Nursing, Unions, and the State of Healthcare Pt. I

Hello, and welcome to Live Like the World Is Dying, your podcast for what feels like the end times. I'm your host today, Inman Arowan, and today we are having a conversation that I'm really excited about. And maybe I think either there's going to be a lot of people who are really excited to hear about it or no one will care. But I think it's like the confirmation bias thing of literally half my peer group and friend group are all people who work in healthcare. And I'm a funny odd duck out where I'm like, I don't want to work in healthcare. I want to shout into a microphone for a living. But we're going to talk about nursing, nursing unions, and kind of like the state of healthcare and like hospitals and like especially like emergency rooms and stuff. Depending on when this episode comes out, you might be able to preorder our new book, Aspiration Risk, which also goes into like horrifying detail about like the state of healthcare. But before we get to all that, we are a proud member of the Channel Zero network of anarchist podcasts, and here's a jingle from another show on the network.

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And you, Frodo, must go to Brokeback Mount Doom and destroy the Ring.

Should we not take it to a king?

Bah, fuck kings, Frodo! But make sure that when you rest at night that you do so well apart, for the Ring does strange things to fools' hearts.

I don't think Gandalf meant for us to come this way.

Gandalf didn't mean for a lot of things to happen, Sam, but they did.

I only wished to catch a fish, so juicy sweet.

Is it madness to feel this precious?

Why on earth would you want to go back out to Brokeback Mount Doom?

You've got responsibilities here now, Sam.

I only want to help you, Mr. Frodo.

Yet a day will come when he will grow jealous And he will try to take your preciousness from you.

This is a real one-shot thing we got going here, Sam. When the ring is gone, what will become of us?

This month on Strangers, we have Brokeback Mount Doom by Inman Narowin. Brokeback Mount Doom is a short little radio play performed by Shakespeare Theatre that reimagines Lord of the Rings and Brokeback Mountain smashed together in glorious harmony, as we all always imagined it. Read or listen at tangledwilderness.org or wherever you get podcasts. And we're back. Thanks so much for coming on the show today and for doing the work that you do. Could you introduce yourself with your name, pronouns, and I guess like a little bit about Your background in nursing and unions.

Hi, Inman. Thank you so much for having me, my friend. I am Dominique. I am a registered nurse. I've been that since I was 27, 26. So it's been about 9 years since I became a nurse, right around the time— no, I think I was a nurse for 1 year. on a floor. It was an orthopedic floor/neurology floor, so a lot of bone surgery patients, and then like stroke, seizure, anything to do with like the brain and having some sort of abnormality was the other side of the unit. That's what— that's the first job that I got. But about a year into that, there was a vote to whether or not the nurses at that hospital wanted to unionize, and I voted yes. And I've been involved with my union ever since.

Hell yeah. Hell yeah. Listeners, Dominique's voice also might sound familiar from such fun audio feature cast recordings as Frodo from Brokeback Mountain, because Dominique is part of the Shakesqueer Collective. And I just need to plug that because I love— we've been performing together on stage for like, Like 8 years or something.

Something like that.

At this point. Yeah, yeah, yeah. And I just love it so much. And that's actually why I've called you here, is to gush over how much I love performing with you on this podcast.

Yeah, I mean, I think that Shakespeare has been a lifesaver in so many ways. Creative community bliss, for sure.

Hell yeah, love that. But unfortunately, that is not what we're here to talk about today, unless we want to do a deep dive back into Romeo and Juliet, which maybe we'll get there.

The thing that I will say, because there is a connection, I think, between the two is, so yeah, I became a nurse like 2017, was a nurse for a few years, then the pandemic came, and I was working on the COVID unit. I moved to the ICU around that time, and in the ICU, every patient essentially had COVID and every patient, you know, was just on death's door. It was very stressful. I lost a lot of patients. It was obviously a horrible time for everyone during the pandemic, but being a nurse during that time in the epicenter of everything was extremely mentally challenging with regards to our mental health. And I didn't go out because I was afraid that You know, I would maybe get somebody sick. So I was really isolated at home, just going to work and then coming home. But coming out of that around 2022, I really wanted to figure out a way to get back into the world. And so I felt kind of brave and was sick of being so scared and alone. And so I tried out for this play. And it was so healing to be doing something so beautiful and collaborative. And it had nothing to do with the hospital and had nothing to do with nursing, but it was, I mean, Romeo and Juliet obviously has so many beautiful monologues that are reflecting on what death is. And so I think that my being a part of that not only brought me out of my little foxhole and back into the world of community, but it also gave me a space to think about what I had seen and process it a little bit, considering that these, monologues were written several hundred years ago, and it's just such a part of being a person is seeing death and, you know, meditating on it. And so I think Shakespeare really helped me out of my darkest period of being a nurse, and I'm forever grateful for that.

Oh, hell yeah. I have known this for a long time, and it makes me tearful every time I hear about it. And boy, are some other things maybe going to make us tearful today, which is the— which is— that is a horrible segue. Thank you for that. That's a very sweet reflection. I'm not going to make a joke out of it.

I mean, you can. I feel like nurses actually have a really dark sense of humor, and so if you wanted to, you could.

Wonderful. We're going to have some grim segues coming up.

Go for it.

So the first thing I guess that I want to talk about is I hear my nurse friends all the time talk about how shitty their workplaces are, both from like a provider perspective and from a like, a patient perspective and, like, a care perspective. And which— God, which one do I want to start with? Dominique, what's up with hospitals and art? Like, why are they kind of— what's up with them? What's up with hospitals?

