This is probably one of the bigger if not the biggest union victory in the city of Pittsburgh since the 1930's.
Tom
Roger Odisio wrote:
> Mark,
>
> The unionization of the hospital nurses was a great victory with important
> implications. But, as I'm sure you know, there's no time to rest! The health
> care industry is changing in ways that offer new challenges. Capital is nothing
> if not adaptive.
>
> To cut costs and increase profits, insurance companies have forced the focus of
> health care delivery to shift from the hospital to the home and, hopefully to a
> lesser extant, group homes. Try staying very long in a hospital nowadays, no
> matter what you're in there for. Once you're "stabilized" (i.e.. no longer
> getting worse) out you go. You recover at home. Hospitals have been closing
> or merging for some time now, as the need for beds diminishes.
>
> Most hospitals are in dire financial shape, partly, perhaps mainly, due to the
> declining revenue from patients. The very hospital you've unionized--Allegheny
> General--is in some form of receivership due to the bankruptcy of the holding
> company that owns it. Hospitals' answer, like that of the insurance companies,
> is to cut back on the care provided, as you have explained. Nurses have been
> laid off, replaced by poorly trained general helpers. Today's patient rarely
> knows whether the person taking their vital signs, extracting blood, or
> controlling their medication is a nurse who knows what she/he is doing or some
> low paid helper, who is often oblivious to the kinds of signs a patient is
> having trouble or in danger that any nurse would recognize. So one thing
> unionization of hospital nurses can accomplish is to slow down and perhaps
> reverse the reduction in care, as you have pointed out. One problem is that it
> is hard to extract concessions from capital that is in financial distress. No
> doubt a major reason the vote for the union wasn't stronger was the
> vulnerability the nurses feel for their jobs and their hospital, both as an
> employer, and ultimately as an important institution in the health care
> industry.
>
> Hospitals are fighting back by offering isurance themselves and through tying
> arrangements with doctors. Doctors have begun fighting back too. Only recently
> have they seriously started to combine (though there has always been a small
> union of fairly radical doctors--radical for doctors, that is). Petty bourgeios
> rich folk in the past, many of them have become merely higher paid employees of
> insurance companies who control most the major medical decisions doctors used to
> make. If a doctor gives out too much care, the insurance companies don't like
> it, and she/he risks being dropped from the rolls.
>
> So there is a three cornered struggle for control of the enormous surplus value
> generated in health care. Until recently, the insurance companies threatened
> to gain so much control that they could essentially obliterate doctors and
> hospitals as major players. But the latter have gotten Congress and some state
> legislatures to intervene to try to lessen some of the more extreme forms of
> control by insurance companies. The California law you pointed out that fixes
> nurse to patient ratios is one example. Recently, one HMO, the most insidious
> kind of care denying insurance company, announced that they were giving back to
> doctors the right to make medical decisions. Made a good headline. But I
> haven't seen the fine print. There are many ways the HMOs control the behavior
> of doctors.
>
> The good news in all of this is nurses, educated labor who still have something
> to say about health care provision. The movement from the hospital to home has,
> in particular, enhanced the role of nurses. With home care, the nurse is often
> pretty much on their own making decision and providing care, as doctors hide in
> their offices, occasionally darting over to the hospital to pop in on patients
> to tell them they look good and will be going home soon. I know this first
> hand. I took care of my mother in her home (Mark: do you know about
> Pennsylvania's wonderful Family Care Giver's Act, passed about 6 years ago (at
> the behest of then Gov. Casey) that subsidizes with money or services care
> giving by a relative as long as the care receiver remains a t home. It's
> specifcally designed to allow people to remain in their homes and get health
> care near the end of their lives. Wonderful stuff that that asshole Gov. Ridge
> has not yet seen fit to gut.). My mother's care was provided by the nurses and
> me; the doctor was some shadowy figure that we got to adjust medication when
> necessary.
>
> More and more nurses now work in home care as hospital nursing staffs shrink.
> Also, hospice care is growing, as it branches out under Medicare from covering
> only terminal cancer patients to anyone thought to have less than 6 months to
> live, . That's home care too; hopices are not a building but a type of care.
> It also requires a special kind of nurse, nay, human being; hospice work is
> both brutal and enormously important.
>
> Problem is, home care is typically run by small companies, usually starting out
> with a group of nurses who switched from hospital jobs. Some have tried to tie
> into hospitals--so they get the patients being released from there--and some are
> basically independent. But virtually all are small, low profit endeavors
> (assuming only minimal defrauding of medicare, which is where they get their
> revenue). Unionization of home care nurses is thus very difficult, made all the
> more so by the lurking presence of the reserve army of nurses trained in
> colleges and laid off from hospitals. Troublemakers are easily replaced.
>
> If a home care nurse gives too much care, she can't see as many patients, and
> the company's revenue suffers (Medicare pays per patient). Unions would be
> attractive to many of the home care nurses I know, but they understand how
> vulnerable they are; if they complain or even if they try to do too good a job,
> they can easily be replaced by someone who will see more patients per day.
>
> If home care is indeed the wave of the future, it's going to be important to
> find ways to organize all kinds of nurses to stem the decline in care being
> offered, and to challenge the hegemony of the various branches of capital over
> the health care system. What are your thoughts?
>
> RO
>
> Mark Rickling wrote:
>
> > District 1199P/SEIU Press Release
> >
> > AGH RNs Vote for Union To Protect Quality Patient Care, Gain a Voice
> >
> > Major Improvements Seen in Health Care for Patients, Community
> >
> > AGH nurses voted 731 to 634 form a union in a two-day election supervised by
> > the National Labor Relations Board.