CA 'Gig-Worker' Nurses Could Soon Book Directly With Hospitals as Independent Contractors

Finally, a big change is coming for the nursing industry. Is it safe staffing ratios at last? How about an increase in pay for the staff nurses that have endured literal years of a worldwide pandemic? Protections for nurses at work and policies that don’t require them clocking in while infected with a dangerous virus?

Nope. 

It’s Uber for nurses. Yup, that’s right.

Instead of policies at the leadership level that could enact positive and lasting change for both current and future nurses, there is a push to introduce legislation that will make nurses independent contractors working in an “on-demand” fashion with hospitals and facilities as they are needed. But some are concerned the move could further exploit nurses and negatively impact the travel nursing industry especially. 

Here’s what nurses need to know about the movement towards making RNs independent contractors. 

How it Works

It would work like this: instead of being hired by a standalone staffing agency, nurses could become independent contractors and get hired directly by hospitals on an on-demand basis. For instance, the app CareRev is already offering this service. According to CareReve’s website, the platform is one that “seamlessly connects healthcare facilities and local, flexible healthcare professionals.” A facility posts open shifts and then healthcare professionals can book the shifts directly from the app, without any staffing agency, contracts, or max or minimums involved.  

Because the healthcare workers that use the service are acting as independent contractors, that also means that they will have zero protections or benefits from either the facility they work at or a staffing agency. The nurse as an independent contractor is then responsible for:

◉ Deducting and paying their own taxes

◉ Purchasing all insurance coverage, including health insurance, other medical insurances, and liability insurances

◉ Setting up their own retirement plan

Additionally, the nurse may not have access to any employee-only benefits or services, such as mental health or wellness resources, educational benefits, and training. Some reviews of the app have also warned that there are no placement protections and nurses have been placed in unsafe staffing conditions and working placements outside of the scope of their practice. 

On the flip side, some nurses have raved about the flexibility the app provides. It doesn’t require signing with a travel agency, they can book shifts only as they want or need them, and if they aren’t in need of benefits, it’s an easy way to make their own schedule and build the income that they want. 

The Legislation

With the advent of apps like CareRev and other nurse-for-hire services popping up, California has introduced legislation to legally declare that any nurse or healthcare worker using digital services to book shifts be classified as an independent contractor. The primary purpose of the bill is to classify healthcare workers who use digital platforms and meet certain criteria, as independent contractors. That means, just like an Uber driver, they will not be classified as employees and will not have access to the protections and benefits provided to employees. 

The measure was filed last week with the state’s attorney general’s office and was submitted by the same law firm that was involved with the Uber campaign (Proposal 22) to keep DoorDash, Uber, Lyft, and Instacart workers as independent contractors instead of employees. Coincidence? Maybe not, especially considering that the firm is probably well aware of the fact that the healthcare industry is projected to be one of the fastest-growing in the entire nation. 

And as we all know, the nursing shortage, only exacerbated by the pandemic, is also expected to grow to critical levels. California alone is expected to have a need for 40,567 full-time equivalent RNs, or a 13.6% gap, until 2026. 

MarketWatch revealed that the group proposing the ballot initiative is called Californians for Equitable Healthcare Access and has not revealed its backers yet. But Silicon Valley is already heavily involved in healthcare staffing technology, pouring millions of dollars into apps and websites that will match healthcare workers directly with open shifts. 

MarketWatch also pointed out that California tends to lead the rest of the nation in terms of healthcare policies and legislation, so if the initiative passes, it could very well have an impact on the rest of the country’s nurses and healthcare workers very soon. 

How Could This Affect Nurses?

The biggest concern with a piece of legislation like this is that it could further exploit nurses, who some argue, are far more than gig workers. 

“Nursing…is fundamentally different from gig work,”  Sarah Gray, founder of Trusted Health, an on-demand staffing agency that treats nurses as employees, not contractors, told Market Watch. “There’s a high barrier to entry. It’s a professional career, and in order to sustain that career and provide high-quality care, nurses need to have that proper care themselves in the form of employee benefits.”

