WORKING (NOW) AT THE BEDSIDE
A Conversation with Laura Fitzgerald and The Wax Paper Transcribed and edited by Valentine Sargent
In 1974, Studs Terkel published Working: People Talk About What They Do All Day and How They Feel About What They Do. In the spirit of that landmark publication, The Wax Paper editors have gone into the field to ask Mr. Terkel’s original question.
Laura Fitzgerald works as a bedside nurse at Shirley Ryan AbilityLab, formerly known as Rehabilitation Institute of Chicago. The following text was taken from an informal conversation with Ms. Fitzgerald.
I’m a RN, I’ve got a master’s degree, and I’ve gotten my additional certification in rehab. It’s great, I love rehab. Rehab is wonderful. You do get to see these people come in and they’re all a mess and you are helping them move on to wherever it is they are going to go. Whether it is a skilled nursing facility or nursing home or whether it’s getting them back on their feet enough where they can go home. It’s very rewarding to see.
So, it’s physical rehab, it’s a specialty hospital. On my floor, it’s patients that have chronic illnesses. My floor is the medically complex floor, so it’s a lot of chronic illness complicated by other things. A lot of patients are older patients that, for example, have had a slew of cardiac issues but then they’ve got a bunch of comorbidities [the simultaneous presence of multiple conditions]––they also have diabetes and they also have a history of cancer. So maybe they went to the hospital for a hip replacement but then it got complicated by something else and then they picked up some pneumonia and they are in the hospital for an extended amount of time before coming to us. So, they are generally run down. Before they can go home or to a skilled nursing facility or something like that, they need to get stronger physically, so they are coming in and doing physical therapy and occupational therapy and a lot of the times speech therapy as well. We are still acute care––these patients still need 24-hour nursing care to manage them medically.
The other thing I really like about rehab is it’s interdisciplinary, so there is a lot of communication between the different disciplines. So, that’s medicine and nursing but then you’ve also got occupational therapy, physical therapy and speech therapy pieces to it. It’s a team approach, which I like.
We have some mental health counselors that are there available doing patient family services – which apparently is groundbreaking. It’s more common now, but apparently, regular hospitals don’t do that.
We’re dealing with these people adjusting to their new realities––post stroke, post limb loss, or with a new set of lungs––and so having that emotional support is a huge piece of it. We have a licensed clinical social worker who is just on our floor. We rely heavily on her.
People come in all the time and they’re scared and anxious and I can lessen that anxiety. That’s the most fulfilling part about my job … I’m not saving lives, but I can help somebody adjust a little bit better. I can help them feel a little bit better, and I think that goes a long way and that’s what I like best about bedside nursing.
Bedside nursing is ridiculously close to waiting tables … I do work with a couple people who waited tables for a long time and they’re like, “Oh yeah.” Because you’re doing these constant rounds. You come in, you’re responsible for their coffee, and I don’t mean in a restaurant way, I mean that in a you’re-responsible-for-everything [way]. You’re the patient’s lifeline.
If the patient needs anything, it’s through the nurse.
Some of it is assumed, some of it crosses the line. It would never cross the line from the patient’s side. Hopefully the patient is going to feel comfortable asking for whatever they need, but I should be able to delegate that to somebody else to go take the fucking trash out. A lot of the times, I just take the trash out. We have environmental services, that’s housekeeping services, but they can only do what they can do. Most of the time it’s easier for me to just do it.
As is, it’s unsustainable. We need ratios. It’s unsustainable to go in every day and it’s unsustainable physically. It’s unsustainable emotionally, even in rehab. To have to go in every single day and not get the respect or the money that I deserve. That nurses deserve. And then to actually have physical problems because of it, that’s ridiculous.
It’s the same as your corporate job where you aren’t supposed to lift more than 30 pounds, come on. Honestly, I’m not supposed to lift over 30 pounds. Okay. I try to take care of myself and I try to use proper body mechanics. There’s a lot of people who are like ‘okay whatever’ just accept the physical damage, which I’m not going to do. So, I try to call for an extra set of hands. I try to use my knees. I try to take care of myself where I’m not going to throw out my back. But the older nurses that I work with have back problems. They do. It’s just part of it. It shouldn’t be, but it is.
