In his new book Tom Juravich takes us behind the statistics of the economic collapse and into the work and lives of Americans who feel like they are being sacrificed At the Altar of the Bottom Line. More

At the Altar of the Bottom Line



Jean Griffin, nurse Janet Killarney, nurse

Nursing at Boston Medical

Even though many nurses, like Jean and Mary, worked nights and weekends so they could raise a family, it is difficult to find a nurse who enjoys the erratic schedule and working nights. Janet Killarney describes the impact on her of working nights:

I don’t think my sleeping patterns will ever be the same. I’m disrupted. I’m damaged goods, I tell you. I have a panic, even if I’m not tired, if it’s getting to be ten- thirty, eleven o’clock at night and I’m not near where I should be. It’s like, panic is kind of a dramatic word, but it’s some anxiety of being in bed, because of being sleep- deprived. (2001, 23)

Esther confesses that “some people actually vomit every time they work nights, and it’s tough because your whole biorhythm is really— you’re trying to train something or re- train something that shouldn’t be re- trained.” Like Jean’s, her sleep patterns have been permanently altered. Four hours is the most I can sleep in a row, and that’s unusual. I usually sleep three hours and I wake up and have to do something, take a walk, because since the kids were in school I could sleep three hours in the morning while they were in kindergarten, while the youn gest one was in kindergarten. So I just over the years, I sleep a three- hour nap, when I go home I’ll sleep for two or three- hours, get up, go back and sleep two or three hours before I come to work. Even through my nights off I have a tough time staying asleep. (2002, 8– 9)

Shift work has been associated with many health risks. The Nurses Health Study found for example, that “women who worked rotating night shifts for more then 20 years had an 80% higher risk of breast cancer than women who did not work such shifts” (2006a, 4).

Besides what it does to your body, nurses point out, working nights also puts you out of step with the rest of the world. Janet says, “The worst part is that no one who works the day shift, who has never worked a night shift, really quite understands it.” She continues:

My mother would call me like at noon, when I had just gotten to bed, and say, “Hi, what are you doing?” knowing that I had to work. She just didn’t understand. It would be like calling someone at 2:00 a.m. and waking them up to have a conversation. No matter how you explain it, you just have to take your phone off the hook, and you miss messages. (2001, 4)

Another nurse, Jessica, explains how her work schedule aff ects her marriage: My husband and I are not even on the same schedule and I go, “You know what, I can’t hang with you. It’s my work schedule day. I just can’t do this. You know? I have to be in bed with lights out by ten.” Then I go, shit! I can’t sleep! What is my problem? Am I thinking about this job that I’m hating to go in for because I know you can’t go to work without a brain. You can’t go to work half- assed, in plain En glish. Because people’s lives depend on you being able to jump, your neurons have to pop like crazy. You can’t go in there emotionally a mess. (2002, 12– 13)

In addition to their working irregular schedules, the culture of caring means that, if there is an emergency or if someone calls in sick or if the hospital is short- staffed, nurses stay past their regular shift as a matter of principle. The patients come first, no matter what. In some hospitals this principle was a formal part of the employer’s rules— nurses who left patients unattended at the end of their shift could lose their licenses— but it hardly needs to be mandated, given that it is an integral part of the nursing profession. Even in the best of circumstances, in small, community-based hospitals and before the ravages of managed care, nurses had challenging working conditions: irregular hours, no regular lunch and break times, and dual loyalty to patients and doctors which often left them exhausted. But the intensifi cation of work resulting from the corporatization of health care has, for many nurses, pushed an already a tough set of circumstances over the top. Some nurses at Boston Medical work ten- hour days. Others work twelve. A few, like Janet, work the day shift from 7:00 a.m. to 3:00 p.m., but unlike se nior employees at most other workplaces, all nurses at Boston Medical are required to work an eve ning shift and a weekend shift once a month, according to explicit language in their union contract (SEIU 2001, 10). At the old Boston City Hospital, nurses with ten years’ se niority were exempt from this requirement, but that exemption “went by the wayside” when the hospitals merged (Killarney 2001, 10).

In addition to the already grueling regular schedule, nurses in the OR at Boston Medical are regularly required to work mandatory overtime. Sometimes, as Jean explains, eight hours can be stretched to sixteen: I was upset that I was handed this mandatory overtime Saturday night, 11:00 p.m. to 7:00 a.m., because I am working Sunday 7:00 a.m. to 3:00 p.m. And I don’t mind doing a double, 7:00 in the morning till 11:00 at night. I choose to do that now and then, to have that extra day off . But I can’t be here all night and then work all day at age fifty. I can’t. (Griffin 2001, 22– 23)

It is hard to think of another profession where a senior worker, with more than twenty-five years’ experience, making close to $100,000, is expected to work double shifts, evenings, and weekends. At Verizon, management asserted its control by the Taylorization of the labor process of customer service representatives. While portions of nursing work at Boston medical have been stripped off and given to less skilled workers, nursing remains a highly skilled profession and not subject to the same kind of management control that obtained in the call center. Yet as at Verizon, management exerts its control at Boston Medical through the scheduling of hours.

