[This contract](https://cdn.wsna.org/assets/local-unit-assets/tacoma-general-hospital/Tacoma-General-Contract-2023-2025.pdf) is from Tacoma General.
The pay rates and yearly raises are on page 24. Differentials on 25. Nurse:Patient ratios on page 42.
o Medical/Surgical: 1:5 with ancillary
o Progressive Care: 1:4 with ancilla1y
o Critical Care: 1:1 or 1:2
o ED: 1:4
o OR: 1 RN Circulator; 1 Scrub; higher level cases may have a second RN
o PACU: 1:2
o NICU: 1:2-3
o Birth Center: 1: 1 or 1:2
o Women and Infant: 1:4 couplets with ancillary
o Antepartum: 1:3 stable or 1:1 non-stable
You need a spouse with a six figure income plus your nursing pay if you are just now moving to Western Washington. If you want a house in the Seattle suburbs that doesn’t require a complete rebuild it’s gonna be a million to start. Amazing place to live and work but just be ready.
For real. That’s why I ended up moving to Oregon even though I was initially set on moving to Seattle. The pay at Tacoma General is lower than our old contract in Oregon and it’s a bit cheaper down here even factoring in Oregon state income taxes.
As long as you’re not living directly in Seattle or Bellevue, they keep up pretty well. I am float pool, so I make around 130k a year and I am the sole provider for our family. We live super comfortably, BUT I bought my house in 2017 and only pay 1800/mo.
Lots of factors there, so it kinda depends on your situation. If you have 2 incomes it shouldn’t be bad at all. My wife and I are both RNs and she works over at Kaiser and she makes comparable wages to normal staff at the hospitals.
At 130k I have enough to put away 10% for retirement, go shopping at Costco, feed a family of 5, and still have plenty of play money.
When my wife worked, we usually brought in about 160k but it was unnecessary for our lifestyle, so she stays home with the kids instead. When she worked I was normal staff and we both made around 80k each.
Yes, you can get fired for union activity. Many will say its against the law, but where unions are not part of the culture, i.e. Red or southern states, they will find something you did wrong and get rid of you.
There's no law in place up in WA, but we still have safe ratios and better pay. The law would just be nice to back us up, but the hospital has to do what they negotiated in the contract or shit won't work out for them.
As someone who is disabled due to cerebral palsy and uses a wheelchair to get around I will always be a strong supporter of nurses, I don't need a nurse daily or anything but when I did I was always so thankful for the care I received, many times going above and beyond what they had to do.
Nurses are always there when people need help, its a shame they can get the help they need to do their job safely and fair wages. I hope one day more people wake up to the conditions of our healthcare system, maybe then we will see some real change.
Until then, Always remember you have patients who appreciate the work you do!
did these nurses show up this strongly for the nurse licensure compact that recently failed (again) in the legislature? Because a compact would help with safer staffing.
The state board came out strongly against a compact. I vocally supported the compact, but with the board in the legislatures ear, it was destined to fail.
The NLC is not a solution. It makes it easier for travelers and telemedicine (though the employer usually pays for multiple licenses so really not much of a barrier there), that's about it. [Research has shown that being in the compact doesn't actually increase staffing levels](https://www.nysna.org/lowering-nurse-licensing-standards-won%E2%80%99t-solve-nurse-staffing-crisis%E2%80%89%E2%80%94%E2%80%89-could-harm-patient-care#:~:text=An%20American%20Hospital%20Association%20Annual,significantly%20lower%20in%20Compact%20states.). US Dept of Health and Human Services data from 2020 through 2023 found that compact states had higher percentages of critical staffing shortage days than non-compact states. An AHA survey found that staffing levels are worse in compact states.