Other experts took their caution even further, warning that turning nurses into gig workers will only make the understaffed for-profit model that hospitals operate on even worse. There’s also concern that the initiative could have a ripple effect, impacting all healthcare workers, from nursing assistants to home health workers, stripping them of protections, benefits, and even lowering pay. Currently, California nurses make the highest wages in the entire country, with an annual salary of over $120,000, according to the Bureau of Labor and Statistics. Turning the nurses in the state into gig workers could significantly impact pay and of course, benefits. 

Notably, the move to reclassify nurses utilizing digital services to book work as independent contractors would also take them away from unions, which offer protection. And while flexibility is marketed as the primary benefit of on-demand work, it also leaves out the bigger picture: that “flexibility” means taking shifts that may not be ideal if nothing else is available, and a marketplace that, by definition, puts workers in constant competition with each other. 

Plus, as another source pointed out, it’s important to remember that the customer market of apps that hire nurses for open shifts is not actually nurses—it’s hospitals that are looking to save on labor costs.

Source: nurse.org

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4 Tips To Support a Coworker Who is Struggling Emotionally

When I was burned out in 2014, the thing that made the biggest difference was not what you’d think. It was not the yoga classes, the journaling, or the empowering quotes. It was the connection with others. Support from people that I worked with or the dear friends who could see that something was off and checked in on me. I’ll honestly never forget it. 

Burnout took me by surprise. I knew I had lost that spark. I was crying more, and I felt more resentful with each passing day. But I just kept going. I felt guilty for feeling that way. I felt stuck and so lost. I was new and I didn’t want to say anything to appear weak, like I couldn’t handle it, and wanted to be a reliable good nurse. Little did I know I was setting myself on fire to keep other people warm and it would soon catch up with me. 

When people around me started to check in on me a couple of things happened: 

◉ I felt loved and valued

◉ I got clarity on what I was really feeling

◉ I realized that what I was dealing with was unsustainable

◉ I needed to take action

My environment wasn’t changing for me, but instead, I had control over how I reacted to it, how I set boundaries, and how I treated myself. Through my conversations with the people that cared enough to check-in, I felt validated and supported. This empowered me to take the actions I needed to move forward. Actions that didn’t make me any less of a nurse or human being.   

Now, I know it may feel hard to check on others when maybe you are feeling burnout yourself.  Maybe you get through each day by the skin of your teeth and feel like you are in survival mode 24/7. But if we all took just a few minutes here and there to do a little survey of those around us, and took one action (even just a small one) to check in on each other it could make a huge difference for the individuals involved. Even more, it could help shift the nursing culture to one of unwavering respect, kindness, and solidarity.  

Here are 4 tips to approach a colleague you think is overwhelmed, suffering from burnout, moral injury, or trauma…or maybe they just don’t seem themselves:  

1. BE APPROACHABLE BUT AVOID UNSOLICITED ADVICE

Focus on support instead of sharing what you would do unless they specifically ask you. Connect with them, check-in, and ask questions like, "Do you want to talk about it?" then practice active listening. Offering your opinion could overwhelm them more and may make things worse.  Let them guide the conversation.

2. AVOID VAGUE HELP STATEMENTS

Rather than ask, "What can I do to help?" which may just overwhelm them more (hello, decision fatigue!), offer something specific.  For example, “Hey I am going to be grabbing lunch. Can I get you something?" or “Hey things are a little slow for me right now, can I do _____ for you?” Even if that means getting them a snack or some water.  

3. LET THEM FEEL THE FEELINGS

Sometimes it's uncomfortable when people are sad or mad, but let them feel it. Avoid saying things like "It could be worse" or "Let’s just focus on the positive." Validating their emotions helps them move through them. If their emotions are too great for you or are triggering you, communicate that you would love to support them and choose a time to meet up with them that feels good to you. 

4. FOLLOW-UP WITHOUT JUDGEMENT

If you have a conversation with someone who is struggling, loop back with them and keep your conversation with them private. Don’t engage in gossip. Encourage them to seek additional support if it seems needed. Avoid unsolicited advice unless they ask you for your opinion or you ask for permission to offer it.  

