By Veronica Jacobsen
Reprinted with permission from Baby Love Minnesota blog. The author is an instructor in childbirth classes. Information is available here: Here’s info on my classes: http://www.babylovemn.com/classes-at-babylove/
I have been blogging for almost exactly 5 years in this space, and maternity care outcomes and transparency hold a special place in my heart. I don’t know if anyone gets as excited as I do when new info comes out. After a lot of thought over the weekend, I am posting this. Buckle in.
The Allina nurse strike saga continues. In June, the nurses went on a 7 day strike. Back then, I had concerns about the safety of giving birth with replacement nurses. Now that a strike date of September 5th at 7am has been set, and after careful consideration, I can’t say this without enough emphasis: DO NOT HAVE YOUR BABY AT AN ALLINA HOSPITAL DURING THE STRIKE. CHANGE PROVIDERS AND/OR PLACE OF BIRTH NOW!!!!!
I may not make any friends with the system’s physicians or administration, but the evidence is more than circumstantial to back up my warnings. While I understand the political forces at stake with public opinion of unions in general, staffing ratios and staff safety are always issues at Allina. And in fact, the National Labor Relations Board ruled that the Minnesota Nurses Association’s complaints about unfair labor practices were with merit.
Historically, Allina’s hospitals have had some of the highest cesarean rates in the Twin Cities Metro Area. Recently, a change was made and births are no longer done at Unity Hospital, but in 2014, the c-section rate for Abbott Northwestern was 30.2%, it was 28.3% at Mercy Hospital, and 30.4% at United Hospital; all of these are above the state average of 26.9%. In 2014, 11,207 births occurred at Abbott, United, Mercy, and Unity–an average of 217 per week. With such high volume, Staffing problems will hit maternity services hard. Lactation services are sure to be hit hard as well, as union IBCLC RNs will also be on strike, so moms will have a very hard time getting appropriate breastfeeding help.
The last strike, which was limited to 7 days, cost Allina $20 million. On social media pages, nurses from other parts of the country are posting information they’ve received from staffing agencies recruiting workers to fill in for the striking nurses. Replacement nurses are being offered $6,900 per week and are not required to be licensed to practice in Minnesota. Additionally, because of such a high cost to replace nurses and because of the very large number of striking nurses (4,800), there is absolutely no way that Allina’s hospitals will have adequate staffing– in fact, only 1,400 nurses were brought in during the strike in June. A hospital system with a whopping 71% reduction in nursing staff is without a doubt incapable of providing safe care. While this creates a dangerous situation for all of the hospital units, because safe staffing ratios are so high– 1:1 nurse to patient ratios during labor and birth, and 1:3 nurse to patient ratios postpartum, there’s no doubt that having less than 1/3 the normal number of nurses will put mothers and babies in grave danger.
Very specifically, replacement nurses can’t provide appropriate care in the “Mother Baby Centers” of Allina hospital because:
- Nurses will be much slower at charting in a system that they aren’t familiar with. Even if the nurses are familiar with EPIC, the most common EHR in our area, each organization has their own unique configuration. In births, charting is extensive– many, many things need to be documented in real time, taking away the nurses’ ability to provide patient care.
- Maternity Care practices in our area are very different from those in other parts of the country. We tend to have better outcomes than in other parts of the US–meaning the replacement nurses will probably be used to maternity care practices that are considered outdated or unsafe. So, for instance, while Allina hospitals have Nitrous Oxide as an analgesic option for birth, it’s still rarely used outside of our metro area. Because the replacement nurses won’t have the training needed to provide Nitrous, parents will very likely find that options they expected to be available aren’t.
- Patients with high-risk pregnancies are very likely to have replacement nurses that lack the higher training needed to keep medically fragile conditions under control.
- Staff morale in hospitals during strikes always takes a major hit, distracting from the real need-providing patient care.
- Even if the nurses were perfectly trained to work as Labor and delivery and postpartum nurses, even if they knew exactly how to use the Electronic Health Record System– In no way, shape, or form will there be nearly enough nurses to provide safe care.
When I previously wrote about my concerns, I wasn’t sure what birthing mothers would end up experiencing. However, last week, I made contact with one mother who gave me permission to share her story. Her name is Lisa, and her story follows:
I planned birth at Abbott due to VBAC. I was aware of the strike and very concerned that I would go into labor during that time, but I was planning to birth with my midwife and with my doula and I was reassured that I have nothing to worry about. In fact I’m going to say what no one said to me when I was worried about the strike: RUN! I know everyone might not agree with that, but I speak from personal experience. I moved back from Alabama so that I could receive the care we’re accustomed to here in MN, and I still ended up with nurses from states where I would never give birth. My due date was 6/19. Same day as the strike. Water broke 6/16. Labor never started so I went in 6/18 at 4am for Pitocin.
