I fondly remember attending the Local 17 insulators union hall meetings with my dad when I was a young boy. The scene was similar to what one might expect: a smokey, comfortably packed, dimly lit and musty room in a small red brick building in Chicago’s “Back of the Yards” neighborhood. My father introduced every “Brother” to me as “Mr. Jones, or Mr. Murphy, etc…” My dad seemed very comfortable in that environment as did I. Those memories validate a sense of feeling very safe and very welcomed… taken care of, if you will.
Later in life, I worked my way through college and medical school by removing the same asbestos insulation that my father and his Brethren of Local 17 installed decades earlier. (Local 17 ironically boomed in the 80′s during the asbestos abatement era). I frequently heard that many of those “Misters” I had met in my youth had died terrible deaths due to occupational lung disease and/or Mesothelioma. Every other week my dad recounted another one of his Asbestos Worker Brethren dying in “this or that” hospital, and how he had “so many” kids in school, and “could I go to the benefit with him to help out the family.” He always attended those benefit gatherings and made sure that others did as well. Maybe it was his outright altruism or maybe it was his belief in Karma that led him to do this. Whatever the case, my now-retired-father, disabled from lung disease and dependent on oxygen, receives a pension and health benefits from Local 17–he is being taken care of. Even though his “Cadillac health plan” is not enough to cover his medical expenses and he must obtain his medications at a discount from the VA hospital, he is appreciative, and so am I.
Organized Labor in the United States has a rich and poignant history; one that is far too often taken for granted by the average citizen. Were it not for the Labor Unions, I would not have been able to earn a Medical Degree. Were it not for the Labor Unions, my father would not have been employed after returning home from Vietnam with a wife and baby to support.
Were it not for Chicago’s Haymarket riots and the organized labor movement at the turn of the last century (which codified the 40 hour work-week, child labor laws, and workers’ wages) the world as we know it would look much different, and, in my humble opinion, very bleak.
I now struggle with the current national debate on organized labor. Not only because of the events that have taken place in Madison, but also as it relates to the recent and impending direct actions by the National Nurses Union (NNU).
In Washington DC, the recent one-day nurses strike at Washington Medical Center, incurred a cost of over a million dollars in replacement workers’ salaries. This April, a nurses strike at a potential five Massachusetts hospitals threatens to bring hospital operations at those facilities to a stand still. And, at a time when hospital margins are already lean, direct action has the potential to bankrupt these facilities. The most concerning aspect of these strikes is the impact on patient care. Hospitals in Massachusetts are scrambling to implement contingency plans, recruit replacement nurses, and modify elective surgery schedules. Replacement nurse salaries come at a premium and will drain the already depleted operational reserves. The down stream financial impact could be catastrophic. If you are a hospital employed doc, your salary could be at risk.
Yet, the major issue the NNU is fighting over is NOT wages. The major issue on the bargaining table is nurse to patient staffing ratios. That’s right. The NNU’s platform is patient safety.
Those of you who read my posts understand my passion for appropriate Hospitalist:patient ratios. And so, I am at a crossroads. Do I support the NNU in their fight to improve patient safety or do I support the hospital’s efforts to manage costs in an already austere marketplace? A win for the NNU would have dramatic implications for patient safety on a grand scale, yet potentially a very negative economic impact at the local level.
And so, my Hospitalist Brethren, when the nurses union at your hospital decides to strike, what will be your position? Patient Safety, or Patient Safety?
I welcome your opinions and a spirited debate.