I mean—

Why are they bad?

Yeah, no, this is important. It's important to zoom out. I feel like when I talk to fellow healthcare workers, I'm always sort of assessing what their understanding of why is it bad is. I think that some people are like, I have a shitty coworker or several shitty coworkers. I work with a doctor who doesn't respect us, or, you know, the patient population that I see all the time, they just like are horrible to us nurses and belligerent and combative and things like that. And it's really like down to this individual thing. But I think that when you zoom out a little bit and see that your coworkers are in the same situation that you are, which is purposefully understaffed in order to save money for the hospital company at large, I think then you can sort of see that everyone is doing their best in a bad situation, and we don't have as much patience and respect to give, and we don't have enough for ourselves, let alone anyone else. And so— That leads to burnout, and burnout leads to not, you know, not doing the great job that you're capable of. Same thing with doctors. I mean, if you look at anyone in the care industry, healthcare industry, we're all being asked to do more with less, not only less resources, but less time. And so thinking about that, like, it's no good for anyone, but why are we set up like that? It's not because of, I don't have a hard day because of the tech. that I'm working with, or because a doctor is, you know, being short with me. I'm having a hard day because I work in a hospital system that is essentially a very large company, one of only really a few companies that own most of the hospitals in the country at this point. And their number one priority is making money, and they don't really care about patient safety like they should, and they don't— they certainly don't care about the workers.

Yeah, really jumping into the hospitals are businesses, which is a terrifying concept. I'm sure most listeners know that. But am I— without kind of naming the hospital that you used to work for, it recently switched at some point from being like a not-for-profit to for-profit hospital, right?

Yes, yes. I mean, if you look at the history of hospitals going back to them, like, The— them being built and having these patients and needing the nurses and the staff to— the staff at the bedside to care for them. All of that is fairly young in human history. Like, really the last 100 years, and then really booming in the '50s and '60s. And then in the '90s— And in those earlier years, just like you said, like, they were run by the church. They were run by, like, the community. And in the '90s, late '80s, they started to be bought by these larger companies that maybe at the person at the helm who was running the company was a clinician, like a doctor or a nurse or someone with a healthcare background, medical background, but oftentimes they're not. And so I feel like that really is where we saw the shift in priority of like, now we're not trying to do the best for this patient who needs help and who needs care and time and attention and education on what their disease is, education on what the medications are doing, doing, even just the emotional support that nurses want to give their patients when they're— when the patient is anxious, when the patient is scared, you know, when they're crying or when they're confused about what's going on. That simple reassurance and hand— like holding of your hand and I'll sit here with you while you're going through this hard moment. We don't even have time for that anymore. It's all just, you know, we're pushed to the brink of crisis every shift and that's why it's so hard to be a nurse these days. And that's, you know, that necessitated unions getting involved and workers getting involved in their unions, and then them trying to take— us trying to take some of that power back.

Yeah. What would you say, I guess, Laura, like the— like what are the key dangers that nurses face in the workplace right now?

That the nurses face or the patients face or both?

Uh, let's go with nurses.

Okay. I think that on a psychological level, Something does happen to you when you get this training on how to take care of somebody, and then day in and day out you work your hardest and you still can't do it. I think that there's a very intense shame and guilt and self-blaming that happens. And, you know, maybe it's a little bit every day, but then eventually I think the end result of that without any intervention is that These people, these nurses who wanted to do this work and found real honor in it, got through school, you know, they're smart enough, they're hardworking enough, but they feel like they're not cut out for this work. And so then they leave the profession altogether. And that's one less nurse that we have who would've been great had they been supported, had they had just the tools to do their job well. So I think that's one of the things, it's just like that you lose a career, you lose your livelihood, you lose your faith in this as a profession that you can be a part of. And I just think that that's not true, and it breaks my heart all the time when I see it. And I think that's one of the risks. Another one is if, you know, God forbid something were to happen to a patient, and it was on your shift, it was your patient, the hospital could throw you under the bus, you know, and blame the individual without naming Or bringing up the systemic issues that we are facing, that we're trying to do this work with very little support. And the hospital, I think, you know, would throw a worker under the bus instead of changing its ways. And then that again could like affect your license. The licenses are accredited by state. And so if you lose your license, then that's all those years of school and training out the window. And also, yeah, what are you gonna do?

Yeah. From, I guess, a nurse's perspective in a working environment, are you— I feel like it's like what a reasonable person might think someone's bigger concern is, is providing good enough patient care. But how does that balance with fear of reprisal or fear of just from the company that you work for, or even from like, being sued or things like— it's like, what is the tension like, I guess, of the desire to provide care and any kind of fear of any kind of reprisal either from managers, the company that you work for, or litigation?

I think there's a couple different pathways there. I've seen nurses put their head down and just try and not be seen and do the work without Being seen as any sort of issue or threat. So like, you know, not saying something, not speaking up, I think that's definitely a pathway some people take. I've seen people then speak up on an individual level. Maybe they'll try and have a meeting with their boss, or, you know, try and appease or appeal to their boss's like conscience, and like, hey, this isn't right. I'm being affected in this way. And usually that is met with a very reassuring, thank you for bringing this up, and then no real change has to happen from the boss's perspective because it's just one person. And if that person doesn't want to deal with that anymore, then they'll just leave, they'll quit, they'll get another nursing job somewhere else. And then the third option is getting together with collective action and realizing as a group that we're all feeling this way, and this isn't an individual experience. This isn't an individual experience of both being so devastated day in and day out that, like, we're doing— we're not doing enough for our patients that we know what we're capable of. And then that anger really shifting to, like, we could find an answer ourselves. We don't have to wait for somebody to come and do this. We don't have to wait for a benevolent boss or, like, some other nurse to come and fix this or a doctor to come and fix this. I feel like I that needs to go out the window. Doctors aren't gonna save us. And so that third option is union, forming a union, getting involved in the union, and doing things collectively to make that change.