24 hours later [early in the morning of June 19th, the day of the strike], I’m laboring hard on Pitocin. I have a wonderful supportive Allina nurse. The best nurse I’ve ever had, but there’s a tension in the room so thick that you could cut it with a knife. We all know she has to go home at 7am, when her shift ends and the strike begins. In just 3 more hours. It was awkward. There was an elephant in the room. I considered asking her if she would stay with me but that seemed awkward and inappropriate.
So 7am came and she said “I’m sorry, I have to go now. ”
After that I had a stream of nurses. “I’m you nurse now. ..no I’m your nurse now. No I’m your nurse again.” I was in the shower and they kept interrupting me. I had a doula and a very supportive husband. I just wanted some privacy at this point, I wasn’t asking for extra support.
At another point I had nurses just standing around me with their arms crossed. Just watching me. Like they had never seen a woman labor before. Like I was a fucking zoo animal!!!!
At another point, one nurse was giving another nurse a tour of the room. “Here’s the warming station…” and then the two of them stand in front of the computer and discuss how the medical system works. I just hear whispering and taping on the keyboard. I’m butt ass naked, standing at the foot of my bed, huffing nitrous every 2 minutes for 90 seconds. I can barely speak. I’ve been at this for 30 hours. I wave my hand at them “They need to go. They’re distracting me.” I’m begging/irritated. My midwife then shooed them away.
This still pisses me off. I shouldn’t have to protect my own birth space like this. My midwife was there and my doula and my husband. But no one said anything. I had to ask them to leave.
It’s no surprise that soon after this I lost my ability to handle my Pitocin induced contractions. I asked for an epidural. Then my contractions went to 18 minutes apart and I ended up with a cesarean, again. Cesarean was 6/19 at 6pm.
They surgery itself had some parts that were less than what I would expect from Abbott and my post surgery care was grossly negligent.
I actually had to page my midwife on call during the overnight hours. When the baby was born (unplanned cesarean ) we were told he could stay with us but would need to have his temp closely monitored due to prolonged rupture of membranes. But they never checked his temperature the entire night. Nor did they check my bleeding on the night shift. It literally felt like everyone had left the hospital, apocalypse. When she [the midwife] called me back I told her that I wanted to transfer with my baby to another hospital because no one was taking care of us. I paged her just after 7 am. I knew I was supposed to have a new nurse and still no one had come to check on me or the baby. I told her I was scared because we weren’t being monitored and wanted us to be transferred to another hospital, by ambulance if necessary. She said “hold tight, I’ll see what I can do and I’ll call you back.”
It’s my belief that when she hung up with me she called up there to the hospital and raised hell, because within a few minutes I has my day nurse and the charge nurse there. They helped me clean up the blood that was dried from my waist down, changed my sheets and got me some food. And filled out the white board. There was definitely a turnaround of my care at that point. My midwife called me back about 8am on June 20 and asked if I still wanted a transfer, and told me she could make it happen. At that point I said we had a new nurse and I felt safe again. I told her we would stay.
Hiring a doula won’t be enough. Every single birthing family with babies due in the next month needs to change plans on where to give birth, which likely will result in also changing providers, and they need to do it NOW. Changing is easy– I’ve outlined the process before. If you’re late in the game, you may need to change to a Family Med Provider who does OB care or an OB group. If you need help sorting your options, I’m happy to help. Call or email me– 651-200-3343 or veronica@babylovemn.com.
And Allina union nurses? I have your back. Allina’s C-suite? You are putting people at risk with your ongoing actions, and you need to be ashamed of yourselves.
Veronica
Replacement nurses do require that they have a MN license.
I’m not sure which I’m disgusted by, the shameless self-promotion from the blogger or the fact that they try to blame the MNA’s decision to strike on Allina. MNA came empty handed & walked away from several negotiations, even after Nurses were offered significantly better benefits than the rest of Allina employees, including the villainized C-suite.
MNA is solely responsible for the decision to strike. I’m proud to be providing patient care during the MNA Strike.
I’m an MNA nurse who works at a hospital not on strike, and I find this whole thing very confusing. Both sides are saying things that are polar opposites and I have no idea what the truth is. I work in Labor and Delivery so this is very concerning to me. I really hope this strike isn’t super long and that an agreement can be reached.
