Pulse Check Wisconsin-Insights from a Milwaukee, ER Doc

Meriter Nurses Strike-Interview with Nurse Graetel

• Chris Ford

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Welcome to pulse check, Wisconsin. Good morning, good evening, good afternoon. This is Dr. Ford post check, Wisconsin. I wanted to welcome you all back. we are currently recording more episodes for the upcoming season. I appreciate you all reaching out on social media. I. Following us, liking our videos, But also I wanted to touch base about some of the goings on this summer one of the big stories was the nursing strike at Meriter Hospital in Madison, Wisconsin. I. Did a portion of my training at Meriter Hospital coming up through emergency medicine. So I know a couple people who are at that facility and have worked with them in the past I wanted to reach out to a couple of my colleagues to not only catch up but also to share some of their experiences with the strike. Talk a little bit more about what this strike means for those of us who may not be in healthcare. Those of us who don't know the specifics of what is going on. So I have Nurse Graetel here to see where we ended up with this strike, as well as the amended contract that eventually came out of it. a couple things that came up during our interview were patient safety, A lot of that has to do with the nursing to patient ratios that we see in the emergency department that we see in the hospitals hospital wide, essentially. to make the patient experience as safe as possible at all of our hospitals in the state of Wisconsin. The other thing came up was what we essentially closed our second season out with, with our interview with Nurse Erica, and it has to do with the employee safety, the healthcare worker safety. We've seen an exorbitant rise in healthcare worker violence, and we still continue to see it, not only in the state, but throughout the nation. And so one of the things brought up in this interview was to increase security measures at hospitals, to make those environments safer for nursing staff, for all staff throughout the hospital. And so we'll get a little bit more into that with our interview with Nurse Graetel let's go ahead and start our interview.

Chris (2):

thank you so much Graetel for joining us. We have Nurse Graetel here with us, as well as Darla Mae in the background too. I wanted to get you on because I wanted to talk about some of the experiences. We're seeing a lot in the news right now about Meriter, and, SCIU that's going through, with you guys as well. a lot of us just want to know kind of. From your perspectives, you know, what are some of the things that, that we're talking about? What are some of the things that led up to this strike?

Greatel:

Um, I am Graetel. I have been a nurse since 2008, mostly specializing in emergency medicine and transport medicine, and then in the last year and a half I have transitioned over to vascular access. reasons, a lot of it being my mental and physical health.

Chris:

Mm-hmm.

Greatel:

As nurses and as physicians, you know, we are terrible at taking care of ourselves.

Chris (2):

Yes.

Greatel:

So I finally decided that I needed to be my best. And so in order to do that, I completely switched focuses in my nursing career. And that's one, one of the really great things about being a nurse is you can do that.

Chris:

Mm-hmm. Mm-hmm.

Greatel:

But two, I ended up going back to Meriter, so I was an ER nurse at Meriter for six years. Went to UW for the ER there for 18 months, and then did pediatric neonatal and adult transport for seven. And ended up, I said, coming back to Meriter. And honestly, Meriter feels like coming home. So just. Like the support, the commitment, the middle management leadership is fantastic. So that's me. Yeah. Meritor has been in the news a lot recently.

Chris (2):

And you know, and, and for background, for, for our listeners out there, Graetel was at UW when I was training there too, was very much responsible for. The doctor that I am today, just for all that I learned from her and some of the colleagues that she worked with as well. So very, very much thankful for you and you know, I'm glad that you're in a better situation right now in terms of, you know, that career shift too, because like you said, a lot of times we don't take care of ourselves in a situation and, you know, we all have a, have, have, have a big clock above our heads, you know, ticking and so I'm glad that you're able to get that like you said, Meritor was like going back home for you. You started there as an ER nurse and then you came back with things that are going on right now. What inspired. Inspired you to participate in this because it's a huge strike that we all saw, like national news even. But what inspired you to participate, uh, in this strike at Meriter Hospital?

Greatel:

Um, honestly not. It wasn't just for me, it was for everyone. It was for the new nurses coming out of nursing school. The nurses who went through nursing school and COVID who don't know any better. The nurses who went through COVID, who, you know, they. I, I have coworkers who literally set up bedrooms in their garages because they weren't gonna go and expose their family members to this. And the nurse that I wanna be in, you know, 10, 15 years, I participated for all of those people because we deserve better. We deserve safety. We deserve safe staffing. We deserve to be able to go into work and not worry about, am I going to get hit today? Am I going to get punched today? Is there going to be enough security? At the hospital and is security going to be trained enough to do hands on to protect me and my staff? Or am I gonna have to wait until 9 1 1 gets called and Madison Police get into the hospital and get up to the unit that I'm at where something is going on? You know, there's been a lot of, they're just in it for the money. They're striking for the money. That's not, those were not our. Our big things this year. Yeah. Getting paid more is always nice, but the big, the two big things this year that we, that really truly pushed us to strike were safety and security. We are the one major hospital in the Madison area that does not have a weapons detector in the emergency room.

