April 2005

Inside… Single-payer health care: Employer-based insurance...... 2

President’s column: You are the expert ...... 3   THE NEWSLETTER OF THE MASSACHUSETTS NURSES ASSOCIATION www.massnurses.org VOL. 76 NO. 3 Biosafety legislation backed ...... 3 NARH ordered not to admit more MNA on Beacon Hill: Overtime bill introduced ...... 4 patients than RNs can safely care for Governor’s budget blasted ...... 5 In a landmark victory for unionized reg- Labor Education: istered nurses and their patients at North All about the NLRB...... 6 Adams Regional Hospital in North Adams, Landmark ruling is first an independent arbitrator has found that the to align staffing decisions Region 5 notes ...... 16 hospital can no longer admit “more patients than nurses can safely care for.” As part of a with RNs’ professional Continuing education...... 18 ruling released in early March, the arbitrator issued an order for the hospital to “cease and standards and their ability MNF scholarships ...... 19 desist” from these practices. to meet those standards Nurses from the Salem Hospital Com- “The nurses of North Adams Regional mittee. From left: Fran O’Connell, Ann Peer support...... 21 Hospital have made history with this Marshall, Joanne Raley, Mary Wignall. decision and, if the hospital complies with MNA benefits corner ...... 22 the arbitrator’s order, we believe it will make protects nurses from being forced to care Salem Hospital this hospital one of the safest in the region by for too many patients at once and places guaranteeing every patient first-rate nursing decisions about the safety of patients in the nurses vote for MNA care,” said Robin Simonetti, RN, co-chair of hands of those ultimately accountable for Survey says the nurses’ union at NARH. that care.” union representation A statewide survey has found the The ruling is the first of its kind to deal According to Ruth O’Hearn, RN, a long- Registered nurses of North Shore Medi- with the issue of RN staffing and a hospital’s time nurse at NARH and one of the nurses public would support legislation cal Center/Salem Hospital in Salem and obligation to assign patients based on nurses’ whose grievances over unsafe staffing inci- setting minimum safe RN-to- its North Shore Pediatric Psychiatric Unit ability to meet their professional practice dents in May-June 2002 were the subject of at the Hunt Center in Danvers voted 354-7 patient ratios and prefers MNA’s standards, according to the Massachusetts the decision. “While a long time coming, I see on March 3 in favor of union representation Nurses Association, the union which repre- this decision as a very positive step towards safe staffing bill 3-1 over MHA’s by the MNA. The National Labor Relations sents the nurses at the facility. the improvement in the quality of care at our Board supervised the secret ballot election proposed legislation. In his 30-page decision, arbitrator Michael hospital. While we all want our hospital to with voting conducted at both campuses. The Full details, Page 4 Stutz ruled that the hospital violated the improve and be successful, at the same time, final tabulation came at 6 p.m. that evening. nurses’ rights because “unsafe staffing I want to make sure that it is providing safe ���� �������� �������� ����� ��� ��������� ���� With the successful vote to join the MNA, was allowed by the hospital to occur with- patient care. Ultimately, this decision says it the 570 NSMC/Salem nurses stand to garner Public Supports out cropping admissions or transferring is up to we nurses on the front lines to deter- greater regional clout as they join other nurses RN-to-Patient Ratio Bill 3-1 patients and without adding another nurse. mine what we can and cannot safely do and on the North Shore who are represented by Individual nurses were injured by having to under what circumstances.” Over Hospital Industry Mea sure the MNA at a number of hospitals, includ- �������������������������������������������������� work under unsafe conditions.” Mirroring problems faced by nurses across ing Anna Jaques Hospital in Newburyport, ������������������������������������������ “The nurses of this hospital are thrilled the state and the nation, the arbitration deci- Lawrence General Hospital and more than with this ruling but the biggest winners of sion in favor of the RNs at NARH grew out 500 nurses working at Northeast Health The plan which would The plan which would all in this decision are all the future patients of a multi-year struggle by the nurses to fight reg u late staffi ng lev els re quire hos pi tals to post a Corporation’s campuses at Beverly Hospital, and set a minimum nurse staffi ng plan, re port of NARH,” said Mary McConnell, RN, chair nurse staffi ng lev el it to the Dept. of Public Health, but would not set of the nurses’ union at NARH. “This ruling See North Adams, Page 20 See Salem, Page 7 minimum staff lev els. 62% Workplace violence: an unacceptable reality for nurses 21% us O “It’s part of the job.” many forms, from bodily assault, to the more oc n Those five simple words, spoken matter- insidious verbal attack. F of-factly by a court magistrate assigned a Within these pages are accounts of nurses WO RKPLACE case involving an act of violence against a who have experienced workplace violence nurse, were the catalyst for several MNA- and the response management has taken to VIO LENCE ������������������������� supported legislative bills, organization of protect their safety. Highlights of this issue our Violence and Abuse Prevention Task include an article on the positive actions Force and an ongoing effort to ensure the taken by management at Visiting Nurses of safety of nurses while at work. Boston to assist clinicians who daily enter Throughout is much This issue of Massachusetts Nurse devotes unsafe environments and the reprint of a valuable information on the its focus to “workplace violence,” a term that Nov. 8, 2004 article from The Salem News definitions of and statistics associated with For the latest sadly continues to expand its definition as which chronicles the often unreported dan- workplace violence within the healthcare developments healthcare professionals are exposed to gers inherent in being an emergency room industry. Also included are preventive impacting nurses, physical and psychological traumas. nurse and the absolute deplorable respnse by measures MNA can take on behalf of its Often overlooked, unreported or ignored, management at Northeast Health Systems. members and a comprehensive listing of visit the workplace violence within the healthcare This edition contains brief summations related resources. MNA Web site, industry has in the past been contained to of two recently filed legislative bills deal- And please take the time to read the his- www.massnurses.org emergency services, psychiatric and geri- ing with workplace violence, one calling for tory of the Violence and Abuse Task Force, an atric units. But increasingly, “front line” related educational programs within facili- account which points to the many measures nurses are on the receiving end of this type ties where these acts are rampant, the second taken by this group to facilitate the truism of behavior in reception areas, maternity proposing punishment for those committing “in healthcare or anywhere, violence is not and pediatric wards. And abuse can take such crimes. part of the job.” n Page 2 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 3

Nurses’ guide to single-payer reform Further evidence that employer-based health insurance has failed On Feb. 1, the Division of Health Care Finance and Policy, an agency of the Mas- The top 20 employers with 50 or more employees using public health assistance sachusetts Department of Public Health, issued a report, “Employers Who Have 50 Total or More Employees Using Public Health Public Assistance.” The agency reviewed records Health Employer % of patients receiving health care paid for Employer Name Employer Location Ben. Total Cost Contribution by the state’s Uncompensated Care Pool (UCP) or MassHealth between October Dunkin Donuts Multiple Locations 3454 $3,146,221 75% 2002 and June 2004. The results were staggering. Over $52 Stop & Shop Multiple Locations 2640 $3,074,284 100% million of state money paid for health services to employees of some of the most Wal-Mart Multiple Locations 2914 $2,904,543 52% high-profile and profitable corporations in the state, including a number of large McDonalds Multiple Locations 2124 $2,014,938 70% retailers, food service providers, hospitals and healthcare organizations. Furthermore, Unicco Service Corp Multiple Locations 1356 $1,368,814 78% the vast majority of employers on this list actually offers health insurance to their City of Boston Boston 1110 $1,020,573 90% employees and contributes an average of 70 percent towards the premium. CVS Pharmacy Multiple Locations 1254 $1,403,802 70% Among a list of 140 employers/companies included in the report failing to provide cov- Burger King Multiple Locations 985 $957,805 76% erage to workers are a number of hospitals or healthcare organizations. Most of the Shaws Supermarket Multiple Locations 1099 $1,391,288 63% uncovered workers are low wage workers Boston Medical Center Boston 666 $487,683 81% but others are part time, or not yet eligible for insurance for various reasons. On the Filenes Multiple Locations 924 $973,377 53% list are workers at: • Boston Medical Center Wendys Multiple Locations 914 $718,905 75% • MGH • Brigham & Women’s Demoulas Market Basket Tewksbury 997 $1,049,999 85% • Beth Israel Deaconess • Baystate Medical Center Friendlys Multiple Locations 986 $767,418 50% • Baystate Medical Center • St. Elizabeth’s Home Depot Multiple Locations 912 $830,211 50% • Genesis Healthcare • UMass Memorial Healthcare YMCA Multiple Locations 791 $803,664 70% - 75% • Children’s Hospital • New England Medical Center (Tufts- Walgreens Multiple Locations 678 $632,707 75% NEMC) • Carney Hospital Target Multiple Locations 756 $742,484 68% • Brockton Hospital • Salem Hospital • Commonwealth of Massachusetts Therefore, the report says “the numbers of high quality health coverage to everyone. at least a billion dollars annually in health Why are employees whose employers employers that meet the criteria for inclusion It’s time, instead, to enact the Massachu- care expenditures. offer a health insurance plan using the in this report are assumed to be greater than setts Health Care Trust bill through which For more information on this bill and to uncompensated care pool and MassHealth the numbers reported here.” the commonwealth would implement a get involved in the movement for single instead? Furthermore, employers with fewer single payer health care system to assure payer health care in Massachusetts, contact There are many reasons, including: than 50 employees are excluded from this comprehensive care that is not linked to a MASS-CARE. Email: [email protected]; • not being eligible for the employer’s report. job, cannot be taken away, will stabilize the Web site: www.masscare.org; Phone: 617- insurance plan due to part-time, The report concludes: finances of health providers, and save us all 723-7001. n

“casual” or “per diem” status, which “Although the policies and programs cur- cus On Fo is the trend in all industries today rently in place in Massachusetts provide a WO RKPLACE • inability to afford high co-payments very important safety net for many low- Protect Yourself/Tips VIO LENCE or deductibles income people, it should also be recognized • worker’s spouse or dependents not that such programs provide incentives, for covered both employers and employees, to shift Traumatic effects of violence on patients • limits on health services covered health care costs to the public sector.” According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, • enforced waiting periods before eligi- There is now before the Legislature a Text Revision, Post traumatic stress disorder (309.81) is identified as a person who has “1. bility for employer’s health plan “kicks bill titled “Health Access and Affordability experienced, witnessed, or were confronted with an event or events that involve actual in” Act,” sponsored by Health Care for All and or threatened death or serious injury or a threat to the physical integrity of self or others • wages so low that premiums and Sen. Richard Moore. It would require every and 2. the person’s response involved intense fear, helplessness, or horror.”† other out-of-pocket expenses are not employer in Massachusetts to provide health These events are known to precipitate a multitude of persistent and debilitating affordable insurance to their workers or pay a hefty responses. “The traumatic event is re-experienced in one or more of the following ways, The report cites a number of limita- tax to the commonwealth which would then recurring and intrusive distressing recollections (and dreams) of the event, intense psy- tions in its analysis including the fact that provide insurance to those employees. This chological distress at exposure to internal or external cues that symbolize or resemble information on patients’ employers are self- is often referred to as “pay or play.” an aspect of the traumatic event or physiological reactivity on exposure to internal or reported, employer information is often not MNA believes trends in the state’s econ- external cues that symbolize or resemble an aspect of the traumatic event.”† collected for people whose care is covered omy, employment, and health industry, MNA Task Force members believe that patients suffer secondary trauma in the same by the Uncompensated Care Pool, there are along with the impressive creativity shown manner and from the same causes as nurses and other healthcare workers who experi- inconsistencies in the ways in which various by employers in shifting costs to workers ence or witness workplace violence or abuse. n hospitals report such data, and, lastly, dif- and to public programs, demonstrate that †Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000, American Psychiatric ficulty identifying unique employers among employer-based health insurance does not, Association chain franchises. and can not, guarantee secure, affordable, Page 2 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 3

President’s column Arbitration decision underscores great truth about staff nurses—YOU are the expert! By Karen Higgins, RN We owe it to every placed in that environment. We know what is system, like those working in the Department MNA President nurse at NARH safe and what isn’t and we need to challenge of Mental Health at Taunton State Hospital The front-page story in this issue of the for their multi-year our managers when they persist in endanger- and Worcester State Hospital, and in DMR, Massachusetts Nurse describing the historic struggle to use their ing our patients. and those working at the Fernald Center and arbitration decision in favor of the nurses at union power to win We are experts and as such we need to take Wrentham Developmental Center. They are North Adams Regional Hospital underscores contract language control of the practice of nursing. At the work- speaking out as experts on how cutbacks a great truth that I wish all frontline staff that put in writing place, that means using your union power to in state funding for the care of the severely nurses, and all MNA members could truly the basic precept make sure your voice and expertise governs disabled and mentally ill are devastating the take to heart: every direct care staff nurse that the hospital nursing practice on your unit. care these clients and patients receive. is the expert when it comes to the safety of could not assign Outside of your workplace, being an expert A study also featured in this month’s issue her patients. more patients than means sharing your expertise and opinion highlights the results of a public opinion pool This decision clearly states it was a viola- a nurse can safely where it can have the most impact. Right now, that once again shows that you, as a direct tion of the NARH nurses’ contract to force care for. Karen Higgins that is in the Legislature where our legisla- care RN, are the most trusted source by the them to care for too many patients, and more The nurses at tion on the issue of safe staffing ratios and its public on health care issues. importantly, that hospital management is to North Adams made a stand for their own mandate is before that governing body. Being an expert means standing up and listen when nurses tell them their patient ability to determine what safe staffing is and But for other nurses, such as school nurses, speaking out and convincing others that assignment prevents them from meeting should be for them. They took ownership of being an expert means going before your you are right. When it comes to the direct their standards of care. their responsibility for the safety of patients school committee and parent groups—like care of patients, each and every one of you We all owe a debt of gratitude to each and and then acted on it. the Worcester School Nurses are now doing— is the expert. Use your knowledge and the every nurse in that bargaining unit, and All of us need to do the same. Managers to teach them about school nursing and what power of the public’s acknowledgement of particularly to those whose nine grievances create the work environment, but we are ulti- constitutes safe school health staffing. your expertise to make the system work for provided the underpinning to this decision. mately responsible for the safety of patients And then there are nurses in the State you and your patients. n MNA endorses legislation on regulation of ‘biosafety’ laboratories By Mary Crotty unknown cause tions and maintenance requirements, and comprehensive regulatory program for Associate Director of Nursing of transmission, other appropriate standards to protect the BSL-4 laboratories, based on existing state The MNA, which last month announced such as Ebola public health and environment. law for hazardous and polluting facilities its opposition to the placement of any and other viral Fox began tackling this serious public and federal guidance. Biosafety Level 4 laboratory in an urban, hemorrhagic safety issue prior to the public disclosure The bill would require adoption by the densely populated area where the acci- fevers. Many that several Boston University laboratory Department of Environmental Protection dental or deliberate release of a biological of the agents workers, working in a “less dangerous” and Department of Public Health of regula- agent could adversely impact residents, has could be used in Biosafety Level-2 laboratory operated by tions for BSL-4 lab location, construction, endorsed legislation drafted and sponsored biowarfare and the university had been infected with tula- operation, maintenance, security, emer- by Rep. Gloria Fox (D-Roxbury), with co- bioterrorism. remia bacteria which had escaped from lab gencies, permits, reporting, insurance, and sponsor Byron Rushing (D-Boston), to An agent escap- control last summer. transport; laboratory inspections to ensure regulate BSL-4 laboratories in Massachu- ing containment Undetermined laboratory problems led that the laboratories are operated to pro- setts Mary Crotty would pose a to the illness of the workers. Boston Uni- tect the public health and the environment; Boston University is seeking approval to severe threat to versity, city officials and the Massachusetts financial penalties for violations of laws establish a Biosafety Level 4 research labo- public health and the environment and Department of Public Health then all subse- and regulations; a community oversight ratory, known as a BSL-4, in Boston adjacent could cause a public health crisis. quently failed to disclose the incident to the board for each laboratory to help ensure to Boston Medical Center in a congested Massachusetts has no regulatory pro- public. BU also failed to make the required transparency of operations and research. Roxbury/South End neighborhood. gram for BSL4 laboratories. Massachusetts disclosures during the permitting process There would be a moratorium on con- BSL-4 laboratories are used for research has standards for other inherently danger- for the BSL-4 facility. struction and operation of BSL-4 labs until into the most dangerous toxic biological ous facilities, such as a landfills and power The proposed Fox bill, “An Act to Protect regulations are adopted. agents, those that cause fatal human disease plants, on where they might be located, how the Public Health and Environment from Please ask your representatives to sign by spreading through the air, or with an the location decision would be made, opera- Select Toxic Biological Agents,” creates a on to the Fox BSL-4 legislation. n Emergency contraception 101: how nurses can help By Julia Battel, CNM, MPH has filed a bill to improve access to EC, “An Massachusetts EC Network to present x13. Materials are also available on the web Massachusetts EC Network Act to Provide Timely Access to Emergency a one-hour brown bag lunch in your at www.prochoicemass.org and click on Unintended pregnancy is a major public Contraception.” The bill would require hos- setting. “Current Programs.” n health concern with serious consequences for pital emergency rooms to make EC available • Find out what the protocol is for EC women, children, and society at large. The to rape survivors and allow pharmacists to where you work. Initiate ways to Emergency contraception 101 United States has a higher rate of unintended dispense EC through a collaborative agree- increase access to EC such as institut- • Safe and effective way to prevent pregnancy than most other industrialized ment with a physician. The bill has over 60 ing standing orders for nurses. pregnancy after sex nations in the world. Nationally, almost half • co-sponsors. Encourage providers to make EC part • Plan B® or high doses of oral con- of all pregnancies are unintended and half of Currently, one in six Massachusetts of routine contraceptive counseling and traceptive pills those end in abortion. Health care providers emergency rooms still does not provide EC provide an advance prescription. • Won’t cause an abortion or harm an can play a large role in helping to reduce the • for survivors of rape, according to a 2004 Contact your state legislators and ask existing pregnancy rate of unintended pregnancy. survey by NARAL Pro-Choice Massachu- them to support the EC bill. • Works by inhibiting ovulation, Emergency contraception (EC) is a safe • setts. However, 36 percent of the Catholic Contact the Massachusetts EC Network fertilization or implantation and effective way to prevent pregnancy after hospitals in Massachusetts do offer EC in for more information or materials. • Take pills within 120 hours (five unprotected intercourse. It is most effective cases of rape. For more information or resources, sign days) of unprotected sex—but the in the first 24 hours, but it can be used up Women face many additional barriers in up for the EC Network and receive a free sooner the better to 120 hours after unprotected sex. EC does accessing EC including lack of information e-mail newsletter once a month. The Mas- • 75 to 89 percent effective when not cause an abortion and is not the same as or misinformation, difficulty getting to see sachusetts EC Network is a coalition of taken within 72 hours of unpro- mifepristone (RU-486). Plan B® is the brand- a provider within the 120 hour timeframe, advocacy groups, medical providers, phar- tected sex name for EC in the U.S. It contains two pills pharmacies that do not carry EC or refuse to macists, and government agencies working • Side effects include nausea, vomit- of levonorgestrel, the same hormone found in fill prescriptions, cost, and lack of health care to increase access to and awareness of EC. ing, altered next menses, breast many birth control pills. EC will not disrupt coverage in general. The EC Network provides materials for pro- tenderness or headaches an already established pregnancy and will So what can nurses do? viders and clients, educational resources, • No contraindications not harm the developing fetus if mistakenly • Learn more about EC and help edu- and other support, including samples of • EC can be prescribed or provided taken during pregnancy. cate other providers in your hospital standing orders for nurses. Contact Stacie at in advance of need The Massachusetts Coalition for Choice or clinic. Invite providers from the [email protected] or 617-556-8800, Page 4 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 5

