Episode 8: Nursing Ratios

Catherine Kennedy (00:06.338)
Love it. Well, hello, Kara.

Cara Lunsford (00:10.957)
So, well, first of all, I'm so happy to have you here. I'm excited to talk about this subject of staffing ratios and just to really learn a little bit more about you and to help our audience to maybe even understand more about the union.

Because I think that a lot of times like it's like the big you word. People are like, my gosh, don't talk about unions. So I'm going to start off with just can you introduce yourself to our audience and tell us like who you are and how long you've been a nurse and how did you get where you are today?

Catherine Kennedy (00:46.55)
Yes, yeah.

Catherine Kennedy (01:03.182)
Okay, well that's going way back. Well thank you for this opportunity. My name is Kathy Kennedy. I have been a registered nurse for, woo, 44 years. I started my career back in 1980 and I'm still at the bedside, if you can believe that. So do the calculations, I'm up in age. And I actually love nursing.

And, you know, I became involved in the union when I first became a registered nurse back in 1980. So I was in a non-union hospital in Sacramento. I live in Sacramento, California. And so when I, and I went to a community college, America River College, and became an associate degree nurse. So my first job as a new grad, because they had new grad programs back then, was at

hospital, local hospital, non-union of course, and so I stayed there for two years and I was just ecstatic that I was making nine dollars and ninety-seven cents an hour. However, I had a family. I was a young mother. My husband was, he was working locally trying to get into dental school and I had to pay for health care benefits for my husband, my baby and myself at a nine dollars and ninety-seven cents an hour.

So then when my husband got accepted to dental school in San Francisco, off we went and I got into the union facility and I immediately went from $9.97, I can't remember the exact number, up to $18 an hour. And then, because I was going to work night shift, then I said, how much is it going to cost for my childcare? I mean, not childcare, healthcare. And they said nothing.

I said, wait, what? And they said nothing. And I said, hallelujah. So I was happy. And I had to pay union dues. And so that's how I learned about CNA back then. And I was just grateful for just the opportunity. So I have been at this unionized facility. It's an HMO, very large HMO. I've been there ever since 1982. And I still work for this large.

Catherine Kennedy (03:27.502)
corporation hospital health system. And you know, back then, you know, I knew nothing, but I learned, you know, and I just kind of stayed in the background, know, paid your dues. said, okay, we're going to do an action. I was there. I was there, you know, whatever they needed. I was there because I was just so grateful for everything that I had. And then fast forward, my husband graduated from dental school. We moved back to Sacramento. I was able to transfer from the facility that I was at.

to the facility in Sacramento without loss of seniority or anything. And during that time, was initially when we were in San Francisco, I was on a med surge floor. So back then we didn't have ratios. So it was a 48 bed med surge remote telemetry unit. And on night shift, if the census was full and we had 48 patients, two RNs,

Four aids, we're lucky if we got a third RN for 48 patients.

Cara Lunsford (04:31.277)
Wait, Wait, hold on a second.

Catherine Kennedy (04:34.286)
48 beds, two RNs, if we were lucky we got a third RN that night, and four aides, two on each side, and we were responsible. No LVNs. Well, that's all we got on nights, you know, so yeah, it was like, You know, so this is kind of the life I led for at least a year and a half when I decided I'm going to...

Cara Lunsford (04:43.488)
No, no LVNs, no LVNs, no team nursing, no none of that.

Catherine Kennedy (05:02.306)
But there's an opportunity of rises that I could go into the ICU, I was going to transfer and get into a training program. And luckily, I got into the ICU. And back then, they used to have cross-training opportunities. So I went into the ICU where they have ratios. know, we've had those ratios were in place since 1976. So hallelujah. So I stayed in the adult ICU for many years. And then when we moved back to Sacramento, I was getting

little tired of the adult ICU world and my dream job was to go into the NICU. So there was another opening for another training opportunity back in the late 80s, 90s. So then I went and cross trained into the NICU and that's where I've been ever since. So I'm still in the NICU. So it's a level three NICU.

Cara Lunsford (05:49.616)
And there was still ratios for NICU because it was an ICU. Critical care, yeah.

Catherine Kennedy (05:52.92)
Critical care, that is correct. That is correct. Although it was a little different when you had like normal newborn babies that needed to come to the NICU. We had like a continuing care where there was four babies to one nurse and we also had an LVN in there. So, but anyway, I'm kind of getting ahead of myself. you know, so you can see that over the years I remember working at a non-union hospital to a unionized hospital, working.

you know, as a nurse before the ratios came to be and what we have right now. And now we're trying to get it nationally. So.