Hell yeah. And I guess on the flip side of some of this, which I guess like, what are like some of the dangers that patients face from like, I don't know how to phrase this, from nurses, what are some of the dangers that patients face from nurses or other— other hospital workers not having what they need, we'll say.

Yeah, yeah. I think that it's such a range. We want to prevent med errors. We want to prevent bedsores. We want to give every patient the level of hygiene that they deserve, especially if they have wounds or if they are just wanting that basic dignity of being clean. You know, if I feel like bed baths are so important in a hospital setting and they just go out the window when you're dealing with crisis after crisis. They deserve to, you know, if they need help eating their meals, we should be able to help give them food. You know, if they can't lift the spoon themselves, they deserve to have proper education on what their disease is and what their medications are and who their doctor is and why are they— I feel like one of the biggest questions that I, get asked is, why am I still here? Like, what am I waiting on? You know? And it's like, I, as the nurse and the doctor, you know, we talked amongst ourselves and said, you know, we need to trial this medication. We need to see how it affects their blood pressure. We need to, you know, get this result back of the scan that they just took. And then if all of that's clear, then maybe they're good to go. But who told the patient that? You know?

Totally.

And I think, When everybody's busy, everyone kind of assumes that someone does it. So I think that, yeah, it's a real range. It can be like, you know, on one end, education and emotional support, and on the other end, we need to be able to pay attention and have the attention, you know, we need to be able to have enough attention to give to catch things if something were to go wrong with their status. And what I mean by that is like, if someone has a sudden heart attack while they're hospitalized or a stroke, we need to be able to catch those things. If they're all of a sudden confused and we check their labs and they have really low sodium, we need to be able to catch those things. You know, if they're saying they have chest pain and it's actually like, we were thinking maybe heart attack, but maybe it's something to do with indigestion or like trouble breathing. You know, if we can't catch these things early, they will snowball. And they'll get worse and then it'll be harder to come back from that. And I think that's every nurse's worst nightmare is not catching a thing, but you're being pulled in so many directions from having so many patients and you can't, you know, if you can't delegate to anyone, 'cause no one's there to share, help share this, then it all just becomes too much. And we see it on the patients' faces. We see that they feel guilty asking us for water. You know, or for like help eating or asking us to help dial the phone so that they can call their children, you know, so they can tell them how they're doing or that they need a ride or whatever. They're very understanding, but it is hard. It is hard to be a nurse under these conditions.

Yeah, I feel like the— it's like a lot of the complaints that I hear people talk about or that maybe would love to get broken down a little bit or like, I feel like by the buds in the news or whatever talk a lot about like, patient-provider ratios, especially like, in emergency departments, like, bed capacity. And I guess like, the big one that I hear people talk about is like, ratios. Like, what does that mean? And like, how— yeah. What does that mean, and how can ratios be dangerous or unsafe? That's like, what I hear a lot of people talk about is like—

Yeah.

unsafe ratios.

Unsafe ratios. I feel like a good analogy is classroom sizes for teachers. I know the teachers union talks a lot about how many kids they have in their classroom, saying basically when you— there is a tipping point where now it is really, really difficult to have control of the class, be able to teach everyone, and it's just unmanageable. You still do it because those teachers are You know, dedicated, fabulous hard workers go above and beyond. And I think that it's really similar in nursing. We still do it, but we know that we're not doing our best. We're not giving these patients the best that they deserve. And so, lower ratios means fewer patients per nurse for each of their 12-hour shift assignment. So, when I come on to the floor that I used to work on, I was told when I got hired that I would have 5 patients. Is that

a lot or a little?

That, for that floor is, well, I mean, as a new grad, I had no idea. As a new grad, I was just like, okay, great. That sounds like the right amount. Why would they give me any more or less than what is correct? What I found out though is that the real ratio for that floor was 6. And immediately I started getting 6. When you look at other places in the country, that have really strong and very established unions for the nurses, they have set ratios. And for the floor that I was on, ortho-neuro, that ratio in those places, same unit, same kind of patients, same nursing degree that I had, but they have worked it so that they only get 4 patients for that kind of floor. And so what we found, 'cause it's been about 20 years since the ratio law passed in California, making sure— and that's a law, you know, a law that the nurses union wrote and fought for and won. For every additional patient more than what those California ratios are saying, the mortality rate increases by 7%. So thinking about the floor—

That's a lot.

Yeah. So thinking about 6 patients on a floor where there should be 4.

Yeah.

Should be, meaning it's this, They do it for over here and they've done the research. We've had 20 years of research. That's 14% increase in mortality risk just being in a different state.

Dang.

I think about that a lot.

Yeah. Yeah. And it's like, I don't know, hearing people especially who work in like emergency departments talk about like, it's like kind of like bed capacity. And there's this like, I feel like I wanna talk about this thing that maybe everyone knows about, but it's like, I think a very present problem in healthcare. like, especially in like emergency departments sort of get used for filling a gap in healthcare that doesn't really exist for a lot of people.

Yeah. I mean, just to speak on this a little bit. So my work with the nurses union is, you know, within a hospital system that is a corporation. Yeah. And that's the state of most hospitals. So that's sort of like my focus, my work experience.

