Nursing Power: California Nurses' Collective Advocacy for Patients and Nurses: An Interview with Rose Ann DeMoro

Multinational Monitor, October 2004 | Go to article overview

Nursing Power: California Nurses' Collective Advocacy for Patients and Nurses: An Interview with Rose Ann DeMoro


Rose Ann DeMoro is executive director of the California Nurses Association, the largest and fastest-growing professional association and union for registered nurses in the country. CNA membership has doubled in the past seven years. CNA today represents over 57,000 RNs in 164 facilities across California.

With CNA, California nurses have led the nation in ground-breaking patient advocacy legislation such as staffing ratios and whistle-blower protections.

Modern Healthcare, an industry trade publication, in 2004 ranked DeMoro the thirty-fifth most powerful person in healthcare in the United States.

Multinational Monitor: What proportion of nurses is organized in California or nationally? Rose Ann DeMoro: About 20 percent of hospital-based registered nurses are organized nationally. In California, I believe that number is closer to 60 percent.

MM: What changes for a nurse if they are a member of a union?

DeMoro: For one thing, they have the ability to engage in what we call collective patient advocacy, which is the ability to advocate for patients against hospital management collectively, rather than one-on-one. Nurses who are organized have higher retention rates; they are better compensated; their pensions are better; their health benefits are better. This translates directly into the quality of patient care, because an experienced RN workforce is going to provide better care.

Directly through their collective bargaining agreements, nurses are able to control nursing practice in their hospital. So the introduction of technology and other aspects of work arrangements that might undermine patient care are limited and prevented through the union contract.

MM: Is there a shortage of nurses in the United States?

DeMoro: Yes, primarily because of industry practices that have really undermined the ability of nurses to practice nursing the way they were educated and desire to practice.

It has made hospitals in particular a much less desirable place to work.

MM: Are the hospitals also cutting back on nursing levels?

DeMoro: In some cases, we are still seeing so-called hospital restructuring, which does substitute lesser skilled workers for registered nurses. We're also seeing registered nurse-displacing technologies becoming the new wave of restructuring, which also reduces the number of RNs.

It is not like in the mid-1990s, when there were wholesale layoffs, but we are still seeing closures of hospital units, closure of hospitals and job-displacing technologies, as well as replacement by lesser skilled workers.

MM: How do these changes affect a nurse's typical responsibilities?

DeMoro: In those 49 states that do not have nurse-to-patient ratios such as we have in California, nurses will have a very large patient load. They will have eight, 10, 12 patients that they have to care for. In an eight-hour day, this is very difficult. In the course of any day, there are a number of discharges and admissions--those are much more time consuming. Of course, the registered nurse is responsible for assessing and developing a nursing diagnosis and care plan for every patient they are responsible for. You can imagine when you have that kind of patient load, combined with the fact that patients are much sicker when they are in hospitals nowadays--there is higher acuity--then the workload for an RN in a typical day is overwhelming, unless there is some kind of nurse-to-patient ratio regulation.

MM: How does this impact care?

DeMoro: In California, it impacted care dramatically. There were higher rates of infection, and higher rates of re-admission, because patients who were discharged too early had to come back--patients who didn't get the full care they needed in the hospital, couldn't get the care at home. The ratio is really in response to that, those high number of patients that RNs had to care for. …

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