This is my blog; this was the first story I published. I published two more from moms who gave birth at Abbott during the strike. All 3 had the same issues with getting meds and getting fed. Many more moms shared similar stories on social media. I’m not a nurse, but I am a birth doula who wanted people to see these stories. What these moms went through is horrific. But they are real stories.
Self promotion, an all caps anecdote that’s difficult to read at all, and so much incorrect information. Great blog post. Typical high quality journalism from the desk of MNA.
Lol. The trolls are out in full force Veronica– I’m sorry about that. Speaking truth to power hurts power’s feelings, apparently.
Jessica’s comment shows how easily topics concerning women’s’ health are often dismissed under other guises — this one being, “She’s promoting herself — let’s get hung up on that fact so we can overlook that mothers and babies are being treated poorly.”
All nurses working in MN must have a license
For what it’s worth, I just delivered at United on Sunday and my postpartum care was stellar. The replacement nurses were fantastic and I felt safe. I feel like for every bad story, you will find a good one, and just as many bad ones outside of strike times. Just my opinion.
I worked as a charge nurse during the strike before this one within Allina Health. I have been a nurse for 10 years, with the past six years with Allina Health. As I spent almost 80 hours along side of the agency nurses, I noted the following:
1. The nurses were incredibly engaged and skillful related to clinical skills and documentation. In fact, they were so proficient with documenting on our electronic charting that it freed up more time for patient care.
2. The overall attitude of the nurses were incredibly positive and very in tune with the needs of the patient. Each nurse was willing to go above and beyond their patient assignment to help out the team.
3. The feedback from patients, doctors, family members, other permanent employees, and hospital leadership all echoed the same message.
“The cared delivered by the agency nurses was excellent, if not superior to that of the MNA nurses whom they were replacing.”
It made me think, perhaps this is what patient care could be like if the union was removed from the equation.
Right, lest you forget we’re all human and this was an aberration, ANONYMOUS. If perhaps the truth at all. There are exceptional nurses but they don’t live in scab land like that. I’m not sure how the delusion turned into reality for you but utopia is not found in a group of supposed elite nurses called scabs. Are there some great nurses? Sure. But probably not the perfect one you concocted. Likely few and far between. Sounds like BS to me.
As a replacement nurse at the facility referenced here, I find your post to be flat out deplorable. I don’t know what your beef is with Allina, but this is hands down the best L&D unit I have ever worked for (among 3 others over the last 12 years). First off-the staffing and leadership here is phenomenal! I feel very supported and all needs or questions that I have are answered promptly.
To be frank, your points are completely invalid:
* “many, many things need to be documented in real time, taking away the nurses’ ability to provide patient care”————-I’d NEVER choose perfect documentation over patient care. You better believe I will first do everything to care for my patient AND THEN document later when there’s more time. That can wait, pt. care doesn’t. I will gladly catch up later or leave a little late I needed in order to document after I had over care of my patient to a night nurse.
*”Because the replacement nurses won’t have the training needed to provide Nitrous, parents will very likely find that options they expected to be available aren’t”———So, they provided us with all the necessary training and protocols and now we know. It wasn’t a big deal. Pt’s continue to use it here that want it and we are aware of how to use it.
* “•Patients with high-risk pregnancies are very likely to have replacement nurses that lack the higher training”——I am certified in Inpatient Obstetrics, I worked as a flight OB nurse transporting seriously ill patients to my home facility, I’ve taught childbirth classes, I do more deliveries at my facility than here. Trust me—-the replacement nurses here are highly trained and highly skilled. Furthermore there are directors, charge nurses, and leadership constantly present to provide any needed support.
* “Staff morale in hospitals during strikes always takes a major hit, distracting from the real need-providing patient care”———–The morale is great here. You haven’t been here, how can you say anything about staff morale? I don’t get why you are the expert that you know nothing of? We are working very cohesively as a team and come to build a team atmosphere very quickly.
* “In no way, shape, or form will there be nearly enough nurses to provide safe care.” Again, the staffing here is better than any I’ve experienced before. Again, how can you possibly know what the staffing is like when you are out there and we are in here?
You seem to have so much knowledge that it’s based on legitimate facts. It’s disturbing to read what you have written here and disturbing that you would put fear in the hearts of mothers soon to be delivering.
But I’m sure you won’t allow this to be posted as a comment b/c this completely goes against your agenda.