HERE’S WHAT NOT TO SAY

It can be hard to put yourself out there and check in on others. Their emotions may be overwhelming to you at times and sometimes our own discomfort may cause us to say things to try and fix the situation or help minimize the other person’s anguish. We are healers after all. But be careful about what you say especially if it appears to minimize how someone is feeling.  Here are a few examples of what not to say: 

◉ “Wow, that sounds awful but something way worse happened to me last week so it could be worse!”

◉ “I wouldn’t worry about it. Seriously just move on”

◉ “I wouldn't get this upset about it. Just be positive!” 

◉ “This really isn't worth you getting this upset about it”

◉ “I wouldn’t say anything, it will probably just make it worse”

◉ “Do you think maybe you are overreacting?”

◉ “Good vibes only!!”

We are navigating rough waters but we are always stronger together. Small acts of kindness can ignite massive changes to the environments we work in. You never know the impact you may have on someone who is struggling. We aren’t meant to do life or nursing alone and I challenge you this week to take a look around and try one of the tools above. 

Source: nurse.org

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California Updates Quarantine Policy For Healthcare Workers Amid Surge

California is currently experiencing the highest number of cases of COVID-19 since the pandemic began, which has prompted some new changes to the state’s policies in the workplaces.

Instead of just following the CDC’s updated COVID guidelines, California’s workplace policies are enacted by Cal/OSHA, the California Division of Safety and Health. Some of the changes affect how employees at workplaces are to be tested if an outbreak occurs at work, who needs to isolate after being exposed, and how vaccination status comes into play. And of course, the fact that COVID-positive nurses can just continue working their shifts. (Yes, really).

Here’s a more detailed breakdown of the changes, especially for healthcare workers. 

What the New CA COVID Rules Say

Some of the most recent general workplace changes—put into effect Jan 14, 2022, and in effect until April 14, 2022—stipulate that: 

◉ If there’s an outbreak in the workplace, the employer has to pay for COVID-19 testing for all employees, vaccinated or not. The tests may be self-administered, but it must be observed and read via telehealth or by the employer. 

◉ Masks are required in all indoor locations, including schools.

◉ Cloth masks are highly frowned upon. If they are worn, they must be tight-fitting and thick enough that light won’t show through them. 

◉ Anyone exposed to COVID-19 (even if they are fully vaccinated and asymptomatic) should be sent home with full pay OR wear a mask and stay six feet away from other people for two weeks. (Are all the nurses reading this laughing right now?) However, big catch with this one, because employers also aren’t obligated to pay sick leave for COVID, so not really sure how this actually works in real life. 

◉ Anyone who tests positive should quarantine for 5 days. 

◉ If transportation is a part of employment, fully vaccinated individuals must now wear a mask. 

CA COVID Rules for Nurses

While the general workplace rules are supposed to be in effect for most businesses, healthcare workers and emergency personnel, of course, also have their own set of rules. Nurses working in California will need to follow the rules that fall under AFL 21-08 set by the California Department of Public Health. 

The rules state that thanks to Omicron taking over and staffing challenges, the CDPH is “temporarily adjusting” the return-to-work criteria from January 8, 2022, through February 1, 2022. In other words, the need to keep hospitals staffed trump the “regular” rules. 

Here’s what temporary rules specify for nurses. And prepare yourself, because it’s a lot: 

◉ Any healthcare worker who tests positive for SARS-CoV-2 and is not showing any symptoms can continue working without isolating and without any additional testing required.  

◉ Any healthcare worker who has been directly exposed to COVID-19 and remains asymptomatic can also return to work immediately without any quarantine or testing required.

The only stipulations for healthcare workers who are either exposed or test positive is that they must continue to wear an N95 respirator while working and if possible, only work with COVID-19 positive patients. Additionally, whenever possible, the guidelines also advise any actively-infected but asymptomatic healthcare workers to keep away from their coworkers as much as possible, such as “using a separate break room and restroom.” Because every hospital definitely has that luxury available.  