Totally.

But doing this has really opened my eyes to how this industry, this industry of healthcare from, from top to bottom, is about money, making money for some few people at the expense of our, our sick and our elderly. And really, like what you said about emergency rooms being, um, you know, the place where other, maybe other entities could have helped people before they got as sick as they are, and now they're in this health crisis. This is talking about preventative care, you know, like do people who have insurance go to the doctor, to their primary care every year? And even if you have insurance, does that insurance cover all of your healthcare needs, or do you end up paying things out of pocket still? I mean, it boggles the mind how the wealth in this country is spent. We pay so much for healthcare, more than anyone else really, when you think about like developed countries, and we get such shitty healthcare in return.

It's a fucking joke. It's a joke.

And so, I mean, what do we pay? Like on average, 11% of our salaries towards this thing that doesn't even cover everything. And God forbid we get some larger illness. I mean, and what happens when somebody in our lives gets a larger illness? Have to start a GoFundMe.

Yeah. Or go into incalculable medical debt.

Yeah.

Or both.

Or both.

Yeah. Yeah. And maybe just like thinking about like how emergency rooms kind of get used for like just a catch-all for like people who don't have other options of like places to seek healthcare for like things that emergency departments aren't really designed to do, which is chronic long-term care. Yeah.

Really.

And it's like hearing about, like, it's like, okay, well, like, the bed capacity in the emergency department is like suddenly at a critical level because there are people coming in and they can't go anywhere.

Yeah. I mean, I think that this is a funny thing within union world. You know, we want ratios. One of the big pushes that we're doing and we hope to see gain traction in the next few years is getting a ratio law for Arizona.

Hmm.

So a law that says to the hospitals, you have to have this many patients maximum. And that would depend on the unit. You know, some units it would be 4 to 1, 4 patients, 1 nurse. Some of them 3 to 1, some of them 2 to 1, some of them 1 to 1. And it would depend on, yeah, what kind of unit you're on, how sick the patients are. So like the ICUs would be 2 or 1. Max, et cetera. And in the emergency room, it would be 4 to 1. And then if you have like an emergently critical patient that's going from the emergency room to the ICU, if you have a patient like that, then you get 2 to 1 ratio as well. Because it's an ICU patient, those same rules should apply, right? Logically, they don't here. Like if you have, if you have an ICU patient that's, you know, on a ventilator and like you have to be by the bedside, like every moment, you, you have 3 other patients. You know, hopefully they are well enough that they don't need your constant attention too. But anyway, so thinking about that, I feel like something that emergency room nurses will ask me is, well, this ratio law, won't it hurt us because now the floor, all the floor units are gonna get this nice limit, this cap on how many patients they can take, and isn't that just gonna like clog us up?

Yeah.

And so that sort of introduces I guess an idea of where, where do we actually have limitations in resources? Because if we had better working conditions, more nurses would come to work. And we saw that happen in California. Nurses— there's a waiting list if you want to work in California. It's difficult to work there because so many people want to work there. People work in California as a nurse and then live in other parts of the country because the working conditions are so good there. So thinking about it, if we were to make the working conditions better, then more nurses would come. And if we had more nurses, we would have— then we would have the capacity to take on fewer patients per person because everyone would want to come. You wouldn't be dog-dead tired after every shift. You know what I mean? Like, it would— you would be able to live your life outside of work a little bit more. You would be able to have a lunch break. You know, and, and not just be chronically exhausted from just hustling 1,000% every moment of your 12-hour shift. Um, yeah, so, so that's, I think, something that is an interesting, interesting question. Like, what are the actual resources that we have that we haven't been able to tap into because, because of the way things are now? So I think one of them is there are more nurses out there who would work in hospitals. Mm-hmm. If the working conditions were better. And so making the conditions better, you— if you build it, they will come. But another thing is there, you know, the— this idea of like the limit of beds. Um, I will say that in my almost decade of, of working, um, there have been multiple closing of units. So multiple units within the hospital that used to be up and running and have staff and have patients, and now it's closing down. And then they merge units. And so— there are empty beds, at least in this particular instance, there are empty beds and there are empty units that could be filled, but they're empty because they don't want to staff them. And so I guess that's the question, you know, like, did we run out of beds truly, or do we not have the nurses, um, to cover those beds?

Yeah.

And if we don't have the nurses, it's not as if those nurses don't exist. Yeah, they quit a year ago and they're at home, or they got a job not working in a hospital, doing something else with their license. You know, yeah, resource scarcity, it's a funny thing. Or the idea of it and what it does to us.

Yeah, yeah. It's also funny because it's like even from the angle of nurses having better working conditions that contribute to better care, it's like the larger problem is that there's just these huge structural issues with how the healthcare system is just inherently set up.

Yeah.