MNA on Beacon Hill Public backs MNA’s safe staffing bill 3–1 over hospital plan With health care quality front-and-center of staffing plans, but does not regulate ISSN 0163-0784 USPS 326-050 in public debate, nearly 76 percent of Mas- minimum staffing levels. sachusetts citizens support legislation that • 74 percent believe it is a serious problem President: Karen Higgins would set minimum safe RN-to-patient that HMOs and insurance companies Vice President: Patricia Healy ratios, according to a statewide survey con- are concerned only with profits. Secretary: Sandy Eaton ducted by Opinion Dynamics Corporation • Hearing that Massachusetts hospitals Treasurer: Nora Watts (ODC) of Cambridge. are sponsoring the proposal to require The February 16-20 survey found that the the posting of staffing levels without Directors, Labor: Region 1: Diane public believes the quality of care in Massa- regulating minimum staffing causes Michael, Irene Patch; Region 2: Mary chusetts hospitals is suffering due to nurses just 7 percent of residents to say they Marengo, Patricia Mayo; Region 3: being forced to care for too many patients at are more inclined to support it. Tina Russell, vacant; Region 4: vacant, once. Now that the Massachusetts Hospital • Arguments in favor of MNA’s plan are vacant; Region 5: Nancy Gilman, Association (MHA) has joined the MNA in much more persuasive than those in Connie Hunter. acknowledging the need for patient safety favor of MHA’s plan. After hearing a Directors (At-Large/Labor): Barbara measures, the primary issue before the Leg- series of arguments in favor of each, “Cookie” Cook, Sandy Ellis, Denise islature is how best to solve this problem. support for MNA’s plan versus MHA’s Garlick, Barbara Norton, Beth Piknick, Massachusetts residents prefer the Safe MNA Executive Director Julie Pinkham at a increases by 18 percent. Elizabeth Sparks. Patient Care Act, which would set flex- March 22 press briefing at the State House The survey also found a growing sense of ible minimum patient-to-nurse ratios, by a where results of a statewide survey on impatience by the public for the Legislature Directors (At-Large/General): Joanne margin of 3-1 (62 percent to 21 percent) over safe RN-to-patient ratios were released. to take action on the issue of minimum nurse Hill, Donna Kelly-Williams, Rick the MHA proposal for toothless disclosure of staffing levels. Lambos, Jim Moura, Sharon McCol- staffing levels. The Patient Safety Act is sup- at once, much less six or more. Yet because of • 66 percent say it is time for the Legisla- lum, Rosemary O’Brien, Jeannine ported by the MNA and by the Coalition to chronic understaffing, that is the prevailing ture to back up the nurses’ judgment, Williams. Protect Massachusetts Patients, an alliance of situation in the state’s acute care hospitals. while just 25 percent say the legislature Labor Program Member: Beth Gray- 83 of the commonwealth’s leading health care The way to ensure that patients get the care should keep its hands off the kinds of Nix groups. The bill was filed by Rep. Christine they need is to set flexible patient-to-nurse medical decisions involving staffing. E. Canavan (D-Brockton) and Sen. Marc R. ratios.” • 76 percent of residents say they are more Executive Director: Julie Pinkham Pacheco (D-Taunton). Key findings of the survey: likely to vote for a candidate for state Managing Editor: David Schildmeier Furthermore, the public says legislators • 89 percent agree that since both the legislature who supports regulating Editor: Jen Johnson and administrators should listen to nurses hospitals and nurses in the state are minimum staffing levels, while just 12 Production Manager: Erin M. Servaes when they say that ratios save lives. proposing plans to address nurse staff- percent say they would be more likely Photographer: Amy Francis “The voters of the commonwealth have ing levels, there must be a problem with to vote for a candidate who opposes Mission Statement: The Massachu- stated that they view the current nurse staff- the current system. regulating minimum nurse staffing setts Nurse will inform, educate and ing situation as a clear and present danger,” • 77 percent agree that the quality of levels. meet member needs by providing timely said John Gorman, president of ODC. “The patient care in Massachusetts hospi- This survey also established that nurses information on nursing and health care attitude of the majority of voters on the issue tals is suffering because there are not receive the highest job ratings (89 percent) of issues facing the nurse in the Common- remains particularly striking. Most issues enough RNs working in hospitals. all hospital employees including doctors, and wealth of Massachusetts. Through the either polarize the electorate or don’t have • Similarly, 71 percent believe that are perceived as having the most significant editorial voice of the newsletter, MNA an impact on how they will vote. The safe nurses’ being forced to care for too impact on the quality of patient care. seeks to recognize the diversity of its staffing issue has consistent support across many patients at once is a serious A 2003 survey of registered nurses in Mas- membership and celebrate the con- the electorate, and could clearly influence problem. sachusetts found that 87 percent of nurses tributions that members make to the voters’ choices.” • Over three quarters (76 percent) of supported legislation to establish safe mini- nursing profession on the state, local “Massachusetts residents understand that residents favor legislation regulating mum RN-to-patient ratios. and national levels. quality care requires real action, not public minimum staffing levels. MNA commissioned the ODC poll. The Published nine times annually, in relations ploys,” said MNA President Karen • Less than half (48 percent) favor leg- survey of 400 Massachusetts residents has a January/February, March, April, May, Higgins, RN. “Nursing is the key to quality islation sponsored by the MHA that margin of error of plus/minus 4.9 percent at June/July, August, September, October hospital care. An RN cannot be in two places requires the posting and disclosure a 95 percent confidence interval. n and November/December by the Mas- Kennedy introduces bill banning mandatory overtime for nurses sachusetts Nurses Association, 340 Turnpike Street, Canton, MA 02021. Sen. Edward Kennedy has introduced fed- is affecting the quality and safety of care of stated protections. eral legislation that would disallow hospitals delivered to patients. • To ensure nurses are fully aware of Subscription price: $20 per year and other health care providers from requir- “Senator Kennedy’s measure, combined these new protections, the bill requires Foreign: $28 per year ing nurses work mandatory overtime, barring with efforts here in Massachusetts to set providers post rights in an appropriate Single copy: $3.00 a declared state of emergency. minimum, safe nurse staffing levels will location in the workplace. Periodical postage paid at Canton, MA • “The Safe Nursing and Patient Care Act,” protect patient safety and preserve quality Health and Human Services would be and additional mailing offices. to be enforced through Medicare’s provider care,” said Higgins. required to publish on its Web site the agreements, would ban mandatory overtime, The MNA legislation, in addition to setting names of providers for which penal- Deadline: Copy submitted for publica- thereby improving working conditions for RN-to-patients ratios, would ban the practice ties were imposed under this act. If tion consideration must be received at nurses and quality of care for patients. of mandatory overtime. a provider changes ownership, viola- MNA headquarters by the first day of The legislation would prohibit require- Other salient features in the bill include: tions under previous ownership would the month prior to the month of publi- ments that a nurse work in excess of a • The secretary of Health and Human be eliminated from the site after one cation. All submissions are subject to scheduled work shift or duty period; 12 Services would act as enforcement year. editing and none will be returned. hours in a 24-hour period; or 80 hours in a authority to investigate complaints Kennedy’s interest in the issue arose in Postmaster: Send address corrections consecutive 14-day period. for violations. If a violation is found, 2000 during the historic nurses’ strike at St. to Massachusetts Nurse, Massachu- “Front-line registered nurses applaud the secretary would require a plan of Vincent’s Hospital in Worcester. Kennedy setts Nurses Association, 340 Turnpike Senator Kennedy’s important patient safety action to eliminate the infraction and helped end the strike by hosting the final Street, Canton, MA 02021. measure to ban the use of mandatory over- would have the authority to issue civil settlement negotiations in his Washington, time,” said Karen Higgins, RN, president of monetary penalties of up to $10,000 for D.C. office, where the MNA bargained land- www.massnurses.org the MNA. “Senator Kennedy’s efforts echo known violations. The secretary could mark language to prevent the practice in a recent Institute of Medicine study which also increase those penalties for pat- union settings. found that long hours worked by nurses are terns of repeated violations. Kennedy later praised the St. Vincent’s harming patients. The IOM study confirmed • Providers of services would be prohib- nurses for their courage and conviction what registered nurses have continued to ited from penalizing, discriminating or during the strike and for bringing the matter say: unsafe staffing levels and the use of retaliating in any manner with respect of mandatory overtime to national promi- mandatory overtime to staff hospital floors to a nurse who availed herself/himself nence. n Page 4 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 5 State’s health professionals blast governor’s budget for neglecting the state’s most vulnerable, particularly those with acute mental illness The commonwealth’s system of care for Recommendations for action the most vulnerable mentally ill patients is Survey of staff at Taunton State Hospital, along with numerous In addition to taking their case to the “nothing less than disgraceful, given years of reports from across the state, reveal a growing trend of dangerous public, the Unit 7 Executive Board will advo- cuts in services and funding that have led to conditions and poor care following years of funding cuts cate within the legislature for the following a rapid deterioration in the quality and safety actions to be taken: of care in our state’s hospitals for the mentally • An immediate increase in the DMH ill,” according to Bill Fyfe, RN, president of budget to restore staffing and service the MNA chapter comprising more than 1,800 on their behalf as they deserve to be treated The MNA’s claims of poor care are sup- levels to what they were in 2001 as a state employed health care professionals, also with dignity and compassion – something ported by hundreds of official reports of means of stabilizing the system. known as Unit 7. that is becoming nearly impossible in the unsafe staffing submitted by professionals • An independent audit of the staffing The executive board of the MNA Unit current climate.” at a number of the state’s facilities in recent conditions of all DMH facilities and 7 voted Feb. 15 to make public its concern The executive board was incensed by an years. This includes the results of a recent for the care and safety of clients of the email from Mental Health Commissioner survey of staff in one of the state’s largest state system in the wake of the release of Elizabeth Childs issued to DMH employ- mental health facilities at Taunton State The MNA has made the Governor’s budget, which includes no ees on Jan. 28 which praised the governor’s Hospital (TSH). increase in funding to improve the care to “maintenance budget, which would allow The survey found: repeated requests to those requiring acute and long-term mental the department to operate at current service • 97 percent of the professional staff at health care, following years of cuts in funding levels,” calling the budget “good news.” Taunton State Hospital reported that meet with the DMH for the care of the mentally ill. The MNA has made repeated requests to their units were dangerously under- commissioner to discuss “We can no longer sit silent, while the meet with Childs to discuss serious concerns staffed some or most of the time. Governor and policymakers work under over the deplorable staffing conditions at the • 95 percent of the professional staff at serious concerns over the assumption that years of neglect of the state’s DMH facilities, but she has consistently Taunton reported staffing levels have the deplorable staffing mental health system in our state is not refused to meet. been chronically inadequate for the having a negative impact on the people they “This may be good news for the Governor past two years. conditions, but she has are supposed to be caring for,” Fyfe added. and the Commissioner, but it is horrible news • 89 percent of the Taunton profession- “The people we serve are not people who for those suffering from serious mental ill- als believe current working conditions consistently refused. have access to high-priced lobbyists; they ness. It is not good news to place patients force them to provide a level of care are often the ones in our society no one and staff in a state of constant danger. It is below their professional standards. an analysis of the impact on mortality, wants to talk about. As clinicians who have not good news to have people languishing in • And 100 percent of the Taunton profes- injuries, medication errors, readmis- given our lives and our careers to the care of our state’s hospitals because there is no viable sionals report they lack the sufficient sions, and other outcomes for patients. these patients, we feel obligated to speak out community placement for them.” time to provide the level of care their • An independent analysis of the cost patients require. of providing a safe standard of care to Additional surveys of professional staff at the clients of the mental health system other state-operated facilities in DMH are in in acute care, long-term care and ������ the process of being evaluated. community settings, along with an The health professionals at Taunton State independent needs assessment of the Hospital have already taken their case to number of beds required to care for the ��������������������������������� the media in their community, hoping to mentally ill in the state, both now and push their administrators to do something in the future as the population ages. ����������������������������������������������������������������������������������������������������������������� to improve conditions. • An analysis of the budget required to ��������������������������������������������������������������������������������������������������������������� They have reviewed staffing records at provide adequate staffing in all state- ������������������������������������������������������������������������������������������������������������������� the facility over the last four years and have run facilities, which takes into account �������������������������������������������������������������������������������������������������������������� presented their administration with docu- ������������������������������������������������������������������������������������������������������������ salary ranges for staff that remain mented evidence of the decrease in staffing �������������������������������������������������������������������������������������������������������������� competitive with the private sector. and the impact on nurses. ���������������������������������������������������������������������������������������������������������������������� “We can no longer allow people with ����������������������������������������������������������������������� “We’ve discussed all of these issues with severe mental illness to continue to receive key TSH administrators numerous times ������������������������������������������������������������������������������������������������������������������������� a diminished level of care in an under-funded over the last two years,” said Fyfe, who is �������������������������������������������������������������������������������������������������������������������������� system,” Fyfe concluded. “It is our ethical ���������������������������������������������������������������������������������������������������������������� also a nurse at TSH. “After multiple meetings and professional obligation to advocate for ����������� with management, the message is always the our patients and that is what we intend to ���������������������������������������������������������������������������������������������������������� same: there’s no money in the budget to hire do.” n �������������������������������������������������������������������������������������������������������������� the staff needed to fix the problem. Admin- ����������������������������������������������������������������������������������������������������������� istration consistently tells us that they are ��������������������������������������������������� limited by the constraints placed upon Rep. Canavan appointed ��������������� them by the Department of Mental Health. If that’s the case, then TSH is part of a larger floor division chair � ����������������������������������������������������������������������������������������������������������� State Rep. Christine Canavan, RN, D- ������������������������������������������������������������������������������������������������������������� problem that is in need of urgent repair. And Brockton, has been selected by House ���������������������������������������������������� until that happens some of our state’s most Speaker Salvatore DiMasi to serve as a ��������������������������������������������������������������������������������������������������� at-risk citizens will continue to suffer the floor division chairperson for the 2005-2006 ������������������������������������������������������������������������������������������������������������ consequences.” ������������������������������� ������������������������������������������������������������������������������������ As staffing levels have been cut, nurses legislative session. Her nomination was ����������������������������������������������������� and other professionals throughout the subsequently ratified by House members ������������������������������������������������������������������������������������������������������� DMH system have been regularly assigned during a February democratic caucus. ����������������������������������������������������������������������������������������������������������� mandatory overtime, a demoralizing prac- “I am quite honored by this appointment ������������������������������������������� tice that exhausts the staff and endangers and very appreciative of my colleagues’ � �������������������������������������������������� the patients. As a result of the deplorable support,” said Canavan, lead sponsor in conditions, hundreds of nurses are leaving the House (along with Sen. Marc Pacheco) the state system, where they are paid as much of legislation to establish RN-to-patient ����������������������������������������������������������� as 30 percent below their counterparts in the ratios in all Massachusetts hospitals. Four divisions exist within the House ���������������������������������������������������� private sector. At Taunton State Hospital, more than 30 of Representatives. As a division chair,. nurses have left in the last year alone, and Canavan will act as a liaison between ������������������������������������ more than 50 over the last two years. In House members of the second division and ���������������������� addition, because of the understaffing, the DiMasi regarding legislation appearing level of assaults by patients against nurses on the House calendar and other matters has increased dramatically. pending before the House. n Page 6 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 7

Labor Department: Educating Our Members

A disturbing pro-managment trend is emerging The NLRB: What is it and how it impacts workers

