Staffing, pay, bullying, violence, opioids topics at PEF Nurses Conference
Story and photos By SHERRY HALBROOK
PEF nurses gathered in Albany May 7 for an afternoon conference of workshops and learning before visiting their state legislators the following day to educate them on the need to pass bills to ensure better staffing and working conditions at state health care facilities and worksites.
PEF President Wayne Spence thanked them for taking the time from their busy schedules to make the trip and he reviewed workplace issues that affect them and how PEF is working to address those concerns. PEF Nurses Committee Co-Chair Nora Higgins, who also is Region 12 coordinator, presented information about workplace violence, and Dr. Michael W. Dailey conducted a two-part workshop on the opioid epidemic and how to respond to patients who have overdosed and need immediate care to prevent death.
Spence said the union is making slow but steady strides to improve nurses’ pay throughout the state by getting agencies and the state Civil Service Commission and Division of Budget to recognize they must offer nurses competitive pay to remedy poor recruitment and retention that plague state health care programs. Increasing geographic pay for many nurses at certain worksites and on certain shifts, especially in western an central New York has helped, he said, but the union is working hard to convince the state it must upgrade nursing positions across the board.
The state is struggling to fill nursing vacancies with only salary grade 16 pay and Tier 6 retirement benefits, Spence said. “I’ve had conversations with the state Department of Corrections and Community Service and with the Office of Mental Health. We’ve told them Grade 20 must be the starting point, because geographic differentials don’t really do it. State agencies are starting to realize they can’t fulfill their (mandated) mission.”
Spence said he is telling the state it is risking lawsuits. “We’re talking to the state comptroller and we will talk to the attorney general. It may be criminal to fail to staff properly. We need to highlight how bad it is.”
The PEF president said he knows that nurses are very dedicated and don’t want to let their facility down or complain, but that can make the problems worse.
“Our work ethic prevents us from reporting (illegally mandated overtime) and protesting it, but we must demonstrate the need for more nurses and then the agencies can demonstrate (to the Division of Budget) their inability to hire and retain nurses,” Spence said.
Higgins agreed, saying “Nursing is a very challenging field. We see birth. We see death and we see everything in between.” Forcing nurses to work too many hours and on units with needs and technology for which they have not been trained is dangerous, she said.
“I wouldn’t treat a stranger this way, much less a co-worker. If you don’t give people the information or help they need to do their job, you are setting them up for problems,” said Higgins, who is a teaching and research center nurse 2 in the neonatal intensive care unit at SUNY Stony Brook Medical Center on Long Island.
She led a discussion about bullying, “mobbing” and other situations that can put nurses at risk of emotional and physical harm. Nurses working in state psychiatric and correctional facilities may be in locked units with patients who are emotionally volatile, and a nurse may not have the resources at hand to deal with problems that arise.
A PEF psychiatrist who attended the conference said, “I get threats daily, from a patient with paranoid belligerence, of cutting my head off and another patient will say he is buying me a Rolls Royce.” The doctor added that health care staff do get injured and the mental health facility where he works “lost six full-time workers for a year on workers’ compensation. We send reports to OMH, but we never get feedback. We’ve got to get better at it.”
Higgins advised the members to complete and submit accident/incident reports to document these problems. “The administrators are obligated to contact law enforcement if you are assaulted. We need to get better at collecting and aggregating the data.”
A nurse from the Office for People with Developmental Disabilities said the union has worked hard to address this at her facility and it has learned not to just give the data to the state. “We put the data into spread sheets and we keep a record of the data.”
“This becomes a cascading event every day (at an OMH facility),” one nurse said. “I don’t know where the line is to report it or not report it.”
“It’s unfortunate that it took the death of a PEF nurse to get the Workplace Violence Law,” Spence said. “You can’t let your guard down. Use the state Justice Center (for the Protection of People with Special Needs) to our benefit. We need to report the violence that we experience.”
PEF Nurse Coordinator Dee Dodson said, “You have to jump in there to be heard about these issues when you meet with legislators tomorrow.”