Um, but—

I, I actually, before I was a nurse, I was in nursing school, I had 2 real moments of existential crisis. One was when I was having a hard time, um, oh gosh, what class was it? I think it was pharmacology. I was having a hard time with all of the different meds, and I was like, oh, I'll never get this. Um, so I, you know, I had that moment of like, am I cut out for this? And then I decided I just needed to like buckle down and study harder, and I got you know, I got good grades, it was fine. The other moment where I was like, can I do this, was really reflecting on how this industry is one that harms people because of the way that it's structured. It forgets people. It leaves them on the wayside. I think a lot about, you know, people with mental health issues. And obviously we talked about it a little bit, but like the state of insurance and primary care It's just not robust enough to take care of everybody. It's not accessible enough. It's not easy enough to figure out. And so I had to think like, I'm gonna be a part of that. Can I do it morally, be a part of that? Or should I dedicate my life into something else that might be building elsewhere a different structure, you know? I kind of had to play with that idea. In the end, I decided that I did wanna be a nurse. I did wanna work in hospitals, but I made a promise to myself that I would spend my time off the clock trying to make it better. Mm-hmm. And I didn't really define what that would be, but being a part of the union is— it does bring me peace. It really prevents me from burning out, I would say, just because I know even when I'm having a very difficult day because there's not enough resources, that I'm actively working in my life outside of the hospital walls. I'm actively working to try and change things for the better. And that I think because this system is so big and it already exists, yeah, I think that changing it is a good start.

Hell yeah. I guess like to talk a little bit more about unions, like what are other big things that unions are asking for besides ratios?

This particular nurses union is very progressive, I would say. We really—

So y'all are doing better than other nursing unions?

Well, I'm with the union, you know, National Nurses Organizing Committee. And so this is a union, it's huge all over the country, but it's only bedside nurses in it. So we're not a wall-to-wall union where nurses can be represented with the same union that's like, you know, the techs, the RTs, the people who do laundry and cafeteria workers and all of that.

Is that called like a mixed house?

A mixed house. I've heard wall-to-wall. I think there's advantages to both, honestly. My hope is that, you know, in terms of hospital facilities, that everyone just organizes their nurses within NU and everyone else joins their local that would cover everyone else, and then we can all be represented. But with the nurses union only being nurses, I feel like the advantage is that our issues are really, really razor sharp.

Totally.

Because, I mean, everybody's work is complex. I don't want to diminish that, but I think it's helpful. Yeah. But what are the other things besides ratios? I feel like getting a lunch break is such a simple thing. But so the real answer—

Do y'all not get lunch breaks?

Well, we get, so we get 12.5 hours. Like we start at 7 and we end at 7:30. And half an hour gets taken out of our paycheck, of our pay every shift, because they're assuming that we are taking a lunch break. But a lunch break, 30 minutes, there's no one to come take care of your patients. And so, you kind of ask your neighbor nurse who might have 6 patients of their own, can you take my 6 too? Yeah. And if someone hits the call light, or if, you know, someone has a question or a phone call or whatever, can— and needs meds passed, can you just do it? And then the nurse would say, sure. And because that is a hard thing to ask of a neighbor nurse, nurses often will just take 10 minutes or 5 minutes or, and then just shove food in their mouth and then come back. Or maybe they will, you know, try and take that 30-minute break, but then the neighbor nurse knocks on the door and it's like, hey, you have a phone call from the patient's family. They have a question about blah, blah, blah. And then you're chewing and you're taking a phone call and that's, you're technically still working.

Mm-hmm.

You know, so the big ask is, or demand rather, is 30 minutes uninterrupted duty-free lunch. And the way that we figure that can really happen in a way that doesn't put more work onto another nurse who already has an assignment is to bring in a nurse who doesn't have any patients of their own, but they come, they clock in, and they just are responsible for your patients during your lunch break. And then they go to the neighbor nurse and they say, okay, it's your turn. Give me a quick rundown on your patients. What do I need to know? And then go eat and give me your phone and, or, you know, your work phone and I'll be here. And so it's called a break relief nurse and it gives a real peace of mind to be able to just eat and your patients are, they're okay.

I'm having this like kind of incredulous moment where it's hard for me to believe that this— that that's just not what the standard is already. Because I'm like, that's the only reasonable way to set up a system like that is to have floaters who are just there to help and support and don't have dedicated patients so people can have breaks. Like, that's—

yeah,

like swings. You know,

I think

I'm like, fucking kitchens have swings, you know?

It's a great idea.

Um, I'm glad that they have swings. They should. Everyone should. You know, I think that this also speaks to like, you know, charge nurses. I was a charge nurse on my old unit. Charge nurses shouldn't have their own patient assignment.

No, they're in charge. They're like managing the other nurses. Yeah. Why do they have patients? What do you mean they have patients?

So when I was a charge nurse—

My brain's breaking.

I know it's hard.

It's not what I thought it is.

It's hard. So I became a charge nurse at like 2 years on my old floor. And it was funny because they're like, oh, Dominique, you're so good. You're such a good nurse. We really think that you would be great at this role. And I mean, like, I think I am a good nurse, but also they burned out all the charge nurses and they were asking this person with 2 years of experience to run the unit.

Trick the next fucking—

I know, with all this reassurance. And so I said no multiple times and then I said yes eventually. And I did it for a year and a half, almost 2 years. before I ended up going to the ICU where I have not been a charge nurse there. 'Cause, you know, the charge nurses on my ICU floor are like 20+ years experience, as it should be.

Totally.

Lots of experience to, you know, be able to handle any situation. So I went as a charge nurse, they started giving me patients and I was like, I was told that as a charge nurse, I don't take patients. I'm helping everyone and I'm running the floor and I'm, you know, like there for emergencies and I'm there to help the new grads and They were like—

yeah.

And so they were like, we'll just give you one patient. It'll be a really easy patient.

What patient in the ICU is easy?

Oh no, my old floor, my old floor. But still, so then it was like a real slow frog in the boiling water thing. One patient, then 2, then 3, then 4. And then all of a sudden you're charge nurse with 6 patients and you have to make that call of this nurse needs me. They are— they've never done this specific bedside procedure before. They don't know exactly like the, the, all the stuff to bring to the bedside, the equipment. They, you know, they, they are asking me as the charge nurse, can you just be with me and help me with this procedure that's happening right now?