Chris:

Mm-hmm.

Greatel:

There was one point a patient was admitted for, I think like two weeks, and come to find out on discharge day, he had a loaded gun. Oh

Chris (2):

gosh,

Greatel:

the entire two weeks that he was admitted, child adolescent psych is offsite. It's about 20 minutes away, so they routinely don't have security there. There was apparently a parent in the parking lot there who had a loaded weapon.

Chris:

Hmm hmm.

Greatel:

So safety and security and then safe staffing. Um. You know, our ICU is is two to one, so one nurse for two patients every, you know, once in a while. So if they're on cer, CRT, it's a one-to-one patient.

Chris:

Mm-hmm.

Greatel:

And then very, very, very rarely, if they have multiple step down patients, it's three to one.

Chris (2):

Hmm.

Greatel:

Those are gen care patients.

Chris (2):

Yeah. That's not an ICU patient. Yeah. Right. So those

Greatel:

were ICU nurses, our IMC in the last year, actually just maxed out at three. But again, IMC patients, full cares, wound vx, you know, they, IMC can take up to 0.1 of Norepi.

Chris:

Mm-hmm.

Greatel:

You know, none of them are intubated, but CPAP, BiPAP High Flow. Yeah. So that's, you know, one to three. Mm-hmm. And then our gen care floors, so. Gen Care on days can take up to five.

Chris (2):

Wow. And there's five patients for one nurse there. And so for listeners out there, you know that it really strains you. Especially, you know, when you're on the floor, you, when you're by yourself, you know, let's say Graetel walks into a room and she's taking care or welcome on the floor, she's taking care of five patients. If something goes wrong with. One patient, or two patients, or three patients, you have to page out the doctor. That's gonna be a delay. You're gonna have to, you know, try to titrate the medications, things of that nature. That's gonna be a delay too. And so, you know, what really she's speaking to is a, a safety issue, you know, for that, for that patient care, right? Her license is on the line. You know, patient's lives are on the line too, which are the most important And so that all this is really straining. You know, her as a, as a nurse as well as, Just straining your career in general, like you're doing days and days of this, you know this five to one ratio and it wears on you.

Greatel:

And that's just day shift at night. Sometimes Chris, um, on one floor, they can have up to seven mm because people sleep at night. Which is 100% not true in the hospital.

Chris (2):

Right, right. I know. I never do. And so, you know, one, one of the things that that, that I read about in the, in the reports about this case was more so, you know, it was a back and forth. Right. And, and that's what led to the nurses' union striking at that point in time. What, what was some of the initial. Response because what I'm hearing is, you know, pretty clear, right? So we need safety, uh, which is something that we talked about, on prior episodes we had nurse Erica come on, and we talked about healthcare worker violence, and this is something that we're, we're, we're trying to shine a light on as well as being, in the pits, so to speak. And then also, you know, this patient ratio. Now what, how did, how did management respond to this, these initial demands?

Greatel:

So. The, and I was not on the bargaining team, so this is like, you know, from, from the bargaining team, we were allowed to tune into the the bargaining live. The union itself wanted to be able to have nurses have a voice in the matrix, so have a voice in patient, toit nurse patient to staff ratios. Management was adamant about not putting that language in the contract because if they had to go above the matrix, we could file a grievance. So they were adamant about not having that language in the contract and then adamant about we have a, an internationally recognized security team. They paid for a certification. So, you know, management kept putting out that It's the economics. The economics. The economics. Yeah. We started off high. I know we started off with what we were asking for. We came down millions of dollars on the economics. Management would not move on the, the safety and the staff ratios. They literally just ca kept turning in the same proposal. We would make minor adjustments, turn it, you know, give it to them. They would turn in the same proposal, like verbatim. They just wouldn't even change anything. Here you go. Here you go. Here you go. And so. You know, management says like, upper leadership of Meritor says that they have been quote, preparing for this for six months. We've only been bargaining since January.

Chris:

Mm-hmm.

Greatel:

Six months ago was December, you know, so they have been preparing to essentially say no before we even came to the table. Um. So finally after, I think, I think it was the first bargaining session, we gave them the 10 day notice to strike.

