How We Got Our Lead Nurses Back
Nurses sat stunned. We had been called to a meeting about a “new vision.” In one week, our chief nursing officer (CNO) announced, the charge nurse role would be eliminated.
That would mean loading more work onto already overworked, short-staffed nurses.
The charge nurse is the nucleus of the unit, a jack of all trades. Usually someone with many years of experience, he or she helps with admissions, discharges, and transfers; acts as the recorder for trauma codes; provides advice and support, especially to newer nurses; and offers an extra pair of hands when things get busy.
The CNO said the change would enable nurses to “function autonomously”—but to this day I feel it was a financial decision. Removing the charge nurses from all three medical/surgical units on three shifts would mean nine fewer nurses the hospital had to pay each day.
When we expressed our shock and misgivings, the CNO asked us to try it on one floor, for one week. Then we would reconvene to discuss whether the experiment should continue. We grudgingly agreed. What choice did we have?
A DANGEROUS WEEK
It was a chaotic, sometimes frightening week. They started with the fifth floor, a medical/surgical oncology unit where nurses administer chemotherapy.
Chemo is very precise work with dangerous, heavy-duty medication. A doctor’s orders can change from minute to minute, based on the patient’s condition—and often it’s the charge nurse who communicates these changes. The bedside nurse has to follow strict protocols, working almost one-on-one with the patient—and may be relying on the charge nurse to help her juggle four other patient assignments at the same time.
On top of that, this trial came at a time when the hospital had just hired a cohort of newly graduated nurses. Now they were working without a net.
After the week was up, we met again.
The unit directors asked for feedback—but when staff started voicing concerns, they shut us down. Whether we liked it or not, the fifth floor would continue with no charge nurse for a month; then the sixth and seventh floors would follow.
We decided that for every shift that went without a charge nurse, we would document it by filing a protest of assignment.
One nurse in particular was proactive about filling out the forms and rallying others. Within a week, management started coming after her. At first they were blatant, asking her, “Why are you doing this?” and implying it wasn’t allowed. She knew differently.
When they couldn’t get at her that way, they started finding other things. They nitpicked her documentation, told her she had a bad attitude, and filed a code of conduct discipline against her.
Again she was smart. She got her union rep involved and filed grievances—and in the end the unit directors had to retake a training class about protests of assignment and employees’ rights.
We made sure all the nurses heard about that. We trumpeted every little victory, so people would know they had rights and we were willing to fight for them.
But there was still no charge nurse on the fifth floor. It was clear we needed to escalate our efforts. A dozen nurses who felt strongly came together, and our Safe Staffing campaign was born.
First we circulated a petition asking that the charge nurse be reinstated. An astounding 92 percent of the med/surg nurses signed. We did a “march on the boss” and delivered it to the CNO.
In less than a week, we got a written response—the CNO simply restated her position. We wrote a rebuttal leaflet and distributed it in the employee parking lot at every shift change.
By now our campaign was gaining attention. We were pointing out the bad policy of a bully boss—and that resonated with people all over the hospital. Pharmacists, lab techs, and nurses from other units spread the word about our fight and helped us distribute leaflets.
As our influence grew, managers started to get paranoid. One day they flew into a panic because they had somehow gotten the idea we were going to plan a sickout!
Finally, a med/surg unit director contacted us and requested a meeting to discuss the issue.
We made it clear the agenda had to be about reinstating the charge nurses, and we set out to mobilize as many members as we could—including lab techs, pharmacists, and nurses from other units.
For the morning meeting, a crowd of 20-30 people gathered. The unit directors came in with flipcharts and markers and launched into a discussion about the “med/surg vision.”
We pointed out that this was their agenda, not ours—but they continued to talk over us. So we rose collectively and walked out of the meeting, leaving stunned faces in our wake.
A second meeting was planned for the afternoon. This time 60 people packed the room. Our directors attempted the same scene. Again we rose and exited the room!
READY TO TALK
That’s when it dawned on management that we were not going to back down. The CNO came to the table to negotiate.
We met with members beforehand to redesign the charge nurse role. Nurses wanted a fairer process for awarding the job.
We decided that it should be a biddable position with a pay differential for the hours worked as a charge nurse. Managers should not be allowed to fill the position themselves. We wrote up a job description with specific clinical criteria.
When we met at the negotiating table, management could see that we had done our homework. They kept trying to dilute our criteria and make the charge nurse more of a quasi-management role—but we didn’t take the bait.
By the end of Day One we had a tentative agreement to reinstate the charge nurse on the fifth floor. One nurse volunteered to put on scrubs and go serve as a charge nurse that very evening.
But management refused her offer. We wanted to make sure they wouldn’t find an excuse to back down.
We felt a “call blast” to the CNO would remind her how strongly we felt about this issue. We patrolled through the facility giving out her phone number, asking members to call and say they wanted the charge nurse reinstated immediately. Some people called right then on their cell phones or desk phones. We asked family and friends to call in too.
That same night we leafleted members with a “fairy tale” I had written—a tongue-in-cheek chronicle of our struggle as a battle between the evil bosses and the lowly peasants. It was very well received by the members—not so much by management!
The next morning when we went in to bargain, the CNO said she had received all the messages, and thanked us icily for giving out her phone number. We told her she was very welcome.
From that point on, management stopped stalling. We came away from the second day of negotiations with a new, enhanced charge nurse position.
Management’s only caveat was to change the title from “charge nurse” to “team leader”—a small concession for such a big victory.
The whole campaign took five months, and it taught us a lot of lessons, which we’re applying now in our contract bargaining. If you’re willing to stick together, you may not win everything you want—but you can get a fair amount done.
And while managers will get angry, they also develop more respect for you when they find out they can’t push you around. That was certainly the effect for us.
Deidre Lacey is a staff nurse and team leader in the medical-surgical orthopedic unit at Champlain Valley Physicians Hospital, where she is also a union delegate and the elected executive co-chair for the hospital's bargaining unit of the New York State Nurses.