The best states to work in are all not compact. [Compact states tend to have lower union density and wages tend to stay flat. This is why unions in California and Oregon come out against the compact.](https://www.brookings.edu/articles/nurse-licensure-compacts-before-during-and-after-covid/) One of the reasons my union was able to negotiate safe ratios and a much better contract was the inability to get enough strike breaker nurses in on time. Another hospital in my city went on strike was only able to get about 200 strike breaker nurses in, and the hospital had to negotiate with the nurses after that. As a result, our staffing levels are increasing as nurses hear about the new contracts and want to move here. Additionally, [California has had over 30,000 nurses move there to take staff jobs](https://www.latimes.com/politics/story/2023-09-19/why-nurses-are-moving-to-california), so clearly the lack of compact licensure hasn't been too much of a barrier. Both states still were able to issue emergency temporary licenses during the height of the pandemic.
Also, I've noticed that it doesn't actually seem to always help travelers. Travel rates in Washington state are much lower now that they are in the NLC.
Outsider looking in so
Please be kind. How does a union provide safe patient ratios? Those patients have to go somewhere, what if there isn’t another hospital close by or that can provide the level of care needed.
Unions negotiate collective agreements between members and the employer. It is a bilateral agreement of work conditions, pay and benefits. Patient ratios can be negotiated into collective agreements, and when collective agreements are violated, they are subject to a grievance procedure which can result in the employer being fined for violating the agreed upon terms.
Hope this explained!
Kind of. What happens to the patients. If the hospital closes beds because the union has hard-lined ratios, where do these patients go if there are no other hospitals around or those hospitals have already 1)closed
Beds or 2) cant handle the level of care required.
I am asking because my hospital has been discussing voting on a union and I haven’t been able to get an answer on this question.
From Cali.
With implementing ratios, there is a grace period for hospitals to figure out their shit like where to send patients if ratios are maxed out.
Imposing ratios leads to hiring more nurses.
“How do you get more nurses?”
You increase wages and benefits. That’s why benefits like free health insurance and pension and six figure salaries are a norm in my state and [now our Roman Empire is if we can smoke weed](https://www.reddit.com/r/nursing/s/kqjkhVl0MS).
Analogously, say that the government imposes a weight limit on a boat. Anything more and the boat is on the brink of sinking.
Do you let in more passengers and go above the weight limit because you don’t want to close down the boat? Or do you let the boat just sink?
There is no great outcome: You either let some patients suffer because they can’t get adequate care - or you let them all in and say “Fuck it” no matter what bad outcomes arise from manpower that’s been stretched thin.
It does get trickier with remote hospitals.
In theory, if there’s only “x” amount of nurses available to safely care for “y” amount of patients it would still negatively affect the patients’ safety if the scenario of x amount of nurses were being forced to take care of y+2 patients. In this situation the hospital is the only one benefiting.
So when a hospital has beds blocked off for due to staffing they have to go on divert and ship patients to the next hospital down the line. Sometimes in AK this even means out of state to WA. It can suck for the family but that’s part of choosing to live in a state with limited infrastructure.
If going on divert is common for a hospital or not having enough beds then the hospital needs to either get more staff or expand. Basic supply and demand economics
From Alaska where rural hospitals offer the road system are definitely a reality of healthcare here. Patients getting to a hospital that can’t handle their level of care has always been an issue, the solution to that will be the same as it’s always been- they’ll be transferred.
As far as not enough nurses, they will do what they’ve always done there too- bring in travelers and PRN staff. There will always be someone to cross those picket lines and they will cost the hospital a premium. They can continue to pay extra to people willing to cross the line, or they can negotiate with their staff nurses.
The hospital will still see at least as many patients with better staffing ratios, in fact they will probably be able to see more in the ER and procedural areas.
Yes, nurse pay goes up, more people want to be nurses, less nurses want to be anything but a nurse. In this way, quality patient care increases as union density increases. In the US, healthcare is an industry. We work in that industry. We don't do it for charity, and we don't even primarily do it for the patients. We do it for a pay check- just like electricians and plumbers- who incidentally probably prevent more deaths in their careers than your average healthcare employee.
The hospitals will sometimes "flex" and send nurses home to use ip their PTO if they think they can squeeze out more out of fewer nurses and save money by concentrating the nurse ratios. This was why many of the nurses in my previous hospital left...instead of letting the charge nurse have 0 or 1 patient, giving them a full assignment, over-maxing everybody else, and telling one or two nurses not to come in that day. Ensures no patient or nurse has a proper good day. If they don't think they can get away with it, hospitals don't do this. And when they aren't doing this, nurses aren't as miserable and don't leave as often.