Cara Lunsford (06:30.468)
What would, I mean, it's always, to me, it's always kind of just a no brainer. I always think to myself, okay, well, if I'm a patient and I'm in California and I am part of a state where I'm one of five or one of, know, it would be, it seems like a logical thing that,

If I were to go next door to Nevada or Arizona or something like that, that it would be natural that I would expect to be also one of five or one of six as a patient. And I think that a lot of the public does not realize.

Catherine Kennedy (07:04.514)
Okay.

Cara Lunsford (07:25.658)
We've always kind of made this a nurse centric issue, but I wonder how much we need to involve more of the public to get the more of the public support. And what have you seen in the past in turn and all the way up maybe to today in terms of kind of rallying the patients? I mean, they're the one they're the end.

Catherine Kennedy (07:50.606)
you

Cara Lunsford (07:55.568)
They're the end user here.

Catherine Kennedy (07:57.656)
That's correct, yeah, yeah. Well, you if you look at our timeline, you know, and we have it, you know, on our website, National Nurses United, but talking specifically about California, as I said, you know, I started my career in 1980, and no, the struggles of being a med-surg nurse back then, even though the patients weren't as sick as what we're seeing today, that's still, the numbers didn't add up. Yes, you had your aides to help you.

And in some facility, they did utilize LVNs. The hospital that I was at in San Francisco did not. But when I started my career in Sacramento, they utilized LVNs very heavily back in the day in the acute care setting. And when we started, there was a couple of things that the CNA had to do in order to really tackle the whole, the different

categories of nursing that we had, patient populations, you know, within an acute care settings, we started tackling that in 1993, you know, because we had the acute care ratios that were established back in 1976, but no one had ever looked at the rest of the patient population within the acute care setting. So I'm talking medical surgical patients, those patients that

that level of care where they needed a little bit more attention, step downs, and then you had the critical carriers. Also, know, L and D, mom, baby, back then it was called postpartum, and pediatrics, all those different areas. So we started our track first, we had to break away from the American Nurses Association. So that was something that, you know, the American Nurses Association pretty much purported that they were the voice of nursing back in.

those days. And again, like I said, I was this young little nurse, very naive, didn't know anything, but just said, you know, I was a good soldier. So when California decided to take back their union, because they really wanted to push the fact that nurses save lives, you know, we save lives, but we had to first break away from, you know,

Catherine Kennedy (10:20.418)
the ladies in heels and pearls that purported that they knew best for us, you know, bedside nurses. So that happened. And once CNA frontline staff nurses took over their organization and became a union and a professional association, then we went to work. And so the first time we tried to pass a staffing ratio bill was in 1993.

Governor Pete Wilson was governor, Republican, and of course he vetoed it. But, you know, okay, that was the first shot. So we continued to push, push, push, push until we finally, and we got an in between that time, we really started educating the community. And to let them know, sure, sure.

Cara Lunsford (11:06.202)
So Catherine, can I ask you a question really quick about that? Sometimes like people say stuff and I'm like, I have to ask a question about that. So.

Catherine Kennedy (11:14.796)
Yeah.

Cara Lunsford (11:18.116)
What has been, you know, because you said that Governor Pete Wilson, vetoed it. And so what has been the narrative from certain, from those who have been, who have not been in alignment with this? What has been that?

Sorry, the reason behind that or that from their perspective, from their perspective, what would they say is their reasoning?

Catherine Kennedy (11:55.16)
The reasoning for not even taking a look at ratios, mean, nurse to patient ratios like that, I'm just sure I understand it.

Cara Lunsford (11:59.824)
Yeah, I mean, I think we can kind of say like, OK, I think that there are people, know, certain people that are in alignment with big business or the hospital industry, that they have friends in the corporate sector, that they that that they feel more beholden, let's say, to to certain industries.

Catherine Kennedy (12:09.79)
hospital industry, of course. Yes, yes, yes.

Catherine Kennedy (12:28.056)
Yes, I mean all of that because, and again, you you're right because the American Nurses Association were in alignment with the Hospital Association because you're talking about managers, all those managers, CNEs, they were called Director of Nursing at the time, you know, they were in alignment with the hospital because we're talking about budgets and so therefore.

It was almost like a labor management partnership when you're talking about the American Nurses Association. And so we knew we needed to get them out of the way because they had no idea they were so far removed from what we at the bedside were experiencing and why our working conditions were horrific back then, even back then. so we knew. We had to educate the community to say, do you know who's taking care of your patient at three o'clock in the morning? I mean...