I don’t know how somebody can be a nurse if they’re not really into being a nurse.
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I was reading some random blog post on Facebook this morning––ICU [Intensive Care Unit] nurses being burned out after two years. Which you can certainly see why an ICU nurse would get burn out. But then I was thinking, it’s probably across the board for any nurse today.
I think people get burned out at the bedside, pretty quickly.
Emotionally and physically, it’s just a lot. In general, I’m a little jaded right now, but bedside nurses get treated like shit––by their own place of business. It’s tough work, obviously, and you’re dealing with people that are in a bad place in their lives.
It’s hard dealing with the patients, but that’s part of the job. The part that I wasn’t expecting was getting treated like shit by administration.
It’s cutting costs left and right. Staffing ratios are awful. Essentially what it comes down to is you’re expected to take on more than what is appropriate.
So I come in, I have six patients. Maybe I’m training a new nurse. Three out of six of my patients are not even appropriate for my floor because they’re confused or combative or otherwise not alert and disoriented so, that takes more time. Then I have a couple of patients that are really actually pretty, fucking sick and need my attention. Then I’ve got a couple of patients that are just needy in general and need just a little bit of extra TLC, if you will, which takes time. They’re not that sick but they require more time. And then you have discharges, transfers, new admissions coming in, you’re having to deal with that. You’re supposed to spend plenty of time with the patients; of course. You’re just spread small, on all levels.
You come in, you get your assignment of five or six patients, and you take care of them for eight or 12 hours. So, it’s passing medications, doing dressing changes, doing nursing assessments, watching for anything to change medically. And for us in rehab, it’s a lot of education, a lot of education for the patients, a lot of education for the family members.
The problems come in when you have somebody that needs your medical attention and you don’t notice something, that you are missing something clinically, because you’re spending time someplace else. I can’t even see that this patient is exhibiting symptoms because I’m spread too thin in all these other places. And that’s nursing every single day.
I work four days a week, 2 eights, 2 twelves. A lot of people work 3 twelves a week. A lot of people maybe work less than that, so it’s constantly changing. One of the big challenges for us as opposed to the other disciplines is that we don’t have a specific caseload … In theory, I can have different patients each day, or I can be with the same patients for three days. But then I’m off for a few days, I come back, and I have a totally different group of patients.
It’s kind of just the way it goes.
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See, here’s a text message right now––trying to guilt me into working tomorrow.
She said, “Hi, it’s Taylor*. Your floor is down three RNs,”––which is insane––“would you be able to work till seven?” At least she’s asking for tomorrow.
We have a good culture, or we did. But, this idea of guilting you to come in and work when somebody didn’t do their job by staffing the place appropriately. It’s not my job now to fix it, a day before on a Saturday. No, go fuck yourself. I’m working almost ten days straight. So now, I have no problem saying no, because I started looking at it as if I was enabling them––to go further, to be crappier. Which is bad in the short run, because we may not have enough staff, but hopefully they’ll get their shit together in the long run if people stop saying yes. Can we just hire some more nurses please?
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We aren’t union … None of my friends from nursing school are union. I know a few people that work union hospitals. Most don’t have good things to say about it. People are scared of it. There’s the reputation for unions being bad hospitals to work for. That’s the reputation, which is interesting. When I leave Shirley Ryan, I want to work at a union place and see what that’s about … How could it be bad?
*Names have been changed
Ms. Fitzgerald continues to work at Shirley Ryan AbilityLab in Chicago. Laura made sure to note that she has a new floor manager and chief nursing officer, and the nurses feel much more supported now than they did with past leadership. Ms. Fitzgerald has started a new role as an education program manager in the patient resource center, however, she still works several shifts a week at the bedside. Laura will give a presentation on transitioning rehab patients back to the community at REACH, the national conference for the Association of Rehab Nurses, in the fall.
