We'll Talk Later

Unlike just two or three years ago, no one in my personal circle seems to be feeling financially comfortable and confident right now. Payrolls have been "downsized," either by eliminating jobs entirely or cutting pay, companies are struggling, and I am newly aware of an undercurrent that must pervade much of otherwise happy family lives, as breadwinners wonder how much longer they will be able to pay the bills, or what threats may lurk around the next corner. An educator friend is giving me inside looks at the protests ongoing in Wisconsin, as the governor and allied lawmakers attempt to eliminate public employees' right to bargain collectively, a sobering and scary prospect. Many of my elderly clients, who worked and saved responsibly throughout their lives, barely can make ends meet now, and any unforeseen additional expense has the potential to pull them under. And I can't quite imagine how the bright but socioeconomically "at risk" student I tutor will pay for high school (yes, high school!) next year.

So far, my home is warm, my larder full, and my overindulged dogs content. But with clients who pay late and then only partially, or who are not-for-profit entities whose survival by no means is assured, or whose programs are faltering, there can be no assumption that next month's provisions are secure. And I am one of the lucky ones.

The temptation to succumb to fear is real, but the stronger that temptation grows, the more dangerous it grows as well.

Yesterday I lunched with representatives of a large company that would like to hire me . . . for approximately half the salary I made in my previous work. Not addressing the money for the moment, I explained that because I represent more than one client, it is essential that I remain an independent entity and that my role and relationship with each client is clear. There can be no appearance of using a relationship with one client to give a competitive advantage to another, and the ethics of representing an organization as an employee while simultaneously representing another client independently to the same market, are muddy at best. My luncheon companions understood.

I offered the option of their company procuring my services through my own company, Cima Services, in which case my independence and objectivity would be preserved, with my advocacy for and representation of all of my clients clearly defined, and no conflicts of interest apparent or extant.

The response? "We don't contract with nurses. We only contract with therapists." And my reply, "We'll talk another time."

There is little doubt that should that company want my services badly enough, they will enter into a business relationship with Cima Services without regard of its being owned by a nurse instead of a therapist; that reality may or may not ever come to pass. But the truth today is that the position of my luncheon companions' company can be taken liberally right now . . . because nurses permit it.

I walked away from that lunch with handshakes and smiles, and we will talk later . . . so that I can drive home my point with focus and clarity apart from the hubbub of the restaurant and the messiness of mutually feeling our way through a new relationship. But I walked away without a contract because too many other nurses do not walk away at all. Even as they complain about a "nursing shortage" and expect nurses to carry workloads dangerous to themselves and to their patients, employers in healthcare by and large continue to operate on the assumption that there always are more nurses to be found who will accept the abuse and its attendant risks. So it is not necessary to pay more, to redefine roles and responsibilities, or to enter into contractual relationships with independent nursing professionals. Nope, there's always another sucker out there who's worried about paying the rent, educating the children, and helping out the grandparents, and so who will drive 200 miles to make home visits to ten patients in one day, or work back-to-back double shifts day after day, or accept a low wage simply because it is offered, and it is a job.

Contrast this with another luncheon meeting last year, with the owners of another large company eager to hire me away from my previous employer. Never mind that the honchos didn't seem to have a job in mind that they wanted me to do, and seemed more eager to undercut my old boss by decimating his team than to build a quality operation of their own, but note their comment in passing that they simply were unable to recruit Physical Therapists. "They all have their own companies," lamented the honchos, "and when we have to contract with them we don't have the control that we would with our own employees. They tell us who they will see and who they won't, and they are considerably more expensive than our own personnel would be."

Hats off to our colleagues in Physical Therapy! They know their own worth, and have assumed control of their own practice. Many are personal friends, and I know they see patients on weekends, do paperwork at night, and drop what they're doing and head off to evaluate a new, high risk patient on a moment's notice . . . hard work, and less-then-ideal circumstances. But done on the therapists' terms, with the therapists having the power to accept or decline referrals, and to set their prices. Certainly if they are not competitive or not readily available their practices will suffer, but the decisions and control are theirs.

And then there is the nurse, often (albeit not always) with a broader scope of responsibility, more education, and more experience, who makes less money and is told, "You're on call because your employer determined you would be, you must accept this assignment, no matter if it's excessive, unsafe, you're tired, or if doing so would put you, us, and the patient at risk." The nurse grumbles, but acquiesces.

My word to my colleagues is, "You must stop." You are compromising your professionalism and integrity, you are placing yourself and those in your charge at risk, and you are enabling healthcare employers to continue to underpay and overwork nurses. You are enabling them to say, "We don't contract with nurses. We contract only with therapists." You are giving away your power. You are modeling passivity and a herd mentality for your children, despite the excellence of your professional skill.

Stop. When you tell that employer that you will drive fifty miles to see five patients, but not 200 to see ten, and stand your ground, that employer can choose between losing the revenue from all ten patients, if you walk away, or losing the revenue from only five, in which case there would be work left over for your nurse colleagues. Is this less lucrative for your employer? You bet! The CEO may have to give up one of his Mercedes or forego one of his luxury vacations . . . and it will be the fault of professional nurses who insisted on reasonable workloads and fair compensation. Reasonable workloads and fair compensation will not destroy the employer, no matter how much the employer wants everyone to believe otherwise. But insisting on these will constitute a much-needed step towards reducing that huge gulf between America's richest and poorest citizens.

Such a deal, my fellow nurses: More money, more power and control over your own practice, better patient care, a sane life, the opportunity to work independently if you wish, and doing your patriotic duty to boot, by taking some of the fat out of the executives and stockholders' wallets and seeing that it is reinvested in workers and in real work.

But it takes some courage: Courage to walk away with smiles and handshakes instead of employment contracts. Our colleagues in Wisconsin are talking, saying an unequivocal "No" to unilateral, top-down determination of their salaries, working conditions, and benefits, and insisting on having a respected place at the table, with a voice, a vote, and self-determination. Our colleagues in Physical Therapy have said "yes" to being their own bosses, and "no" to dictatorial employers. Historically it has been the workers who have prevailed to gain reasonable workweeks, benefits, safe condtions, fair compensation, and a measure of security. Nurses, no matter how scary the prospect and no matter how uncertain the times, whether we bargain collectively, or stand alone, it is time to do the same. It is time to explain what we offer and its price, to insist on a place at the table, rather than on the menu, and to leave with our values and dignity intact, knowing that regardless of the outcome,

We'll Talk Later.