Chris (2):

So this had been going on for a while. Right. And so like this, this is the thing, right? A lot of people will only see the striking aspect, but they don't have that context to how long this has been going on, how long in advance this had been given before. Yep.

Greatel:

So bargaining started in January. It is June 1st, second right now, you know, and we, we gave them the 10 day notice to strike then. So that was on a Friday. And then we came to the table again on Monday and it was the same thing. I know that mon'cause I tuned in that Monday for just. Like we were still totally pushing safety and security and um, safe staffing, but you know, they were pushing economics on that. Monday we came down$4 million. So with, you know, across the board raises it. It's not even a cost of living raise,

Chris:

right?

Greatel:

So, yeah, so four,$4 million. The union came down over a two year timeframe. Management would not budge on the safety and security.

Chris (2):

Hmm.

Greatel:

So that's what did it,

Chris (2):

and we talked a little bit, uh, beforehand too about some of the responsibilities that still existed, right? So the reality was this, you all went on strike for a very good reason. Uh, patient care still had to continue as well. How did that, how was that remedied and like, you know, what daily responsibilities and interactions with patients, how was that impacted? From the strikes?

Greatel:

So there have been, you know, some of our coworkers didn't strike. Which we were all like, if you can't that's fine. We get it. Mm-hmm. But me personally, you know, I, I stand with my coworkers. So in, during the strike and talking to some of the people who were still working, the strike nurses, they didn't talk to people.

Chris:

They

Greatel:

interact. They just did their thing. There has, there have been quotes in the news from a patient that says, I was there prior to the strike and I'm still currently there with the strike nurses. The care has declined. I am late for pain meds. They're not flushing my iv. They're charting things and then leaving meds unopened on countertops.

Chris:

Hmm.

Greatel:

Thursday, I think it was over the course of a day. And don't quote me on this, but I mean you can't, from what I was told, there were 15 rapid responses and two quotes in one day.

Chris:

Oh my gosh. Hmm.

Greatel:

And I honestly don't think that would've happened if we would've been there.

Chris (2):

Yeah. And you know, for, for, for those listeners too, you know, tho, tho those rapid responses are people, you know, who for, for a number of different reasons in the hospital, somebody passes out in the foyer or somebody who falls down and is on blood thinners, you know, for those codes too, peoples who literally their heart stop, right? Or they stop breathing. So those are incidences like Graetel is on the rapid response team. So she'll go there and she'll start iv, she'll drop medications, start compression, things of that nature. And a lot of times we see them in the hospital, but at that volume is usually indicative that something is missing or you know, something went wrong in the care of that patient to have that much

Greatel:

Wednesday we were told that one emergency general surgeon, all of the vascular surgeons and then another surgeon, I'm not sure who that third surgeon was, but they all said, we are not doing surgeries the rest of the week. You told us we would have adequate, adequate, and appropriate staffing and you don't general surgery all of our vascular surgeons and another one. Are you kidding me? That is huge. Huge.

Chris (2):

And, you know, that, that shows some of the solidarity too. You know, my, my limited experience in, in working at Meriter, uh, I believe we rotated there on the ob uh, wing during residency and, you know, you can kind of feel that familial sense, right? Amongst, you know, all the staff, right? Not even the nurses, the texts, the doctors, et cetera. And you know, that. Really speaks to the fact that it is very fortunate you all have that. And then you also have the unions versus other hospitals in the state, in the nation too, don't have that union and don't have that ability to speak back, you know? Could you speak to your, your, your experience in that respect? At least having a voice.

Greatel:

It is huge. So when I worked at uw, they were trying to get the Union Bank,. If I made a little mistake and I got called into my boss's office, I, my heart rate was in like the one thirties because I was either going to get fired, disciplined, or I. Who, who knows what, you know, like it's, it's insane the difference that, the different feeling that I have from working where there is no union, to where there is a union and I can, and I can say no, they have my back. I know that even if I'm called into my manager's office. I can say, cool, I want my union rep, even if I didn't do anything.

Chris:

Mm-hmm.

Greatel:

And they have to abide by that.

Chris (2):

So, just recently released yesterday, I believe, was that there was a tentative agreement, at least at that time, which has since been ratified as well. So, congratulations.

Chris:

Thank you.

Chris (2):

What were the outcomes

Greatel:

so they have, in contractual language, stating that they are going to increase security, verbal communication, saying that they're going to also increase security numbers. We are getting a weapons detector in the emergency room. Right. Which is amazing.