Mm-hmm.

And then on the other hand, I have my own patient who, you know, maybe they have some sort of need, um, that it's not like life or death, but you should do it now, you know. And so there's all of these prioritization calls that we have to make. And it's always just who do you choose? Who is deserving of your limited attention? And it's really messed up to make us make those calls.

Yeah.

Yeah. It does something to you where you're just constantly assessing and deciding who gets care in that moment.

Yeah.

It's not right.

No.

They both need help.

Yeah. And no one should be in this situation having to like, Decide that. Yeah, like care should be plentiful.

Plentiful. But I mean, I will say, I will say, I'm, I'm just constantly in awe of how hardworking my coworkers are, how smart they are, how giving they are. And I mean, that, that skill of prioritization, you know, nurses with 5, 10, 15, 20 years experience, you do get better at like you know, this can be delegated, that can— we have, you know, that can wait, this has to be now, um, we need to call the doctor and get them bedside for this, they need to see what's going on, um, and they do it so calmly.

Yeah.

And I think that's what also makes it such a funny situation overall is here's a group of people, they, they want to help.

Yeah.

They are really invested in this work, and they want to go They're able to go above and beyond. They do it all the time. And I feel like it's like you're kind of taking— these hospitals are taking advantage of people who are very giving.

Yeah.

And so I feel like my job as a union leader is to really look a nurse in the eye and ask, where is your line in the sand?

Yeah.

For when, when are you going to not take it anymore?

Yeah.

You know, because I think that a lot of these nurses, they're self-sacrificing until a certain point. Yeah. And that point sometimes is reached and then they quit. But what I'm trying to do is see where that point is and then they'll get involved in trying to change the system.

Yeah. I imagine it's so difficult as a new nurse, like someone who maybe like, I mean, people have so many reasons for picking a career or like a job. And for some people, I'm sure it's just a job. Maybe they don't really care. Yeah. I imagine a lot of people who are new nurses are people who are, like, excited to give care. They're there to give care and probably assume that the institutions that they work for, these care facilities, care about them or care about actually providing care. And it must be— it must— I imagine, like, being a union, like, like doing union organizing, trying to get people to who, like— To break whatever spell there is for people over that, like, the union has the rest of it, like, whatever, you know? It's like, to make change, to draw a line in the sand must be really hard. Which, yeah, I want to hear your reaction. And maybe as like part of that question is like, which that wasn't really a question, is like, what is talking to people? What is talking to nurses about union stuff? Yeah. Like, how does that go? Are people apprehensive, skeptical, weirdly loyal to an institution that probably doesn't care about them? I'm obviously biased. Yeah. What is it like talking to people?

I guess the first thing to say is that nursing is a field where it's really diverse.

Totally.

It is all walks of life, class, race, you know, culture, personality type. Like, it's, it's a very diverse group.

Yeah.

Um, and so, but we do have the one thing in common where we, we got into this work. I feel like the top 2 reasons, um, number one, to help people, and number two, because it is stable work and you will always be able to find a job. Recession come recession, come moving, come whatever.

That's why everyone I know has become nurses, is they're like, it's literally the only stable financial situation where we live.

Yeah. Yeah, yeah. And there's, there's a lot of merit to that, you know. So, so breaking those down though, you're, you're caring or, or you're, you're putting your body into this and your heart and your soul into this because, um, of your love for your community or your, your self-respect or both, you know, like trying to set yourself up for success financially and, and with job security. And so when I'm talking to nurses, because it is such a diverse group, the first thing that I have to do is really ask questions on who they are, why they became a nurse, and what issues are making them the most upset.

Yeah,

some nurses it's about the patient care. Most of them, I think it's about the patient care. Very few, I think, that I interact with, it's only about money and, and like the res— you know, disrespect towards nurses. And yeah, most people, it's some sort of combination of both.

We saw that with the the, um, Teamsters for like the— are the Teamsters the same people who run trains? Those are the Teamsters, right?

That I don't know for sure.

Or is it just rail workers? I don't remember. With whatever the— when the rail workers were striking and when UPS was striking, it's like their complaints were actually very specifically not about money. I mean, the UPS one was like the full-time workers were like, no, it's fucked up that you won't like hire part-time give part-time workers, like, real money or real benefits. And we're not the ones who need these pay bumps. And the same with the rail workers. They were like, it's not about pay bumps. It's about safety.

Yeah.

Yeah. But sorry, go ahead.

I mean, I think that this is— I think it's probably hard for people who run corporations to understand that morality, that something could just be not totally be about money.

Yeah. Yeah, yeah.

I think it is actually like hard to compute.

They're like, what do you mean? I'm throwing bags of money at you.

Yeah, why aren't you stopping your complaining? But yeah, I think that's the first thing is really just to shut up and listen. Yeah, who, who are these individuals? You know, what, what makes them— what brings them to this work? And what are the, um, issues that they see that is like making them not like this work? And so once I sort of understand that, I think that the conversation then can turn to, do you realize it could be different? Like, somebody is making these decisions. This isn't— these working conditions are not the word of God.

Yeah.