Since Shirley Ryan is a rehab hospital, there was not an influx of coronavirus patients. Instead, the hospital has been taking in post-COVID patients for rehabilitation. A floor was designated for these post-COVID patients after spending weeks recovering in a hospital. Like many hospitals around the nation, Shirley Ryan faced a lack of PPE (personal protection equipment). A donation of masks allowed the hospital to avoid a shortage.
WORKING (NOW): NURSE AND NEGOTIATOR
A Conversation with Paul Pater and The Wax Paper Transcribed and edited by Valentine Sargent
In 2017, we met Paul Pater across the street from The University of Illinois Hospital (UIH) under a portable canopy. Nurses had set up several canopies in anticipation of a strike, which was averted that morning. Chatter and sirens clamored intermittently in the background as Mr. Pater—a nurse for three years and the co-chief steward of the Illinois Nurses Association at UIH—spoke about labor rights, unions, a successful negotiation, and the challenges facing today’s nurses. The following text was taken from an informal conversation with Mr. Pater.
I work in the emergency department. It’s always something new, always something different, never boring. It works for me.
When I got this job, someone in the emergency department recognized that I was interested in labor stuff and interested in union activities and recruited me fairly early on. [They] encouraged me to keep my head down while I was going through my [new hire] probation period which was the last six months here. It’s a long probation period. And then, I ran for a position as the emergency department steward. I was the only person running, so I won.
Do most hospitals have unions?
No, no! It’s rare! Out of all the hospitals in the city, there’s only four.
The whole reason I got on negotiations was that someone had seen I caused a little bit of a ruckus at a––it’s called an ANE meeting––which is a conference for all nurses interested in working in like, a shared governance; it’s like a fake union. And I brought up some questions that nobody had been asking and combine that with my activities with the union in general, trying to engage membership.
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We just had a great victory in negotiating. Solid win for the labor movement.
In an effort to be in good faith in the negotiation, we gave up some things that weren’t going to make or break us. It’s fine; this contract is amazing. It’s for three years, the duration of our contract usually is every three years.
It was stressful. I think I was the right person for the job. In combination with the rest of the team, we did a really good job.
Towards the end I was beginning to feel more like a lawyer than a nurse.
They kept trying to write language that was vague enough to impose their will upon us and no one at the table was stupid enough to fall for it. I’m very fortunate to have a strong, intelligent team that I stand shoulder to shoulder with.
It felt like negotiating with Donald Trump on occasion. They would just repeat the same things over and over, “Well, this is a very fair deal” and “this is really good for you guys,” “I can’t believe you are passing on this excellent deal.” And the thing was, is that they’d get gradually less disgusting (laughs). This was not a traditional negotiation that I’m used to.
It was one lawyer from some union-busting firm. The dude’s worth millions of dollars … We actually looked him up and he’s donated over the course of his life, half a million dollars to the Democratic party, but busts unions for his work.
What made this so hard is that we had a bunch of administrators who have never been through a contract negotiation. They’ve never had to negotiate any contract.
There’s been a rollover of administrators, because part of the problem is administrators don’t stay. They use the university system as a steppingstone to a bigger and better job.
They kept telling us how unfair we were being, how greedy we were being, how overpaid we were. That was one of their negotiation tactics, guilt and shame. They get paid quadruple what I get paid and they’re calling me greedy. And I know for a fact they’re not going to stay here for 10 years, they’re not going to stay here for 20 years. I’m the one who’s going to be here for 10 or 20 years. While they go and find some better job.
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The hospital is supposed to negotiate something called the Acuity Tool with us if they are going to replace our current one. So, what it does is it helps us appropriately staff the hospital. It tells us which patients are more sick, which are less sick and how much care they’re gonna need, and how many nurses we’re gonna need for the hospital for that day.
And [the administrators] want control of that?