Are you guaranteed that there's going to be a registered nurse there if there was somebody that you loved needed help at the middle of the night? So we really began a campaign where we educated the community and everything. But hospitals had a lot of money. Hospital lobbyists, even back then, they had a lot of money. And so, of course, Governor Wilson back then sided with the hospital lobbyists because, you know.

They were helping him stay where he was. And so we knew that. And so, you know, as nurses, we began to have, you know, we started lobbying our representative because we're constituents. And so these people that we put in office at the state level are supposed to be helping us, you know, with what we need. So we had a, you know, a strategy on what we needed to do, but we started with the patients in the communities, informational leaflettings.

really getting them on our side as we tried to move forward. So we failed, you know, I never say fail. We didn't get it passed, you know, in 1993 and I think that was AB 695, I think it was, and then we came back again. We had, you know, Senator Kuhl, who was the co-writer of AB 394, and we continued to push. I mean, it took us six years to get it, but eventually...

Catherine Kennedy (14:48.962)
We got it, you know, and it came into, it was finally enacted in 2004. So we've had 20 years, yeah, yes, absolutely, yeah.

Cara Lunsford (14:58.053)
Congratulations. California is still one of the safer states to be getting care.

Catherine Kennedy (15:05.006)
Believe it or not, but we still have issues with that, you because it's the enforcement piece of it, you know, because it's at all times. And so, you know, and there have been many studies out there that really show what we finally accomplished. I mean, it was signed in 1999, but it didn't go into effect until 2004 because they had to really take a look at what made sense. And we had to agree on what were those ratios going to be, nurse to patient ratios in these different areas. So, took some time.

Cara Lunsford (15:08.026)
We do.

Cara Lunsford (15:33.06)
What were the arguments back then? when you're sitting at a table and you're, you know, this is back in the 90s and you're sitting around this table and you're hearing the for's, the against, the concerns, the this, the that. What was that chatter like back then? What were you hearing?

Catherine Kennedy (15:54.594)
Well, you know, of course they're going to say, where are we going to find the nurses? You know, there's a nursing shortage. Where are we going to find the nurses? know, nurses were leaving because they were getting injured. They didn't have the support that they needed. They were struggling. I remember my manager saying, we don't have overtime on this unit. This was the unit that I was on, seventh floor. Only if there's a code blue, you know, can you write for overtime. And so the expectation was,

She didn't care if you stayed over time to charge, she wasn't gonna pay you. You got paid eight hours, that was it. mean, so people said, you know what, I can do something else. So they left. so, we said, no one, and even today, same thing, COVID, everything, and other states that do not have ratios, it's because of the working conditions. And you go home and you're crying because you thought, God, I wish I could have done better.

Cara Lunsford (16:47.706)
Yes.

Catherine Kennedy (16:53.154)
You know, and then you come back and you see that the person's still there, you go, good, they're still here. You know, because you worry, did I make a mistake? You know, because you're, all those things. And that's, as a nurse, I remember before the ratios, I thought, am I going to be able, and I was 20, let's see, when we moved, I was 23 years old when I started as a registered nurse. And when I went to San Francisco on this MedSearch floor, I thought,

I don't know if I'm going to make this, you know, it's like my husband's in dental school, I'm it, you know, can I survive? I was scared back then, you know, and so, you know, fast forward to today, you know, and all the other states, you know, people are looking at California because we have the gold standards. It's not, I mean, we still have things that we're fighting for here in California, but across the United States, patients are no different, no different than what we have in California and really.

There should be a standard of care for everybody across this country. So we fought hard and we continue to fight hard for what we have here.

Cara Lunsford (17:55.245)
Absolutely.

Cara Lunsford (17:59.19)
I, every time I hear someone say, well, you know, there's a nursing shortage. I always, I always say, no, no, no, there's a shortage of nurses willing to work in these conditions.

Catherine Kennedy (18:04.622)
Ha ha ha.

Catherine Kennedy (18:14.894)
That's correct.

Cara Lunsford (18:16.62)
And there is not a nursing shortage. There's plenty of nurses. There's so many nurses. In fact, there's nurses who come from other countries. There's people who, you know, there. And at the end of the day, there's not a single person out there that would be willing to gamble the lives of people.

Catherine Kennedy (18:27.81)
Yes.

Cara Lunsford (18:40.58)
gamble their license and their livelihood after Redondavat, you know, potentially, you know, be criminally prosecuted for a mistake. There's no one that's willing to even gamble the lives or the livelihoods or the licenses of their coworkers and the safety of their coworkers. It's just not something that anyone can or will do for any

Catherine Kennedy (19:01.954)
Right?

