As a psychiatric nurse practitioner, Diane Solomon counsels patients in therapy, prescribes medications and practices independently in her medical office in downtown Portland. "I'm completely autonomous," she says. Oregon and Washington are among 16 states with liberal practice laws to allow licensed nurse practitioners to care for patients, order diagnostic tests and prescribe pharmaceuticals without a physician's oversight. As the U.S. extends health coverage to 32 million people, so-called "advanced practice" nurses are likely to be key in areas of medicine with too few doctors, such as primary care, obstetrics, geriatrics and mental health.
Tufts Medical Center nurses and management met for 20 hours Sunday and Monday and were close to agreeing on a new contact that would avert a strike on Friday. But as often happens with serious labor-management disputes, the nurses won't decide whether to strike on Friday until the very last minute. Another negotiating session is not scheduled until tomorrow. Nurses said yesterday that one last issue stands in the way of a resolution: whether nurses on the day and evening shifts at the Boston teaching hospital can be required to care for six patients at a time, or whether they win language limiting the maximum number of patients to five.
Hawaii's major hospitals are collaborating to launch the first statewide nurse residency program this summer in an effort to keep more registered nurses in the profession. The program, sponsored by the Hawaii State Center for Nursing, will give new graduates a chance to gain necessary experience to land a job in the competitive field, as well as train them in specialty areas they otherwise might not work in, according to Gail Tiwanak, the center's executive director. "The residency program really is intended to support new grads as they transition into their first professional position, usually in a hospital setting," she said. "One of the big benefits of this is to improve job satisfaction and increase retention rates within the organization and the community."
Nurses at St. Vincent Hospital are planning to walk off the job Friday because of stalled negotiations for a new contract at the downtown medical center, but their dispute goes beyond Worcester and reflects a disagreement between nurses' unions and hospital managers nationally about staffing. Unions in Maine, Illinois, California and Minnesota have raised complaints about staffing levels in contract negotiations recently in what hospital officials describe as a national union agenda and what nurses call concern for their patients. The issue generally boils down to ratios. Nurses' unions have argued that the way to guarantee safe staffing is to limit the number of patients handled by nurses on a unit. Hospital officials say ratios are too rigid and fail to account for complexities such as the skills of nurses assigned to particular units and the severity of patients' illnesses. The Massachusetts Hospital Association collects voluntary filings on staffing levels from hospitals and posts them on its website, but it opposes fixed ratios at hospitals.
Nurses at Tufts Medical Center moved closer to a strike yesterday, notifying administrators they will hit the picket lines May 6 if they don't reach an agreement on their patient ratio demands. Tufts Medical Center boss Tufts Medical Centersaid she has replacements lined up. "We have no concerns about being able to properly staff the medical center," said Zane, who said she has arranged for about 200 out-of-state registered nurses to care for patients. "We would prefer our own nurses, but these nurses come highly recommended." The Massachusetts Nurses Association, representing 1,100 Tufts nurses, handed its formal 10-day strike notice to Tufts management at the end of yesterday's negotiating session. The union said the one-day strike will begin at 6 a.m. on May 6 and end the next day at 7:00 a.m. The notice doesn't guarantee a strike, and talks will continue until May 6. But last night, neither side showed signs of backing down.
The labor union representing registered nurses at Tufts Medical Center said it has scheduled a Thursday vote to authorize a one-day strike at the Boston teaching hospital as Tufts and union leaders continue to clash over staffing levels. The hospital responded with a statement calling on the union "to resolve its differences at the bargaining table without the threat of a strike." Staffing at Tufts Medical Center and several other hospitals across the state has emerged as an issue in contract negotiations with the Massachusetts Nurses Association, which represents 23,000 members at hospitals, health care clinics, and other sites across the state. The union says that recent cuts in staff and other changes in how they deliver care mean that nurses are caring for more patients at one time on nearly every unit. These changes, its says, have transformed the hospital from one of the best staffed in Boston to the worst. The hospital says that it has shifted some duties previously done by nurses to other staff and that it fares well on various measures of quality care.