By Joe Twarog to undermine the union by union busting the working of an funded by Congress in recent years, with Associate Director of Labor Education tactics, there may be a violation. effective union an $8.7 million shortfall in 2004. Therefore, The National Labor Relations Board is a by intimidating as the case load increases, the NLRB has federal agency that administers the National Challenging violations employees into fewer staff, time and funds devoted to Labor Relations Act (NLRA); the law that Violations such as these can be challenged silence and non- investigations, trials, and preparations governs collective bargaining in the private by the union by filing an unfair labor practice involvement. for representation elections. The Bush sector. The NLRB’s primary activities are: (ULP) “charge” against the employer with 3 The NLRB more appointments being made to the board • conducting elections to determine the NLRB. The board will assign an agent to and more often have become more and more conservative whether or not employees want union investigate the charge by interviewing the “defers to arbitra- and anti-worker in tone. The balance that representation; employees and/or witnesses involved and tion” violations of was intended to be struck between employee • investigating and remedying unfair reviewing relevant documents. The board law. This forces the rights and employer rights has tilted dra- labor practices by employers and will also investigate the charge by meeting Joe Twarog union to grieve the matically towards the employer. unions. with management to get their version of the matter and take it Consider these recent NLRB actions: The NLRB has 33 regional offices located matter. Employee statements are not shared through the arbitration process, before • The board is making it harder for throughout the country, with Region 1 (cover- with the employer by the NLRB agent unless the NLRB acts on the issue. The NLRB workers to form a union by attacking ing Massachusetts, Maine, New Hampshire, the matter proceeds to a formal hearing. The has therefore created a recent history of card check recognition. Rhode Island and Vermont) being in Boston. regional office then reviews what the agent’s excuses why not to enforce the law by The board (NLRB) has a five-person body that investigation has found, and determines these procedural practices. Cynicism heads up the agency based in Washington, whether there is reason to believe that the and delays abound, in effect denying While the NLRB has an D.C. These five board members are appointed NLRA has been violated. If the regional workers true access to the NLRA. by the president and approved by the Senate. office finds that in fact there was a violation 4 If the NLRB does issue a formal com- important role to fill in They review and rule on appeals of decisions of the law, it will issue a “formal complaint” plaint and pursue a case, it seeks a labor relations, the recent made by the NLRB regional directors (the against the employer based on the union’s settlement with the employer based Region 1 Director is Rosemary Pye). The initial charge. Basically the regional office on what it believes is fair, leaving the trends are disturbing. board in effect sets and forms private sector has found “probable cause” that a violation worker and the union little recourse. labor law by its rulings that interpret the has occurred and the NLRB attorney then These settlements, as stated above, are The reality of the current law. becomes the advocate for the union in pros- usually watered down and may be NLRB and its enforcement ecuting the case. more pragmatic than practical. Violations of the NLRA Formal complaints will then proceed to 5 The NLRB also may dismiss the charge of the NLRA are mixed at The NLRA lists the types of violations of a formal hearing or trial conducted by an filed by the Union out of hand. In the best. law by employer conduct that is illegal. In administrative law judge who will make a process the NLRB may offer a face saver summary they are: final ruling on the matter and has power for the union by having it withdraw • statements or actions that interfere to provide a remedy and assign penal- the charge, but the impact is the same. • The board last year modified how with, restrain or coerce union activ- ties. However, most formal complaints are The union has the right to appeal the Weingarten rights (the right to ity settled between the parties with the NLRB dismissal to the NLRB in Washington, representation in disciplinary inves- • domination of unions (that is, any form again acting on behalf of the union, before which in turn usually rubber stamps tigations) applies, denying them in of a “company union” that in fact the they get to a formal hearing or trial. Often the Regional Office’s dismissal. non-union settings. employer controls) however, these settlements are not always 6. And then there is the so-called “merit • The board withdrew NLRA coverage • discrimination against employees who as clear as the union wants, and all too often dismissals” that the NLRB uses to and protections for a whole class of engage in union activity includes a statement of “non-admission” of “exercise discretion to decline to workers (graduate student employees) • retaliation against employees who file guilt by the employer. Settlements like these prosecute meritorious cases where at private universities. unfair labor practice charges occur because the NLRB is the moving party the public cost would outweigh the • The board has weakened the NLRA • refusal to engage in good faith bar- at this stage and has the power to mandate a public benefit.” (from a memo of the by limiting its remedies. gaining with the union resolution whether the union agrees or not. NLRB Associate General Counsel to • The board has sided with the chamber There are many examples of such viola- all Regional Directors). This means the of commerce in basically agreeing that tions, including the following: The reality NLRB reserves the right to dismiss a state (California) taxpayer dollars can If the employer or hospital sets up a While the NLRB has an important role to case that has merit - denoting that the be used by employers to fight union- “nurses’ council” that deals with manda- fill in labor relations, the recent trends are law was violated by the employer as the ization. tory subjects of bargaining (issues involving disturbing. The reality of the current NLRB union charged - but that they do not • The board has been reversing in wages, hours or working conditions), there and its enforcement of the NLRA are mixed choose to pursue the matter because recent years many decisions made by may be a violation by implicitly establish- at best. Some basic points to consider are: of “budgetary constraints”! the Clinton NLRB, to the loss of the ing a “company union.” There has been 1 The process is a very lengthy one In many cases, the best that can be expected worker. such a trend lately as hospitals seek Magnet which delays a resolution of the vio- from filing a charge with the NLRB may be status, usually terming such experiments as lation. In the meanwhile, the employee sending a signal to the employer to stop its Conclusion “shared governance.” continues to suffer and the employer illegal activity and the potential damag- While the Board remains an integral part If the employer intimidates or interferes denies any wrong-doing. Time and ing media that impacts negatively on the of the American labor movement utilized with a union floor representative from resources are also squandered in the employer’s image. by workers and their unions to continue to doing his or her job, there could be a vio- process. enforce the NLRA, there is little confidence lation. Similarly, if the employer targets, 2 The penalties, even for the most seri- The current NLRB’s direction and no illusions that workers’ interests will harasses, or disciplines a union member ous violations, are often a “slap on The NLRB is charged with upholding and be upheld solely through this process. for union activity, a violation may have the wrist” that employers are willing protecting American workers in their jobs Consequently, unions are being forced occurred. to accept as a perverse price of doing by enforcing the provisions of the NLRA. to be creative and seek alternative ways If the employer unilaterally changes a business. For instance, many official But recently, the board has become more of to achieve the correct and appropriate condition of employment (meaning without NLRB remedies amount to nothing an advocate for the employer, hurting and remedy to violations of law. The use of the formally bargaining with the union) involv- more than an “official posting” in the undermining worker rights and basic legal NLRB and the filing of unfair labor practice ing a mandatory subject of bargaining, a workplace listing violations of law protections. Even management consultants charges are therefore most effective, even violation occurs. Such a unilateral change that the employer claims it did not do and that boast of their “union avoidance” pro- with the limited remedies they are likely may be the imposition of a new tracking won’t do again! If there is any monetary grams (Adams, Nash, Haskell & Sheridan to achieve, when it is a part of a larger device on nurses without negotiating with remedy involved, the employer often of Kentucky) recently stated that “the board strategic plan. Workers and the union are the union. recognizes that such penalties are lately has been giving incredibly management- ill-advised to rely on the NLRB alone to If the employer fails to bargain with the minimal and will factor these into its favorable decisions.“ remedy work place problems and violations union in good faith or intentionally attempts plan if its over-all goal is to destroy The board has been deliberately under- of the NLRA. n Page 6 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 7 Good Samaritan nurses oppose significant cuts in surgical staffing Registered nurses, health care profession- caregivers at our facility.” while not jeopardizing employees’ jobs. Ini- practices were previously tried at Good als and other employees at Caritas Good The cuts, which were first announced to tially, an April 17 target date had been set for Samaritan Medical Center during the 1990’s Samaritan Medical Center in Brockton the nurses on March 2, appear to be proposed the staffing cuts. and failed. Recent scientific research has recently mobilized to oppose announced cuts by Caritas Christi on the corporate level, The nurses are particularly surprised clearly demonstrated that cuts in RN staff- in staffing for all areas of surgical services, based on the recommendations of a high- and outraged by the cuts as they come on ing lead to increases in patient complications, which the nurses believe “will result in dete- priced health care consulting firm, Applied the heels of a meeting with management in injuries to patients, medication errors and rioration in the quality of care for patients” Management Systems, Inc. (AMS). Ciccolo early March where both parties agreed that even patient deaths. According to a report undergoing surgery at the hospital. confirmed during the March 17 meeting that there were a number of issues of concern in by the Joint Commission on the Accredita- As part of this effort, a delegation of the proposed cuts were a GSMC management the surgical areas of the hospital related to tion of Healthcare Organizations, hospitals employees including RNs from the MNA initiative and that although the number of understaffing of RNs. This was reinforced that cut nurse staffing were less profitable local bargaining unit at GSMC, delivered OR cases has increased slightly over the past by a recent, highly publicized job fair at the and efficient, and conversely, hospitals that petitions signed by more than 500 employees year, cuts in staffing were needed, in response hospital where operating room nurses were had healthy RN staffing had lower costs and to acting CEO Joseph Ciccolo at a meeting on to the consultant’s report. being recruited. Operating room nurses are higher profits. March 17, a meeting that resulted in a two- The reductions would result in the loss of among the most highly touted and sought AMS makes its recommendations for cuts week moratorium on the staffing slashes. more than 250 hours of RN nursing care per after nurses in the health care job market. in hospitals based on a comparison of cur- The petitions, addressed to Robert M. week (the equivalent of six full-time RNs), “These layoffs make no sense given the rent staffing levels with its own database of Haddad, MD, president and CEO of Caritas including 88 hours per week cut from same current shortage of nurses, especially peri- staffing levels from across the nation. When it Christi Health Care, stated: “We the under- day surgery, 64 hours from the operating operative nurses in the current health care deems a hospital to be above what AMS con- signed caregivers and staff of GSMC call room, 64 hours from the recovery room and climate. We are convinced that the impetus siders to be a reasonable level, it recommends upon the administration of Caritas Health 35.5 hours from endoscopy services. for these shortsighted cuts is part of a larger cuts to hospital staffing. The company prides Care to stop its plans to make dramatic and The hospital, on March 18, agreed to a corporate agenda being driven by Caritas itself on applying “industrial engineering” devastating cuts in registered nurses and union proposal to implement a two-week Christi, based on its financial troubles and processes to hospitals. other valuable support staff in all areas of moratorium on the cuts, while a task force not on what the patients of this hospital actu- “Hospitals are not factories and patients are surgical services…These cuts were made consisting of union members, management ally require,” said Karen Gavigan, co-chair not widgets. The AMS approach is to bring by outside consultants who never met with and doctors gather alternative prosposals to of the RN bargaining unit and a nurse in the staffing in hospitals to the lowest common or discussed these changes with front-line increase efficiency in peri-operative services, same day surgery department. “As nurses, denominator,” Gavigan said. “We believe we want our management and the public we staffing and patient care should be based on care for to understand that we are already what patients need, not on what this glorified …Salem staffed at a barebones level and there is no accounting firm says it should be.” justification for any reduction in our staff- The nurses’ union has made an official From Page 1 ing, not only for nurses, but more importantly, ing, not without jeopardizing our ability to request to receive a copy of the full AMS Addison Gilbert Hospital in Gloucester and for the patients who seek care here.” maintain the quality of care that people of report upon which the cuts were based. It the Hunt Center. In addition to the regional strength this community expect.” intends to continue efforts to educate the The NSMC/Salem nurses previously were the MNA will provide the Salem nurses, AMS is one of a number of national con- public about the impact of the cuts and represented by American Federation of State, Pinkham also points to its long-time pres- sultants notorious for recommending deep what they would mean to quality and safety County and Municipal Employees (AFSCME ence as the union representative at nearly cuts in hospital staffing to cut costs. These of patient care. n Council 93). all the hospitals in the Partners Health Care “We are thrilled to become members of System, which owns Salem Hospital. Part- the Massachusetts Nurses Association,” said ners facilities represented by MNA include The two faces of MHA on mandatory overtime Fran O’Connell, RN, the long-time president Brigham & Women’s Hospital, Faulkner of the nurses’ local at Salem Hospital. “The Hospital, Dana Farber Cancer Center and MNA is a professional union that can offer Newton-Wellesley Hospital. The nurses at nurses significant clinical and nursing prac- Brigham & Women’s Hospital and Dana tice resources as well as their expertise in Farber are among the highest paid nurses collective bargaining. This is an organization in the nation. Nurses at Faulkner Hospital run by nurses for nurses and health care recently negotiated strong language to pre- professionals that has led the fight to pass vent workplace violence, an important issue legislation to improve staffing conditions in for the nurses at Salem Hospital, who have hospitals and to stop dangerous practices, suffered a number of assaults in recent years. such as mandatory overtime.” Massachusetts General Hospital is the only According to Julie Pinkham, executive facility that remains non union. director of the MNA, “With this vote, the While other unions are losing members, North Shore has become a true strong-hold with the Salem election, the MNA will now of MNA power and nurse activism. This elec- represent nearly 23,000 nurses in 86 health “The MHA is committed “These restrictions (fed- tion provides a tremendous opportunity for care facilities in the commonwealth and to the elimination of eral ban on mandatory nurses in this region to work together for throughout New England, including 52 of the use of mandatory overtime) would impair improved working conditions and safe staff- the state’s 67 acute care hospitals. n overtime. The use of the ability of caregivers Advance Clinical Research Education workshops mandatory overtime as to meet the demands of The Center for Information and Study on mentary lunch, national speakers, as well a routine way to staff is patients on the spot.” Clinical Research Participation (CISCRP) co- as a thank you breakfast reception honoring not appropriate…” —Paul Wingle, MHA spokesperson, sponsored by Northeastern University’s clinical research participants. The honorary — MHA “Patients First” quoted in the Boston Globe, Bouvé Institute of Professional Leadership co-chairs are Lt. Gov. Kerry Healey and Campaign Brochure Feb. 15, 2005 will host a program to provide general edu- Mayor Thomas M. Menino. Two morning cation about the clinical research process to workshops will be held followed by a com- While the MHA’s slick “Patients First” brochures and PR platitudes profess a commitment patients, the public and professionals. plimentary lunch with a keynote speaker. to safe staffing and a ban on mandatory overtime, when faced with the prospect of actually AWARE for All, Annual Workshops to For more information or to register being held accountable for adhering to a real standard of care, the hospital industry’s true Advance Clinical Research Education, will online visit www.ciscrp.org/programs/ colors come shining through. In February, the MHA unveiled its “Patients First” campaign, be held Saturday, May 21 at Northeastern awareness.asp. For more information which included a “commitment” to stop the dangerous practice of mandatory overtime. University’s Curry Student Union. CISCRP contact Robert Amara at 617-927-9500 or Yet, when Senator Kennedy unveiled legislation on the federal level to ban the practice is an independent, non-profit that does not [email protected]. CISCRP is also except in cases of emergency, the MHA voiced its strong opposition to the measure. recruit patients for clinical trials nor is it reaching out for organizational partners The patients in our hospitals, whose lives are placed in jeopardy every time a nurse is involved in conducting clinical trials. to help spread the word to the public, forced to work beyond their limits, can’t afford to rely on promises and platitudes. They The event is free and open to the public patients and to those who have participated deserve a guarantee that no nurse will ever be forced to care for too many patients or and will include six educational work- in clinical research studies. If you know of asked to work when they are fatigued. Fortunately, legislators in Massachusetts have the shops, (five pending continuing education any hospital, research site, health center, opportunity to provide such a guarantee with the passage of An Act Ensuring Patient approval) in the morning, free health advocacy group or community group that Safety, legislation that would establish safe, minimum RN-to-patient ratios and a ban on screenings throughout the day, a compli- might be interested, please contact us. n mandatory overtime. n Page 8 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 9

‘Sometimes it’s just about doing the right thing’ ER nurse assaulted while on duty reaches out to others on the ‘front line’ Just over two years ago, Charlene Rich- devastating night in Richardson’s career; to be silent would perpetuate similar inci- who nearly two years following her experi- ardson, an emergency room nurse at Beverly a night that forever altered the way she is dents prompted The Salem News to publish ence is faced daily with the ways in which it Hospital, became the victim of assault and viewed by herself, those closest to her and as an editorial (also re-printed here) calling for has changed her life. abuse while on the job. Her story became the it turns out, her employer. Richardson’s need hospital officials and those outside the health- Richardson demonstrated great fortitude foundation for a Page 1 article appearing in and desire to come forward and share her care industry to look the issue directly in its the night of the March 2003 incident and sub- the Nov. 8, 2004 edition of The Salem News, a story has resulted in an increasing awareness ugly face and at the very least, acknowledge sequently by sharing the events of that night re-print of which appears on this page. that those in the nursing profession are often the dangers confronted by emergency room with The Salem News. Her apparent resolve to The article, “Emergency room violence asked and expected to put their personal personnel while on duty. tell her story until it is truly heard is taken to growing concern for nurses” written by safety on the line as “part of the job.” Also included on Page 9 is powerful com- a new level in her personal perspective of the staff writer Jill Harmacinski, chronicles that Richardson’s courage and recognition that mentary from Charlene Richardson herself, real impact of workplace violence. n Emergency room violence growing concern for nurses By Jill Harmacinski Part of the job? Image problems? bitter about the way she says her employer Staff writer Police are accustomed to getting dispatched Nursing advocates say hospital admin- treated her. BEVERLY—Charlene Richardson has been to Beverly Hospital’s emergency room, said istrators don’t like to talk about workplace Richardson said she spoke publicly about bitten, kicked and punched by patients during Beverly Lt. William Terry. Generally, the calls violence because it ruins the “hotel-like her assault because she wants to improve 13 years as an emergency room nurse. are about disruptive patients, “someone who image” hospitals want to project. safety for nurses. She knew the job could get rough. But one is out of control and being disorderly. Most “The mindset is, ‘This is a hotel and the Despite repeated requests, Beverly Hospital night in March 2003, Richardson said, the of the time, it’s because they are drunk,” client — the patient — is always right,’” said officials would not comment on Richardson’s abuse went too far. Terry said. Evelyn Bain, who studies workplace violence assault or on the general issue of workplace A drunken, 50-year-old Salem man was Salem Lt. Conrad Prosniewski said police for the nurses association. violence. Instead, the hospital released a brought to Beverly Hospital for treatment. officers in that city are often sent up to the Last year Beverly Hospital tried to have prepared two-sentence statement praising As Richardson helped him get ready to hospital to control drunken, unruly people. security officers alter their uniforms, switch- its emergency room staff. leave, he lunged at her, grabbed her crotch In most instances, these individuals are taken ing from a police-style shirt and pants to Silence on the subject of hospital violence and tore through her hospital scrubs. He into police custody and charged with disturb- professional-looking suit jackets and ties. In is common. A study conducted by the U.S. refused to let go. ing the peace or disorderly conduct. response, campus security officers formed a Department of Justice this year showed that For 90 seconds “that felt like forever,” she “A lot of people who are under the influ- union and successfully fought the change. many assaults go unreported. said, the two struggled, wrestling into the ence of a lot of different things often show “They wanted to turn us into valets and The study showed a “persistent perception hall, where another nurse, three security up on the hospital’s doorstep,” Prosniewski customer-service people, not security offi- within the health care industry that these guards, two emergency room patients and said. cers,” said David Arsenault, president of assaults are part of the job. Under-reporting a visitor came to help. Once security guards Patients have assaulted emergency room the hospital’s security union. “They wanted may reflect a lack of institutional reporting handcuffed the man, Richardson grabbed the workers. “It happens every once in a while,” patients to see someone in a nice suit jacket policies, employee beliefs that reporting phone and called police. Prosniewski said. walking around ready to help them.” will not benefit them or employee fears that “I was shocked and upset and angry,” she At Salem Hospital, a nurse working in a In Richardson’s case, she said, hospital employers may deem assaults the result of said. “But I was OK.” mental health unit was once pushed down management refused to talk to her about employee negligence or poor job perfor- Her story is not unique. Nationally, crimes a flight of stairs by a patient, according to her assault, even after her attacker was con- mance,” according to the federal study. against nurses and health care workers are Fran O’Connell, president of the 560-member victed of indecent assault and battery and Salem Hospital has a workplace violence as common as assaults on police and cor- nurses union. sentenced to 18 months in jail. She is still a response plan in place, according to spokes- rectional officers. One study completed this Working a Friday or Saturday night shift in nurse at Beverly Hospital, but Richardson is See ER violence, Page 10 year indicates hospital assaults often go the emergency room can be crazy, O’Connell unreported. said, depending on the volume of patients Richardson and Essex County District and types of emergencies, which may include Editorial: ER safety should be a priority Attorney Jonathan Blodgett spoke at a stabbing and domestic violence victims or Hospital officials should join their nurses’ unions and the district attorney in recognizing recent seminar sponsored by the Massachu- victims of drug overdoses. the threat unruly, sometimes violent, patients pose to those working in their emergency setts Nurses Association about emergency “The emergency room is always a con- rooms. room violence. More than 70 people, most of cern,” she said. “You never know who’s A story Monday by Jill Harmacinski detailed the hazards inherent in working in a place them nurses, attended the event at Angelica’s coming through those doors and how stable which, by its very nature, is suffused with stress and trauma. restaurant in Middleton. When asked for a they are.” The majority of those who visit local emergency rooms want only to be diagnosed and, show of hands, almost half of the nurses at the Other nurses said they’ve endured slaps, if possible, have their suffering relieved. And by all accounts the doctors and nurses at the seminar indicated they had been assaulted at kicks and punches from patients. hospitals in Salem, Beverly and Peabody are more than equal to the task. some point during their careers. “At what point do people have to have con- But these ERs also see their share of those who are under the influence of alcohol or Blodgett, the son of a retired Salem Hospi- sequences for their actions ... consequences drugs or are in a violent state of mind. And as happened with nurse Charlene Richardson, tal nurse, said that’s unacceptable. for their own unacceptable behavior?” asked who has toiled for 13 years in Beverly Hospital’s ER, their behavior can turn assaultive. “Some might say that’s just part of the job,” Susan Vickory, a registered nurse who lives Now she’s doing her part to help focus public attention on the dangers unstable patients Blodgett said. “But no one should ever have in Lynn. pose to emergency personnel. to tolerate such horrible behavior.” In 2000, Vickory was working for a Greater Unfortunately some employers, including Richardson’s, seem reluctant to acknowledge In 2002, more than 4,000 hospital employ- Boston veterans hospital when she witnessed these threats. While Richardson is willing to testify in great detail about the May 2003 ees were assaulted while working in a patient slam a fellow nurse repeatedly incident, which resulted in a 50-year-old Salem man being sentenced to 18 months in jail for emergency settings across the state, accord- against a metal door. An “embarrassed” indecent assault and battery, Beverly Hospital’s only response was to issue a two-sentence ing to the Bureau of Labor Statistics. Area hospital administrator later tried to ignore statement praising the ER staff. hospitals would not provide numbers on the assaults, she said. Other nurses have reported similar problems in getting their administrators to take how many nurses were assaulted locally in “She wanted to pretend nothing ever these problems seriously. recent years. happened,” Vickory said of the adminis- But now nurses have a powerful ally in the person of District Attorney Jonathan Blodgett, Police records show patrolmen were called trator. “It was that whole blame-the-victim whose mother worked as a nurse at Salem Hospital and thus is personally familiar with to Beverly and Salem hospitals on more than mentality.” the hazards of the job. Given the normal hazards of working in a hospital environment, 380 occasions in the first eight months of this After this assault, Vickory joined a group of Blodgett told those attending a Massachusetts Nurses Association seminar in Middleton year, though the calls were for a variety of nurses who pushed for criminal prosecution recently, ER employees should not have to put up with violent behavior either in the wait- reasons — from helping to handle drunk of violent patients. Today, Vickory, a nurse ing area or treatment rooms. and unruly patients, to standing by while a for 36 years, works with an MNA task force There is, of course, no way to anticipate every physical outburst or keep every suspicious Medflight helicopter landed. that studies hospital violence and supports patient under guard. But simply acknowledging the problems, then soliciting the advice Since 2001, police have been called to Bev- victims. of those on the front lines on how to deal with them, would be a good first step. erly Hospital’s emergency room 536 times, “I’ve collected more stories than you can n again for a variety of reasons. imagine,” she said. Reprinted with permission of The Salem News. Page 8 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 9