Chris:

Mm-hmm.

Greatel:

And then in contractual language, it states that essentially the floor nurses have a say in their matrices.

Chris:

Hmm mm-hmm.

Greatel:

So there's going to be, I think it's like a, a new council. It's not gonna be unit council, it's not gonna be management, but a new councils are gonna be formed to make the floors and the staff nurses have a say and a voice in patient to nurse ratios.

Chris (2):

Yeah. Okay. Well, I mean that the, you know, that's a start, right? it's a start and going in the right direction. Um, especially having someone there who, who has been in that situation before, um, and knows kind of firsthand what those experiences are. What, what I. A, a patient that needs more, you know, means to someone versus the actual number, right? It could be like, you know, three to one, but if this patient is requiring, you know, wound changes or you know, maintenance of certain medications, like all those things are gonna play into that factor too. And so how do you feel about some of the compromises that you guys made from your, your end of the negotiations? Do you feel like, you know, it is that walk in the right direction

Greatel:

I do. I feel like it is a walk in the right direction. I feel like in two years when we bargain again, there will be more push in the next two, like next two years when we bargain again for more. Clear and concise contractual language, but just the fact that we got it in there to begin with is a massive win.

Chris:

Mm-hmm.

Greatel:

It is a massive win for nursing. It is a massive win for patients because then they actually have a nurse who has an appropriate number of patients that they are safely. Because we now have the voice to say, this is what we as a nursing staff can take care of and can take care of safely and appropriately. And there are a lot of studies that show lower nurse to patient ratio. Better outcomes for the patients, less readmission rates for the patients, and just overall better patient satisfaction.

Chris (2):

Absolutely. What lessons have you and your colleagues learned from this experience? I don't know if this has been your first strike that you've had the opportunity to participate in, but like what, what, what, what are you gonna take from this experience?

Greatel:

We are a team.

Chris (2):

Mm-hmm.

Greatel:

I met so many people that I wouldn't have met otherwise. You know, I, I go to Babyland to start IVs and put PS in, but. The solidarity between the labor and delivery nurses and postpartum and antepartum nurses coming over to the tower. They, you know, as, as a labor and delivery nurse, their ratios were lower to begin with because as a laboring mom, you kind of need like a one-to-one nurse there to, you know, walk you through. Your epidural, your mm-hmm. Your pushing, your, your checks. So the fact that the labor nurses were over supporting, we call it the tower. So Mariner is kind of sectioned off into, there's an east wing, a north wing. The north wing is baby land.

Chris:

Mm-hmm. Mm-hmm.

Greatel:

Antepartum, labor and delivery postpartum. And then the NICU is all over in, in Babyland. And then the tower side has the emergency room or, um, pre-op pacu. Gen Care, neuro I-C-U-I-M-C, and then surgical. So the fact that they were over there standing with us as well was amazing. Like the team, the team spirit, the fact that even though they had it good, they were still standing with us so that we could have it.

Chris:

That's fantastic.

Chris (2):

You spoke a little bit before we came on about, you know, some of, some of your management and like the great relationship that you have with your management too.

Greatel:

Yep. Yep.

Chris (2):

Like I said, in a lot of places that I've worked, I, I can't even count the number of hospitals that I've worked at at this point in time. You know that, that that relationship sometimes is there and it's sometimes missing, and that's just given the size of those places or given how impersonal it can be the environment that you work in, but how do you envision the relationship in the future between nursing staff and hospital management?

Greatel:

So we went back to work yesterday. It was tense and that's really, truly unfortunate. Like we as striking nurses got emails stating, you know, no comments, no snarky remarks. No hostility. Well, we came back to unfortunately, some of the middle management being upset at us sta, you know, stating, hope you enjoyed all causing all of this chaos for a dollar rates. Um, I think that our middle management was put in a super hard spot. Like you said, so many places are just, you're, they're thrown in and they get to check all the emails, say all the things, and take all the heat. My team is technically under mobile unit, so, or like the resource pool unit. My mobile unit management is fantastic. Every day, Monday through Friday, if they're in the building at 11 o'clock, they meet with my team. Asking, how are things going? How are picks going? Do you need more support? Is there anything that I can do for you? I hope that that relationship continues, in my opinion, my team and like mobile unit itself, because we do go everywhere and we kind of see everyone and interact with so many different people. We're very used to the flow and the fluctuation and. Turning on a dime and saying, mm-hmm well, hey, you're going here. You're going here. And I think that really truly is the embodiment of our managers as well. So I think that they, they will be able to still continue to be there with us and do what's best for the patients.

