Friday, October 05, 2007

Treatment of Nurses Supports Social Conflict Theory

I have a deep rooted respect for nurses. Three of my father's sisters were nurses. They provided frontier (horseback) nursing services in Appalachia, served as military nurses in World War II, and in civilian hospitals for decades after the war. In my generation on my father's side both of my female cousins became nurses.

Nurses form the first line of defense in our health care system. When we visit the doctor's office a nurse is the first health care practitioner we meet, and often the one that interacts with us the most. When we enter the hospital the majority of our care comes from nurses.

The training for nurses is challenging and demanding. I know because I observe it happening in my own college. Not everyone has the intellectual ability or the emotional stamina to become a nurse.

There is a documented shortage of nurses in this country. One that gets worse with each passing year.

So we have an occupation that provides an extremely important, valuable service (function) for society, which also requires extensive training that not just anyone can do, and there is a demonstrable shortage in this valued occupation. Structural-functional theory in sociology (Davis and Moore "Some Principles of Stratification") would suggest that nursing should be a highly rewarded (both in monetary terms and in a wide range of benefits), and highly regarded occupation. If structural-functional theory were correct, nurses should be able to write their own ticket when it came to pay and working conditions.

Not being a big fan of structural-functional theory, it doesn't surprise me that the theory fails to accurately reflect the real world treatment of nurses.

This week, in the Appalachian region, more than 650 registered nurses in the Appalachian Regional Healthcare System are on strike when their contract ended and negotiations failed to produce a new contract. While pay is an issue in the contract dispute (the offered 2% raise would be entirely swallowed up by increased cost of health insurance and decreases in holiday pay), the nurses greater focus is on the issues of benefits and staffing/work schedules.

The new contract ARH put forward, offered the nurses "flexible" scheduling -- it offered the the choice (!!??) of 10 hour shifts or 12 hour shifts. ARH nurses are required to work overtime, every week. Overtime is a mandatory condition of all ARH nursing positions.

The practical result makes it common for the actual nurses shift to be 15 hours, and 24 hour shifts happen all too often. Not only are nurses stretched thin in overly long shifts, but they are covering greater numbers of patients during those shifts. These conditions are not only draining the nurses, but they compromise the levels of care that are provided. A Lexington Herald-Leader article on the strike provided comments from a number of the striking nurses such as:
Lynn Hall, who has been a nurse at McDowell for 16 years, said she is the only person who works in the hospital's four-bed intensive-care unit.
"I don't even have someone to help answer the phone," she said. "It's just the opposite of the way it should be. A hospital should strive to have nurses with high morale, instead of walking out with tears in your eyes because you couldn't do it all."
The ARH response to all this? They aren't even trying to negotiate. They have already started looking for permanent replacements, while in the short run they bus in nurses from temp agencies. Nothing could make it clearer that the occupational realm is one governed by conflict and power, with the hospital administration holding most of the cards. The nurses recognize, but regret the struggle.
"Still, Hall and the other nurses said they would rather be working than striking.
"We don't want to be here," Tanner said. "We tried not to be here. We just want to negotiate the rest of our contract."
The only hope the nurses have is support from the general public. Unfortunately most people in eastern Kentucky have few choices. For those who do, consider taking your medical business else where, to hospitals and clinics where the nursing staff is treated more fairly and with the respect they deserve.


Jessica G said...

This is a very sad story. You are correct about the nurses role in health care. I see the nurses more than any doctors. I believe this shows the very sad state of healthcare, not only in Kentucky, but all over the U.S. Nurses so very often get the proverbial short end of the stick when it comes to schedules and benefits. You would believe that we would want to take great care of those providing care to us.

Anonymous said...

Yes, this is a sad story, though largely fictionalized. As a physician who worked in a nearby town and admitted my patients to one of Appalachian Regional Healthcare's larger hospitals for over 34 years, I am not aware of any nurse working a 24 hour shift. I am not saying it never happened, but I am not aware of it. Most nurses usually worked 40 hours a week or less and when overtime was mandated, it was usually because of a last-minute call-in by another nurse who wasn't coming to work.

Still I agree the strike is sad and needs to get settled.

Sue said...

To anonymous,
Many of the ARH nurses are my former students, and I know any number personally, and yes, sometimes they DO pull 24 hour shifts. Although these are not frequent they do occur. The mandatory overtime, on the other hand happens all the time. Blaming mandatory overtime on other nurses is ridiculous. Any rational organization should have sufficient staffing that emergencies and illnesses are automatically covered without having to rely on the extensive mandatory overtime used by ARH. Even when they are not on over-time ARH nurses suffer from staffing inadequacies -- without back up that would allow them to take normal bathroom breaks and meal breaks.