In her own words: How ER assault has changed RN Charlene Richardson’s life, work By Charlene Richardson, RN my story through activities sponsored by Since the story of my March 2003 indecent the MNA and in the media, I was made to assault was published in The Salem News, I feel intimidated by my employer and asked have been overwhelmed by the public to sign a document pledging me to remain response and the questions I have been asked silent. I was made to feel as if I had done in regards to this incident. Most people are something wrong and that I was making quick to say they are impressed with the things worse by trying to protect myself article, yet wondered after reading it how and other nurses in my department. this incident has impacted me and affected This incident has also opened my eyes my life both personally and professionally. to the reality of normal post-traumatic Since then, I have taken extensive time to response and the effect that an inadequate think about how to even begin to answer response can have on the victim. I now real- these complex and difficult questions. Most ize without the proper support systems in times I find myself unable to find the words to place, a victim’s recovery from an incident describe the turmoil this incident has caused can be prolonged. Luckily, I have special in my life and the impact it has had on me. In friends I have been able to lean on to sup- searching for the right words, I have been told port me during this most difficult time. by my closest friends and support systems to Now, I am speaking out to let other “search my soul” and the words will follow. nurses know that it hurts intensely when a While trying to follow this advice I came to victim of violence does not receive the sup- the realization that an incident of this mag- port needed after such a critical incident. nitude is more traumatizing than any words Every word said to the victim post-incident could ever express. I have also come to the RN Charlene Richardson at an MNA workshop on violence held last October listens to is critical since any negative comment will realization that such an experience can rob keynote speaker District Attorney Jonathan Blodgett. reintroduce trauma and re-victimize the you of your soul. could hurt—was more than I could bear. and with that comes the judgment of many victim. Most days, just when I think I have I became a nurse to help people and work- Perhaps admitting this to my peers was so and lack of understanding due to ignorance cried my last tears over this issue, I am ing as an ED nurse was always a dream for hard because I was their leader for so long. of the situation. I have yet to understand the surprised at how I become re-victimized. me. For nearly 12 years I functioned in this However, even leaders bleed when cut. present mentality that suggests it is reasonable The pain is as fresh as it was immediately role and although ED nursing is a stressful Since this incident I have to kick-start for nurses to be abused in any way or form by following the incident. career, I welcomed each new day and enjoyed myself daily where previously I was a gen- patients or visitors since we are in this job to In my case an ounce of compassion the challenge that came with the profession. erally happy and energetic person. I fight help them. This present mentality insinuates would have gone a long way. Support of As ED nurses we must be skilled and ready every day to find the “pre-incident me” as I that if this occurs while we are on the job “it is a co-worker is crucial post-incident. It can for anything to happen in a moment’s continue in my multiple roles as nurse, wife, OK” because the patient is a “customer” and make or break the victim. notice. mother, daughter, grandmother, and friend. that our choice of occupation makes us second This is written in hopes of saving any nurse from ever having to endure such a Job includes violent patients It is grueling to rise each day and look in the class citizens. mirror only to see myself as someone’s victim. I rise daily to ask myself these same ques- deplorable incident. And if they do suffer Unfortunately our job includes taking care Friendships become altered due to lack of tions: How did this whole incident become of violent patients; those who sometimes understanding of a normal post-traumatic about anything else except me being a victim assault. There are people who present to the response. An incident like this is haunting to a brutal felony crime? How can I be judged My incident has been and causes sleepless nights, restlessness, by some who actually believe what happened completely life altering. and generalized feelings of insecurity in all to me was OK because of my choice of occu- Support of a co-worker aspects of life. Life stays disrupted long after pation? I no longer work in the after an incident is crucial. the bruises are gone …and the scars last for- ever. There is no longer any sense or feeling No support or counseling ED, something that was It can make or break the of security or safety. I would love to say my employer was one always my dream and who took this issue seriously and the neces- victim. Incident opened my eyes sary steps to provide me with the professional that I dearly loved. This incident has opened my eyes on many support and compassionate care that victims of issues and given me a better understanding of such trauma deserve, but my employer didn’t workplace violence, it is my hope to help ED for legitimate help with their illnesses certain things. I now completely understand do that. Instead, just the opposite occurred. I ensure the victim is treated with the com- and I have always felt more than up to the why sexual assault victims refuse to move was never provided support or counseling, and passion and respect so rightfully deserved. task in those circumstances. However, many forward with prosecution of their assailant. no one ever even said “we’re sorry this hap- All nurses need to reach out to and sup- people present to the ED with the primary The legal process is long and exhausting pened to you.” When I finally decided to share port their colleagues who are victims of intention to be disruptive and maybe even s O assault. violent to the ED staff and other patients or cu n Fo visitors. With this in mind, nurses are often Protect Yourself/Tips WO RKPLACE MNA legislation must pass put in a situation of being on the “front line” VIO LENCE The MNA has filed legislation to make it without the adequate support and resources mandatory that every hospital have a plan to keep us safe. Program offers self-defense basic tactics in place to prevent workplace violence from My incident has been completely life alter- The Rape Aggression Defense System (R.A.D.), a nationwide program that provides occurring, to educate all employees about ing. I no longer work in the ED, something realistic self-defense techniques for women, is currently being offered through the Beverly the issue, and to offer a system of support that was always my dream and that I dearly Police Department. and counseling for those who are impacted loved. And it has left my husband married “For those living in areas other than the North Shore, just contact your local police depart- by workplace violence. We need to make to a completely different person, one who ment to locate where the closest course to you is being held,” according to Beverly Police sure this law is passed. he describes as “not being a whole person Officer Brian Long, who is now accepting applications for a no-cost class slated in April. Fortunately, I know in the grand scheme anymore.” This is emotionally distressing The R.A.D. System is a comprehensive course for women. It begins with awareness, of things I have won and the common- because I know he is right. I have feelings prevention, risk reduction and avoidance then progresses to the basics of hands-on defense wealth doesn’t share the opinion that I am about this incident that I am unable to training. Not a martial arts program, R.A.D. has gained national acceptance mainly due a second class citizen because of my occu- convey, even to him. How do you tell the to its ease, simplicity and effectiveness. It provides a woman with the knowledge to make pation. Furthermore, my assailant received most important person in your life that you an educated decision about resistance and instructs participants on effective options for the maximum penalty allowed in this state. feel destroyed by one 90-second violent inci- self-defense and psychological well-being. Justice prevails and so does the truth. Yet dent? It is especially hard since he works in “The focus is risk avoidance,” said Long. “We teach students how to protect themselves sometimes the right path isn’t always the law enforcement and prides himself on put- in and outside the home and how to modify lifestyles to avoid issues of safety.” easy path and as tough as this has been for ting such criminals away where they belong. Identified as a “confidence building course,” the R.A.D. system “makes you safer than me I can look into the mirror and see myself I guess the bottom line is that admitting to you were and teaches you how to be aware of your surroundings.” with a free conscience. So the moral of the my peers how deeply this episode hurt To sign up for the Beverly class, contact Long at 978-921-6040, ext. 550. story is, sometimes it’s just about doing the me—more deeply than I ever thought I For more information on the R.A.D. program, visit www.rad-system.com. n right thing. n Page 10 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 11 VNA of Boston: ‘They know we need to be safe’ “The streets change when it gets dark or nurse might have to deal with, including management is committed when the weekend comes around,” is how going into homes where there is no phone,” to ensuring personnel’s Sandy Grant described the inherent condi- according to Grant, vice chair for the Hyde safety. tions of work as a registered nurse with Park office union whose active involvement “We ask the clinician the Visiting Nurses Association of Boston on VNAB’s Safety & Security Committee is to leave a situation if they (VNAB). in part borne of personal experiences while feel compromised,” said “There is an escalation of violence in the on the job. Martin, co-chair of the city particularly in the summer and fall “Personally, I have had to call 911 when I Safety & Security Com- months, but problems can occur outside was with one diabetic client who was high on mittee. “While an issue higher crime areas and sometimes just have drugs and having hallucinations,” she said. could be environmental, to do with one patient, not the environment,” “I was with the same patient at a different sometimes it’s related to said Grant, with VNAB for the past ten years. address when the police conducted a drug the client’s home. It could “But management has heard us and there is raid on the floors above and below us. Both be a family member who a heightened awareness and concern for our were frightening experiences. Nurses know may become agitated, or safety.” there is always a risk, but if we keep things in it could be a neighbor- That increased awareness and concern has the forefront, everybody stays aware.” hood issue, such as youths translated into new contract language relative While VNAB’s security committee has on the street during the to security, a more active Safety & Security been long-standing, it recently combined summer.” Committee, cab availability and two-way with the facility’s safety committee and has The 10-member com- radios for staff working in “high crime” become more active due to increased crime mittee, which includes a areas. Moreover, a stronger working rela- within the areas its personnel enters. As a former Boston police offi- tionship with Boston police is now in place. result, cabs are available in high crime areas cer, asks personnel to report VNAB is also in the process of upgrading its for those on the evening team, and said Grant, all incidents so they can be phone plan to ensure that all staff members “there is now a stronger emphasis for cabs analyzed for trends. have cellular phones. Meanwhile, monthly during the day.” “We also conduct inci- reimbursement is provided to all who use “Our executive committee works closely dent de-briefing because their own cell phones. with management,” said Grant, noting posi- sometimes a clinician is The oldest Visiting Nurses Association in tive implementations, including screening in an area where their the country, VNAB employs 450, including patients of violent crimes prior to their being safety is at risk and they 170 nurses who in the year 2003 served 15,000 accepted as clients and establishing security don’t realize it; it doesn’t patients throughout Boston and surrounding alerts for nurses entering at-risk areas where hit them immediately,” communities, including Somerville, Quincy an act of violence was recently committed. said Martin. “VNAB also and Braintree. Annmarie Martin, district director at holds educational safety RN Marie Dupont, a member of VNAB’s Hyde Park office staff, “There are a number of issues a visiting VNAB’s Charlestown office said VNAB workshops at least once gets into a cab en route to her rounds. a year. Making sure our

cus On staff is safe is on-going. You can never stop designated manager on each shift of safety Fo WO RKPLACE working at it.” concerns in the field. The VNAB designated Protect Yourself/Tips VIO LENCE Cathy Regan, bargaining unit chapter chair manager will be responsible for disseminat- and a member of the VNAB staff for the past ing information that may affect overall staff Violent incidents defined 20 years applauded the “increased communi- safety as appropriate.” cation between staff and management.” “Management is committed to keeping the The following brief “dictionary” of violent incidents is re-printed with the permission of the Office “It has come over a course of time and nurses safe,” said Regan. “Things seem to be of William R. Keating, the district attorney for the Norfolk District. This excerpted series of legal now there is more standardized language working out.” definitions was used during an MNA conference on Workplace Violence and Abuse Prevention. in the contract,” said Regan, in reference Grant echoed that sentiment. Assault to a December 2004 contract insertion that “I’ve seen a true vested interest in staff’s states, “Management and staff are commit- safety,” she said. “Management knows we There is no statutory provision defining assault; assault is defined in the common ted to open communication about security need to be safe and it is acknowledging that law as an attempt or offer to do bodily harm to another by force and violence. Another concerns. Staff will immediately notify a n manner in defining assault is that assault is an attempt or immediate threat to commit 100 percent.” a battery. However, an attempt or threat to commit a psychological harm does not con- stitute an assault. …ER violence

Battery From Page 8 Criminal battery consists of harmful or offensive touching. Every battery includes an man Arthur Bowes. He said any employee anonymously. Hospital administrators, in assault. The two types of batteries must be distinguished because of the issue of consent. assaulted there would be offered immediate large part, are also very hesitant to address Physically harmful batteries are unlawful regardless of consent. Such batteries are those medical attention and followup counseling. the issue, she said. that include touching where “bodily harm is likely to result.” It is notable that consent “We’d provide as much support to the Bain traces the problem in part to poor is also immaterial to charges of assault and battery with a dangerous weapon, because employee as possible,” Bowes said. staffing levels for both nurses and security such weapon necessarily entails bodily harm. However, for batteries that are only offen- guards at hospitals. At the same time, she sive, the commonwealth must prove non-consent as an element of the offense. This is so Learning to help said, “society has become more violent. There because “an offensive touching is so only because of lack of consent. The affront to the Evelyn Bain, the nurses association occu- are more drugs around, and handguns are victim’s personal integrity is what makes the touching offensive.” pational health and safety specialist, said more available.” Bullying support after an assault can be the key to But denial is not helping anyone, she said. The term “bullying” appears to be more of a descriptive term rather than a legal term. helping nurses cope. “Hospitals today are convinced they are A search of Massachusetts cases, statutes, and administrative codes, as well as legal dic- Even if an assault causes no serious physi- hotels,” she said. “They have a hotel focus. tionaries and legal reference material, fail to produce a definition or relevant discussion cal injury, she said, it can be “psychologically And no one tells you when someone is of the legal elements of “bullying.” traumatic.” assaulted in a hotel.” And too many nurses, she said, complain Charlene Richardson said the assault has Threats that after a violent episode, the hospital admin- made her a more cautious nurse. At the same A threat to commit a crime is a crime in Massachusetts. However, the term “threat- istration turned its back on the victim. time, the experience has shaped her future. ened” is not defined by that statute. Case law defines the elements of threatening include “No one said they were sorry. No one told She now wants to pursue a second career in “an expression of intention to inflict a crime on another and an ability to do so in cir- them they didn’t deserve this,” she said. legal nursing and hopes to become a safety cumstances that would justify apprehension on the part of the recipient of the threat.” “That’s a very comforting and very impor- advocate for others in her profession. There needs to be more than a mere expression of intention. It is not absolutely neces- tant thing someone can do.” “We are on the front lines without guns, sary that the threat be communicated directly to the victim, in some cases the threat Bain has interviewed nurses who have bulletproof vests and Mace,” she said. “We may be communicated by a third party to the intended victim. In this circumstance the been sexually assaulted, held hostage, intimi- are out there trying to help. When did it commonwealth must prove among its other burdens that the defendant intended to com- dated by patients’ family members and even become OK to hit or beat us?” n municate the threat to the third party acting as intermediary. This burden is “onerous” saw fellow hospital workers get shot. Nurses Reprinted with permission of The Salem where the third party is an eavesdropper. n who have been attacked often prefer to talk News. Page 10 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 11

A history of activism and By Evie Bain Health & Safety Program Coordinator accomplishment • Feb. 24, 2000: Task force organized by Karen Higgins, chair- • September 2002: Japanese nurses visit to share concerns about person for the MNA Cabinet for Labor Relations. “We are here workplace violence in healthcare settings. The MNA in response to all incidents, but the catalyst was the episode • January 2003: OSHA complaint filed relative to workplace vio- in Quincy related to a violence episode that when the nurse lence against MNA members. Massachusetts Office of Victim Workplace pressed charges, the magistrate said, “It was part of the job.” Assistance (MOVA) representatives visit task force meeting. • May 30, 2000: Task Force members addressed by Trooper Linda • April 2003: Task force members speak at UMass Lowell NIOSH- P. Orlando, Massachusetts State Police, Michael Jackman, office sponsored educational conference on issues of workplace Violence and of District Attorney William Keating, Jim Thomas, captain of violence. detectives, Weymouth PD and Jan D’Allessandro RNC, BS on • June 2003: Members learn of technique to aid victims of vio- Abuse Prevention short- and long-term resolutions for the problems being faced. lence and post traumatic stress disorders after violence—Eye Mission statement adopted. Movement Desensitization and Reprocessing (EMDR). Task Force • November 2000: Seven members attend meeting with Justice • October 2003: Members participate in focus group for research Barbara Dortch-Okara, chief judge of the Trial Court. Members project at UMass Lowell; promoting safe and healthy employ- testify on workplace violence before the Massachusetts Legisla- ment in healthcare, PHASE. tive Nursing Commission. • January 2004: Workplace violence and abuse survey developed • January 2001: Bills on workplace violence prevention and cooperatively with the UMass Amherst and distributed to three accountability filed with the Massachusetts Legislature: Pen- MNA hospitals. sion parity for Unit 7 members; safe staffing; felony to assault • February 2004: Members participate in two focus groups at a healthcare worker; and violence prevention programs and Suffolk University Law School on bullying in the healthcare employee counseling following assault. system. Abuse prevention added to the title of the task force • March 21 2001: MNA Lobby Day. Workplace violence is the topic. and all its activities. MNA members featured in a story in Revolution magazine. • April 2004: “Workplace Violence and Abuse, Changing the • April 20, 2001: “In healthcare or anywhere, violence is not part of Culture that Allows it to Continue” is the second day-long the job,” educational conference, in conjunction with AFL/CIO educational session developed and presented by the Task Force Worker Memorial Day, held at MNA headquarters; 65 attended members with 64 people in attendance. Workplace violence and and TV and radio coverage provided. Members testify on assault abuse prevention position statement ready for distribution. Evelyn Bain and violence prevention and education bills. • August 2004: A well-deserved summer outing. • May 2001: “Workplace Violence, Prevention and Intervention” bro- • January 2005: Attorneys Christine Pulgini and Lori Harling chure ready for distribution. visit to discuss issues of workers’ compensation. • May 2002: MNA regional workplace violence education pro- • February 2005: Chris King, RN, student at Regis College, will grams begin in three parts; nurses who are injured, the local do an internship at MNA health and safety program and focus district attorney and OSHA. on issues of workplace bullying. • June 2002 : “Top Ten Actions Following an Assault” ready for • And they are not through yet! n distribution.

