Thursday, June 24, 2010

Living My License

Early this week, nurses voted to allow their negotiating teams to call an open-ended strike if they deem necessary, and I voted with them. You may well wonder why I consider this necessary. In short, this vote was the natural consequence of living my license.
Because I am licensed by the State of Minnesota and not by Abbott Northwester Hospital or Allina Health Systems, I have an independent responsibility to my patients. Because I am a licensed professional, I also have a responsibility to my profession. And just because I’m a grown-up, I have responsibilities to myself. Living my license involves all three spheres of responsibility, and it’s at the heart of these contentious negotiations.
That nurses have an independent responsibility to our patients is most clearly evident in the operating room. In addition to the surgeon and the anesthetist, there are two additional critical roles, the “scrub” and the “circulator.” The scrub may be, but seldom is, a nurse; he or she passes instruments as called for by the surgeon, and keeps track of needles, blades, sponges, and other items on the tray. The circulator is always a nurse, and is the interface between the sterile surgical field and the non-sterile world. The circulator also watches everything: he or she can stop the surgery because the sponge count is off or sterile technique is broken or any number of other reason. This might annoy the surgeon, but that doesn’t matter. The circulator is there to protect the patient, not the surgeon’s ego.
The major sticking point in our contract negotiations is around staffing levels. How many nurses does it take to care for this many patients, and who gets to decide? While facilities in the Twin Cities staff better than many places in the country (I know, I’ve been there), it still may not be enough. Patients are sicker, and the components of safe patient care are continually becoming more numerous and more complex. When I, as a charge nurse, call for more nurses than our staffing scheme allows, it is for concerns of safety, not so we can catch up on our online shopping and not to torpedo the hospital’s bottom line.
This also reflects my responsibility to my profession. Administrators do not, and cannot, know what it takes to provide care to patients on a day-to-day, shift-to-shift, hour to hour basis. They aren’t there. I am. We are. It has been so thoroughly demonstrated that the closer the decision making gets to the point of service, the better the decisions, it’s practically a law of nature. Part of our professional duty is to determine how our services will be provided. Determining the number of nurses needed to take care of patients is an important part of that professional control.
We are individually and collectively responsible for ourselves. Assuring the solvency of our pension fund and the stability of our health insurance is in our personal best interests. We understand that neither of these are inexpensive propositions, and will negotiate on them because it’s also in our best interests to have solvent and stable workplaces. However, it’s our responsibility to look out for ourselves, rather than hoping someone else will.
Living our license can be tough work. Holding a picket sign in the rain washes away romantic illusions, leaving the unyielding realities of our responsibilities. Standing up to a temperamental physician can be nerve-wracking, but critical. We are independently responsible to our patients. We are responsible to our profession. We are responsible to ourselves. It is out of these responsibilities that we make our voices heard and presence known, early this week and in these days that follow. It is ironic how much our employers depend on us to live our licenses and take these responsibilities seriously, even with the resulting expense and inconvenience they find so encumbering. We take these responsibilities seriously because we understand who and what we are. We are professional nurses. Allina isn’t health care; Abbott Northwestern Hospital isn’t health care. We are health care. I am health care.

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