You know, it's a person making these calls who isn't prioritizing the patient safety like you would think, and who isn't prioritizing keeping you here. They don't care if we quit. In fact, you know, wouldn't it be— if I, if I were running a company, I think it would be more advantageous to have a bunch of people who are new because they're not invested in making the, making the facility good. You know, like institutional knowledge really does help run a unit. If you've had a charge nurse there or a floor nurse there even who has been there for, for 20 years, they know what is up. They know this patient population. They know these doctors. They know who to call, you know, who's running this or that or the other right now, because they've just seen it time and time again, so they've become experts. So yeah, if people just keep quitting, they don't get that institutional knowledge, and then they don't share that institutional knowledge, and you have a bunch of people who aren't very invested because they're like, well, if I don't like it, I'll just leave.

Yeah, yeah.

But the organizing conversation, I think, in a weird way, I feel like a big part of it too is if I— how do I say this? It's already, I think, important to me to be a good nurse, but I'm just very aware that I wouldn't have very much influence if I didn't have respect.

Mm-hmm.

And so what I really like about union work is it's like, I take this work really seriously. I'm very professional, you know, to my patients, and I'm very professional at work. I do try and help, and I I want to do a good job, and I want to do my charting right, and I want to I want to do everything just as perfect as can be. And that's as someone who sees myself as kind of an artsy fartsy person. This like new this other side of me that's like more type A came out with nursing that I really like. You know because I I like being helpful, and I like being like I enjoy being good at my job, and I'm always you know trying to read more about. about disease processes and like read scientific journals and talk to these more expert nurses about how they would do something. And so all I'm trying to say is that like if you're trying to have any kind of influence as a union leader, you do have to be good at your job. That's sort of like a parenthetical thing that I feel like more people should know is you have to be really— you have to be good, you know? Because otherwise people aren't going to really respect what you have to say about making things different or better in the workplace.

Yeah. Yeah. I understand that, and I'm also like, that sucks. You know? Because it's not— it's like, I don't know, a lot of people are probably going to be good at their jobs, but it's like, I don't know, a lot of people are mediocre at their jobs, and they still absolutely deserve to get listened to about labor safety and stuff like that.

I don't even think it's about medi— because I think with mediocrity, I would even put that into there.

Oh, okay. Cool.

Um, I think I put a little bit of extra pressure on myself to be really good. Um, but I guess I would say that within nursing, there's a very small percentage of people who are actually super bad at it.

I'm sure. It's like there's so much like school and training and like—

Yeah, yeah, yeah. And, and those, those folks, you know, aren't, are never the union leaders ever.

Yeah. Yeah. What is like, what is like a common line in the sand that people give when you ask them that?

Pre-COVID or post?

Post.

Post.

Yeah. Or whatever. It's like pre-COVID was almost 7 years ago.

I mean, it's, there was the world before COVID and there was, you know, nurse world after COVID.

Yeah.

Um, you know, I think it really depends on that person's understanding of the issue. For example, there is a nurse who I think is a brilliant union leader. And she kind of came that way from being a nursing graduate. And I think a lot of it is because she has a good understanding of the billionaire class running the world and that unions can be a very strong response to that and a democratic response to that in a world where democracy kind of is under question in this country right now. And so she, yeah, she's like, what, 24? Just turned 24. She has a really, really solid political framework. And something that I do see a lot with these younger nurses is they have, they don't have loyalty to the company, as sort of you were alluding to earlier with your question. They don't see the value in it.

Gen Z fucking hates BS.

They have a lot of audacity.

They hate it. I love it.

Audacity.

I

love it. I think that I have a lot of faith in the youth because of that. Yeah. And so, but I don't want to make a blanket statement because there are other younger nurses who I think if they are maybe the first in their family to go to college, if this is the most money that they've ever made before, if, you know, as a new nurse, or if this is the most— if they're like making more than their parents ever did, you know, like I think that there's a a very beautiful humility and gratitude that they just have as people. And it feels funny to try and shake that up. Yeah. Because it is wonderful to be humble and to have gratitude. But like, you can't have so much of that that you're willing to look the other way at these— at your patients who are suffering because of systemic issues that should be changed. And so I think that Yeah, for a lot of people, I do have to bring it back to the patients, what they see, what they wish they could do to make their patients' hospital stay better. And yeah, the other line in the sand is like, where is your self— like, especially when it comes to pay, you know, like groceries, gas, rent, it's all going up. And are we seeing that reflected in our pay stubs? And it's always better to ask those questions, have the person answer it. You know, instead of just talking at them. So yeah, I think that line in the sand, it just depends on who they are. It depends on if they have, in other aspects of their life, if they feel like they can and should challenge things. Sometimes the hardest people to organize and bring into this work are folks who come from some, you know, family structure where, like, their dad was the boss.

Totally.

And then their husband. is the boss.

Yeah.

And they don't have an area in their life where they, where they have a voice or they can dissent. And so I think though that's actually been really eye-opening for me to see really, again, this is a very diverse group and some people, they've just never really felt that self-realized power. And what's beautiful is seeing folks like that come into their power at work, And I can see, like, a light in their eyes change. And you know what I mean? And it's a beautiful thing.

Hell yeah. How do— I guess I'm trying to figure out how to talk about them. So it's like hospital admin?

Mm-hmm.

Like, what is the sort of, like, within, like— and especially it's like we're talking a lot about hospitals today. So it's like there's nurses, but it's like, who's kind of Who is your boss as a nurse? It's not doc—

No, it's not doctors.

It's not doctors.

No, doctors are our coworkers that direct the care.

Yeah, yeah, yeah, exactly.

But they're not our boss. Little quick side note. So my godmother was a nurse. She became a nurse in the '70s and had this story about when she was in nursing school, there was this nursing professor she had who was like kind of like a women's lib feminist person.