s O Two bills call for prevention, punishment cu n Fo Safety WO RKPLACE Legislation to address workplace violence and abuse prevention Tips VIO LENCE By Evie Bain there is minimal staffing, where patients and team and other forms of crisis interven- Health & Safety Program Coordinator visitors are under the influence of alcohol or tion to help prevent employees affected or Members of the MNA Workplace Violence drugs and/or security within the facility is injured by violence from developing post What are the risk and Abuse Prevention Task Force have again minimal or poorly prepared. incident stress disorders. The bill carries a submitted legislation to address issues of con- fine of not more than $2,000 for employees factors for violence? cern. Two bills have been filed that would Legislation calls for prevention who do not follow the requirements of the The risk factors for violence vary from require employers in healthcare settings to The first bill outlines an act requiring legislation. hospital to hospital, depending on loca- develop violence prevention programs and health care employers to develop and The second bill notes: An act relative to tion, size and type of care. Common risk would assure that perpetrators of such vio- implement programs to prevent workplace assault and battery on health care providers factors for hospital violence include the lence be charged with a felony. violence. It moreover requires employers calls for punishment of whoever commits following: to assess their facilities for certain risks such an act to imprisonment in the house Late shifts vulnerable • Working directly with volatile related to violence, develop and implement of correction for not less than ninety days people, especially if they are under Task force members are aware from narra- programs to minimize these risks and nor more than two and one-half years or the influence of drugs or alcohol tives told by (nurse) victims of such violence, train and educate employees on appropri- by a fine of not less than $500 or more than or have a history of violence or that often their perpetrator had a history of ate responses to escalating violence. It also $5,000 or both. certain psychotic diagnoses. violence, had threatened to attack and had calls for a system for the ongoing report and These bills did not have numbers or com- • Working when understaffed; par- planned out the attack in a systematic fash- monitoring of these events. The bill requires mittee assignments at the time of deadline for ticularly during meal times and ion. Events often occur on late shifts where development of an in house crisis response this issue of Massachusetts Nurse. n visiting hours. • Transporting patients. By Chris Pontus guidelines for preventing workplace vio- • Long waits for service. Would you or your co-workers like MNA lence. • Overcrowded, uncomfortable staff members to come to your facility or The second workplace violence educa- waiting rooms. region with a program on workplace vio- tional program offered by MNA at your • Working alone. lence? facility is a one-hour presentation called • Poor environmental design. The Health and Safety Program at MNA Recognizing and Reporting Workplace currently has two different types of pro- Violence. This program is also presented • Inadequate security. MNA offers grams related to workplace violence, both by Evie Bain with a greater focus on pre- • Lack of staff training and policies of which can be facilitated on your site. vention and reporting aspects. OSHA is for preventing and managing workplace violence The first program offers 2.0 contact discussed in more depth as is the in-place crises with potentially volatile programs available hours and is called Workplace Violence: reporting mechanism that should be fol- patients. Assessment, Prevention & Response. It lowed after an incident. This program is • Drug and alcohol abuse. in all regions features speakers, including a nurse who offered as a stand alone presentation or • Access to firearms. was injured or assaulted during an act of can be combined with another educational • Unrestricted movement of the violence and representatives from both the presentation. public. county district attorney’s office and local For more information on these and other • Poorly lit corridors, rooms, parking police department. In addition, the MNA educational programs offered through lots and other areas. n health & safety program staff introduces MNA contact Chris Pontus at 781-830-5754 Occupational Health and Safety (OSHA) or e-mail [email protected] n Page 12 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 13 Workplace violence prevention and intervention: Being assaulted is NOT part of the job no matter where you work

should take place. The sequence of these steps You can also help by Mission statement depends on the individual situation. • deflecting self blame The mission of the MNA Workplace Violence and Abuse Prevention Task Force: In • Report any impending and actual acts • providing non-judgmental listening order to eliminate violence, there must be awareness that the problem exists. Education of violence at work to your supervi- • helping with police reports of nurses, health care workers and administrators is necessary. Prevention programs sor, regardless of who is the victim • keeping in contact by phone or visiting that address the violence continuum are essential. Efforts must be directed at legisla- and whether or not there are injuries. • assuring that the Steps in Actions are tors, members of the judiciary and society at large to assure the safety of all health care Reports must be written as well as followed verbal. workers. The task force advocates a zero tolerance policy for violence in health care What can the union do to help vic- settings. • Call the police immediately. If necessary tims of workplace violence? MNA workplace violence task force members recognize more: file a police report as soon as possible. • patients under the influence of drugs and alcohol Take someone with you when you file • Plan a system for addressing Workplace • children and adolescents presenting with aggressive behavior the police report, preferably co-workers Violence. Use the Actions Following an • weapons seen in the emergency department who are familiar with the event. Assault steps as the basis for planning while recognizing fewer placement options for: • If the assault is from a patient, docu- your system. • detoxification from drugs and alcohol ment the patient’s behavior in the • Help your co-worker through the steps. • adolescents and children needing psychiatric treatment nursing notes. This is the most essential • Advocacy may be needed to obtain legal documentation. copies of reports. • Seek medical attention even if there are • Designate someone to keep in caring Workplace violence is not uncom- among patients, their families or no “obvious injuries,” be sure to docu- and concerned contact with your mon in health care settings friends ment any physical injuries and your injured colleague. emotional state. Follow the health care From 1992 to 1996 non-fatal assaults on • increasing use of hospitals by police provider’s recommendations for treat- Personal safety tips nurses, others in health care and mental and the criminal justice system for ment and work restrictions. • Use the buddy system if available or health settings were similar in frequency to criminal holds • Request and participate in Critical Inci- develop your own. those in law enforcement, well over 200,000 • care of acutely disturbed, violent indi- dent Stress Debriefing (CISD). CISD is • Don’t carry keys, pens, jewelry or other annually. Annual average assaults in health viduals essential following a violent episode. items that could be used as weapons. care settings included 69,500 nurses, 24,000 • unrestricted movement of the public in • Co-workers who witness assaults must • Don’t wear items around your neck that technicians, 56,000 other health care work- clinics and hospitals be included in CISD. could be used against you in confron- ers and 10,000 physicians. In mental health • long waits in emergency or clinic • Keep a diary of the progress of treat- tational situations. settings 50,300 assaults were reported on areas ment, discussions related to your • Make sure that nurses and physicians professionals, 43,500 on other workers and • low staffing levels during times of injuries and the progress of any claims are not alone when performing inti- 8,700 on workers in custodial positions1. specific increased activity • isolated work with clients for Workers’ Compensation. mate physical exams on patients. Workplace violence is a crime • solo work in remote locations • Ask for and retain copies of all Work- • Attend classes in self defense and crisis ers’ Compensation, incident, medical, intervention when available. Nurses and other health care workers who • lack of training in recognizing and injury and insurance reports that relate are assaulted at work have the same rights managing hostile and assaulting behavior to the event and your treatment. What can the union do to prevent as workers assaulted on the job in any other workplace violence? work setting. You are entitled to file a police Actions following an assault Show that you care Promote zero tolerance for workplace vio- report to assure the incident is investigated • Encourage the assaulted co-worker to: lence. by police with follow-up in the courts when Steps to follow: While there is no clearly • report the incident Create and maintain a safe work envi- indicated. defined process for the victims of violence, • • talk about the incident ronment as well as the prevention and The victim may file a report at the police the Task Force has identified certain steps that response for workplace\violence. department or the District Court of jurisdic- us O oc n Make workplace safety and health a pri- tion. According to the Massachusetts Office F • WO RKPLACE ority and standing item for committee of Victim Assistance, cases come into the Protect Yourself/Tips VIO LENCE and labor management meetings. criminal justice system in several ways, Maintain union presence on hospital including police complaints, citizen com- Resources for nurses • safety committees. plaints and indictments. Police complaints • In the Aftermath of Crime—A Guide to Victim Rights and Services in Massachusetts. Learn the employer’s policy and proce- are issued by a clerk magistrate in District Cambridge Street, Boston, MA 02201, 617-727-5200 • dure for violence and harassment and Court based on information supplied to them • Guide for Victims and Witnesses, William R. Keating, Norfolk County District Attorney, educate self and members. by police officers. Citizen complaints are also 781-830-4800 Accompany victims when they are issued by a clerk magistrate in District Court • Local police departments • filing police reports. Accompany them but are based on information provided by • County district attorney during police and court proceedings. both the victim and the defendant. • Massachusetts Nurses Association, Injured Nurses Network, 340 Turnpike Street, Introduce the OSHA Guidelines for Canton, MA 02021, 781-821-4625, x776 • Preventing Workplace Violence for Definition of workplace violence • Victim’s Bill of Rights, Massachusetts General Laws Chapter 258-B Health Care and Social Service Workers Violence in the workplace is best described • Resources for union committees or employers who are developing workplace violence to management as the basis for violence as existing on a continuum from verbal/ prevention programs prevention activities. emotional abuse to physical assault and • Critical Incident Stress Management, Western Massachusetts Emergency Medical Identify a Critical Incident Stress homicide2. In health care settings, workplace Services, 413-586-6065 • Debriefing Resource that can be violence can be perpetrated by patients, fami- • International Critical Incident Stress Foundation, Inc. @ www.icisf.org/cis.html accessed whenever needed. ASAP is a lies, friends, visitors, co-workers, physicians, • Guidelines for Preventing Workplace Violence in Healthcare and Social Service Set- formalized support system that can be supervisors and managers. ting, U.S. Department of Labor, OSHA, available at www.osha.gov implemented in a facility. Myths that nurses believe about Work- • Massachusetts Division of Occupational Safety. A state agency that utilizes OSHA Develop a buddy and escort system to place Violence in healthcare settings: guidelines to address safety and health concerns, including workplace violence, to • protect workers in remote areas and • “The nurse must have done something protect workers in state facilities. 617-969-7177 parking lots. to provoke the attack.” Anticipate “slip ups” in the Workers’ • “It can’t happen here, or it won’t happen References • Compensation process and advocate to me.” 1. Bureau of Justice Statistics, Special Report: National Crime Victimization Survey, Workplace Violence, 1992-96, Revised for the injured worker. • “It’s part of the job.” 7/28/98 - www.ojp.usdoj.gov File grievances. • “Patients aren’t responsible for their 2. Illinois Nurses Association Position Statement on Workplace Violence, Illinois Nurses Association, 1995 • Encourage the development of support behavior.” 3. Guidelines for Preventing Workplace Violence in Healthcare and Social Service Setting, U.S. Department of Labor, • groups for injured workers. Recognizing a violence prone work- OSHA, available at www.osha.gov Report on activities in local unit news- place3 4. Western Massachusetts CISD Team, c/o WMEMS, 7 Denniston Place, Northampton, MA 01060, www.wmems.org/ • letters, especially the progress toward • prevalence of handguns as weapons cisd.htm prevention. Page 12 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 13

So you think it’s safe at work? Notes from the Congress on Health and Safety Members of the Workplace Violence and Abuse Prevention Task Force By Evie Bain been able to address issues of workplace violence and sup- have accomplished is taking a stand through the Workplace Most members of the Task Force come from acute care settings, port her peers in the day- to-day realities at work. Connors Violence and Abuse Prevention Position Statement. The sup- while others represent the specialties of psychiatric nursing, emer- is appreciative of the approach Task Force members take as port of nurses injured by violence is also a valuable activity gency nursing and community settings such as group homes. Their they address the many facets and depths of issues violence to which members of the Task Force are committed. common goal is to reduce the incidence and frequency of violent and abuse presents to nurses and others. She is of the opinion events against staff in all healthcare settings and to educate nurses that victims’ stories drive the work of the Task Force and that Kathy McDonald and others about their rights if they are assaulted. Following is an members’ response to victims and the subsequent support Kathy McDonald notes that she became interested in the introduction to the Task Force members: provided is rewarding. Task Force because so many staff members on her unit (med/ geri/psych) were assaulted by patients, in addition to there Rosemary O’Brien Mary Bellistri being a few incidents of assaults and threats from family Rosemary O’Brien is the chairperson of the Task Force and Mary Bellistri became involved after a nurse who was members. According to McDonald, “We didn’t know our became interested in it after learning about the problems her injured by a patient went to court and was not taken seriously rights, we had trouble sorting out whether it was our fault, peers were having at work. O’Brien has been a member of by the clerk magistrate who thought the violence was “part we didn’t know the law and we didn’t know where to look for the Task Force since its’ first meeting in 2000. She has worked of the job.” As a result of her years as a member of the Task support. I don’t think that our managers and administrators on legislative initiatives and has been influential in bringing Force, Bellistri has become more of an activist. She believes understood how pervasive and upsetting the violence was. workplace violence to the attention of legislators and gov- the most important activity of the Task Force is getting the We didn’t have a mechanism to let staff know which patients ernmental officials, particularly Norfolk County District message out that “in healthcare or anywhere, violence is not were dangerous.” Changes have come about on the unit, she Attorney William Keating. She believes education and sup- part of the job.” said. “Now we use the “precautions” section of the nursing port for members are the most important accomplishments of assessment/care plan to flag patients who are assault risks the Task Force. Currently, O’Brien is interested in developing Harumi Mihara and we note in the care plan what precipitates aggression. legislation that would require healthcare facilities to receive Harumi Mihara is interested in workplace violence preven- How to approach the patient is also noted in the care plan. information about aggressive and violent patients and share tion in her work setting. She is also involved in spreading the Our unit is doing a better job of helping staff when we get that information with caregivers. word about the work of the Task Force to nursing students threatened or assaulted, although we are still underreport- who visit her from Japan. She brings Japanese nurses and ing.” McDonald has spoken to nurses on other units about Chris King nursing students to Boston to further their studies. They fre- the MNA Top Ten list (What a nurse should do following an Chris King is the newest member of the Task Force. She quently attend Task Force meetings while in the area. One assault) and ways the Task Force and MNA representatives joins the group as a nursing intern with the MNA Health and group shared their violence prevention activities through a can be helpful. “My best moment was when one of our per Safety Program. King is interested in workplace violence as it Power Point presentation, translated for us by Mihara. diem nurses told me she had used info from me when a physi- affects residents and workers in long term care settings. She cian at one of her other jobs had tried to intimidate her and learned of the Task Force’s work through a nursing colleague Marcia Robertson she reported him to administration and got a lot of support.” who has been involved for several years. She believes the most Marcia Robertson came to the Task Force upon the sugges- McDonald added, “All the Task Force members and staff are important work of Task Force members is as outreach sources tion of a member, following a violent event. She believes the a great group of people and a pleasure to work with!” for nurses dealing with violence in the workplace. emotional support given to injured nurses who are survivors of violence at work by Task Force members is invaluable to Kate Opanasets Susan Vickory their emotional healing. According to Robertson, the Task Kate Opanasets was very closely involved with an event Susan Vickory is a nurse on acute psychiatry. A few years Force has brought the issue of workplace violence in hospi- of violence in the ER where she worked. She joined forces ago she noticed increasing incidents of assaults on staff. Two tals out into the open and has kept the focus on the issue to with her colleagues and the MNA to file an OSHA complaint of her colleagues wanted to file criminal charges against the ensure that changes are being made. She would like to see related to the incident. As a result, she became frightened patient/perpetrator and were successful with the court language relative to workplace violence and abuse in collec- and felt traumatized and had to stop working in the ER. system. Then, Vickory saw the Massachusetts Nurse and read tive bargaining contracts for MNA members. Opanasets sought out and found “refuge” in the Task Force. about the Task Force. She felt she could learn more about There have been changes in that ER, including placement of a other nurses’ experiences and make a contribution if she Noreen Hogan permanent security guard during the night shift. The patient joined. Vickory developed and presented a paper outlining Noreen Hogan joined the Task Force after a co-worker on care area is permanently locked and staff uses a security the process for nurses to follow when filing criminal charges a child/psych unit was severely injured in a violent incident code to enter and to allow visitors and family members to against a perpetrator. She has presented at continuing edu- and was out of work for six months. She had been assaulted enter. Moreover, patients and visitors in the seclusion room cation programs and orientation in her workplace for new herself on several occasions and unsuccessfully tried to must surrender their belongings. Nursing and security now staff based on knowledge gained from working with the convince hospital management and her co-workers to form collaborate to maintain safety. Opanasets believes the Task Task Force. a coordinated response to these incidents. Hogan eventually Force is a resource for nurses; a place to go if threatened left that hospital, due in part to her frustration over the lack or injured by violence. Those nurses who make use of the Rosemary Connors of response received on the issue of violence in the workplace information provided by the Task Force and its’ members Rosemary Connors came to the Task Force after becoming from management and colleagues. Another co-worker had soon learn that “nurses here know what you are talking about concerned for the safety of patients and staff at her workplace. read about the Task Force and recommended that Hogan join. and that other professionals understand,” she said. “I love As a result of her membership on the Task Force, she has Hogan believes the most important work the group and MNA the fact that it exists.” n

cus On Fo The result of workplace violence— Protect Yourself/Tips WO RKPLACE critical incident stress VIO LENCE Tragedies, deaths, serious injuries, sexual assault, hostage situations and threatening If assaulted at work: 10 actions to take situations are all common to workplace violence. These events are known as “Critical Incidents.” Sometimes an event is so traumatic or overwhelming that significant stress 1. Get help. Get to a safe area. reactions occur. A process known as Critical Incident Stress Debriefing (CISD) is specifi- 2. Call 911 for police assistance. Remember, it’s your civil right to call police. cally designed to prevent or mitigate the development of post-traumatic stress. 3. Get relieved of your assignment. Recognizing critical incident stress: You may see signs and symptoms of critical inci- dent stress in those who have experienced or witnessed workplace violence. Symptoms 4. Get medical attention. occur as physical, cognitive, emotional and behavioral and can be noted as: 5. Report the assault to your supervisor and union representative. 6. Get counseling or assistance for critical incident stress debriefing (CISD) to Physical Cognitive Emotional Behavioral address concerns related to post traumatic stress disorder (PTSD). Chills Confusion Fear Withdrawal 7. Exercise your civil rights. File charges with the police. Fatigue Uncertainty Grief Inability to rest 8. Get copies of all reports and keep a diary of events. Nausea Hyper-vigilance Panic Intensified pacing 9. Take photographs of your injuries. Weakness Poor abstract thinking Depression Hyper-alert to environment 10. Return to work only when you feel safe and supported. Page 14 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 15

