Most days, Mary Alice Martinez, a registered nurse at Mills Peninsula Medical Center in Burlingame, doesn't even stop for a meal break during her shift.
"If I'm starving, I'll grab a Graham cracker and a glass of juice, just to keep my blood sugar up," Martinez said.
During her 18 years working at the hospital, it's becoming increasingly hard to find even a moment for that quick snack, she said.
"Our patients are a lot sicker than they were 18 years ago," Martinez noted.
Several years ago, she added, a nurse in her unit fainted from exhaustion and lack of food.
It's these perilous working conditions, Martinez said, that propelled her and more than
5,000 other registered nurses onto Bay Area streets Wednesday for a two-day strike against medical facilities owned by Sutter Health in Sacramento,according to the California Nurses Association.
Despite a recent advertising blitz by the union that violations of nurse-to-patient staffing ratios are the chief reason for the strike, the actual reason is a little more nuanced: The union is demanding enough nurses on the floor to provide adequate meal breaks, said Jan Rodolfo, a negotiator with the nurses' union and a registered nurse in the cancer unit at Alta Bates Summit Medical Center in Oakland.
"The primary focus is the meals and breaks," Rodolfo said.
Without adequate breaks, nurses are prone to exhaustion and at greater risk for making mistakes. Or if a licensed vocational nurse assumes a registered nurse's duties during a break, the lesser- trained vocational nurse might miss signs of trouble.
"They don't have the ability to assess patients," said Rodolfo. Another bone of contention for the union is the reliance in some hospital units on using charge nurses -- who have numerous oversight responsibilities -- for providing breaks for five to six nurses on the floor. The charge nurse requires a break as well.
"Now you're talking about seven hours out of an eight-hour shift that a charge nurse is providing breaks," said Rodolfo. "It makes no sense."
While the current contract provides for meal and breaks, the language is vague and "open to interpretation," Rodolfo said.
"It doesn't have teeth," she said. "It needs to be much more substantive, because they're still not providing meal and break relief," she said.
As an example, she cited a $2 million state penalty assessed against Alta Bates Summit, with campuses in Berkeley and Oakland, for failure in 2005 and 2006 to provide adequate breaks. And the figures probably don't reflect the real rate of missed breaks, added Rodolfo, as many nurses are reluctant to report missed breaks or to ask for overtime, she said.
Jill Gruen, spokeswoman for Alta Bates Summit, said she's heard nothing about the penalty and can't comment on it.
Gruen also added that the medical center follows state law governing the provision of breaks and nurse-to-patient ratios.
"We have relief nurses working in our facilities every day to provide meal and break relief," Gruen said. "They do it all day, and they do it well."
In addition, the striking nurses are demanding more consistent adherence to the state-mandated nurse-to-patient staffing ratios.
In 2004, the nurses union won a long-fought battle when the ratios took effect, making California the first state in the nation requiring a set ratio of nurses to patients. In surgical units, for example, there must be no more than five patients for every nurse, while in units with sicker patients, such as emergency departments, the ratio can go as low as one-to-one for trauma patients.
The union is satisfied, overall, with the effect of the ratios in improving working conditions and patient safety, said Chuck Idelson, spokesman for the California Nurses Association.
"It's certainly better now than before the law was enacted," he said.
A 2006 statewide survey of nurses, conducted by the Center for California Health Workforce Studies at the University of California, San Francisco also found that nurses had a better view toward staffing issues than in 2004.
"A lot of people wrote (in the survey) that they were pleased with the improvement with staffing levels in the hospitals," said Joanne Spetz, associate director of the center. "There were concerns, however, about enforcement of the ratios."
While some units at Sutter Health hospitals are in compliance, others are not, he said, describing compliance as "spotty."
In contrast, the union cites Kaiser Permanente as providing strong adherence to nurse-to-patient ratios and meal and other breaks.
"Kaiser is probably at the top of implementation," said Jim Ryder, the union's collective bargaining director for Northern California.
Idelson said another reason for the strike is to add language to all contracts signed by the nurses union with Sutter medical centers that require the hospitals to follow the state ratios. While it's a redundant move, given the law is already enacted, adding it to the contract allows the union to move more swiftly against violations, since they would fall under contract law. (source) |