Cara Lunsford (19:10.113)
period of time. And now we're seeing that

nurses who are coming even out of school who are not sometimes getting the appropriate amount of clinical hours or that now that all of that is paired with a lack of feeling competent and coming straight out of nursing school. And so that is a that that is just a storm, right? That's just a storm that that's brewing and has been brewing for for many years. And now there's

Catherine Kennedy (19:24.078)
All

Catherine Kennedy (19:40.6)
Yeah.

Cara Lunsford (19:46.114)
added components to that storm that are making it worse. This is like level five category hurricane. And the destruction that it has the potential to do and the collateral damage that it has the potential to do is monumental. so I think that and I would be remiss if I didn't

Catherine Kennedy (19:53.228)
Yeah, yeah, it's true.

Catherine Kennedy (20:07.072)
Yeah, exactly.

Cara Lunsford (20:15.856)
highlight the fact, and I know sometimes people say like, you you're gonna make this a gender issue. Yes, I'm gonna make this a gender issue. I'm going to say that we are a female dominated industry. And how can you not pay attention to that? How can you not look at that and say that that is a factor in why there's a certain level of

Catherine Kennedy (20:30.414)
That's right.

Catherine Kennedy (20:36.462)
Correct.

Cara Lunsford (20:46.435)
oppression.

Catherine Kennedy (20:48.394)
Exactly. mean, and you know, I go back to when we broke away from the American Nurses Association and they thought that we couldn't do it, you know, but yet we did. And we continue to push the things that are very important to nurses. I mean, it's about community patients and

caring and really what's best for the patients. mean, there were studies after studies that showed, you know, as we were trying to get, you know, the staffing law into place, where it clearly showed that the less patients that a nurse had, the better the outcome for that patient. mean, study after study showed that. And, you know, despite all of that, you had the hospital industry really pushing really hard at us. And, you know, and one of the things that I know about, you know, our organization is that, okay, so

We didn't get it this time, but we're coming back. We're coming back, and we're not giving up, and we're going to come back, and we're going to get more people involved in this. We built coalitions, communities, all the people that realize that it makes a difference. And then once the bill passed and we got it into place,

Despite the naysayers, the nurses came back. They came back. And I remember there were times where first they say there's a shortage, next thing you know, we have a surplus. So it goes back and forth. And so really, this is a crisis that the employers create. Because again, it's profit over patience. And really, we're about patience. This should not be a business. This should be about.

that everyone has the right to a quality of care, a standard of care across this nation. And you know, so that's our fight. Absolutely. Yes, yes.

Cara Lunsford (22:45.466)
Well, this is a public service, right? Like we're public servants. And I think that it's important to remember that, we are a profession, right? We're trying to make a living, too, but we're not trying to do it on the backs of people's lives and their health and their well-being.

We deserve to be able to make a living, to be able to buy a home, put our kids through college, take a vacation, because the work we do is hard. And so it's important to, yes, I do think sometimes we're called to do this work, or this is something we're passionate about, but it's...

Catherine Kennedy (23:13.112)
Absolutely.

Catherine Kennedy (23:19.768)
Yes.

Cara Lunsford (23:32.92)
It's a sensitive issue when you start calling it a calling because then it starts to sound like you're not doing it to make money. And that's a dangerous place to go with things because the priesthood is a calling or being a nun is a calling. You don't necessarily associate those things with making a living.

Catherine Kennedy (23:36.76)
Yes.

Catherine Kennedy (23:43.981)
right.

Catherine Kennedy (23:52.248)
Correct. Right.

Cara Lunsford (24:01.608)
So I do think it's really important to differentiate there. And I have a question for you. Are you familiar with Rebecca Love and the Commission for Nurse Reimbursement? Let me tell you a little bit about it. You can actually go back and listen. You can listen to a podcast I did with her. Rebecca Love is an incredible futurist.

Catherine Kennedy (24:16.418)
Mm-mm. Okay, Rebecca Love.

Cara Lunsford (24:29.957)
She founded the Society of Nurse, my God, it's Sancial, scientists, innovators, educators, and leaders. And she is really trying to push forward certain initiatives. And one of the initiatives, sorry, is what she's calling

Catherine Kennedy (24:42.286)
Okay.

Cara Lunsford (24:56.388)
the commission for nurse reimbursement. And so in the episode that I, where I interview her, she is talking about how, you know, a hundred years ago when nurses were, they were billing the hospitals for their services. You know, they, they were independent contractors, essentially, you know, they were billing, you know, for, their services. And at some point,

The physicians didn't really like that. They didn't like that they were up against women nurses who were billing for their services. They were taking a piece of the pie, if you will. And that wasn't really well received during that time. This was like kind of before even like around the time of the women's suffrage. So there was a lot of pushback there.

