January 2019, Volume XXXII, No 10

interview

A trusted voice to create positive change

Rose Roach

Minnesota Nurses Association (MNA)

MNA has successfully grown and adapted to the needs of its members as health care delivery evolves. What are some examples?

Health care technology is one such change, but MNA nurses have legally binding contracts with language that provides a voice for nurses to ensure that technology does not impact patient care. One example would be the use of acuity tools to help determine patient staffing needs and basic charting through systems such as Epic. Nurses believe, however—in their professional, “hands-on” judgment related to patient care—that more time spent at the computer rather than at the bedside puts both patients and the nursing profession at risk.

Another recent attempt by hospitals to save money is through the implementation of “Lean” management initiatives. Nurses have used their collective voices to ensure that such initiatives do not come at the expense of patients.

You advocate for single-payer health care. What can you share with us about this?

Every one of us needs, or will need, health care. Instituting barriers to care through narrow networks, high deductibles, and co-pays is immoral, inhumane, and financially irresponsible. Health care is not a consumable good. It’s a public good. We don’t notice that chemotherapy is on sale and then try to get cancer to take advantage of the discounted price.

We are penny-wise and pound-foolish in this country when it comes to health care. We blame the diabetic for struggling to take their insulin when the price of insulin has risen 3,000 percent, but we never hold the pharmaceutical companies accountable for the deaths they cause due to diabetic ketoacidosis. It costs $15,000 per day for an intubated diabetic in the ICU because he or she couldn’t afford the $700 per month insulin. None of us should die sooner than we’re supposed to simply because we couldn’t afford the care we need when we need it.

Staffing ratios are a key priority for the MNA. Please tell us about these issues.

Nurses have to care for too many patients at one time. Nurses on every patient unit are assigned a specific number of patients to care for during their shift. As science and technology continue to make advancements, people live longer. Inevitably, people in our hospitals are much sicker than they ever used to be. Patients have surgery and are discharged on the same day. Nurses are expected to keep working faster, regardless of what the patient needs. Nurses have a legal, ethical, and moral obligation to not accept more patients than they can reasonably care for at one time. Patients are in the hospital because they need nursing care; otherwise, they would be outpatient.

We are penny-wise and pound-foolish in this country when it comes to health care.

In addition to being a professional association, the MNA is also a labor union. What are some of your labor issues?

Nurses uniquely use the collective bargaining process for patient advocacy. Their number one issue is to achieve proper staffing levels based on their judgment of the acuity needs of their patient. Nothing concerns nurses more than when they have so many patients requiring attention that they are forced to “prioritize” based on severity of medical need at a given moment.

Nurses are also very focused on protecting patients, hospital staff, and themselves from the violence that has become a daily occurrence at hospitals. Nurses are constantly pushing hospitals to increase security, implement de-escalation training for employees while tracking violent occurrences, and involve RNs in the discussion of solutions to prevent workplace violence.

Right-to-work laws and the lobby around them pose serious problems. What can you tell us about this?

MNA believes in the workers’ right to organize a union and collectively bargain a contract. We oppose any efforts to silence employees’ collective voices in their workplace, including the anti-union effort to make Minnesota a “right-to-work” state. We work alongside our brothers and sisters in the AFL-CIO unions to make sure that any attempts to make Minnesota a right-to-work state are defeated.

With the ongoing consolidation of health care and an increasing number of physicians becoming employees, what benefits might be gained if physicians unionized?

They would gain power. The only way to deal with the industry’s push to take the patient’s needs out of the center of the health care system is for providers to come together in solidarity to fight for their respective professions and patients. Physicians, like nurses, are experiencing severe burnout as corporations dictate care overriding physicians’ professional assessments. Physicians would once again have a say in the treatment of their patients and in their profession.

What are some of the legislative issues that the MNA will focus on this coming session?

MNA is in the process of putting together its legislative agenda for the 2019 session. Issues that may come up at the Capitol in 2019 include: ensuring there is a funding source for MinnesotaCare, to replace the provider tax that is slated to sunset on Jan. 1, 2020; expanding MinnesotaCare so that more people can buy into it; strengthening workplace violence prevention laws; addressing gun violence prevention initiatives; and dealing with the rising cost of prescription drugs.

The roles of advanced practice providers and care teams continue to expand. From a nursing perspective, how could interactions with physicians be improved?

Mutual respect is the key word, even though physician organizations’ oppositions to expansion of scope of practice for advanced practice registered nurses (APRNs) remains a significant obstacle. In addition, we believe that:

  • Collaboration and team approaches are the only ways that physicians and APRNs can provide safe, quality care to patients and the community.
  • APRNs should be allowed to practice to the full extent of their education.
  • The profession should understand that APRNs are not taking over physician jobs, but are filling the gaps in the health care needs and shortages of primary care providers.
  • The Institute of Medicine states that it is imperative that all health professionals practice to the full extent of their education and training to optimize the efficiency and quality of services for patients.
  • The term “independent practice” for APRNs has become a charged term for some physician groups, which view it as implying solo or competitive practice.

MNA operates a booth at the Minnesota State Fair. What stories can you share?

The fair gives nurses a chance to talk directly to patients about health care issues. We’re building a community of patients who want to help us tackle these issues together. At one recent fair, a man wearing a National Rifle Association patch wanted to talk to a nurse about health care and the rising costs and declining care. He ended up signing our petition and joining our mailing list of single-payer advocates. That kind of story tells us that we’re all hurting from the state of health care, and that nurses are a trusted voice to create positive change.

What new ways can nurses and physicians partner together?

Nurses should be instrumental in the development of collaborative teams. Having the right people on a collaborative team for process improvement in patient care is critical to a successful improvement effort. Nurses should have a strong voice on health care teams that seek to build a better process of communication.

Open communication between leadership and nurses, and mutual support of the health care team, are certainly in the best interest of patient care. Nurses would advocate for a team environment that increases open, nonjudgmental communications, and would participate in a health care-driven team approach designed to improve patient care.

Rose Roach is the executive director of the Minnesota Nurses Association. She has also served on Gov. Mark Dayton’s Task Force on Health Care Financing and the City of St. Paul’s Earned Safe and Sick Time Task Force. She attended Metro State University in St. Paul and Inver Hills Community College in Inver Grove Heights. 

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Rose Roach is the executive director of the Minnesota Nurses Association. She has also served on Gov. Mark Dayton’s Task Force on Health Care Financing and the City of St. Paul’s Earned Safe and Sick Time Task Force. She attended Metro State University in St. Paul and Inver Hills Community College in Inver Grove Heights.