Wednesday, March 27, 2013

will nursing unions survive?

I'm probably the biggest union advocate you could find.  I grew up with a mom who worked in factories all her life and was the sole support of my brother and I.  She was a fierce union advocate and she passed that on to me.

Without unions, nurses wouldn't have what we have today: somewhat decent wages, benefits.  Nurses worked hard to get to this point, they sacrificed.  However, I am beginning to wonder whether our unions need to change in order to deal with a changing health care environment, otherwise they might cease to exist.

I think a lot about what is the future of nursing in health care.  I see the health care system painfully changing to adapt to less reimbursement, patient satisfaction, obamacare.  Hospitals are quickly changing to adapt.  I see our doctor group adapting.  Then there are nurses.  As usual, we sit back and let it all pass us by.  We resist change for the most part. We aren't proactive, but reactive.

These days our unions settle contracts that try to keep what we have, forget about getting anything more. Unions have rigid contract provisions, necessarily so.  They have to be clear cut.  The thing is, how does that fit in with a changing health care environment?  How does nursing adapt and change and prosper within this rigidity? It doesn't.

If we don't change, adapt, we will be left by the wayside, replaced by cheaper workers.  An example of this: there is a new program in my city that is called community paramedics.  It is just starting. The goal of this, bottom line, is to keep people out of the hospital.  They will do followup, do preventative care, anything they can to maintain peoples health. This fits right in with obamacare, medicare changes.  In other words, they are doing a lot of what home health care nurses are already doing.  The thing is they can be paid half of what nurses do.  This is an example of things to come as health care systems look for ways to decrease costs.

Can our unions become more flexible or will they cease to exist? Are unions outdated?  Will nurses care enough about our profession to wake up and take control of our future?  Only time will tell. Any thoughts?



FrankC said...

Sounds like China's "barefoot doctors".

Aesop said...

Unions are outdated when they become a mechanism for protecting the slovenly and incompetent, while seeking simultaneously to increase salaries and benefits. (cf. the auto industry).

When they seek to prevent dangerous conditions to patients and nurses, they are just what's needed. As the corporate model of healthcare digs in like a tick, trying to run a hospital like an immigrant-staffed sweatshop of the turn of the last century is once again becoming the norm.

Unlike you, I've seen unions as primarily a huge PITA, coddling the peopple we should throw out of the profession ourselves, because they do, and we won't.

But if they start advocating for something besides just bigger paychecks, they'll make a comeback.

As to sending paramedics out to do the equivalent of home nursing care, unions, individual nurses, and state nursing boards need to work in sync:
If anyone is attempting to replicate nursing care without benefit of a license, they need to be restrained and injuncted out of existence from our scope of practice. Period.
BUT, and this is the part they'll ignore, they need to push with both hands for getting nurses prepared AND DEPLOYED to fill the roles that need doing. If what patients need in the field is nursing care instead of hospitalization, the solution isn't to send a paramedic because it's cheaper than a nurse, it's to send a nurse because they're vastly more qualified than a paramedic AND cheaper than a hospital visit.

The problem is, most nurses without a protective hospital cocoon, and suitable practice safeguards, want nothing to do with the liability bomb that is out-of-hospital practice.

When even our own profession doesn't have our backs when we're working inside the walls, who can blame nurses en masse for not wanting to go outside on their own, without a safety net?