And they decided that they were going to lump nurses in to the room rates. And they took the hotel model. They looked at the hotel model and they said, housekeepers. Nurses are like housekeepers in hotels. That's we're going to take that model. We're going to lump them into the room rate of the hospital. Forever making nurses a cost to the system.

and not ever a benefit to the system, right? Not reimbursable by insurance. And so really, Rebecca feels like this is an insurance issue. Okay, you have to make nurses a profit to the hospital. We live in this for-profit system and that's probably not gonna change anytime soon. So.

Catherine Kennedy (26:33.71)
Thank

Cara Lunsford (26:49.642)
Maybe if the hospital saw us as a profit, as part of the getting them into the black, not getting them into the red, and that the insurance companies needed to reimburse for the time, the hours that a nurse spends with a patient, no different than the number of hours that

A doctor spends with the patient. Now, I'm sure that we could find a million problems with this situation. Because there always is, right? There's two sides to every coin. But I think she's on to something. I don't know that it's been fully fleshed out. I don't think that it's not fully baked. But I can see where she's going with it.

Catherine Kennedy (27:44.418)
Yeah, you know, I guess I look at it in terms of, you know...

organizing nurses to really belong to a union because through the collective bargaining agreements where you're, because again, you look at what it is a nurse or a nurse practitioner, all of the careers of a registered nurse bring to the table. And part of that is bargaining the economic piece of it. And you can see the

disparity between a non-union hospital and a facility and those nurses that want a union because it is about, you know, leveling that playing field, leveling, you know, what nurses make, whether you're in California, Mississippi, North Carolina, New York, you know, because there is such a difference, you know, and they want to talk geographic difference, cost of living and all that stuff. Really, that's nonsense.

The patients are no different anywhere. And so what I have seen and what our organ, what CNA and NNOC and really NNU for that matter across the United States, it is about, you know, uplifting everybody, everybody, you know, so not so much looking at nursing as a, well, we are a line item, I guess, in the hospital's budget, but what we're talking about is respect what we do.

You know, I think a lot of times because, you know, we're, you know, 85, 90 percent female, they think that we don't deserve the whole dollar, you know. It's like, you know, going to quote somebody else, it's like, want the whole damn dollar, you know, Shirley Chisholm, you know. And so I think that they need to value us for who we are, what we bring to the table. Yes, we are, we're absolutely professionals. We do this because, again, this is what we want to do. This is a career path that we chose to do.

Catherine Kennedy (29:47.938)
whether it's a calling or not, mean, we have a right to that whole dollar. And I think that one way to do that is through union, because you have collectively a stronger voice together in solidarity. yeah, so I'll listen to Rebecca Love, but yeah.

Cara Lunsford (30:07.608)
Yeah, I mean, I think that there's just people trying to figure out how to solve this issue, right? And to the small rural hospital who says, well, what about me? Well, what if I get forced into certain ratios and I can't afford it? Or or,

I get, what happens when I get gobbled up by some larger health system because I can't keep my doors open? Yeah, it is.

Catherine Kennedy (30:48.674)
Yeah, well that's happening right now, you know, and it's been happening for many, many years. So I mean, I go back to the 90s when we had the mergers and acquisitions. I remember living through that red lining, you know, where you're looking at communities of colors like, we're going to close, we're to shut the doors because they cost more money for us. So, and then they gobble it up, lay off the nurses and have this beautiful building up on the hill, you know, where everybody has to travel farther and yet.

may or may not be able to get in, although there are laws with EMTALA so they can't refuse a patient. But all of that happened back then and we're seeing it again. being here in California and being, I wear a different hat in another, anyway. Well, we're looking at the entire state of California, the rural areas, the places where they have a high density of nurses and things like that. So they're.

There are ways to make sure that we don't leave our rural brothers and sisters out of the equation because they are just important. So there's incentives, know, we're saying look at everything. If you need people there, a lot of times those folks that live in that area, even though they may have to go outside of their city to get the education, they do come back. You know, if you give loan forgiveness.

those types of things, there are ways that they can do it. Again, I'm talking about putting the money back into the community, not making a profit. And so it's really trying to tell people, you need these facilities to care for the community, preventative and the need when you need the hospitalization, and you need to build your infrastructure. And so I think that, you know, looking at all of those things are so important.

Cara Lunsford (32:32.463)
Yes.

Catherine Kennedy (32:37.518)
here in the state of California and across the United States. So that's the reason why we're really pushing for the federal ratio bill and looking at wages to bring the nurses up.