Yeah. They can dictate how many patients you have. One of the administrators said that an excellent nurse takes six patients at a time. A nurse that really, truly goes above and beyond takes six patients a day. That is dangerous. And disgusting. It’s crazy. There’s no way I could safely take care of six patients in the emergency department.
I left a job that that was their standard. I said, “You can’t do this. I can’t do this anymore, or I’ll lose my license.” Because if I make a mistake, it’s on me. It’s not on the administration. It’s not their problem.
They should be more aware that this creates burn out on nurses and destroys their longevity. I gotta be here 20 years, they don’t. All the administrators and directors of patient care services had to sign an affidavit saying that they were incompetent in the areas of patient care.
It’s a legal trick to get what they need.
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There were two days of strike voting, then negotiations followed. Due to the pressure on the hospital from 30 public officials such as governors, congresspeople, and leaders of organizations, the hospital agreed to negotiate. Negotiations lasted from 7 p.m. to 3 a.m. the following day.
During the second-strike vote on the first day, one of the UIC police officers said, “Administration wants you arrested for trespassing.” I was standing in front of the spinning doors right there (points across the street), on the steps, guiding nurses, asking nurses if they had voted yet, telling them where to cross the street to vote.
Originally, security came up to me, said I had to cross the street. I wasn’t able to hang out there and talk to people outside the hospital. I said, “No, it’s enumerated in my contract I can do this, explicitly.” I said, “If you don’t agree, go grab your supervisor and we can explain it to him.” Instead he brought out the UIC police and that officer told me I needed to cross the street and I said I wouldn’t, because I have the right to be there, and he said, “Well, the administration wants you arrested for trespassing.” And I said, “Lock me up. Do it. Because I’m not leaving. I know my rights; I’m staying right here.”
We filed an unfair labor practice against them. We’ll see how that goes.
All that hard work, it’s gotta feel great.
I’m sure it’ll feel better after I get 10 hours of sleep. I was supposed to start a vacation yesterday (laughs) but I’m still here doing this shit.
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Three years later, the contract Mr. Pater negotiated in 2017 has ended and negotiations for a new contract with UIH Administration are underway. These negotiations will conclude at the end of August.
The nurses’ union have two big asks: safe staff to patient ratios by passing the Safe Patient Limits Act (HB 2604) and an economic package that provides six months paid leave for new parents.
Safe staffing ratios are essential to the union because they ensure the nurses are not overworked and patients are fully managed by their nurse. The best ratio for staffing is three patients to one nurse, yet some hospitals require a staggering, high number of eight patients to one nurse. Published studies reveal that patient mortality rates were 17% lower with safer staffing ratios1. For each additional patient assigned to one nurse there is a 7% increase in mortality by treatable causes1. Safe staffing ratios also protect healthcare workers. For each additional patient, hospital staff are more likely to experience violence. In 2004, California enacted safe patient limits and saw a 30% decrease in violence toward healthcare workers1.
Extending paid leave for new parents is a more challenging ask than safe staffing ratios. The U.S. is the only developed country that does not offer government-mandated paid leave for new parents. Currently, under the Family and Medical Leave Act (FMLA), UIH staff are ensured up to six months of unpaid leave as a new parent, but this essentially ensures job security only. UIH allows only two weeks of paid leave for new parents. Employees must cover the additional time with accrued vacation leave, sick days, or family leave, or suffer a financial penalty for spending six months with their newborn.
Mr. Pater and his team have pushed the hospital to support its employees as they work on the frontlines of the current pandemic. UIH became the first hospital to offer hazard pay in the nation, a concession Paul helped negotiate from an ICU bed for three days with a suspected case of the coronavirus. Hospital staff have fought for access to PPE (personal protection equipment), specifically N95 masks, an ongoing struggle to this day.
Mr. Pater is resolute, “This is a chance for labor unions and the working class to stand up and demand better. You think you’re going to use my death to stimulate your wealth? You’ve got another thing coming.”
1. "Safe Patient Limits Act," National Nurses United, 2020