What nurses want

She didn’t have time to chat. The registered nurse hopped down to the coffee cart in the Washoe Medical Center cafeteria for a latte. Then it was back to work.

She agreed it was good, though, to be back at her job after a one-day strike before Thanksgiving—followed by four more days of unpaid leave.

She ordered her coffee and told me that if I were interested in talking about the strike, I should call the organizing union, Operating Engineers Local Union No. 3.

“They’ll find you some registered nurses to talk to,” she said.

“I know. I just came down here to ask ordinary nurses, ‘What do nurses want?’ “

Another registered nurse in line perked up at this.

“We want the same things we’ve always wanted,” Nurse Two said. “Reasonable staffing, a reasonable patient load. And we want more money.”

“But it’s not even money anymore,” Nurse One said.

“No, it’s not,” said Nurse Two. “Some days, $300 an hour wouldn’t be enough for what I have to do.”

“We just want a safe patient load,” Nurse One said.

Nurse Two explained that, in one ward with extremely ill and needy patients, each nurse had a load of six to seven patients that day.

“There’s just no way we can give them all the quality care they need,” she said.

Neither nurse wanted to give her name.

Nurse Two said she didn’t participate in the strike this time around. She stayed at work. She knows that she could easily get work elsewhere, probably even make a few extra bucks as a signing bonus for changing hospitals.

“A lot of nurses are leaving,” she said. For now, she’s content to stay put.

“I’d like to see things change,” she said. “But no one’s holding a gun to my head to make me work here, either.”

Union organizer Carin Ralls, a registered nurse and former Washoe Medical Center employee, said that more than 100 nurses showed up to picket on and off during the 24-hour strike. The strike ended at 6 a.m. Thanksgiving Day. Striking nurses were not allowed to return to work until Monday because replacement nurses from U.S. Nursing Corps required a five-day contract.

Washoe Med Spokeswoman Judy Davis said the move was not intended to punish striking nurses. Though information at the Web site for U.S. Nursing Corps does suggest that you can hire a nurse “for just one day or as long as you want,” the company does have a minimum five-day contract, she said.

“That doesn’t mean we have to use the nurses for five days,” Davis said. “But if we were to say, after the first day, ‘You can go now, our nurses are coming back,’ then we’d be paying double. … It was strictly an economic decision. It was not in any way meant to be punitive.”

Davis said that the replacement nurses filled in smoothly over the weekend. “Nothing presented any concerns from a quality-of-patient-care standpoint,” she added.

During the strike, union activists called attention to their picket with two inflatable rodents of unusual sizes mounted atop panel trucks with the painted words: “Rat Control, Local 3” and “U.S. Nursing Corps.”

“I’m not too sure where they purchase those blow-up rats,” Ralls said. “They are union-made, though.”

Striking nurses referred to the U.S. Nursing Corps replacements as “rats” and “scabs.” Ralls said that nurses still tell stories about the poor care given by the replacement nurses during the last strike in June.

“We had a couple of medications given that were misread or not appropriate for care,” Ralls said. “One of the travelers gave medication without a doctor’s order. Routine IVs were not changed over. In fact, nurses from non-striking units had to go into striking units to do simple IV restarts because traveling nurses were incapable of the task. I mean, you’re taught that in your first year of school!”

She hadn’t yet heard how it went this time around. Ralls sniffed as she spoke. She said she probably caught a cold while picketing. She tried to stay on the line for the entire 24 hours but ended up leaving at 4 a.m. Thursday.

“The wind gusts just got too much for me,” she said.

Negotiations between the nurses and the Washoe Med administration have been muddled for the better part of a year.

The union had repeatedly asked Washoe Med for its “last and final” offer, Davis said.

“They asked us to make a move,” she said. “In March, we did that. ‘Last and final’ to us meant ‘last and final.’ The ball’s in the union’s court.”

The hospital’s “final” offer included a $1.56 per-hour pay raise effective April 16 and eligibility for a 4 percent merit increase on each registered nurse’s annual review date. These raises, Davis contended, could equate to a 10 to 12 percent increase annually for most nurses. The average base pay for registered nurses in the bargaining unit is $24.71 per hour, not including benefits, overtime or shift differentials.

That’s not what 640 nurses in the Washoe Med bargaining unit want.

Davis said that the economic package sought by the union would cost $10-$11 million per year.

“That’s just not an acceptable offer for us,” she said. “It’s difficult to be convinced [that the union is seeking a resolution] when they have terminated the most recent negotiation sessions with no explanation, and when they will not provide economic counter-proposals.”

In August, union representatives made compromises regarding changes in health insurance, changes in arbitration and staffing. Ralls said she doesn’t know how the nurses’ requests could cost the hospital $10-$11 million a year.

“I don’t know where they’re coming up with that figure,” Ralls said. “They need to show us how they’re adding that up.”

Better staffing is key, nurses agree, to satisfying their need to work in a safe environment and give the kind of care they are proud of. Many say that the nurse-to-patient ratios are too high.

Just how many patients can one nurse reasonably be expected to care for?

That all depends, said Dr. Julie Johnson, a Ph.D./RN and director of the Orvis School of Nursing at the University of Nevada, Reno.

“A newly admitted patient may need a one-to-one,” Johnson said, speaking of an intensive care unit situation. “Patients getting ready for discharge may be three-to-one.”

In, for example, an oncology ward, one nurse serving six or seven patients may be doable, Johnson said.

“It’s so variable,” she said. “There are no givens. It really depends on the severity and the treatments being given. … The bottom line is, can the nurses provide safe care?”

As a nationwide nursing shortage worsens, Johnson agreed that the nurse-to-patient ratios could dangerously increase.

Johnson declined to comment on the particulars of the Washoe Med nurses because she’s not familiar with the environment there, she said.

Davis said that nurse-to-patient ratios are reviewed with every shift change in every ward. The ratios are adjusted according to several variables. She didn’t know what the range of ratios might be in a given department.

With regard to nurses working 14-hour shifts and reports of not having enough time to go to the bathroom, Davis said that working overtime is strictly voluntary at Washoe Med. Because of the national nursing shortage, Davis said, Washoe Med has nursing vacancies “like every other hospital in the country.”

“There are times when we ask nurses if they’d like to pick up extra hours,” Davis said. “If they’re working 14 hours, they probably made that choice. While we appreciate that choice, they need to run out and go to the bathroom if they need to go to the bathroom.”

And the administration does greatly value its nurses, she said. “We are very aware that our nurses work very hard, and we absolutely appreciate what they contribute to patient care.”

From the union’s standpoint, last week’s strike was a success. Ralls said the nurses intended to gain community support. And given the feedback so far, they think they’ve earned that.

“With community pressure put on the hospital, we’ve made some headway," Ralls said.