Workshop Talks: Losing nurses and patients for profit

February 17, 2011

by Htun Lin

Recently, two nurses were killed on the job by patients at state healthcare facilities in California’s Bay Area. Contrary to management’s attitude, these are not isolated incidents. More than 50% of emergency room nurses, for example, experience violence by patients on the job. For many years, like nurses all across the country, the staff at those healthcare facilities have been complaining of chronic staffing shortages which endanger patients and workers alike.

I work at the largest HMO in California. In spite of our best ever quarterly profit report, management is conditioned to protect the budget at all costs, patient care be damned, and never mind the workers. The prime directive to nursing supervisors now is “just-in-time” staffing, which often is not “just-in-time,” but too late.

Management falsely blames chronic understaffing on a nursing shortage. But many nursing school graduates tell me their job applications have been rejected by one employer after another. Hospital administrators have been repeating this mantra of a “nursing shortage” for almost a decade, while we see them use plenty of traveler nurses from out of state.

They insist on using temp agencies to supply health workers. They don’t want to make a commitment to hiring permanent workers, because they prize the ability to get rid of workers at a moment’s notice. A nurse supervisor’s prime duty these days is to constantly monitor each floor for “overstaffing,” or they are called on the carpet. They even send nurses home mid-shift.

What they call overstaffing, we call safety. They say budget overruns are a danger to the survival of the hospital. But they are killing patients and workers in the process in the name of improving efficiency and productivity. Often nurses will get into arguments with their supervisors over staff assignments because of their concern over safety.


Just-in-time staffing in healthcare is counter-productive because management’s budget obsession doesn’t allow room for a spike in patients showing up in the emergency room. Often these patients need intensive care. They cannot be moved into the ICU until other patients are moved out. But they do not have enough nurses to make other rooms available. We are trapped in a Catch-22.

This chronic crisis condition is really a crisis in thinking that goes with capitalism. What I see in my shop is a cadre of highly talented veteran nurses with decades of experience, whose primary function as supervisors has been reduced from that of a nurse to an accountant, constantly made to monitor not the quality of care but the company bottom line. Made to obsess over labor time, that is, any excess nurse-minutes, they behave like production foremen in an assembly line.

This total inversion of thought and reality, that is, treating units of labor-time as real instead of treating concrete labor like providing healthcare as real, is the animating delusion that runs through the whole economy. It’s the delusion behind all the draconian budget cuts that will, in California, for example, cut millions from the state’s Medi-Cal program. California’s new Governor Jerry Brown said: “It’s better to take our medicine now and get the state on a balanced footing.” That medicine is deadly for patients and workers.


There is a constant effort in the workplace to force workers to internalize this inhuman thinking. At labor-management team meetings we are told to be mindful of the customer. By “customer” they mean the corporate and state bureaucrats who hold the purse strings to employer-sponsored healthcare for their employees.

Their conventional wisdom tells us to believe that what’s objective is the economy “out there” and their budget battles are what’s real. They want us to believe that there is no alternative and that these nurses’ deaths are just the way it is.

We workers know better. Through our concrete labor, we know the essential economy is in our daily interactions with each other as human beings. The bureaucrats are right to say that there is “no alternative” to these recurring crises under capitalism. For us workers then, there is no alternative to abolishing capitalism.

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