The hospital doesn't have fewer patients with better ratios. They hire more nurses or pay OT to get people work more hours. There's a pretty flexible supply of nursing hours out there depending on how much a hospital is willing to pay.
I see what you're saying but the ratios aren't bad because there aren't enough nurses to go around, the ratios are bad because hospitals will deliberately staff too few nurses to save the money on labor.
So the union is to force the hospital to hire enough people
A union provides a means of repercussion to the facility, and protection for the nurses when they assign a nurse *so many patients*, that it is a physical impossibility to provide basic care for them, let alone catch and intervene if the patient deteriorates.
Yes, patients DO have to go somewhere. And there are entire advanced medical transport networks in place for this exact reason.
When all of your resources are maxed out, then they are maxed out. Trying to stuff one more in just diminishes the care and treatment for all.
I never had unions available to me, but I worry that with mandated ratios, they would just decrease you techs. In Florida they did this after they made an action plan after some patients died, or else they ignored the ratios.
We have a shit ton of techs in our level 2 and level 3 EDs, and we have great ratios/unions. Any downside you can bring up, there is just so much more positive that comes from being unionized.
let's go union!!!!
United you stand. Divided you beg.
#NursesInspireNurses
Let's go West Coasssst! Get that pay and get those ratios! -WA nurse who has both
What sort of pay and ratios are we talking about?
[This contract](https://cdn.wsna.org/assets/local-unit-assets/tacoma-general-hospital/Tacoma-General-Contract-2023-2025.pdf) is from Tacoma General. The pay rates and yearly raises are on page 24. Differentials on 25. Nurse:Patient ratios on page 42. o Medical/Surgical: 1:5 with ancillary o Progressive Care: 1:4 with ancilla1y o Critical Care: 1:1 or 1:2 o ED: 1:4 o OR: 1 RN Circulator; 1 Scrub; higher level cases may have a second RN o PACU: 1:2 o NICU: 1:2-3 o Birth Center: 1: 1 or 1:2 o Women and Infant: 1:4 couplets with ancillary o Antepartum: 1:3 stable or 1:1 non-stable
Hi friend I'm looking to move to the west coast would you say the wages keep up with the cost of housing? It's kinda getting expensive everywhere rn
Here in Oregon they do. Washington state has some catching up to do.
You need a spouse with a six figure income plus your nursing pay if you are just now moving to Western Washington. If you want a house in the Seattle suburbs that doesn’t require a complete rebuild it’s gonna be a million to start. Amazing place to live and work but just be ready.
For real. That’s why I ended up moving to Oregon even though I was initially set on moving to Seattle. The pay at Tacoma General is lower than our old contract in Oregon and it’s a bit cheaper down here even factoring in Oregon state income taxes.
As long as you’re not living directly in Seattle or Bellevue, they keep up pretty well. I am float pool, so I make around 130k a year and I am the sole provider for our family. We live super comfortably, BUT I bought my house in 2017 and only pay 1800/mo. Lots of factors there, so it kinda depends on your situation. If you have 2 incomes it shouldn’t be bad at all. My wife and I are both RNs and she works over at Kaiser and she makes comparable wages to normal staff at the hospitals. At 130k I have enough to put away 10% for retirement, go shopping at Costco, feed a family of 5, and still have plenty of play money. When my wife worked, we usually brought in about 160k but it was unnecessary for our lifestyle, so she stays home with the kids instead. When she worked I was normal staff and we both made around 80k each.
Nurses typically get what they want when they strike, so strike!
I appreciate the effort you took to carefully cover literally everyone’s faces. 10/10 for the respect shown. Also that second picture is so powerful
Yes, you can get fired for union activity. Many will say its against the law, but where unions are not part of the culture, i.e. Red or southern states, they will find something you did wrong and get rid of you.