Chris (2):

Because at the end of the day, that's it. Right? Like that, this is why we're here. Right.

Greatel:

This is why we are here. We are here for them. You know, I don't know about you, but I got into this industry to help.

Chris (2):

Mm-hmm. Absolutely.

Greatel:

I didn't get in it for the hours.'cause the hours suck.

Chris (2):

Mm-hmm. Mm-hmm.

Greatel:

You know, as a, as a nurse who works in the hospital. I work every third weekend. I work holidays. I, you know, I miss birthdays, I miss anniversaries. I miss going out with friends on a random, you know, Friday night because I work seven A to 7:00 PM and I have to be back at seven A, you know, so I didn't get in it for the schedule.

Chris:

Mm-hmm.

Greatel:

I got in it to help people and to help patients, and to help people feel better and to be there, you know, on the patient's worst, sometimes the worst day of their lives. Yeah. And not only patients, but family members.

Chris (2):

Mm-hmm.

Greatel:

As well.'cause sometimes it's a family member's worst day of their life.

Chris (2):

Absolutely. And you're the nurse for the whole family.

Greatel:

You are the nurse for the whole family, not just the patient. Um, but yeah, so like that's really, in my opinion, what this strike was for, was for them

Chris (2):

in looking forward. So we had the governor come on and we talked about some of the, some of the plans that are in place right now in order to address the looming nursing shortage, uh, throughout the state of Wisconsin. And as we see in institutions like your own right, when nurses have a voice and they're able to do this bargaining with the hospital system, we see. Some nurses that are powerless in some situations too, and you know, that's worrying on them, you know, their, their careers are being shortened by the day, given the fact that they don't have that voice. Just to kind of close out, what advice would you offer to nurses and other institutions who are facing similar challenges that are being faced, you know, throughout the state, throughout the country? What advice would you give them?

Greatel:

Take care of yourself because honestly. In my opinion, in all reality, we don't have a nursing shortage. We have a bedside nursing shortage. You know, as nurses get older or nurses who come into the field fresh, they realize that it's not worth getting hit. Kicked, working the night shift, working the weekends, take care of yourself because if you can't take care of yourself, you can't take care of anyone else. And again, whether that's at a union hospital or a non-union hospital, it still stands true, like my mental health is exponentially better getting away from. The, the toxic management and the toxic, you are just a number at other hospitals. Like I could call one of my bosses right now and be like, Hey, what's up? And we could literally just have a conversation. So I now have supportive management, supportive coworkers, and I'm learning through lots of therapy.

Chris (2):

Mm-hmm. Which is also, I recommended blanket for every healthcare provider across the board.

Chris:

Mm-hmm.

Greatel:

Mm-hmm. Even if you just sit there for the hour, doesn't matter. That's your

Chris:

hour. It's

Chris (2):

your hour. No, absolutely.

Greatel:

Yeah. My, my recommendation to anyone in the field is take care of yourself.

Chris (2):

Well, Graetel again, thank you so much for your time. I appreciate it. Many congratulations for what you all accomplished. Now. Hopefully this is, this is kind of the first step and a long journey of continuing to push the envelope, continue to make our hospital safer. Safer, not only for us as healthcare providers, uh, but also for our patients too. So thank you so much.

Greatel:

Yeah, of course.

Chris (2):

Good to see you. Good to see you my friend.

Big shout out goes to the nursing staff at Meriter Hospital to the Allied Healthcare staff as well, who helped them fight for the advances that they got, as well as SEIU here in the state of Wisconsin. I want to thank everyone for listening to this episode. Again, we're gonna continue to push for safer hospitals. We're gonna continue to push for safer healthcare worker conditions, as well as safer environments for us to help you get better. So if you come to the emergency department, you shouldn't have to worry about if your nurse is tired, if your nurse feels safe at your hospital, if you feel safe at your hospital, those are things that should not be at the forefront of your mind. It should be more so getting better. For those of you who are interested, we recently completed a collaboration effort with Milwaukee based artery ink. There is clothing available shirts as well as jackets that are available to highlight healthcare worker violence. The campaign is heel not harm, and so, we'll have that. Link available on the website for post check Wisconsin. You can go to the Artery Inc link. as always, you can always follow us on social media, Pulse Check Wisconsin, or you can follow my own personal social media. We'll have those links available for you. So with that being said, we are currently recording the rest of season three. We are excited to get some of those episodes out. We got some really good interviews done thus far and we are very excited to get it out to you guys. looking forward to doing that. And with that being said.

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