By RoseAnn DeMoro, Executive Director of National Nurses United
Article from National Nurse Magazine - November 2012 Issue

If there was ever a critical moment for building a powerful, effective movement of all registered nurses to protect the interests of patients and nurses, that time has surely come. Here are 101 reasons for RN unity. All reflect the way in which nurses, their patients, practice, families, and communities are under attack. Let’s call this a partial list. Add your own reasons. I welcome your thoughts.

1. Budget-driven short staffing, regardless of patient need

2. Erosion of RNs’ ability to practice in the exclusive interest of patients rather than maximizing profits

3. Misleading “patient satisfaction” goals that substitute budget-driven scripting and rounding for actual care

4. Time spent on the caring process considered “non-productive” time

5. Needed patient services cut based on corporate business models to increase profit margins

6. “Evidence-based” medicine eroding care based on individual patients’ needs

7. Hospitals cutting back on basic equipment and supplies needed to provide good care

8. RNs being required to float to specialty units without proper clinical expertise or orientation

9. Replacement of specialist RN care with generalist RN care

10. Efforts to roll back California’s nurseto- patient ratio law

11. Hospital industry’s nationwide campaign against nurse-to-patient ratios

12. Medical redlining, i.e. hospitals cutting services for lower-income patients and communities

13. Long waits for emergency care

14. Patients being shifted from hospitals to outpatient and home settings where care is provided by non-RNs or family members

15. Laws and regulations that sacrifice patient safety to the bottom line and erode RN practice

16. Lack of protection for non-union RNs who advocate for better patient care

17. Deskilling of the nursing process by routinizing it, i.e. by fragmenting and standardizing it

18. Standardized clinical protocols that limit RN judgment

19. Manipulation of hospital census numbers to short staff and reduce RN hours

20. Speed-up through understaffing

21. RNs being denied meal and rest breaks via short staffing and manager coercion

22. Support staff cuts

23. Mandatory overtime

24. Attacks on RNs’ hard-won scheduling options

25. Increased employer discipline of nurses on pretexts

26. Exposure to antibiotic-resistant and other hospital-acquired infections

27. Hospitals failing to provide protective equipment or inform nurses of exposure to infected patients

28. Unsafe lift policies and other hazardous working conditions that increase injuries

29. Employers’ failure to enact measures to protect staff and patients from workplace violence

30. Lack of mentorship for new RNs

31. Lack of protection for non-union RNs who blow the whistle on unsafe hospital conditions or billing fraud

32. Crises of conscience for nurses unwilling to work in unsafe settings

33. Nurses leaving the profession due to stress, burnout, or employer-created hostile environment

34. Increased management control through workplace surveillance technologies

35. Surveillance of nurses’ use of social media, such as Facebook and YouTube

36. Use of information technology to displace RNs and override RN professional judgment

37. Technology-driven speed-up

38. Use of information technology to downgrade patient acuity to justify short staffing

39. Electronic charting that forces the RN to focus on a computer rather than on the patient

40. Telemedicine displacing hands-on patient care

41. Medical errors caused by electronic medical record systems and other health information technologies

42. RNs being scapegoated for medical errors actually caused by technology

43. Employers’ isolation of individual RNs through technology adoption and other tactics, undermining senses of unity and community

44. Loss of institutional memory of what nursing was prior to the advent of health IT and other management innovations

45. Federal government tying reimbursement to adoption of health information technology

46. Cuts in or elimination of employerpaid pensions (defined-benefit plans)

47. Employers eliminating health benefits or reducing them by increasing outof- pocket costs, among other changes

48. Reduction of sick leave so nurses are forced to work when sick, a risk to themselves and patients

49. Employers not paying overtime

50. Two-tier wage and benefit structures that pit new RNs against more experienced RNs

51. Reductions in paid continuing education leave for RNs

52. Unpaid hospital internships and preceptorships

53. Attacks on RNs’ hard-won seniority rights

54. Loss of contract-based due process and freedom of speech rights in the workplace

55. Lack of protection against unjust firing or other discipline for non-union RNs

56. Multi-tier healthcare system based on ability to pay

57. Skyrocketing insurance premiums, co-insurance, co-pays, and deductibles

58. Hospitals and physicians making medical decisions based upon insurance coverage

59. Poorer health barometers (such as lower life expectancy) than countries with national health systems

60. Patients delaying preventive care or necessary treatment due to high cost, leading to medical complications

61. Hospital price gouging, billing additional charges for labs, services, and personnel, often without advance patient consent

62. “Non-profit” hospital chains exploiting tax-exempt status for financial gain that vastly exceeds what they provide in community benefits or charity care

63. Medical credit screening being used to track patients based on ability to pay, including requiring advance payment from those least able to pay

64. Healthcare tourism, i.e. patients going out of the county for care 65. Federal government tying reimbursement to “patient satisfaction” scores

66. Hospitals subcontracting travel nurses from outside companies rather than employing RNs directly

67. Increased mergers and acquisitions by big corporate hospital chains resulting in fewer independent and locally-controlled hospitals

68. Hospital and emergency room closures 69. Privatization of public health facilities and services

70. Profitable hospital units being moved to independent medical specialty centers to extract concessions from unions based on budgetary considerations or to justify closing a hospital completely

71. Establishment of for-profit non-acute medical specialty centers to increase profits by evading public oversight

72. Private equity firms buying hospitals to squeeze them for profits, then leaving them drowning in debt

73. Inadequate funding for county and state hospitals and clinics

74. Private hospitals dumping low-income patients on underfunded public hospitals

75. Nurse executive organizations claiming to speak and legislate on behalf of directcare RNs

76. “Nurse leaders” disdainful of directcare nursing

77. Differentiated practice and ANA campaign for requiring BSNs

78. State nursing boards being stacked with employer representatives to reverse RN licensure and practice protections

79. Push for national Compact State Licensure to lower standards for all RNs to lowest state requirements

80. Expansion of scope of practice for LVNs/LPNs and unlicensed staff at the expense of RN scope and jobs, as well as patient safety

81. Layoffs and hiring freezes dictated by budget goals, not patient need

82. Hospitals trying to erode the public’s trust in RNs with ad campaigns attacking RNs as overpaid or unreasonable

83. Loss of collective voice through erosion of union rights

84. Non-RN unions seeking to represent RNs, resulting in low priority for RN practice and workplace needs

85. Weak and partner healthcare unions undermining RNs by accepting concessionary contracts

86. Cuts in nursing programs and reduced access for low-income nursing students

87. Private nursing education increasing debt for new RNs

88. Unemployment among nursing school graduates

89. Corruption of the democratic process by corporate/wealthy spending on lobbying and elections

90. Elimination of public regulatory oversight

91. Nurses supporting extended family members due to the economic crisis

92. Declining health due to economic crisis job loss, home foreclosure, high medical bills, and poor nutrition

93. Environmental degradation increasing preventable illnesses

94. Budget cuts for Medicaid and public health programs

95. Campaigns to cut and privatize Medicare and Social Security

96. Deep, widespread cuts in mental health services

97. Anti-union “right-to-work” laws being extended to more states

98. Weak labor law penalties for employers who violate worker rights

99. Growth of healthcare anti-union industry, including management attorneys, consultants, and strike replacement firms

100. Prevalence of labor-management partnerships in which unions advocate for employers and against the interests of workers and the public

101. Lack of nurses and women generally in leadership roles