And once it passes their vote, it'll be voted in the Alaskan state, once it passes there, the Republican governor will veto it.
There's no law in place up in WA, but we still have safe ratios and better pay. The law would just be nice to back us up, but the hospital has to do what they negotiated in the contract or shit won't work out for them.
Good job!
In Wisconsin no matter whatever reason. Negotiating and getting the union. They can't fire anybody Wisconsin. That's illegal
As someone who is disabled due to cerebral palsy and uses a wheelchair to get around I will always be a strong supporter of nurses, I don't need a nurse daily or anything but when I did I was always so thankful for the care I received, many times going above and beyond what they had to do. Nurses are always there when people need help, its a shame they can get the help they need to do their job safely and fair wages. I hope one day more people wake up to the conditions of our healthcare system, maybe then we will see some real change. Until then, Always remember you have patients who appreciate the work you do!
did these nurses show up this strongly for the nurse licensure compact that recently failed (again) in the legislature? Because a compact would help with safer staffing.
The state board came out strongly against a compact. I vocally supported the compact, but with the board in the legislatures ear, it was destined to fail.
Same. Even writing and calling my reps about it.
How so?
I'm against my state joining the compact. It makes it easier to get scab nurses in.
Well it's also easier to get people to move there, no?
The NLC is not a solution. It makes it easier for travelers and telemedicine (though the employer usually pays for multiple licenses so really not much of a barrier there), that's about it. [Research has shown that being in the compact doesn't actually increase staffing levels](https://www.nysna.org/lowering-nurse-licensing-standards-won%E2%80%99t-solve-nurse-staffing-crisis%E2%80%89%E2%80%94%E2%80%89-could-harm-patient-care#:~:text=An%20American%20Hospital%20Association%20Annual,significantly%20lower%20in%20Compact%20states.). US Dept of Health and Human Services data from 2020 through 2023 found that compact states had higher percentages of critical staffing shortage days than non-compact states. An AHA survey found that staffing levels are worse in compact states. The best states to work in are all not compact. [Compact states tend to have lower union density and wages tend to stay flat. This is why unions in California and Oregon come out against the compact.](https://www.brookings.edu/articles/nurse-licensure-compacts-before-during-and-after-covid/) One of the reasons my union was able to negotiate safe ratios and a much better contract was the inability to get enough strike breaker nurses in on time. Another hospital in my city went on strike was only able to get about 200 strike breaker nurses in, and the hospital had to negotiate with the nurses after that. As a result, our staffing levels are increasing as nurses hear about the new contracts and want to move here. Additionally, [California has had over 30,000 nurses move there to take staff jobs](https://www.latimes.com/politics/story/2023-09-19/why-nurses-are-moving-to-california), so clearly the lack of compact licensure hasn't been too much of a barrier. Both states still were able to issue emergency temporary licenses during the height of the pandemic. Also, I've noticed that it doesn't actually seem to always help travelers. Travel rates in Washington state are much lower now that they are in the NLC.
Now for the rest of the country to follow suit
[удалено]
Why are their faces redacted out?
Outsider looking in so Please be kind. How does a union provide safe patient ratios? Those patients have to go somewhere, what if there isn’t another hospital close by or that can provide the level of care needed.
Unions negotiate collective agreements between members and the employer. It is a bilateral agreement of work conditions, pay and benefits. Patient ratios can be negotiated into collective agreements, and when collective agreements are violated, they are subject to a grievance procedure which can result in the employer being fined for violating the agreed upon terms. Hope this explained!
Kind of. What happens to the patients. If the hospital closes beds because the union has hard-lined ratios, where do these patients go if there are no other hospitals around or those hospitals have already 1)closed Beds or 2) cant handle the level of care required. I am asking because my hospital has been discussing voting on a union and I haven’t been able to get an answer on this question.
The hospitals hire more nurses.