Cara Lunsford (32:50.54)
Is it fashion? Is the is the federal bill pretty much fashioned after the the California bill?

Catherine Kennedy (32:58.346)
It is, but it's even a little bit better than that because on a med surge right now in California, we have a one to five and we're realizing that those patients that are on the med surge floor right now used to be in a higher level of care, like a step down or even in the ICU. So we're seeing sicker patients now. And so really we're looking at a one to four, not a one to five because patients are extremely complex and

Nurses need to have the ability to really care for those patients and do what needs to be done.

Cara Lunsford (33:32.72)
How would that differ, Catherine, if you did include LVNs? Because I have heard that more LVNs are coming back to the acute care setting. We kind of talked about that a little bit. That idea of team nursing, I just did an episode called Nursing Through the Ages with this wonderful woman, America Farrell.

And she had gone all the way from being an LVN up to being a CEO. And her hospital is just a really great example of what it can look like when you have nurse leadership like that. And so she talked a little bit about the power of team nursing and how wonderful that was back in the 70s.

So how does that affect ratios?

Catherine Kennedy (34:25.666)
Well, it waters it down, you know, and again, when we're talking about the ratios, again, this is absolutely no disrespect for those nurses that are at LVNs because there is a place, they hold a license. It is a limited license, unlike the registered nurse, and the LVN, what I remember, you when I started my career in the 80s, there was a high level of LVNs in the acute care setting because why? They were cheaper.

And then they really, unfortunately, they would interpret the language of the scope of practice for an LVN to their liking. So unfortunately, you had LVNs that were doing work that followed into the realm of what a registered nurse is supposed to do. And as an RN, you know, we are the coordinator of care. you, you know, back then I did team nursing. I remember this. So as the team leader, as the RN,

I was a coordinator and had an LVN that did, because they have a license, they could do the IM injections, the intramuscular injections, help pass medications, PO medications, and then you had your aid that helped with the bathing of the patients. I remember all of that. There is a place for the LVN. However, when you're talking about in an acute care setting, when you have an LVN there,

you still have to have an oversight of the registered nurse. So then that takes you out of the ratios. And so really, you know.

There is a place for the LVN maybe in the ambulatory area in the clinic where there's an injection, know, clinic, things like that. There's a place for them. But when you're talking about the acute care, you know, and the racial law that we have in California, once you put an LVN into an acute care setting, you still need an RNT.

Catherine Kennedy (36:27.576)
to be the oversight for that LVN. So does that mean that the RN's going to have their assignment and the LVN has theirs? Now the RN is responsible for not only theirs but the others. So now you're out of ratios. So, yeah.

Cara Lunsford (36:40.112)
Yeah, so I'm wondering because I mean, I used to, you know, work alongside an LVN when I did pediatric oncology for many years. And. And she was amazing. She was really wonderful because she was someone that we could really rely on to do some of the tasks like.

Catherine Kennedy (36:53.536)
yeah.

Cara Lunsford (37:04.577)
you know, passing meds and putting NG tubes in and putting Foley catheters in and it did in a way free us up to be more a part of like the assessment side and the care planning and being able to speak with the doctors and have more direct

communication with the doctors and part of like that that that planning, like I was saying, like, you know, more of like the the assessment side of things. And and I think she was also an exceptionally good LVN. But she had worked alongside and she never really wanted to move up into she didn't want the role of being an RN. She didn't want. And and that was fine. And I think there's plenty of people out there that that do.

want that. So I've had a good experience working in the acute care setting with having like a team, a teammate that frees me up to do some of the things that I'm really good at. So I mean, I, but I also can see how you add in, you know, labor that's a little bit more inexpensive.

to the healthcare system and I think that this is the problem is that it always goes back to greed. It just goes back to greed, mean, greed is just like such a huge issue. It's like if we could just not be so greedy and just realize like, hey, at the end of the day, this allows our nurses to provide the absolute best care to the patients.

Catherine Kennedy (38:36.392)
It is. Yes. Yes.

Catherine Kennedy (38:42.275)
It is. Right?

Cara Lunsford (38:55.394)
every moral distress is is no longer a thing. People don't feel like they're constantly at risk of someone being injured or dying on their watch. And and they can also take breaks and not feel like they're burdening their colleague with, you know, an entire assignment of of people for 30 minutes, where you may or may not come back to a mistake that happened.

So yeah, mean, I feel like there's just, we should be able to utilize these things. We should be able to utilize people like LVNs.

Catherine Kennedy (39:39.298)
We are, we are, we are. In clinics, always encouraging nurses, whether they're LVNs or even RNs, to continue if they choose to a path of whether it's post-graduate degrees or even be an RN. But really making sure that they are within their scope of practice, that's the main thing because it will be the hospital that will violate

Cara Lunsford (39:40.502)
Yes, yes.