32 years ago, in 1984, I had my son Daniel during a nurses strike. I had an x-ray technician and other non_OB/GYN persons who had ever worked in the Birth area. This was at St. Mary’s Hospital in Minneapolis, MN. Help with breastfeeding was virtually non-existent and my child (though I struggled through 6 weeks of round the clock nursing as he could only get about one quarter of the milk I had) had to go on formula. He had what my mid-wives called “failure to thrive”. I had to go have him weighed there every other day. I even called the La Leche Leaugue but even that woman refused to come over to help me (perhaps she was on strike too). Needless to say- it was a horrible experience all the way around. I would say Run too! As far as possible to people that know what they are doing. I still suffer emotionally from these memories. I FULLY support these nurses striking but DO NOt go to these hospitals for delivery or I fear you will regret it.
Interesting how all the replacement nurses are named
Anonymous. Is that a common name? If things are so great how come you can’t put your name to it? There is a lot more to the story then what the media portrays.
$6900 a week? Guess you are all selling your soul to the devil that is Allina Health. Non-Profit my ASS!
Ands to think Penny Wheeler cared for my wife.
My name is not ANONYMOUS. It is Shiloh, RN in L&D.. I was here working this strike back in June and I am here again for the second go around. I am absolutely disgusted at the fact that you claim to be empowering women with knowledge when in fact you are feeding them a load of crap to support your own agenda. Your attempt to sell your opinions as facts is a ridiculous scheme to scare all of the local women in the community. I have been at United for both of these strikes and have found this unit to be amazing. The care given here by those of us that actually decided to show up for our patients has been exemplary. I know this by the smiles and thank yous and the tears I have shared with every single one of my patients. The unit leaders that have stayed as well as those dedicated nurses that crossed the picket line have been absolutely amazing and supportive and thankful to us for being here. We have shown beautiful teamwork and have made our patients number one. The morale in the hospital has been uplifting and professional unlike that outside where the union nurses are screaming profanity and acting like they no longer have any couth or reserve. Lets correct a few of your factual mistakes. 1. We are absolutely required to have a Minnesota license whether it is permanent or by endorsement in order to work here. This was done through license verification, skills verification, work verification, and criminal background checks completed by the state of Minnesota. 2. We are required to prove our skill set through multiple tests and modules ( oh, i forgot, you are not a nurse and may not know what a module is…. look it up from a factual source this time) We must provide current documentation of all of our certifications held, ie. CPR, BLS, ACLS, NRP, CPI, IFM, AFM. I’m sure, again not being a nurse, that you do not know what all of those letters stand for but I am sure you can find a source to help you with that. 3. The majority of travel agencies require a minimum of 5 years experience in this unit. 4. Being a nurse, we are very accustomed to learning new charting systems. It takes all of maybe 2 days to have it down. We have always had constant help with documentation thanks to those who decided that their patients were more important that standing outside screaming at the very nurses that arrived so that your community would not be abandoned. I can promise you this, every labor and delivery nurse has experience with taking care of their patients first and charting later. It’s part of the job and our patients did not lack. You posted the account of the woman who felt that her birth experience was a failure and ended in cesarean because of the strike. She stated it was going wonderful until what exact moment? When was it that it all turned around for her? Oh yes, i remember…when 0700 came on the first day and union nurses abandoned her. That was the problem. Yes, transitions are difficult as all nurses know, and I am sure it wasn’t absolutely ideal and for that I regret it couldn’t have been better for her. I deeply regret it because i make it a point to make sure it is the best day of my patients lives. Again, It would have never happened had the nurses of Allina not abandoned their community to walk a picket line. The replacement nurses jumped in immediately and worked hard to learn this unit, these doctors, and this community to keep patient safety and satisfaction #1. You refer to us as selling our soul to the devil for coming here. I am quite sure this community see us quite differently. We have sacrificed our time with our families and the comfort of our homes to come here and make sure these women have nurses to support them through this amazing experience. We have come here so that they are not affected by your decisions to leave. You want to throw our compensation in our faces and make it out to be greed. It is a shame that you can not see the amount of money you have cost this system by walking off of your jobs. This system is what provides you with a career and this community with medical care. The very standards you want raised in particular hospitals could have been funded with the money lost in this strike. Reality is, our insurance plans in the US have changed in the past several decades and you should be thankful that you work at a facility that offers insurance. You say you want what is best for patient care but you won’t accept a very good insurance plan that will save the hospital millions of dollars that can then go back into patient care. I am very proud to be here and supporting the Allina system. While I understand that there are two sides to every situation like this, I see Allina providing for its clients and I see MNA standing outside screaming and insulting fellow nurses. I see MNA sneaking into the hospital and trying to sabotage fellow nurses. I see MNA attacking their friends over coming to work for financial need despite the strike. I see MNA allowing people like you to represent them so poorly fashioned in articles such as this. It is hatred and slander. It is not what this community needs.