In collaboration with Mass. DPH MNA offering bioterrorism preparedness modular presentation components MNA in collaboration with the Massa- • Describe the properties that make in- presentation will introduce the components “take” chusetts Department of Public Health is fectious diseases likely agents of of basic incident command as they apply to • Explain vaccine storage and han- offering bioterrorism preparedness modu- bioterrorism a mass dispensing clinic. Check lists for pur- dling lar presentation components. • Describe the epidemiological charac- pose of planning and implementing a mass • Describe the procedure for reconsti- teristics of Category A bioterrorism dispensing clinic will be handed out to aid tution of smallpox vaccine BT agent presentation agents (anthrax, botulism, plague, with the presentation. • Demonstrate smallpox vaccine The presentation on bioterrorism agents smallpox, tularemia, and viral hem- The specific objectives for the overview of administration technique using the will include a general overview of the orrhagic fevers) mass dispensing clinics are: bifurcated needle Category A agents, including anthrax, • Describe reporting requirements • State the need for a mass dispensing Presentation credits 2.5 CMEs, 3.0 nursing botulism, plague, smallpox, tularemia, and and laboratory testing services for clinic contact hours, and 3 EMT/paramedic credit viral hemorrhagic fevers. The overview Category A agents • Identify necessary components of a hours. will cover the characteristics of each agent, • Identify infection control measures mass dispensing clinic clinical description, reservoir, transmission, for Category A agents • Identify present resources available Mass dispensing training exercise incubation period, infectious period, and • Review the MDPH role in outbreak to operate a Mass dispensing clinic Following the presentations on Category general epidemiological features, such as management • Identify potential community A bioterrorism agents and mass dispens- the distribution or incidence in populations. Presentation credits 1.5 CMEs and 1.8 nurs- partners available to assist in plan- ing clinics, the presenters will conduct The presentation will provide information ing contact hours. ning and operation of a local mass an interactive exercise that incorporates regarding the reporting requirements and dispensing clinic and discuss their the principles of the incident command laboratory services available for confirma- Mass dispensing clinic presentation individual roles system (ICS) into mass dispensing clinic tion. It will also identify the specific infection The presentation will include a general • Apply the principles of basic incident operations. To ensure a valuable take-home control measures for each agent, including overview of mass dispensing clinics. The command during the operation of a experience that is both practical and real- the applicable isolation and quarantine overview will outline the various types of mass dispensing clinic istic, this exercise will utilize population requirements to contain person-to-person mass dispensing clinics, their potential use, Presentation credits 2.0 CMEs and 2.4 nurs- data and local resources specific to the spread. The presentation will also identify as well as examples of previously planned ing contact hours. community. Following the exercise, par- the supporting role of the Massachusetts and operated clinics. The presentation will ticipants should be able to effectively set Department of Public Health in outbreak outline the necessary components of a mass Description of mass dispensing site: up local emergency dispensing clinics in management. Educational materials, such dispensing clinic such as potential locations, smallpox specific presentation their communities. as relevant fact sheets for each agent, will staffing, supplies, and auxiliary operational The presentation will include an overview The specific objectives for the training be distributed. needs. It will focus on assisting participants including an outline of the current national exercise are: The specific objectives for the overview of in identifying resources within their com- and state smallpox preparedness program. • To engage the audience in a discus- bioterrorism agents are: munities to develop and run a clinic. The It will outline the history of smallpox and sion of the issues related to setting smallpox vaccination. The program will up emergency dispensing clinics, review the principles of a mass dispensing including the principles of incident site and the specific requirements of such a command system and interagency site with regards to smallpox vaccine admin- communication Register Now! istration. Participants will be instructed on • To walk through the steps of setting pre and post event screening for smallpox up a mass dispensing clinic in a local ��� ����� �� ���������� ������� �� vaccine administration, how to evaluate a community vaccination “take” post vaccination, proper • To provide participants with the take ����� ������ �������� ��� ����� ������ vaccination site care, and adverse events home tools they need to plan for a ������������ ������ ��� ������ ����������� reporting. The presentation will review and mass dispensing clinic in their com- provide hands on training with regards to munities smallpox vaccine administration and practice The learning outcomes for the training ������ ������ ��� ������ �� ����������� using the bifurcated needle. Upon comple- exercise parallel these objectives: �������� ���� ��� ����� ���� ��������� ��� ��� ������ tion, qualified participants will be certified • Participants can describe the issues in smallpox vaccine administration by the and challenges related to setting up MDPH. local mass dispensing clinics, includ- ��� ���������� ���� �� ���� �� ��������� ����� ��� ����� ���� The specific objectives for the mass dis- ing the application of ICS structure ���� �� � ���� �� �� ��� �� ��������� ��������� ������ ������������ ��� pensing site: smallpox specific are: in the clinic setting • Discuss components of the current • Participants can outline the neces- ��� ���������� ���� ������� ������ �� ������ ��� ������ �������� ��� �� ��������� ����������� ��� smallpox vaccination administration sary steps to operate a successful ���� ���� ����� ����� ������� ���� ��� ��������� ������� ��� ���� ���������� ������� �� ���������� program mass dispensing clinic in their local �������� �������� � ���� ���� ����� ��������� �� ��� �������� ��������� ��� ������������ ������ ��� • Describe components of a mass communities ������� ��� ���� ���� ����� ����� ���� ��������� �� ����� ������ dispensing site specific to smallpox • Participants can utilize the tools vaccine administration and templates provided in the ����������� �������� �������� �� �������� �� ��� ���������� ������ ����� ��������� ������� ������ �� ���� ����� �� ������� ���� ��������� ��� ���� ���� ���� ����������� ������������ ������� ��� ��������� ������� • Explain the screening procedures training exercise to set up a success- ��� ��������� ���� ����� ��� ��� ���� and contraindications for receiving ful mass-dispensing clinic in their the smallpox vaccine communities ���������� �������� ��� ������������ �������� ����� �������� ���������� ��������� ������� ��� ������ • List adverse events to the smallpox If interested in having one or more of ���������� �� ���������� ��� ���������� �� ������� ���� ���� �� �� ������������ ����� ���� ���� ������ vaccine these programs brought to your facility, �������� ��� ����������� • Demonstrate care of the vaccine site contact Chris Pontus at 781-830-5754 or email • [email protected]. n ����� ������ ���� ����� ���������� ��������� ������� ��� ������ ��� ����� ���������� ������������� ��� Explain evaluation of the vaccine ���������� �� ���� �����������

��� ���� ����������� ���� ����� ������� �� ������������� ���������������������� �� Health & Safety Contacts �� �� ����������������� ��� ����� �� �������������� For questions, comments or concerns related to health & safety issues, contact: �� ���� ������� �� ������ ��� ������

���� ���������� �� ������������ ��� n Evie Bain, MEd, RN, COHN-S n Christine Pontus, MS, RN, Associate Director/Coordinator, COHN-S/CCM Health & Safety Associate Director, Health & Safety ���������� ��������� ������ �������� ������� ������ � ��������� ����� ��������� � ���� ���� ������ �� ������� ������ 781-821-4625 781-821-4625 [email protected] [email protected] ���� ����� �� ��������� �� � ����� ���� ��� �������� ��������� ��� ������������ ������ ��� ������ ������� ����� ���������������� ������� ����������� ����� ���������� ��������� Page 14 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 15

Join MNA for an exciting trip to the Italian Riviera! Reserve Early • Space is Limited The Massachusetts Nurses Association joins MITSS to provide Nov. 12–20, 2005: Italian Riviera, $1569* support for nurses as a result of an adverse medical event.

Join this wonderful nine-day, seven-night tour to the beautiful Province of Liguria, which is nestled along the Italian Riviera “To Support Healing (north of Florence and south of Milan). You will enjoy a seven-night stay in a first- class hotel overlooking the azure Gulf of & Restore Hope” Spezia. The tour includes an extensive daily sightseeing program with three meals Program Mission/Philosophy every day. During this vacation we will visit • Portovenere, Genoa, Portofino, Cinque We believe that nurses have a professional responsibility to Terre, Carrara, Pisa, Sarzana, Pontremoli, support colleagues who have been affected by unexplained Lerici, San Terenzo and Vernazza. The medical outcomes or adverse patient events. area’s mild climate permits visits to these • We believe that early support can lessen the emotional places all year long and our itinerary effects on the nurse clinician provider. features short daily excursions throughout the magnificent countryside and along the • Are you a nurse who has been impacted beautiful coastal region. Don’t miss this emotionally by an experience associated with grand tour of the picturesque Riveria region. an adverse medical outcome? To receive more information and a flyer on these great vacations, • Would you like to talk confidentially to a MITSS contact Carol Mallia at 781-830-5744 or via e-mail at [email protected] therapist? • Join in a peer-led support group? * Prices listed are per person, double occupancy based on check purchase. Credit card purchase is $30 more. Prices include air fare, hotel, transfers, tours and all meals. • Would you like to join or participate in Applicable departure taxes are not included in the listed prices above. a structured support group led by an experienced psychologist?

Medically Induced Trauma Support Services (MITSS), Inc. is a non-profit organization that supports, educates, trains, and offers assistance to individuals affected by medically induced trauma.

Support the MNA Diversity Committee’s Medical Missions Team MITSS supports clinicians using the following resources: • One-on-one interaction via phone The MNA Diversity Committee is planning a Healthcare Missions trip, May 11–18, 2005 to the Dominican Republic. The plan is to work with Mercy Ships to set up and run a community based • Group sessions led by a professional facilitator clinic that addresses a multitude of basic health needs and to also work alongside the ships’ efforts. • Training for fellow survivors who would like to help others The Diversity Committee is currently seeking nurses interested in joining the healthcare team. No experience is required and training will be offered. Interested individuals must raise their own funds for the trip, at a cost of approximately $1,500 per person. MITSS Toll-Free Number 888-36-MITSS In addition to interested volunteers, the committee is seeking donations to cover the costs of the MNA MITSS Referral Line 781-821-4625, x.770 project. Those costs include medications and supplies. Donations of any amount will be gratefully MITSS Web Site http://mitss.org accepted. For more information on becoming a volunteer or to donate, please complete this form:

o Please send more information about becoming a volunteer This service is available to any R.N. in Massachusetts. o I am unable to volunteer but would like to assist the committee in fundraising o Please accept my donation (make check payable to Mercy Ships)

Name ______Address ______City/State/Zip ______Telephone______Email ______

Return to: MNA, c/o Carol Mallia, 340 Turnpike St., Canton, MA. 02021 For more information or questions, contact Carol Mallia at 781-830-5744 or [email protected] Page 16 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 17

Region 5 Notes MNA Region 5: What is my money going to anyway? Great question, let’s answer it! Region 5 • An Opinion Dynamics Research members, $30,000. • A donation to the MNA Diversity Council was created to promote professional Study for the MNA Legislative • Professional certification and Committee to defray the costs of development, support collective bargaining Department to hone a message non-MNA CEU program reim- Region 5 members participating in and engage in member advocacy on issues to the voters in 2005 to pass An bursement for all MNA Region 5 the Mercy Ship program overseas, which members have deemed important. Act to Ensure Patient Safety (safe RN and health care professional $3,000. The council is composed of the elected local staffing bill), $21,000. members up to $30,000 in total for • Reimbursement for Region 5 union leadership. Each Region 5 MNA union • Massachusetts Ad Hoc Committee fiscal years 2005 and 2006. A limit members attending MNA Con- has a voice and vote on the council. Not all to Defend Health Care, $3,000. of $500 per member per year until vention in 2005 $12,500. (Why committees are sending representatives. Each • Massachusetts Senior Action the budget amount is exhausted. aren’t you going?) Region 5 member pays $30 a year to support Council, $3,000. • St. Elizabeth Hospital MNA local So the next time you hear someone say Region 5. So where did it go in 2005? 2. Professional development and union sponsored CEU and dinner their union does nothing for them, hand We funded the following: member support; program in April 2005 open to all them this article. Make sure your union 1. Building coalitions and member advo- • Massachusetts Nurses Foundation Region 5 members on addictions committee sends a representative to the MNA cacy to pass An Act To Ensure Patient scholarships to benefit Region in the profession, $1,000. (Any Region 5 Council meeting so your dues can Safety, the right to health care under 5 members or their families, committee can get this assistance be used for what matters to you locally. For our state constitution and promotion $42,000. for a solidarity or member appre- information call the MNA Region 5 office in of universal health care in the com- • Massachusetts Nurses Foundation ciation activity.) Canton, leave a message and we will get back monwealth by donating to: 2005 Golf Tournament (Region 5 • Cambridge Health Alliance MNA to you. If you don’t know whether you are a • Massachusetts Nurse PAC, members and family golf for free, union committee CEU offering in Region 5 member, call MNA membership at $15,000. why aren’t you going?), $5,000. May 2005 open to all Region 5 1-800-225-8076 to see if you qualify for any • Campaign for Massachusetts • Massachusetts Nurses Foundation members, $500. of these benefits. Health, $3,000. 2005 Convention raffle, $500. • Boston VNA MNA union commit- And don’t forget—all CE courses are free • Universal Health Care Education • MNA Nursing Department free tee CEU program and breakfast of charge to Region 5 members. n Fund, $3,000. CEU programs for Region 5 $1,200. Free money available to MNA Region 5 members

Ever ask what your MNA Region 5 dues can do for you or Region 5 members pursuing a MSN. Preference shall policy, health care professional tracts or labor rela- your family? A great deal actually. The MNA membership be granted to those pursuing a MSN, but those pur- tions shall be considered with a preference given to created us to support professional development and collective suing an advanced degree in public health policy or the nursing degree candidates. bargaining. The Region 5 Council, composed of the elected labor relations shall be considered also. • Five $2,000 scholarships offered to the child of a chairs of each of Region 5’s union committees, voted on Febru- • Two $2,000 scholarships shall be granted to Region 5 Region 5 member who is below 25 years of age and ary 16, 2005 to put the following money at your disposal and members pursuing a PhD in nursing or any advanced pursuing any college degree program at any level in use. All you have to do is contact the Massachusetts Nurses degree in public health policy or labor relations at any course of study in an accredited program. Foundation (781-830-5745) to apply for one of the following any level. A preference shall be granted to the PhD Apply to the Region 5 Council (781-821-8255) for reimburse- scholarships (application deadline is June 1; scholarships are applicant in nursing. ment of CEU programs required for professional licensure awarded at Convention in September): renewals in the Commonwealth. MNA Region 5 member Regional Council 5 family scholarships RNs and MNA Region 5 Health Care Professionals will be Janet Dunphey Scholarship • Five $2,000 scholarships for the child of a Region 5 reimbursed 100 percent up to $500 a calendar year in 2005 and • Five $2,000 scholarships shall be granted for Region 5 member who is below the age of 25 and pursuing 2006 until the budgeted $25,000 is exhausted. Apply early. members pursuing a BSN. Preference shall be granted a BSN or nursing degree in an accredited AD pro- Call the MNA Nursing Department (781-821-4625) to enroll to those pursuing a BSN, but those seeking advanced gram. in any one of the many MNA CEU/ACLS programs held in degrees in public health policy or labor relations shall • One $2,000 scholarship to the spouse of a Region 5 Canton or throughout the commonwealth for free if you are be considered also. member pursuing a BSN or nursing degree in an a Region 5 member. This benefit shall be offered until the • Three $2,000 scholarships shall be granted to those accredited AD program. Degrees in public health $30,000 is exhausted in fiscal 2005 and 2006. Enroll early. n

Honor your peers with a nomination for 2005 MNA awards One of the greatest honors one can achieve is the rec- Judith Shindul Rothschild Leadership Award: Rec- enhance clinical nursing practice, including precepting ognition of one’s peers. In this fast-changing health care ognizes a member and nurse leader who speaks with a students or new staff nurses. system in which nurses strive daily to carry out their strong voice for the nursing community. MNA Research Award: Recognizes a member or duties to their patients, there is very little time for them MNA Advocate for Nursing Award: Recognizes the group of members who have effectively conducted or to acknowledge their own professional accomplishments contributions of an individual—who is not a nurse—to utilized research in their practices or who have pro- and those of their peers. nurses and the nursing profession. vided exemplary leadership to assist others in nursing The MNA awards, established by the membership MNA Human Needs Service Award: Recognizes an research. with the approval of the MNA Board of Directors, offer individual who has performed services based on human Kathryn McGinn Cutler Advocate for Health & all members an opportunity to recognize nurses who, by needs with respect for dignity, unrestricted by consider- Safety Award: This award recognizes an individual or their commitment and outstanding achievements, have ation of nationality, race, creed, color or status. group that has performed outstanding service for the bet- honored us all. These are often ordinary nurses and other MNA Image of the Professional Nurse Award: terment of health and safety for the protection of nurses individuals who accomplish extraordinary things and Recognizes a member who demonstrates outstanding and other health care workers. who challenge us all to achieve excellence. leadership in enhancing the image of the professional Frank M. Hynes Award: This award recognizes a For detailed information on selection criteria and to nurse in the community. deserving freshman state legislator or municipal official receive a nomination packet, call Liz Chmielinski, MNA MNA Nursing Education Award: Recognizes a nurse who has clearly demonstrated exceptional contributions Department of Nursing, 781-830-5719 or toll free, 800- educator who has made significant contributions to pro- to nursing and health care. 882-2056, x719. fessional nursing education, continuing education or staff MNA Legislator of the Year Award: This award rec- Elaine Cooney Labor Relations Award: Recognizes development. ognizes a senior state or federal legislator who has clearly a Labor Relations Program member who has made a sig- MNA Excellence in Nursing Practice Award: Rec- demonstrated exceptional contributions to nursing and nificant contribution to the professional, economic and ognizes a member who is a role model by contributing health care. general welfare of nursing. innovative, progressive ideas that serve to improve and The nomination deadline is June 15, 2005. n Page 16 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 17

Consent-to-Serve for the MNA 2005 Elections

I am interested in active participation in the Massachusetts Nurses Association MNA General Election  President, General* (1 for 2 years)  Nominations Committee, (5 for 2 years) [1 per region]  Secretary, General (1 for 2 years) q Bylaws Committee (5 for 2 years) [1 per region]  Director, Labor* (5 for two years) [1 per Region] q Congress on Nursing Practice (6 for 2 years)  Director At-Large, General (3 for 2 years) q Congress on Health Policy (6 for 2 years)  Director At-Large, Labor (4 for 2 years) q Congress on Health & Safety (6 for 2 years)  Labor Program Member* (1 for 2 years) q Center for Nursing Ethics & Human Rights (2 for 2 years)

*General means an MNA member in good standing and does not have to be a member of the labor program. Labor means an MNA member in good standing who is also a labor program member. Labor Program Member means a non-RN health care professional who is a member in good standing of the labor program.