One of the nurses advised the members to “make this a standing action item for (workplace and agency) health and safety committees and labor-management.”
Meeting opioid challenge
Dr. Dailey is chief of prehospital and operational medicine and associate professor of emergency medicine at Albany Medical Center College, and is Regional Emergency Medical Services director for the Albany area. He is board certified in both Emergency Medicine and EMS.
It is easy to underestimate the danger of opioid addiction and abuse, Dailey said.
“They make you so sleepy, you forget to breathe,” he told the nurses. As a person becomes dependent on the drug, their body makes more receptors that cause them to crave more of the drug. Your breathing slows and each time you stop breathing, your brain is damaged. Finally the heart stops beating and you die.
“The goal is to keep the patient breathing. First ‘hurt’ them by rubbing your knuckles on their sternum (to see if they respond), if their breathing is very slow and they are gasping for air or they stop breathing, administer naloxone and CPR, if needed. If they are breathing very fast, turn them on their side,” Dailey advised.
Dailey said it is vitally important to immediately administer naloxone to a person who has overdosed and whose breathing and heartbeat become very slow and stop. He distributed samples of Narcan Nasal Spray that can dispense two life-saving 4 mg doses of naloxone HCL. He cautioned the nurses not to “prime it” because they will waste the dose.
Dailey said drug makers are too aggressive in marketing opioids and both pressure and incentivize doctors to generously prescribe these addictive and potentially deadly painkillers.
Sometimes the person who is hurt or killed by the prescribed drugs is not the person who was meant to take them. One PEF nurse said his younger brother took morphine that had been prescribed for their grandmother who was in hospice care. His brother overdosed and died.
Hospital emergency rooms see many patients experiencing overdose or withdrawal, Dailey said, and while they can help patients through the momentary crisis, “the ER is the wrong place to treat opioid addiction.”
One of the PEF nurses said that our society sees it as drug addiction when the person is a racial minority but “now that opioids are affecting whites, it is called a disease.”
Dailey said there is some truth in that. “I think there is an element of racism” in the way society views and responds to the problem based on who is affected.
The PEF psychiatrist in the audience said, “An opioid hijacks your brain. All (chemical) addictions require more and more until they shut down your nervous system. “
Dailey said the U.S. has worsened the problem by “training doctors and nurses to give opioids for pain. We use 75 percent of all the opioids in the world.”
New York State acted in 2012, Dailey said, to require prescribers to check the state’s prescription drug monitoring program before prescribing more painkillers for patients.
Heroin has made a resurgence and it has returned “much more pure than in the ’60s. Two percent of heroin users die each year, many from heroin addiction,” Dailey said. But he added that a popular form of fentanyl is “10,000 times as potent” as heroin.
Now, the need to is to get all of the government and private programs and organizations to work together to save lives, prevent overdoses and treat addiction.
“We’ve trained 20,000 law enforcement officers in upstate New York plus an unknown number in New York City on how to administer naloxone to patients dying from an overdose,” Dailey said. Unfortunately, a state health law inadvertently made it illegal for nurses to administer naloxone, but that has been corrected. The overdose death of a celebrity’s daughter helped spur awareness of the need to make naloxone widely available, and to train the public and first responders in how to use it.
But saving someone from dying from an overdose is not enough, Dailey cautioned, because their addiction may bring them back to a deadly crisis again and again.
“It’s frustrating for police officers to reverse the same person multiple times,” Dailey said. Nevertheless, “We’ve trained 2,000 NYS troopers and we’re now at 5,000 reversals since 2015. In 97 percent of overdose cases, police were on the scene and in 40 percent of cases, police were on the scene five minutes or more before EMS arrived.”
A nurse who works at a state prison regional medical unit said DOCCS is “trying to never prescribe or let inmates use opioids. We had a patient who had hip surgery and received only Motrin afterward.”
“We need systems in place for people seeking care for problems directly related to substance abuse, such as abcesses, endocarditis or overdose,” Dailey said. “We need a social EMS framework at the forefront of training and practice. There are no easy answers. It’s hard to get inpatient services funded by insurers.”