Kudos, Shiloh, I believe they call that a mic drop. Happy to have you working here at Allina supporting our patients.
I second Eric’s comment. Welcome aboard Shiloh, thank YOU for your dedication to the patient’s you serve.
Well said Shiloh. I am working in the mother baby center and it has been a very rewarding experience. I’ve never worked with such an awesome group of nurses. The patients are getting care above and beyond anything I’ve ever experienced. I have even received calls from families thanking us for the exceptional care they received. All the nurses I’ve worked with jumped right in on day one. Charting has been getting done and they have all caught on quickly. Typically, a new hire gets 3 months orientation to do this. I would work with these women anytime.
We choose to be anonymous due to the lack of respect from the union staff.
I can say hands down that this is the single most, non-factually based article I have ever read. Not only does Veronica Jacobsen not provide any factual basis for any of her main points, she immediately assumes all replacement nurses are hired off the street with absolutely no experience, or training. I would believe an article that stated North Korea has more democracy versus the United States than this. The replacement nurses that are currently filling the position are extremely qualified to work in all units of the hospital. Again, the article assumes that only ALLINA nurses are well trained and that every other nurse is unqualified. To simply put it, the replacement nurses are extremely qualified. It’s sad to see MNA posting articles of someone with such low journalism quality.
BOOM!! Well said, Shiloh!!! My experience working here as a strike nurse has been nothing but wonderful. The regular staff, doctors, and fellow strike nurses have been a pleasure to work with. My patients have been a pleasure to take care of as well. My patient I had last night gave me a hug goodbye this morning and told me she was glad that I was there to take care of her. Thank you, Allina for a wonderful experience and the opportunity to meet some amazing people!!
George, I’m so sorry to hear Dr. Wheeler cared for your wife. I hope she and your child made it through despite Dr. Wheeler’s best efforts… I’m sure you and your wife would like to tell us all here on this blog what an evil, vile creature she is and how disrespectful she was. Did you see the horns too?
So many lies. The reason they only need 1400 nurses to replace 4800 union nurses is because they actually are working full time plus. Not a 0.4 FTE and STILL getting full benefits like Allina pays those that are striking (thats 16 hours/week for those of you playing along at home). The replacements are working 12 hour shifts 6 days/week. We are actually better staffed than usual thanks to the wonderful employed nurses who have stayed at their patient’s bedside delivering care. And nearly without exception, the replacement nurses are as skilled and qualified or moreso than those who have left. They all have to be licensed in MN before working, but not before they agree to come. I feel that morale is doing just fine. That won’t be the case when the strikers return. And about “scabs”… That is a term used with great irony. Maybe that works in old Detroit when the UAW goes out and the unemployed there go into the factory to perform low-skilled tasks. That is NOT the case here. Almost all of the replacements are brought in from outside of our area, and will return to their homes once the strikers decide to come back and do their job. They are highly skilled and highly competent. The real scabs here are the striking nurses that go and take another local job to “make ends meet.” It turns out that YOU are taking someone else’s opportunity to have meaningful work. But because the striker is likely over-qualified to be a home health aid, they take the position that someone without prior experience would have used to get a leg up. And yes, standing ovation for Shiloh!
To the author – Why do you consider the nurses to be the ones in the right to such an overwhelming degree and the management to be so overwhelmingly in the wrong?
This is Shiloh and I would like to add another little fact to this blog. We have been told by upper management at United just tonight that #1 This unit in L&D has had the highest patient satisfaction rate this past few weeks than it has had for the entire year previously. #2 Hand hygiene is up 10 points since we have been here. 10 points in only 3 weeks. This is not to gloat nor call ourselves superior to the staff nurses of Allina. This is just further proof of our capabilities and our dedication to our patients.
Well said Shiloh!! It is a shame that the union nurses are so upset with the strike nurses. WE are only here to hold the hospital together until you guys come back. Allina had no choice but to bring us on in order to save the organization. You always have the option to cross the picket line and come back to work. The first day I came to work at United someone peed in the locker room. It was also noted that several items have been stolen from people’s lockers. The level of immaturity I have experienced is astounding. Hopefully this will come to an end soon. I really hope that the union nurses can come to an agreement with Allina soon.