Please type or print — Do not abbreviate Name & credentials ______(as you wish them to appear in candidate biography)

Work Title ______Employer ______

MNA Membership Number ______MNA Region ______

Address ______

Cfty ______State ______Zip ______

Home Phone ______Work Phone ______

Educational Preparation School Degree Year

Present Offices/Association Activities (Committee, Congress, Regional Council, Unit, etc.) MNA Offices Regional Council Offices

Past Offices/Association Activities (Committee, Congress, Regional Council, Unit, etc.)Past 5 years only. MNA Offices Regional Council Offices

Candidates may submit a typed statement not to exceed 250 words. Briefly state your personal views on nursing, health care, and current issues, including, if elected, what your major contribution(s) would be to the MNA and in particular to the position which you seek. This statement will be used in the candidate biography and pub- lished in the Massachusetts Nurse. Statements, if used, must be submitted with this consent-to-serve form.

Signature of Member Signature of Nominator (leave blank if self-nomination)

Postmarked Deadline: Preliminary Ballot: March 31, 2005 Return To: Nominations and Elections Committee Final Ballot: June 15, 2005 Massachusetts Nurses Association 340 Turnpike Street, Canton, MA 02021

• Hand delivery of material must be to the MNA staff person for Nominations and Elections Committee only. • Expect a letter of acknowledgment (call by June 1 if none is received) • Retain a copy of this form for your records. • Form also available on MNA Web site: www.massnurses.org Page 18 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 19 MNA Continuing Education Courses Spring 2005

The Real Nursing World—Transition from Student to RN Cardiac and Pulmonary Pharmacology Description Don’t miss one of these unique programs offering you an opportunity to Description This program will provide nurses from all clinical practice settings with a address questions or concerns to a panel comprised of recent graduates better understanding of how cardiac and pulmonary medications work. from various schools of nursing and experienced nurses with knowledge in The actions, indications and nursing considerations will be discussed for nursing education, nursing administration, labor relations, political action the major categories of cardiac and pulmonary medications.

and career counseling. Area hospitals and other health care facilities Speaker Carol Mallia, RN, MSN

will be available before and after the program to discuss employment Date June 21, 2005 opportunities. Time 5–9 p.m. (light supper provided) Facilitator Carol Mallia, RN, MSN Place MNA Headquarters, Canton Panel TBA Fee MNA members $45; all others $65 Date March 31, 2005: Marriot, Springfield Contact Hours* 3.6 April 5, 2005: Crowne Plaza, Worcester MNA Contact Liz Chmielinski, 781-830-5719 or 800-882-2056, x719 April 7, 2005: Lombardos, Randolph Time 5:30 p.m. – 9:30 p.m. (light supper provided) Place (see above) Congress on Nursing Practice Fee Free to senior nursing students and faculty Offers free programs to regions, bargaining units, schools of nursing Contact Hours * None MNA Contact Theresa Yannetty, 781-830-5727 or 800-882-2056, x727 Accept, reject and/or delegate an assignment: A guide for nurses One hour, 1.2 contact hours Diabetes 2005: What Nurses Need to Know Medication errors: focus on prevention Description This program will discuss the pathophysiology and classification of Dia- Two hours, 2.4 Contact hours betes Type 1 and 2. Nursing implications of blood glucose monitoring and For further information: Contact Dorothy McCabe, Director, non-pharmacological interventions such as exercise and meal planning will Department of Nursing. 781-830-5714 or [email protected] be addressed. Oral pharmacological agents and a comprehensive update on insulin therapy will be presented. Nursing management of the newly diagnosed diabetic patient, both complicated and not, will be explored. Nursing management of the diabetic patient in the pre/post operative, ambulatory care, home care and school setting will be discussed. Continuing Ed Speaker Ann Miller, MS, RN, CS, CDE Date April 14, 2005 Course Information Time 8:30 a.m. - 4 p.m. (Lunch provided) Place MNA Headquarters, Canton Registration Registration will be processed on a space available basis. Fee MNA members $125; all others $150 Enrollment is limited for all courses. Contact Hours * 7.2 Payment Payment may be made with MasterCard or Visa by calling MNA Contact Liz Chmielinski, 781-830-5719 or 800-882-2056, x719 the MNA contact person for the program or by mailing a Advanced Cardiac Life Support (ACLS) check to MNA, 340 Turnpike St., Canton, MA 02021. Refunds Refunds are issued up to two weeks before the program Description This American Heart Association course will provide information on the date minus a 25% processing fee. No refunds are made clinical management of cardiac and respiratory emergencies through less than 14 days before the program's first session or for case study approach. Course content includes assessment, arrhythmia recognition, intubation, defibrillation and pharmacological interventions. subsequent sessions of a multi-day program. This is a two-day certification class and a one-day recertification class. Program MNA reserves the right to change speakers or cancel Recertification candidates must present a copy of their current ACLS Cancellation programs when registration is insufficient. In case of card at the time of registration. inclement weather, please call the MNA at 781-821- Speaker Carol Mallia, RN, MSN 4625 to determine whether a program will run as originally Other instructors for clinical sessions scheduled. Registration and fees will be reimbursed for all Date April 26 , 2005 and May 3, 2005 Time 9 a.m. – 5 p.m. (light lunch provided) cancelled programs. Place MNA Headquarters, Canton *Contact Continuing Education Contact Hours for all programs Fee Certification: MNA members $155; all others $195 others Hours except “Advanced Cardiac Life Support” are provided by the Recertification: MNA members $125; all others $165 Massachusetts Nurses Association, which is accredited as Contact Hours * 16 for certification only a provider of continuing nursing education by the American MNA Contact Liz Chmielinski, 781-830-5719 or 800-882-2056, x719 Nurses Credentialing Center’s Commission on Accredita- tion. Contact hours for “Advanced Cardiac Life Support” are Cardiac and Pulmonary Emergencies provided by the Rhode Island State Nurses Association, Description This program is designed for registered nurses in acute, sub-acute and which is accredited as an approver of continuing nursing long-term care settings to learn the clinical management of cardiac and education by the American Nurses Credentialing Center’s respiratory emergencies. Clinical management of chest pain, brief EKG Commission on Accreditation. interpretation and ABG interpretation will be covered. Clinical manage- To successfully complete a program and receive con- ment of respiratory distress will also be discussed. tact hours or a certificate of attendance, you must: Speaker Carol Mallia, RN, MSN 1) sign in, Date June 7, 2005 2) be present for the entire time period of the Time 5–9 p.m (light supper provided) session and Place MNA Headquarters, Canton 3) complete and submit the evaluation. Fee MNA members $45; all others $65 Contact Hours * 3.6 Chemical Scents may trigger responses in those with chemical MNA Contact Theresa Yannetty, 781-830-5727 or 800-882-2056, x727 Sensitivity sensitivity. Participants are requested to avoid wearing scented personal products and refrain from smoking when attending MNA continuing education programs. All MNA programs are free of charge to Region 5 members. Page 18 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 19 Scholarship funding available through the Massachusetts Nurses Foundation Printable applications are available at or nursing degree in an accredited AD Council 3 member pursuing a BSN. to a health care professional. www.massnurses.org. Application deadline program in nursing. ♦ One $1,500 scholarship to a Regional is June 1, 2005. ♦ One $2,000 scholarship to a spouse of a Council 3 member pursuing a MSN or Labor Relations Scholarship For further information or to request an Regional Council 5 member pursuing a doctoral degree. Scholarships are funded annually by a application, call the MNF Voice Mail at 781- BSN or nursing degree in an accredited ♦ One $2,500 scholarship to a child of a grant established by the MNA. 830-5745 and leave your name (please spell), AD program in nursing. Second prefer- member of Regional Council 3 pursing ♦ Two $1,000 scholarships for an RN or address and name of the scholarship applica- ence will be given to those pursing a a BSN. health care professional, member of tion you would like mailed to you. degree in public health policy, health ♦ One $1,000 scholarship to a child of a MNA, attending a baccalaureate or care professional tracts or labor rela- member of Regional Council 3 pursuing masters program in nursing, labor Janet Dunphy Scholarship tions. an associate’s degree in Nursing. relations or related field. Funded by a scholarship established by ♦ Five $2,000 scholarships to a child of a Regional Council 5, scholarships are being member of Regional Council 5 below the Regional Council 2 Kate Maker Scholarship offered to an active member in Regional age of 25 and pursuing higher education Funded by Regional Council 2, four (4) This scholarship was established to Council 5 as follows: at any level in any course of study in an scholarships will be awarded to a Regional honor the memory of Kate Maker, RN, a ♦ Five $2,000 scholarships to those pursu- accredited program. Council 2 member as follows: great leader and powerful activist. Kate’s ing a BSN. Second preference to those ♦ One $1,000 scholarship to those pursuing primary focus as an activist was with the seeking advanced degrees in public Regional Council 4 a BSN, MSN or Doctoral Degree. Massachusetts Nurses Association. Kate health policy or labor relations. Funded by Regional Council 4 ♦ Two $1,000 scholarships to a child of a was a long-time member of the MNA Board ♦ Three $2,000 scholarships to those ♦ One $500 scholarship is being member of Regional Council 2 pursuing of Directors, and she served two terms as the pursuing a MSN. Second preference offered to a registered nurse who is a nursing degree. chairperson of her bargaining unit at UMass to those seeking advanced degrees in a member of Regional Council 4 to ♦ One $1,000 scholarship to a family Memorial Health Care’s University Campus public health policy or labor relations. continue studies for a baccalaureate, member of Regional Council 2 for con- in Worcester. Kate participated in pickets and ♦ Two $2,000 scholarships to those pursu- masters or doctoral degree in nurs- tinued education in nursing. strikes for nurses at several Worcester area ing a PhD in Nursing. Second preference ing. hospitals and particularly effective when it to those seeking advanced degrees in Regional Council 1 came to explaining the connections between public health policy or labor relations Regional Council 3 Funded by Regional Council 1, scholar- safe-RN-staffing ratios and their immediate at any level. Funded by Regional Council 3, scholar- ships will be awarded as follows: impact on patient safety. ships will be offered to an MNA member ♦ One $1,500 scholarship to a family The scholarship will be awarded to a stu- Regional Council 5 active in Regional Council 3, the awards are member of Region 1 member, or a stu- dent (entry level or practicing RN) pursuing Funded by Regional Council 5, family as follows: dent sponsored by a Region 1 member an Associates Degree or Bachelors Degree scholarships: ♦ One $1,500 scholarship to a Regional pursuing a degree in nursing. in nursing. Preference will be given to stu- ♦ Five $2,000 scholarships to a child of a Council 3 member pursuing an associ- dents living in or working in the Worcester member of Regional Council 5 who is ates degree in nursing. Unit 7 Scholarship area first, and then to other areas of MNA below the age of 25 and pursuing a BSN, ♦ Two $2,500 scholarships to a Regional Funded by Unit 7 State Chapter of Health Regional Council II. If the applicant is a Care Professionals: practicing RN pursuing a Bachelors Degree ♦ Two $1,000 scholarships are being she/he must be an MNA member. In the offered to a member of Unit 7 State event that no applicants meet the geographic Donations needed for Chapter of Health Care Professionals criteria listed above, the scholarship will be who are pursuing a degree in higher awarded to a deserving candidate that meets education. One will be awarded to a all other criteria as determined by the MNF MNF Auction! registered nurse and one will be awarded scholarship committee. n We Need Your Help The Massachusetts Nurses Foundation is preparing for its 22nd Annual Silent & Live Auction to be held at the MNA 2005 Join the Bargaining Unit Challenge Convention. Donations are needed to make this fundraising event a MNF Golf Tournament big success. Your tax-deductible donation helps the Foundation raise funds to support nursing scholarships & research. Brookmeadow Country Club Thursday, JUNE 23 ü Valuable Personal Items Canton, Massachusetts ü Gift Certificates ü Works of Art � Compete in the Bargaining Unit Challenge – an award will be given ü Craft Items to the unit with the best score! ü Memorabilia & Collectibles � Cash Awards & Prizes for Men’s, ü Vacation Packages Women’s & Mixed. � Hole-In-One Prizes! � Raffle and Awards!

A great way to raise funds FOR MORE INFORMATION OR for nursing Contact the MNF at 781-830-5745 to obtain an auction scholarships donor form or mail or deliver your donation to the Mass. TO REGISTER A FOURSOME Nurses Foundation, 340 Turnpike Street, Canton, MA 02021. 781-830-5745 Page 20 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 21

…North Adams

From Page 1

decisions by hospital management to cut reg- allows sufficient time to meet all the basic istered nurse staffing levels in an effort to standards of care.” slash operating costs. This included a nearly Referring to the hospital and the union, unanimous vote by the nurses to authorize a the decision states, “The parties expressed strike over these issues in 1999, and followed intent to assure nurses that their profes- later by a concerted effort to win revolution- sional standards will be respected and ary contract language in 2001 that protected that nurses will not be assigned to a Peggy O’Malley Sandy Eaton A. Eldridge Malone Julie Pinkham RN’s professional judgment and to protect greater number or acuity of patients than patients from unsafe conditions. A provision they can safely care for. Should census or in the NARH MNA contract states, “[T]he acuity threaten to become too high, then 10,000 nurses for a constitutional hospital would only keep and admit the management must correct the situation number of patients that registered nurses can by adding nurses, stopping admissions right to affordable health care safely care for.” It also calls upon the hospital or taking other measures to ensure that to promulgate and adhere to staffing policies nursing assignments remain within safe We’re sponsors of the Health Care for Massachusetts Campaign—a citizen-led and procedures that comply with “profes- parameters.” initiative to create a constitutional right to affordable, comprehensive health sional standards of nursing practice.” The decision cites the fact that under and mental health care for every Massachusetts resident. And we’re hoping The problems with staffing and patient Massachusetts law, registered nurses are care at NARH came to a head in November held responsible for their patient care, while you’ll join us in transforming our health care system. 2001 when the hospital, on the advice of a also citing nursing research, particularly a We’ve endorsed, the MNA has endorsed, 71,385 voters have endorsed, 52 consultant, cut the RN staffing, resulting study published in the Journal of the American legislators have co-sponsored and 153 legislators voted for the Amendment in in a dramatic increase in the number of Medical Association, which demonstrated the the July 14 Constitutional Convention. We’re half-way to putting this historic patients assigned to each nurse. The hospi- negative impact of unsafe patient assign- tal also eliminated its “float” pool of nurses ments on the safety of patients. “Patients amendment on the ballot in 2006. who were to be on hand to staff units expe- in hospitals with the lowest nurse staffing We’re looking for 10,000 nurses to join us so when we go to the Legislature riencing a spike in census or sick call. At levels (eight patients per nurse) have 31 next session to lobby for the critical second vote we need to put the amend- the time of that decision’s announcement, percent greater risk of dying than those in ment on the ballot every legislator will know—in no uncertain terms—how the nurses’ union held a press conference hospitals with four patients per nurse,” the announcing its objection to the plan and ruling states. important universal health care is to the nurses of Massachusetts. warning the public of deterioration in the While ordering the hospital to cease and Join the 10,000 nurse campaign. Endorse yourself and sign up 19 of your quality and safety of patient care. desist from forcing nurses into situations that co-workers. Then fax it back to the Campaign at 617-868-1363. It just takes a True to the nurses’ predictions, as a endanger patients, the arbitrator stopped result of these decisions, many nurses, short of accepting the MNA’s request that few minutes particularly on the night shift, began to NARH be required to hire more RN staff. Thanks so very, very much. see their patient loads double, from being While citing recent improvements in staff- responsible for five or six patients, before ing and the fact that these incidents occurred Name City/Town the changes, to often being assigned 10–12 more than three years ago as reasons for patients after the staffing cuts. holding off on requiring a staffing increase, Numerous grievances, in the form of the wording of the decision holds open the unsafe staffing reports, were filed by many possibility that this could be a remedy in nurses throughout the winter and spring the future. of 2002, with nine of those grievances filed “It is our sincere hope that our admin- between May and June of 2002 ultimately istrators have learned a lesson through selected to be put forward for review by this process and will now heed nurses’ the arbitrator. judgment in these situations,” McConnell The arbitrator, after hearing evidence explained. “However, we intend to spend a from the hospital and the RNs, found that great deal of time educating our members in all nine incidents cited by the RNs, the of the importance of documenting very hospital violated the contract by requiring carefully their objections to unsafe staffing RNs to care for too many patients and found assignments so that we have a detailed record each instance to represent an “unsafe” to take back to the arbitrator should that ever situation. The testimony of the nurses was become necessary.” supported by a nurse administrator at the The MNA points out that the ruling not time, who testified that “she repeatedly only represents sound labor law, but also expressed concern about staffing levels to complies with recommendations regarding higher management because she believed RN staffing and decision making promoted that the level of care was insufficient to by the nation’s leading experts on nursing meet the patient needs.” The arbitrator and patient safety. In fact, in late 2003, the writes that the administrator testified that prestigious Institute of Medicine of the “she was later forced to resign, told that National Academies of Science issued the she was ‘not the leader’ that management most extensive and exhaustive report on the wanted for the Hospital.” issue of nurse staffing and patient safety, The arbitrator’s decision focuses great which recommended that ultimate decisions Region 5 Notes attention on the scope of nursing practice regarding RN staffing should lie with direct and the numerous responsibilities that caregivers. It recommends that hospitals comprise their role. Stutz wrote, “Nurses “overstaff” units to account for fluctuations are subject to established professional in census, that float pools be utilized and that standards that define proper nursing prac- hospitals should transfer patients from units tices. The Standards of Clinical Practice, for where nurses are overburdened or working example, include ….assessment, diagnosis, beyond 12 hours. outcome identification, implementation and For O’Hearn, the arbitration process and its evaluation. These standards of care include result underscores her faith in unions and the measurement criteria and documentation. protection a union offers for nurses to speak In order for nursing practice to meet these out on behalf of their patients and their prac- professional standards, it is beyond dispute tice. “I can tell you that in this current health that nurses must have a patient assignment care environment, I would never work in a load, including number and acuity that hospital that was not unionized.” n Page 20 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 21

Correction The mailing statement that was published in the November/December issue of the Mas- sachusetts Nurse was incorrect. The line i. was incorrectly submitted and published incorrectly as 19,618 under average no. of copies which should have been published as 19,398. It is being corrected and appears below. Peer Assistance Program United States Postal Service Help for Nurses with Substance Abuse Problems Statement of Ownership, Management, and Circulation

I. Publication Title 2. Publication No. 3. Filing Date Massachusetts Nurse 326-050 10/12/04 Are you a nurse who is self-prescrib- 4. Issue Frequency 5. No. of Issues Published Annually 6. Annual Subscription Price 9 $20 ing medications for pain, stress or 7. Mailing Address of Known Office of Publication: Mass. Nurses Assn., 340 Turnpike St., Canton, MA 02021 Contact Person & Telephone: Erin Servaes, 781-830-5789 anxiety? 8. Mailing Address of Headquarters or General Business Offices of Publisher Mass. Nurses Assn., 340 Turnpike St., Canton, MA 02021 9. Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor Are you a nurse who is using alcohol Publisher: Julie Pinkham, Mass. Nurses Assn., 340 Turnpike St., Canton, MA 02021 Editor: Jennifer Johnson, Mass. Nurses Assn., 340 Turnpike St., Canton, MA 02021 or other drugs to cope with everyday Managing Editor: David Schildmeier, Mass. Nurses Assn., 340 Turnpike St., Canton, MA 02021 stress? 10. Owner: Mass. Nurses Assn., 340 Turnpike St., Canton, MA 02021 11. Known Bondholders, Mortgages, and Other Security Holders: None 12. Tax Status: The purpose, function and nonprofit status of this organization and the exempt status for Would you appreciate the aid of a federal income tax purposes: Has not changed during preceding 12 months. 13. Publication Title: Massachusetts Nurse 14. Issue Date for Circulation Data Below: September 2004 nurse who understands recovery and 15. Extent and nature of circulation Average No. Copies Actual No. Copies Each Issue During Single Issue Published wants to help? Preceding 12 Months Nearest to Filing Date a. Total number of copies (net press run) 19,398 19,475 b. Paid and/or requested circulation (1) Paid outside-county mail subscriptions 18,920 19,075 (2) Paid in-county subscriptions 0 0 (3) Sales through dealers, vendors 0 0 (4) Other classes mailed through USPS 0 0 c. Total paid and/or requested circulation 18,920 19,075 Call the MNA Peer Assistance Program d. Free distribution by mail 0 0 e. Free distribution outside the mail 220 220 All information is confidential f. Total free distribution 220 220 g. Total distribution 19,140 19,295 781-821-4625, ext. 755 h. Copies not distributed 258 180 i. Total 19,398 19,475 or 800-882-2056 (in Mass only) j. Percent paid and/or requested circulation 98.8% 98.8% www.peerassistance.com 16. Publication of Statement of Ownership. x Publication required. Will be printed in Nov/Dec 2004 issue.