These rules are in effect until February 1, 2022, at which time, the “regular” rules could go back into effect (unless, of course, another set of emergency temporary guidelines are passed). The normal rules stipulate: 

◉ Any vaccinated healthcare worker who tests positive should isolate for 5 days and return to work with a negative viral test. Without a test, they need to isolate for 10 days. However, if there is a critical staffing need, that timeline can be bumped under 5 days with a negative test. 

◉ Any unvaccinated healthcare worker who tests positive should isolate for 7 days and return to work with a negative viral test. Without a test, they need to isolate for 10 days. However, if there is a critical staffing need, that timeline can be bumped under 5 days with a negative test.

◉ For simple exposures, vaccinated workers have no restrictions if they test negative upon identification and again after 5-7 days. Unvaccinated workers should isolate for 7 days and get a negative test upon returning to work. Although again, both of those restrictions fly out the window with critical staffing shortages, in which case all that’s needed is a negative test upon identification of exposure and again at 5-7 days. 

It’s also worth noting that the guidelines specify that “asymptomatic” also includes “mildly symptomatic with improving symptoms.” Yes, for real. 

What Nurses are Saying About The New Rules

As you can imagine, California nurses have some thoughts about the new guidelines for healthcare workers. 

The California Nurses Association criticized the guidelines, as did the American Nurses Association (ANA). 

A full press release on the National Nurses United website reads:

“The California Nurses Association (CNA) condemns the decision by the California Department of Public Health (CDPH) to let asymptomatic health care workers who test positive for Covid-19 or have been exposed to the virus and are asymptomatic return to work immediately without isolation or testing.

‘Governor Newsom and our state’s public health leaders are putting the needs of health care corporations before the safety of patients and workers,’ said CNA President Cathy Kennedy, RN. “We want to care for our patients and see them get better – not potentially infect them. Sending nurses and other health care workers back to work while infected is dangerous. If we get sick, who will be left to care for our patients and community?”

Eliminating the isolation time and sending asymptomatic or exposed health care workers to work will guarantee more preventable transmission, infections, hospitalizations, and death. By doing all this, Newsom and CDPH are in effect guaranteeing more transmission.

“We must protect patients and keep nurses healthy and safe on the front lines,” said Kennedy.

Nurses demand that CDPH rescind its guidance, which is in effect from Jan. 8, 2022, until Feb. 1, 2022.”

California Nurses Association President Zenei Triunfo-Cortez also told KCRA3 News that the guidelines are a “major disaster” waiting to happen. "I think it's callous and it's putting our patients and ourselves in grave danger,” she added. 

Source: nurse.org

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What Does Rationing Medical Care Mean During a Surge in Patients?

Rationing medical care or resources has been an ongoing conversation in parts of the country as the delta variant rages on. Smaller, rural communities do not have the trained staff or equipment to adequately care for the continuing surge of patients. 

Hospitals in Idaho, Montana, and Alaska have all implemented standards of crisis care which allows medical professionals to do the greatest good for those with the greatest chances of survival. Despite the continued concern regarding the rationing of healthcare, this is not an uncommon occurrence in the United States. 

History of Rationing Medical Care

The word “rationing” has a negative connotation in regards to medical care and treatment so it has rarely been used. During COVID, it has been very clear that rationing was being done. Patients with the greatest survival chance were getting the limited resources available. For example, if three patients needed dialysis and only one machine was available then the patient with the greatest success rate would be given access to the machine. 

Rationing in the United States is most commonly done by insurance, price, pharmaceutical companies, etc. Those with better insurance carriers may have an easier time gaining access to treatment options including scans and medications. For example, since 2012 the cost of insulin has seen an average annual increase of more than 15%. Newer versions of insulin retailed for between $175 and $300 a vial. The dramatic increase in the price of insulin caused some diabetics to no longer be able to afford their insulin. As a result, patients began to ration their insulin to make it last longer. 

