Tuesday, June 15, 2010


One change management theory posits that change is accomplished by "unfreezing" current ways of doing things, rearranging to a different configuration, then "refreezing" the changes into place.
As the Minnesota Nurses' Association and a number of Twin Cities hospital systems square off during contract negotiations and another likely strike, things are seriously unfrozen. Normally, the change process is carried out carefully and intentionally. Well, not this one. Change is coming, and no one really seems to know either what we're transitioning from or transitioning to. Neither side is articulating a vision for high-quality and sustainable health care.
MNA demands from employers concessions that run afoul of a particular from Matt Miller's The Tyranny of Dead Ideas. Specifically, "My company should take care of me." Much of the health care and all the pensions provided for MNA nurses are funded by the employer. The costs of these benefits, according to the employer, are becoming unsustainable. Perhaps they are. Even if they aren't, perhaps it's time to remove these benefits from the employer's pervue: they will no longer have to fuss with it and we will no longer feel blackmailed into staying someplace we'd rather not be.
The employer, on the other hand, fails to understand something that must be grasped with utter clarity: hospital nurses are not just the "face of health care" within their facility, they are health care. Whatever the proposal, from changes in the supply chain to staffing patterns, the first question must be, "What impact will this have on the nurses' effectiveness?" If other questions are being asked instead, too often it's because the effect on nursing care is already understood to be negative. Ditto if anyone but nurses are called upon to answer the question.
Nurses need a financially viable venue in which to practice. Hospitals need a dedicated, professional, and effective nursing staff. Both need to provide for the other in ways that are sustainable and make it more likely to get what they need from the other party. That neither side really seems to know what that looks like leaves everyone feeling like they're living a
Despair.com poster.
Right now, everything is in flux, in chaos, unfrozen. Anything is possible. Of course, "anything" includes utter disaster. It also includes the possibility of extraordinary adventure and even extraordinary success, a success that meets everyone's needs and exceeds everyone's expectations.
Does either side realize this, and is either side willing to reach for this, work for this, and convince the other side that it's possible?
I hope so.


  1. "Neither side is articulating a vision for high-quality and sustainable health care."
    I'm not convinced that MNA's staffing proposals are not a viable candidate for the "vision."


    MNA's submission mandates a mutually agreed upon staffing plan that incorporates "patient acuity and nursing intensity."
    The sentences that follow are fat with flexibility, which is one of TCH's biggest concerns, or so its spokesperson Maureen Schriner has articulated.

    Maureen called them "rigid," but it doesn't get any more malleable than the joint determination of the number of staff on a Unit based on how sick the patients are.

    I find this acceptable, in my limited ability to view things from a money-managing perspective. 'Seems to me that it is money well spent, and surely contributes to a vision for higher quality care.

    Just my opinion...

  2. Staffing levels and built-in flexibility are certainly a piece of the larger vision, but I don't see it as a compelling total vision.
    For example, AACN's vision statement goes, "AACN is dedicated to creating a healthcare system driven by the needs of patients and families where acute and critical care nurses make their optimal contribution." This has implications not only for staffing levels but, at least as importantly, collaborative governance. Attempts to decrease our collaboration is something I don't think is getting enough attention, and is at least as dangerous for our patients as understaffing.

  3. Wondering what you would propose? What does "optimal contribution" and/or "collaboration" look like to you. We need to start somewhere. We need something that will protect our ability to have a voice in patient care and safety. As you know nurses at the bedside are in the front line, so to speak. We need to protect ourselves as well.

  4. What I'd love to see is Management coming to the nurses saying, "We have this problem. Here is the nature of the problem, here are the reasons we believe it's a problem, here are some of the consequences of the problem, here are the resources available. Solve it."
    And we answer, "OK."
    Example: one possible solution to issues of staffing flexibility and staffing adequacy is "closed staffing." While a float pool can cover such shortfalls as illness or vacation, each unit (or at least each community) would be responsible for its own extra shift, on-call, and LOA capacities. No one would float to another unit unless [a] it keeps the receiving unit from calling in someone and [b] it's agreeable with both the floating nurse and the receiving unit.
    Of course, we would would also have the tedium of making the rules and keeping the system going on a continual basis. But it would also mean we control the process.