Catherine Kennedy (40:09.314)
the scope of practice. And then you have folks that really, I mean, even registered nurses, I mean, they go, sometimes you have to kind of watch what you do once you go up the ladder a little bit to be very careful and mindful of that. Because I worked alongside of, believe it or not, LVNs in the ICU in San Francisco, back when AIDS was very prevalent. And they were unbelievably great LVNs.

However, they were acting like registered nurses because we were so impacted with patients that were critically ill with AIDS. mean, in San Francisco, it was unbelievable. It was not as bad as COVID, but bad enough. And it was all hands on deck. But yet you have LVNs that are going beyond their scope of practice and they could find themselves in trouble. And so really, we just need to be mindful of that.

Cara Lunsford (41:03.236)
Yeah.

Catherine Kennedy (41:04.098)
There is a place for all of us, but we need to get the insurance company out of it. We need to get the profit out of it. It needs to go back to the communities and people. We had more free-standing clinics so that people, preventative things are looked at instead of using the ER for any and every emergency and educating people on the value of clinics. If they had healthcare, then

You know, there's a place for everybody. There really is.

Cara Lunsford (41:36.848)
So in systems where it's like national health care, I'm guessing there aren't unions, or are there? Are there unions in places where there's national health care or more socialized? I don't know. I don't know the answer to this question.

Catherine Kennedy (41:43.598)
Mm-hmm.

Catherine Kennedy (41:53.771)
yeah, there's salt.

Catherine Kennedy (41:57.836)
Well, Canada, I mean, we have nurses in Canada where they have, you know, national health care insurance and their nurses are very well unionized. Over in Europe, you have large numbers of nurses that are organized in England. I mean, they have national health care. I mean, so, yes, absolutely.

Cara Lunsford (42:17.008)
Okay, so they'll have union facilities as well or not the same?

Catherine Kennedy (42:23.928)
Now, you know, that's beyond my knowledge base, but you know, I think really the key is, you know, that there are countries that have national healthcare systems in place and they are working really well. You know, are there physicians, I'll just pick on the physicians, are the physicians as wealthy as the ones that we have here in the United States in some areas? Probably not, but they do make more money than everybody else, but it's still a public health system. I mean, it's a national.

Cara Lunsford (42:52.431)
Yeah.

Catherine Kennedy (42:53.186)
health system where you have a card, you can go in and you can get the health care that you need. No questions asked, you know.

Cara Lunsford (42:59.824)
Yeah, I know I was in England 20 years ago going to school and I was staying with my, she's like my godmother and I was sick and I thought, gosh, what am I gonna do? And she said, well, you'll just go to the doctor. And I said, well, what do you mean? I said, I don't have insurance here, I don't have, and she's like, what? And she goes, just go, the doctor's like, just go.

Catherine Kennedy (43:06.094)
Mm-hmm.

Catherine Kennedy (43:18.392)
Correct.

Catherine Kennedy (43:29.176)
Yes.

Cara Lunsford (43:29.474)
And I couldn't believe it. And I remember just going and I was in my early 20s at the time. And I thought, how much is this going to cost me? you know, I'm working at a pub kind of under the table for like a friend's pub. I'm like, what am I going to have to pay for this? And they were like, no, there's no charge. And then I went to go pick up my prescription.

Catherine Kennedy (43:57.285)
No charge.

Cara Lunsford (43:57.636)
And I thought, well, here's where they're going to get me. And I remember paying like six pounds. It was like six pounds, which is like, you know, kind of the equivalent of like seventy dollars or whatever it was, you know, and it's different now, probably. But I I thought, wait, what? Just going to go pick up my medication and.

Catherine Kennedy (44:03.008)
Minimal something. Sure.

Catherine Kennedy (44:11.032)
Yeah.

Cara Lunsford (44:25.04)
I was a real fan of even just that basic care.

Catherine Kennedy (44:27.822)
Yeah.

But look at the cost of insulin. These people here in the United States marked it up so much. I mean, it took the Biden-Harris administration to lower the cost of insulin. I mean, this is crazy, you know, but they're making so much profit off of all of us, all this stuff. It's ridiculous. We need to just, yeah, yeah.

Cara Lunsford (44:49.966)
Yeah, greed is I feel like, you know, the theme throughout this podcast episode is, you know, how do we manage greed? And and that's probably if we can fix that issue, Catherine, well, we will have fixed a lot of things. And but at the end of the day. You know. We create systems where unions are necessary.