Rationing care in the time of COVID 

While rationing medical care isn’t a new practice, the continued surge of the delta variant throughout the country has brought it to the forefront of many healthcare systems. On September 16th, healthcare officials in Idaho expanded health care rationing statewide. The Idaho Department of Health and Welfare made the announcement after St. Luke's Health System, Idaho's largest hospital network, asked state health leaders to allow “crisis standards of care” because of the continued increase in COVID-19 patients has exhausted medical resources. 

Officials announces the standards were implemented due to a severe shortage of staffing and available beds in the northern area of the state caused by the massive increase in patients with COVID-19 who require hospitalization. The crisis standards were initially only limited to ten hospitals and healthcare systems in the panhandle and northern region but were later expanded due to the continuing surge in the number of infected patients. 

At the time of this announcement, Idaho was one of the least vaccinated states in the country with only 40% of the population fully vaccinated against COVID-19. As of publication, only 42% of the eligible population is vaccinated and 47% have received at least one dose and the state continues to be in crisis standards of care mode.  

Kootenai Health, in Coeur d'Alene, was the first hospital in the state to officially enter crisis standards of care. Chief of Staff Dr. Robert Scoggins said, “Some patients were being treated in a conference center that had been converted into a field hospital and others received treatment in hallways or in converted emergency room lobbies.” Urgent and elective surgeries are on hold across much of the state. 

St. Luke’s healthcare system reported that 92% of all of the COVID-19 patients hospitalized were unvaccinated and 61 of the hospital's 78 ICU patients had COVID-19.  

Unfortunately, Idaho isn’t the only state currently rationing medical care due to COVID-19. Alaska’s government officials announced at the beginning of October, that twenty healthcare facilities throughout the state would be operating under the State’s crisis standards of care. Officials are pleading with Alaskan residents to get vaccinated and wear a mask. Alaska reports that 51% of the eligible population is fully vaccinated while 57% have received at least one dose.  

Heidi Hedberg, director of the Division of Public Health stated, “We are working alongside our health care facilities to provide state and federal resources to support the surge of patients. We are also imploring Alaskans to do their part. Please get vaccinated if you have not done so already, wear a mask when needed and keep your social circles small. Every action you take helps prevent COVID-19 from spreading and protects you, your family, other Alaskans and our health care system. No one wants to use crisis standards of care guidelines.” 

Ethical Considerations

One of the biggest concerns for healthcare providers is the ethical concerns regarding the rationing of medical care. Nurses and doctors work under the ethical principles of beneficence, nonmaleficence, autonomy, and justice. Nonmaleficence, specifically, is the principle to do no harm. By rationing medical procedures, equipment, and care due to short staffing can and often does lead to undesirable patient outcomes. 

An intensive care unit nurse from Boise told Nurse.Org anonymously, “On a recent shift we didn’t have enough nurses to help with all of the codes that were occurring throughout the hospital at one time in addition to providing regular care to our ICU patients. The doctors, nurses, we were all spread so thin. A patient died. You can’t help but wonder if there was more that could have been done.” 

Nurses aren’t intending to do harm to their patients but it’s the reality when there are not enough resources or trained bodies to go around. While never easy to see a patient get sicker or succumb to their illness, it is happening everyday throughout multiple parts of the country. 

Rationing of Nursing Care

According to research, rationing of nursing care (RONC), refers to “necessary nursing tasks that nurses withheld or failed to carry out due to limited time, staffing level, or skill mix.” The result of rationing nursing care is potentially affecting patient outcomes. 

RONC became popular in 2008 at the start of the nursing shortage and only became increasingly more common due to the ongoing pandemic. According to The American Nurses Association (ANA), more registered nurse jobs will be available through 2022 than any other profession in the United States. There are estimates that an additional million nurses will be needed in the next decade. 

The truth is that the rationing of care has now become more related to the lack of nursing staff, respiratory therapists, and other trained healthcare professionals. "The staffing crisis is the worst it has been," says Siegel of America's Essential Hospitals. Health care systems have hundreds of vacancies that can't be filled, even if they pay top wages because "people just aren't there anymore."

Source: nurse.org

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