17. Signature and Title. Production Manager Date: 10/12/04

Support Groups for Nurses and Other Health Professionals with Substance Abuse Problems

Below is a list of self-help groups facilitated Meets: Fridays, 6:30-7:30 p.m. • Partnership Recovery Services, 121 • Substance Abuse Support Group, by volunteer nurses who understand addiction • Health Care Professional Support Myrtle Street, Melrose. Contact: Jay St. Luke’s Hospital, New Bedford, and the recovery process. Many nurses with Group, Caritas Norwood Hospital, O’Neil, 781-979-0262. Meets: Sundays 88 Faunce Corner Road. Contact: substance abuse problems find it therapeutic to Norwood. Contact: Jacqueline Sitte, 6:30–7:30 p.m. Michelle, 508-947-5351. Meets: share their experiences with peers who under- 781-341-2100. Meets: Thursdays, 7–8: Thursdays, 7–8:30 p.m. stand the challenges of addiction in the health 30 p.m. Western Massachusetts care profession. • Professionals in Recovery, Baystate Other Areas Central Massachusetts VNAH/EAP Building, Room 135, 50 • Maguire Road Group, for those Boston Metropolitan Area • Professional Nurses Group, UMass Maple St., Springfield. Contact: Marge employed at private health care • Bournewood Hospital, Health Care Medical Center, 107 Lincoln Street, Babkiewicz, 413-794-4354. Meets systems. Contact: John William, Professionals Support Group, 300 Worcester. Contacts: Laurie, 508-853- Thursdays, 7:15–8:15 p.m. 508-834-7036 Meets: Mondays. South St., Brookline. Contact: Donna 0517; Carole, 978-568-1995. Meets: • Professional Support Group, Franklin • Nurses for Nurses Group, Hartford, White, 617-469-0300, x305. Meets: Mondays, 6–7 p.m. Hospital Lecture Room A, Greenfield. Conn. Contacts: Joan, 203-623- Wednesdays, 7:30–8:30 p.m. • Health Care Support Group, UMass Contacts: Wayne Gavryck, 413-774- 3261, Debbie, 203-871-906, Rick, • McLean Hospital, DeMarmeffe Build- School of Medicine, Room 123, Worces- 2351, Elliott Smolensky, 413-774-2871. 203-237-1199. Meets: Thursdays, ing, Room 116. Contact: LeRoy Kelly, ter. Contact: Emory, 508-429-9433. Meets: Wednesdays, 7–8 p.m. 7–8:30 p.m. 508-881-3192. Meets: Thursdays, 5: Meets: Saturdays, 11 a.m.–noon. • Nurses Peer Support Group, Ray 30–6:30 p.m. Southern Massachusetts Conference Center, 345 Blackstone • Peer Group Therapy, 1354 Hancock Northern Massachusetts • Professionals Support Group, 76 W. Blvd., Providence, R.I. Contact: Street, Suite 209, Quincy. Contact: • Baldpate Hospital, Bungalow 1, Bald- Main St., Suite 306, Hyannis. Contact: Sharon Goldstein, 800-445-1195. Terri O’Brien, 781-340-0405. Meets: pate Road, Georgetown. Facilitator: Kathy Hoyt, 508-790-1944. Meets: Meets: Wednesdays, 6:30–7:30 p.m. Tuesdays & Wednesdays, 5:30 p.m. Teri Gouin, 978-352-2131, x15. Meets: Mondays, 5–6 p.m. • Nurses Recovery Group, VA Hospital, & coed Wednesdays, 7 p.m. Tuesdays, 5–6 p.m. • PRN Group, Pembroke Hospital, 5th Floor Lounge, Manchester, N.H. • Caritas Good Samaritan Medical • Nurses Recovery Group, Center for 199 Oak Street, Staff Dining Room, Contacts: Diede M., 603-647-8852, Center, Community Conference Room, Addiction Behavior, 27 Salem Street, Pembroke. Contact: Sharon Day, 508- Sandy, 603-666-6482. Meets: Tues- 235 N. Pearl St., Brockton. Contact: Salem. Contact: Jacqueline Lyons, 978- 375-6227. Meets: Tuesdays, 6:30–8 days, 7–8:30 p.m. n Eleanor O’Flaherty, 508-559-8897. 697-2733. Meets: Mondays, 6–7 p.m. p.m. Page 22 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 23

MNA membership dues deductibility 2004 Benefits Corner Below is a table showing the amount and percentage of MNA dues that may MNA offers valuable insurance programs not be deducted from federal income taxes. Federal law disallows the portion As a member of the MNA, you are fortunate to have access to a number of insurance of membership dues used for lobbying expenses. programs to protect your medical and financial health. From Health Insurance to Long Term Care, your MNA benefit program is a valuable resource for personal and financial Region Amount Percent services. Some of the programs offered to members include: Portable Health Insurance Plans offering managed care and comprehensive indemnity Region 1 $16.63 5.0% plans to members who are self-employed, unemployed, working part-time or per diem. This provides access to health insurance for those members who are not otherwise covered Region 2 $16.63 5.0% by an insurance plan. Contact Ellen Kaplan, Group Health Specialists at (800) 604-3303. Short Term Disability protection is available to protect member’s income in the event Region 3 $16.63 5.0% of an illness or accident, enabling you to have an independent source of income during Region 4 $16.63 5.0% or following a period of disability. Contact Nathan Gardner, ISI New England Insurance Specialists, LLC at (800) 959-9931. Region 5 $16.63 5.0% Long Term Disability protection is accessible to members for coverage for 1, 2, or 5 years or up to age 65. Our members receive the most competitive rates in the industry. Contact Paul Bouchard, Lead Brokerage Group at (800) 842-0804. Long Term Care Insurance is a flexible and comprehensive plan through John Han- cock offering solutions to meet almost any need. Contact William Clifford, John Hancock ��������� Financial Services at (800) 878-9921 ext.110. ����������������������������� ����������� Term Life Insurance is available to members for coverage up to $250,000 at special ����������� discounted rates. Contact Paul Bouchard, Lead Brokerage Group at (800) 842-0804. ���������������������������� Simply contact the representative listed for specific plan information and options. These ��������������� individuals are familiar with the MNA negotiated discounts and are able to work with ������������������������������������������������ ��������� you to meet your specific needs. n ���������������������� ��������� ������������������������������������������� �������������������������������������������� ������� �������������������������������������������� �������� ��������������������������������������������� ����������������������������������������������� ���������� Tsunami relief assistance needed �������������������������������������� �������� Several humanitarian organizations are currently conducting ������������������������������������� relief efforts for victims of the devastating Indian Ocean tsunami. �������������������� ���������� Those interested in assisting these efforts are encouraged to visit ������������������������������������������� www.usafreedomcorps.gov and find out how best to help. n ���������������������� ����������� �������������������������������������� ������������� ����������������������������������������������������� �������������

Nonprofit nursing association has an opportunity for a Nurse Planner in Online RN to BSN Program its Education Department. Reporting • Nationally accredited to the Education Manager, this position will be responsible for • No campus visits planning and implementing • Learner support online continuing nursing education and by phone activities in compliance with American Nurses’ Credentialing ��������������������� ����������������������������� Center criteria. Duties include, but �������������������������������������������������� Enroll today! A more rewarding are not limited to, planning �������������������������������������������������������� career is as close as your computer development, and implementation of �������������� educational programs, and the Go to: http://bsn-linc.wisconsin.edu development of research-based General Info: 877-656-1483 publications. Experience in education ������������������������������������������������ program development required. The ������������������������������������������������������ successful candidate will be a ������������������������������������������������ Master’s-prepared RN. One of the candidate’s academic degrees— either Bachelor’s or Master’s—must be in nursing. The candidate must possess excellent verbal, written, and communication and presentation Massachusetts Nurse accepts unsolicited skills, and will be proficient in articles, photography, press releases, Microsoft Office software. Experience and other pieces for consideration in infusion nursing is a plus. Full as editorial material. Submission by benefits package. deadline dates does not ensure pub- No phone calls please. EOE ������������������ ����������������� lication in any issue. All submission copies and ideas should be sent to: Mail or fax cover letter, resume, and �������������������������� ������������������������������� salary requirements to: ����������������������� ����������������������������� Editor, Massachusetts Nurse Attn: Human Resources ���������� �������������������������������� 340 Turnpike Street Infusion Nurses Society ���������� Canton, MA 02021 220 Norwood Park South 781-830-5717 or 800-882-2056, x717 Norwood, MA 02062 email: [email protected] OR e-mail: [email protected] Page 22 Massachusetts Nurse April 2005 April 2005 Massachusetts Nurse Page 23 ������������������� ������������������������� ������������������������

���������������������������������������������������Massachusetts Nurses Association Home Mortgage Program������������������� ��������������������������������������������������������������� ����������

• Purchases & Refinances • Single & Multifamily Homes • Home Equity Loans • Second Homes •Debt consolidation • Condos • Home Improvement Loans • No money down • No points/no closing costs • Investment Properties

Group discounts: �������������������������������������������� ��������������������������������������������������������������������� ��������������������������������������������������������������������� ������������������������������������������������������������������� �����������������������������

Expert advice: ����������������������������������������������������� �������������������������������������������������������������������� �������������������������������������������������������������� �����������������������������������������������������������������

�� ����������������������������������������������������������������� ����������������������������������������������������������������� ������������������������������������������������������������������� �������������������������������������������������������������������� ������������������������������������������������������������������ ������������������������������������������������������������� ������������������877-662-6623����������������� � ���������������������� ����������������� ������������������������ ���������������������������������� � �������������������������������������� �������������� �������������������� � ������������������ � ��������������������� � ������������������������������������������� � ���������������������������������������

������������������������������������������������������� �������������� �������������� �� ����������������������������������� �������������������������������������������������������������������������������������������������������� Page 24 Massachusetts Nurse April 2005 MNA Member Benefits Save You Money

Personal & Financial Services VERIZON WIRELESS...... 617-571-4626 Receive an 8 percent discount on plans priced $34.99 and above! Receive a free Motorola V60s on PORTABLE HEALTH INSURANCE any new purchase or upgrade. ELLEN KAPLAN, GROUP HEALTH SPECIALISTS...... 800-604-3303 OR 508-875-3288 NEXTEL COMMUNICATIONS, DON LYNCH ...... 800-313-2700 Managed care & comprehensive indemnity plans through Blue Cross/Blue Shield as well as other Enjoy free incoming call plans and direct connect. Save 10 percent on rates and 30 percent on equipment. carriers. Many phones to choose from, including the new 1830 and the new Blackberry 7510. PROFESSIONAL LIABILITY INSURANCE DISCOUNT DENTAL & EYEWEAR PROGRAM NURSES SERVICE ORGANIZATION ...... 800-247-1500 (8:00 a.m. TO 6:00 p.m.) CREATIVE SOLUTIONS GROUP...... 800-308-0374 Leading provider of professional liability insurance for nursing professionals with over 800,000 Best benefits—a health care savings plan that cuts the cost of health care expenses. Discounts on health care professionals insured. dental, eyecare and chiropractic expenses. CREDIT CARD PROGRAM JIFFY LUBE DISCOUNT MBNA AMERICA...... 800-847-7378 MNA MEMBERSHIP DEPARTMENT ...... 800-882-2056, X726 Exceptional credit card at a competitive rate. Obtain an MNA Discount card to receive 15% discount on automobile products & services. TERM LIFE INSURANCE CONSUMER REFERRAL SERVICE LEAD BROKERAGE GROUP ...... 800-842-0804 MASS BUYING POWER...... 866-271-2196 Term life insurance offered at special cost discounts. Mass Buying Power is a no-cost, no-obligation benefit offered to MNA members. Before you make LONG TERM CARE INSURANCE your next purchase visit www.massbuy.com for any new products and services. Log in as a group WILLIAM CLIFFORD ...... 800-878-9921, X110 member (sign-in name: MBP, password, MBP) Flexible and comprehensive long-term care insurance at discount rates. DISCOUNT ELECTRONICS & APPLIANCES SHORT TERM DISABILITY INSURANCE HOME ENTERTAINMENT DISTRIBUTORS...... 800-232-0872 OR 781-828-4555 ISI NEW ENGLAND INSURANCE SPECIALIST LLC ...... 800-959-9931 OR 617-242-0909 Home electronics & appliances available at discount prices for MNA members. Six-month disability protection program for non-occupational illnesses & accidents. OIL BUYING NETWORK DISCOUNT LONG TERM DISABILITY INSURANCE OIL BUYING NETWORK ...... 800-649-7473 LEAD BROKERAGE GROUP ...... 800-842-0804 Lower your home heating oil costs by 10 – 15%. Provides income when you are unable to work due to an illness or injury. WRENTHAM VILLAGE PREMIUM OUTLETS RETIREMENT PROGRAM Present your valid MNA membership card at the information desk at the Wrentham Village AMERICAN GENERAL FINANCIAL GROUP/VALIC...... 800-448-2542 Premium Outlets to receive a VIP coupon book offering hundreds of dollars in savings. Specializing in providing retirement programs including 403(b), 401(k), IRA, NQDA, Mutual SIGHT CARE VISION SAVINGS PLAN Funds, etc. MNA MEMBERSHIP DEPARTMENT ...... 800-882-2056, X726 DISCOUNT TAX PREPARATION SERVICE Obtain your Sight Care ID card to receive discounts on eye exams, eyeglasses & contact lenses at TAXMAN INC...... 800-7TAXMAN Cambridge Eye Doctors or Vision World locations. 20% discount on tax preparation services. HEALTH CARE APPAREL HOME MORTGAGE DISCOUNTS WORK ‘N GEAR DISCOUNT...... 800-WORKNGEAR (FOR STORE LOCATIONS) RELIANT MORTGAGE COMPANY...... (877) 662-6623 Receive 15% discount off all regularly priced merchandise. Simply present your valid MNA Save on your next home loan/mortgage with discounts available to MNA members and their membership card at any Massachusetts Work ‘n Gear store to pick up your discount card. families. Receive discounts off mortgage applications for home purchase, refinance and debt Travel & Leisure consolidation loans. Inquire into no points/no closing costs programs and reduced documentation programs. Receive free mortgage pre-approvals. HERTZ CAR RENTAL DISCOUNT HERTZ ...... 800-654-2200 TAX REVIEW SERVICE MNA members discounts range from 5 – 20% mention MNA discount CDP#1281147. MERRIAM TAX RECOVERY ...... 508-340-0240 Experts in recovering overpaid taxes. DISCOUNT MOVIE PASSES MNA MEMBERSHIP DEPARTMENT ...... 800-882-2056, X726 Products & Services Showcase Cinemas/National Amusements, $6. AMC Theatres, $5.50. Regal Cinemas (not valid first 12 days of new release), $5.50. Call to order by phone with Mastercard or Visa. AUTO/HOMEOWNERS INSURANCE MANSFIELD: COLONIAL INSURANCE SERVICES ...... 800-571-7773 OR 508-339-3047 DISCOUNT HOTEL & TRAVEL PRIVILEGES WEST SPRINGFIELD: BATES FULLAM INSURANCE AGENCY ...... 413-737-3539 CHOICE HOTELS INTERNATIONAL (SOS PROGRAM)...... 800-258-2847 BOSTON: ROBERT S. CLARK INSURANCE AGENCY...... 800-660-0168 20% discount on participating Comfort, Quality, Clarion, Sleep, Econo Lodge, Rodeway & LOWELL: JAMES L. COONEY INSURANCE AGENCY ...... 978-459-0505 MainStay Suites, Inns & Hotels. Advanced reservations required mention SOS Program WOBURN: LENNON INSURANCE AGENCY ...... 781-937-0050 #00801502. Membership in Guest Privileges Frequent Traveler Program. FALMOUTH & POCASSET: MURRAY & MACDONALD INSURANCE SERVICES ...... 800-800-8990 CENTRAL FLORIDA AREA ATTRACTIONS TURNERS FALLS: PARTRIDGE ZCHAU INSURANCE AGENCY...... 413-863-4331 THE OFFICIAL TICKET CENTER ...... 877-406-4836 Save up to 6 percent on Massachusetts auto rates; 12 percent account credit for homeowners when Discount admission to Orlando area attractions. we write your auto policy. ANHEUSER-BUSCH ADVENTURE PARKS DISCOUNT CELLULAR TELEPHONE SERVICE MNA MEMBERSHIP DEPARTMENT ...... 800-882-2056, X726 CINGULAR WIRELESS...... 781-690-5368 Obtain Adventure Card to receive discount admission to Busch Gardens, Sea World, Sesame Place, Save 10–20 percent on SuperHome rate plans with no activation fee plus 20 percent discount on Water Country USA & Adventure Island in Tampa, Fla. accessories. Some discount plans include free nights (9 p.m. to 7 a.m.) and weekends. T-MOBILE ...... 508-369-2200 UNIVERSAL STUDIOS MEMBER EXTRAS Get more of the wireless products and services that keep mobile professionals connected. T-Mobile Log onto the MNA Web site at www.massnurses.org and click on the Universal Studios Link to is offering MNA members and their families a free phone with activation, free nationwide long obtain special discount prices or e-mail [email protected]. distance and roaming and free nights and weekends (on specific plans). International rates also available. No activation fee is required for members.

MNA’s premier group benefits programs help you get more out of your membership and your hard-earned money! Take advantage of these special benefits specifically designed for MNA members. For information on our discount programs, contact the representative listed or call Chris Stetkiewicz in the MNA membership department, 800-882-2056, x726. All benefits and discounts are subject to change.