Catherine Kennedy (45:02.061)
Yeah.

Catherine Kennedy (45:06.339)
Yeah.

Yeah, I know.

Cara Lunsford (45:20.26)
And if we were more altruistic in the ways we operate, Relias owns nurse.com, and the mission for Relias is to measurably improve the lives of the most vulnerable in society and those who care for them.

That's our mission. And that's the mission of nurse.com as well. And it doesn't mean that we don't work with for-profit companies or that they don't sponsor things that we do. But at the end of the day, our message back to them all the time is we are trying to do what's right for nurses. If you're in line with that and you want to sponsor something we're doing, we embrace that.

You know, yes, of course we need money to be able to operate too, but at the end of the day, it's about, you gotta feel good about what you're doing. You know, gotta feel good about the partnerships that you make and the customers that you have.

And I think that we do. I think we do feel good about the relationships that we build. And we're also always trying to elevate. We just did a partnership with Top Workplaces, and there's a whole series of survey questions that they have that they give to...

to hospitals and when we were having the conversation about co-branding something with nurse.com I said well they're gonna have to answer some of my questions and here's my questions. And so I added a whole, I think we had like seven or eight questions that got added to that survey and I said well.

Catherine Kennedy (47:09.529)
Mm-hmm.

Ha ha ha.

Cara Lunsford (47:21.408)
if the nurses answer these questions and say that they do feel like they can provide safe patient care, that they do feel like their hospital or their place of work has instituted things that prevent violence in the workplace, that, you know, and we identify, do they have the supplies and equipment to do their job safely?

Catherine Kennedy (47:41.55)
huge.

Cara Lunsford (47:50.168)
So all of the questions have to do with that. It's really around safety, feeling safe in your workplace and providing safe patient care.

Catherine Kennedy (48:00.01)
and ratios, how many patients does a registered nurse get, you know, in the different levels of care.

Cara Lunsford (48:03.012)
Yeah, because at the end of the day, yeah, because at the end of the day, it is about ratios. But when you ask a nurse, do you feel like you can provide safe patient care? That usually is tied directly to how many patients they have, right?

Catherine Kennedy (48:09.559)
it is.

Catherine Kennedy (48:21.92)
ask them if they get a lunch break without having to eat at the station. You'll hear that they don't get a break. What profession doesn't allow for a nurse to take an uninterrupted break 30 minutes away from your patients? mean, there's a lot of states that don't have that, and it's unfortunate. Yeah.

Cara Lunsford (48:42.436)
Yes, absolutely. That stuff has to change. I'm incredibly grateful to you, Catherine, to the work that you have done over the decades. If I was wearing a hat, it would be off to you. My hat would be off to you. And I'm just grateful for the time that you spent with me today to uncover a lot of this, to talk about this issue. I always try to...

Catherine Kennedy (48:54.446)
Thank you.

Cara Lunsford (49:10.394)
talk about all sides of things because I think it's important for people to be able to see the full picture, you know?

Catherine Kennedy (49:18.158)
Well, you know, I think it's important to never forget the history, you know, and I invite people to come to National Nurses United to really look at the history because, I can remember an old video we're talking about how nurses were making less than the gardeners, you know, or the grocery clerks, you know, and recognizing that we are a profession. Like you said, it's not a calling, but it's trying to put food on the table for our families and stuff. And so that's the reason why nurses

began to unify and say enough is enough, you know, and it's really important. So yeah, yeah, yeah.

Cara Lunsford (49:56.44)
Absolutely. Well, I know this this this episode will release later, but happy Halloween to you. It's Halloween.

Catherine Kennedy (50:06.126)
Thank you very much. Thank you very much. Can I also put a plug in? have a, within National Nurses United, we have an opportunity for nurses, if they're interested in looking at organizing at all or finding out more information, we have Nurses Advocacy Network, NAN, and they can actually join our...

Cara Lunsford (50:11.886)
Yeah, absolutely.

Catherine Kennedy (50:33.838)
Association for $50 a year. Learn more about how, if they want to try to organize the nurses and fight for ratios. We would love to have them. So just, you know, for your viewers to just take a look, okay?

Cara Lunsford (50:45.466)
Fantastic. Absolutely. Well, we'll make sure that we add that link. Catherine, thank you. Thank you so much. Have a wonderful rest of your day.

Catherine Kennedy (50:50.538)
Okay, all right, Kara. Thank you so very much.

All right.

Thank you and don't forget to vote. Okay. All right. See you later. Bye. Okay.

Cara Lunsford (51:00.91)
I won't, I promise. Okay, bye. See you later, bye.