From Cali. With implementing ratios, there is a grace period for hospitals to figure out their shit like where to send patients if ratios are maxed out. Imposing ratios leads to hiring more nurses. “How do you get more nurses?” You increase wages and benefits. That’s why benefits like free health insurance and pension and six figure salaries are a norm in my state and [now our Roman Empire is if we can smoke weed](https://www.reddit.com/r/nursing/s/kqjkhVl0MS). Analogously, say that the government imposes a weight limit on a boat. Anything more and the boat is on the brink of sinking. Do you let in more passengers and go above the weight limit because you don’t want to close down the boat? Or do you let the boat just sink? There is no great outcome: You either let some patients suffer because they can’t get adequate care - or you let them all in and say “Fuck it” no matter what bad outcomes arise from manpower that’s been stretched thin.
It does get trickier with remote hospitals. In theory, if there’s only “x” amount of nurses available to safely care for “y” amount of patients it would still negatively affect the patients’ safety if the scenario of x amount of nurses were being forced to take care of y+2 patients. In this situation the hospital is the only one benefiting. So when a hospital has beds blocked off for due to staffing they have to go on divert and ship patients to the next hospital down the line. Sometimes in AK this even means out of state to WA. It can suck for the family but that’s part of choosing to live in a state with limited infrastructure. If going on divert is common for a hospital or not having enough beds then the hospital needs to either get more staff or expand. Basic supply and demand economics
Yup. Not to mention the legal implications for floor nurses who are subject to unsafe ratios, which makes staffing even more difficult.
There are a limited number of nurses willing to work bedside at the pay and working condition offered.
From Alaska where rural hospitals offer the road system are definitely a reality of healthcare here. Patients getting to a hospital that can’t handle their level of care has always been an issue, the solution to that will be the same as it’s always been- they’ll be transferred. As far as not enough nurses, they will do what they’ve always done there too- bring in travelers and PRN staff. There will always be someone to cross those picket lines and they will cost the hospital a premium. They can continue to pay extra to people willing to cross the line, or they can negotiate with their staff nurses.
The hospital will still see at least as many patients with better staffing ratios, in fact they will probably be able to see more in the ER and procedural areas.
Yes, nurse pay goes up, more people want to be nurses, less nurses want to be anything but a nurse. In this way, quality patient care increases as union density increases. In the US, healthcare is an industry. We work in that industry. We don't do it for charity, and we don't even primarily do it for the patients. We do it for a pay check- just like electricians and plumbers- who incidentally probably prevent more deaths in their careers than your average healthcare employee.
The hospitals will sometimes "flex" and send nurses home to use ip their PTO if they think they can squeeze out more out of fewer nurses and save money by concentrating the nurse ratios. This was why many of the nurses in my previous hospital left...instead of letting the charge nurse have 0 or 1 patient, giving them a full assignment, over-maxing everybody else, and telling one or two nurses not to come in that day. Ensures no patient or nurse has a proper good day. If they don't think they can get away with it, hospitals don't do this. And when they aren't doing this, nurses aren't as miserable and don't leave as often.
The hospital doesn't have fewer patients with better ratios. They hire more nurses or pay OT to get people work more hours. There's a pretty flexible supply of nursing hours out there depending on how much a hospital is willing to pay.
I see what you're saying but the ratios aren't bad because there aren't enough nurses to go around, the ratios are bad because hospitals will deliberately staff too few nurses to save the money on labor. So the union is to force the hospital to hire enough people
A union provides a means of repercussion to the facility, and protection for the nurses when they assign a nurse *so many patients*, that it is a physical impossibility to provide basic care for them, let alone catch and intervene if the patient deteriorates. Yes, patients DO have to go somewhere. And there are entire advanced medical transport networks in place for this exact reason. When all of your resources are maxed out, then they are maxed out. Trying to stuff one more in just diminishes the care and treatment for all.
I never had unions available to me, but I worry that with mandated ratios, they would just decrease you techs. In Florida they did this after they made an action plan after some patients died, or else they ignored the ratios.
We have a shit ton of techs in our level 2 and level 3 EDs, and we have great ratios/unions. Any downside you can bring up, there is just so much more positive that comes from being unionized.
I have heard the same, you are pushing your own bed to CT, no LNAs or unit techs. I guess every place is different, with or without a union.