk about hospital conditions without feeling that there's going to be any retribution," says Sen. Ginny Lyons, (D-Chittenden), who sponsored the Senate version, S. 154. "It just does not make sense to me that people would not be able to identify egregious issues and then have to pay a price for doing what is right."

While a patchwork of federal laws protects some health-care professionals who disclose abuse, fraud, unethical or life-threatening practices, most of those statutes only apply to government-run facilities -- like veterans' hospitals -- or those that receive federal funds. Rep. Donahue's version of the bill, H.399, was split off from a more comprehensive hospital oversight bill and is now in the House Judiciary Committee. She says its future remains uncertain, though there is a chance it may squeak by this year. Likewise, Sen. Lyons says if there's political will in Montpelier to pass any of these bills, it will be whistleblower protection.

While nurses may not have much cause for celebration during this National Nurses Week, they are hopeful that changes will come, albeit slowly. "We are at a crossroad, I believe," Marley Skiff told nearly 200 fellow nurses at a recent candlelight vigil supporting her reinstatement. "We can continue to do business as usual or we can rise above it."