Oh, yeah.

And so this professor was like, if any of you stand up when a doctor comes in the room, or get out of an elevator when a doctor goes in there, or if they ask you for coffee and you go get it, you will fail this class. Oh my God. And I really love whoever that was. I wish I knew. But yeah, there was a— there was for a long time a weird culture where like the doctor was like some paternal overlord. And they obviously have more schooling. Like, I, you know, God, their resources of information and, you know, clinical knowledge, and they're the ones really calling the shots in a lot of ways. But nurses are the eyes and the ears. We're the ones that are like reporting everything, and we're there with the patients, and we're physically administering the meds. We're physically like doing a lot of the treatments and procedures that these patients need to stay alive. And so I feel like It's a collaborative coworker situation where we have a different set of skills. But our boss is actually, so we have a manager and then of the unit and then director and they oversee multiple units and then a CNO who is the chief nursing officer and they oversee the whole hospital nursing staff.

Are they a nurse or a midwife? They're all nurses. Okay, cool.

They're all nurses. Okay.

That's good at least.

With varying degrees of floor experience, I feel like. You know, there are some folks that they became managers later in their nursing career, and there are some who put in their year or two being a bedside nurse, and then they're like, I want to be a manager, I want to run things. And so they're making decisions maybe 20, 30 years into their career, and it's been decades since they've touched a patient, you know. And so I feel like that can lead to them being a little out of touch with especially how things have changed in healthcare for the, you know, for the worse. With regards to it being run by these larger companies, and decision-making up very high being made by people who are not clinically competent.

Yeah, yeah. So it's like, I guess this maybe sort of answers it, but it's like, who is the sort of, I guess, antagonist for a nursing union? And how does whatever that is usually react to hospitals, nurses wanting to unionize, or unions doing union stuff in the hospital? Yeah.

Who are the antagonists for nursing unions? I think it's ultimately the company themselves. And then that angst gets trickled down to our more direct managers and directors.

Thanks so much for listening. If you enjoyed this podcast, then please excuse this abrupt ending to this episode. It ended up being like a more than 2-hour-long conversation, and we really just had to split it up into 2 episodes. So tune in next week for a really awesome continuation of this conversation about mostly focusing on nursing unions and what a nursing strike looks like. If you enjoyed this podcast, you can also support it, and you can support it by supporting our publisher, Strangers in a Tangled Wilderness. And a great way that you can support us right now is by waiting for our next book to go to preorder. It is called Aspiration Risk, and we're gonna have an interview with the author up here in like 2 weeks, I think, from the time this is being recorded in November. We're really excited about this book, and this 2-week, uh, entreat into nursing is gonna lay a really good groundwork for, uh, this book, which is a memoir about sex work, healthcare, and doing street outreach work. You can also support Strangers by checking out our Patreon at patreon.com/strangersinentangledwilderness, where for a variety of tiers of support, you can get a whole bunch of different things. And I'm— Really just not gonna get into it today because I'm tired. And so I'm just gonna read this list of names and things and stuff that people have asked me to by signing up for our Patreon acknowledgment tier. This makes it sound like I don't like doing this. I love doing this. Thank you for getting me to say all these things. And I really love the creativity that people are having with it. And I'm like, what else can we put into the world. So someone— I was joking with someone about, I'm like, I don't know, I'm waiting for like someone to like put their call out on here. And I actually don't want that energy. Not that there aren't things worth calling out, but— and maybe, maybe y'all are doing that already and it's just gone over my head. I'm gonna, I'm gonna stop this right now. I'm so thrilled to thank these wonderful people, places, things, animals, fictional concepts, different organizations, and random stuff. Thank you, August Hope, Ghost Cats Eddie and Percy, Chuchali, Defending Tikunu, We Will Remember Flora Tristan, the Chattanooga Free Store, Santa Fe Food Not Bombs, Glenn, Please Fight Anti-Fatness, Arizona Sunsets, Bunny Bionics, Patrick Harnett Marshall, rest in peace, all wiener dogs everywhere, Joseph, the first 2 chapters of The Eden Project by James Hollis, the Kiwanis Socialists, the Athens People's Assembly of Athens, Georgia, Mr. Kraft, your Canadian friend, Mark, Tiny Nonsense, Sarah, A Future for The Canadian Socialist Rifle Association. I want to shout out Abby, who recently helped me make a flyer. Thanks to that Abby. I don't think you listen to the show, but I'm thanking you anyways. He and He, Max, Lancaster County Chooses Love, Karen, the Astoria Food Pantry, the Enchanted Rats of Turtle Island, Feral in West Virginia, Blink Cat, the Massachusetts chapter of the Socialist Rifle Association, Shulva, Jenny and Phoebe the cats, Jason, Aiden and Yuki the dog, Alexander Gopal, Sunshine, Opticuna, Portland's Hedron Hackerspace, Julia, Appalachian Liberation Library, Lord Harken, Baby Acab and Her Three Great Pups, Ephemeral, Princess Miranda, Janice and Odell, Boldfield Alley, Paparuna, Milica, Theo, SJ Page, the Pocono Pink Pistols, Nicole and Tikva the Dog, David, Towser's Love of Bumblebees, May It Be Forever, Carson, Dana, Chelsea, Amber, Marjorie, The truth that we will outlive them. Kirk, Micaiah, Chris, the incredible Rennerai, Micah, and Haas the dog. Uh, thanks so much for everything because this is an entirely listener-supported podcast and we love that and we love you. So tune in next week to hear more about nursing unions. Bye.