In the OR, overtime results when surgery that extends beyond one’s normal shift— which happens frequently because of how tightly the ORs are booked as Boston Medical Center continually works to increase revenue. “It’s quarter of four,” Jean explains.

I’m going to assume, I guess I have to stay and finish the case. The case could end at 4:30 or the case could end at 5:30. Now, what if I was a mother who has to pick my child up from day care? And if I was up front, I can’t break scrub to go on the phone. I could ask my circulator to call. If she’s too busy, she can’t call. So these are the things that are happening, and this is why we are losing OR staff . Because people need to have control of their lives. (Griffin 2001, 21)

Nurses at Boston Medical cope with the tough schedules, the off - shift work, and the overtime by swapping shifts and covering for each other. Doing this feels less like helping out the hospital than helping out one of their colleagues, and, by their reports, they do a lot of it. Like soldiers on the battlefield, it is the commitment to their colleagues that drives nurses at Boston Medical to work more than they should. As Mary explains, “There’s a woman who’s in her sixties, who doesn’t have a car, and she has to do night rotations every so often, or be on call. Now I’ll take hers. You know what I mean? There’s some people that you will step in [for]. Another woman has kids and I’ll take the second half of the three to eleven, seven to eleven. I’ll take the seven to eleven, find somebody for three to seven” (Katides 2001, 24– 25). No matter how tough it gets, Sharon says, “Somewhere in that group of nurses will be somebody who’s going to say, ‘I’ll do the floor tonight.’ Nobody’s going to walk off a case. Nobody’s going to walk out” (2002, 13– 14). Mary adds, “At this point, you don’t even care about the money. A lot of times it’s really just kind of helping each other” (2001, 25). Helping each other out and being called on by management to fill in for irregular hours, however, often aff ects nurses’ health and well- being. One of the first things to go is mealtime. “Sometimes,” Jessica says, “you’d like a good meal and you go sit down and you’ll be eating and you’ll get, ‘Sorry to interrupt your lunch. I need you. . . .’ They have no problem about interrupting us. The patients don’t have any problem about it. Visitors don’t have any problem” (2002, 17). In her research on nursing and break times, Ann Rogers found that “nurses reported having a break or meal period free of patient care responsibilities less than half (46.6%) of the shifts they worked” (Rogers et al. 2004, 512).

Food in general is a problem. “Eating Chinese food at three a.m.? Even though you’re working and you’re active,” Janet says, “it’s just not a healthy way to live” (Killarney 2001, 4). And, Suzanne Gordon suggests, “obesity, which is associated with stress, is a significant problem among nurses, particularly in North America” (2005, 307). As Jean Griffin tells it, “It was taking its toll on me. I was miserable, being I’m older. I was 35 when I had my youngest. I had started to gain weight. I called it silent weight gain. You know, a few pounds every month when you are working nights, and you just try to attack that and you can’t. When you are tired you just gain” (2001, 6). Given the culture of caring, nurses tend to sacrifice their own health to take care of their patients. Jean Griffin talks about running “from 2:30 to 11:30 nonstop, no bathroom privileges, no water privileges, no supper. I would go home and I would be so crippled, the next day I don’t know if this is worth it” (2001, 26).

Jean, Mary, and Janet agree that much of the overtime and the need to call nurses in on their days off is just poor management. Despite surgeries routinely taking more time, management has failed to adjust staffing in the OR. Unlike scheduling at Verizon, which is overly formal and mechanical, scheduling at Boston Medical, according to the nurses I spoke with, seems underplanned and poorly executed. Janet asserts:

I’m of average intelligence. So if I can figure it out, the people who are getting paid to figure it out, what are they doing? That’s what I don’t understand. You are unwilling to let people balance their schedules, so then this poor person has to stay, and I have to make three phone calls for her from the [operating] theater. How eff ective do you think she is being? How much do you think she wants to come here tomorrow, because the same thing might happen. She had her eight- year- old son get off the bus and there is no one there to pick him up. How dare you! What are you doing in all these meetings that you can’t figure this stuff out? (Killarney 2001, 28)

The SEIU Local 2020 president, Celia Wcislo, tells how the union conducted research on the problems with scheduling at Boston Medical. “[We] just sent one person to every floor over the last four hours and we got a calculator and added up” the holes in the nursing schedule for the week. Doing this very simple experiment, they discovered 1,100 regularly scheduled shifts for the current week that were unfilled. Even management, she reports, was surprised with the number: “I mean they turned white . . . you could see them think, ‘No wonder this sucks’ ” (2002, 10).

In the 1980s I conducted research in a small New England electronics assembly plant (Juravich 1985) where, I found, industrial workers were plagued by “chaos on the shop floor”: materials that weren’t right, machines that didn’t work, and bosses who gave contradictory instructions. The workers found these conditions extremely frustrating. Boston Medical personnel feel very similar. Despite the large and growing number of managers, management just hasn’t been able to figure out how to make staffing work. Maybe it works on paper or on financial spreadsheets, but it is clearly not working in the operating rooms or on the floor at Boston Medical. Or maybe the administration there lets the inadequate staffing happen as long as the revenue keeps coming in. Celia Wcislo suggests that this is not only the case at Boston Medical but a problem nationwide: “The whole health care industry is in such economic turmoil that they’re reacting and not planning” (2002, 4).