February 2001 27:1 JOURNAL OF EMERGENCY NURSING 9

LETTERS

reporters of their health and medication histories. Theymay not understand that even occasional use of a medica-tion needs to be reported. They may be embarrassed toadmit that they use Viagra or lack knowledge about theimportance of reporting the use of Viagra.

After caring for this patient, the following questionarose for our staff: Should a question about Viagra use beincluded in the screening of male patients with chestpain?—Robin Walsh RN, BSN, CEN, CCRN, MercyHospital, Springfield, Mass; E-mail: Rwrn627@aol.com

REFERENCES1. ACC/AHA Expert Consensus Document: Use of sildenafil

(Viagra) in patients with cardiovascular disease. Circulation1999;99:168-77.

2. Pfizer Viagra Package Insert [on-line], 1999. Available at: URL:www.viagra.com/hcp/pro_pack_insert.htm.

3. Clinician Reviews: Summary statement of the American Collegeof Cardiology and the American Heart Association on the use ofsildenafil (Viagra) in patients at clinical risk from cardiovasculareffects [on-line], 1998. Available at: URL: www.medscape.com.

4. Viagra information [on-line]. Available at: URL: www.healthcen-ter. com/pharmacy/.

18/64/113249doi:10.1067/men.2001.113249

More on Mandatory Overtime and Wearing Blue Ribbons

Dear Editor:I would like to thank you for your supportive, com-

prehensive, and eloquent editorial (2000;26:201-2). I havebeen a nurse for 14 years and have worked at St VincentHospital for 8 years. St Vincent’s was a Catholic hospitalwhen I began working there and it was sold, and then soldagain, finally to the second largest for-profit hospital chainin the United States. Over the course of my years at StVincent’s, our benefits began to disappear. Holidays, vaca-tion days, even our paltry charge nurse differential (60cents an hour) were gradually taken away.

What finally forced our call to organize and ultimate-ly strike, however, was dangerously low staffing. Whennurses left, their positions were not re-posted. The num-ber of nurses decreased from 600 to 535. Our patientassignments rose from 5 or 6 patients on the day orevening shift to 9 or 10 patients. We had to prioritizewhich patients would get essentially no care, because oth-ers were sicker. We went to managers and said that wecould not go on; we were dead on our feet, we constantly

believed that we had not done nearly enough for ourpatients, and the situation was dangerous. Managers wereas helpless as we were. Administration said that staffingwas solely at the discretion of management and that nurs-es had nothing to say about it.

It was under this administration that nurses were toldthat they could only issue one blanket per patient becauseblankets weighed more than sheets and cost more to dryin the laundry. If a patient complained of being cold, wewere to give them a double folded sheet. There was a mas-sive outsourcing and contracting of patient services,resulting in 130 people being laid off. Patient services andprograms that did not make a profit were shut down.Supplies and equipment became cheaper and cheaper.Parts of IV sets were incompatible with other parts. Bloodtubing and filters were inferior and clogged easily; as aresult, precious blood was lost that should have gone topatients.

We called the Massachusetts Nurses Association(MNA), asked for help, and began to organize. What fol-lowed was 2 years of dragged-out negotiations in whichnurses made concession after concession in an attempt tocomplete our first contract. Hospital administration saidthat the MNA was using us for “another agenda” that wasnever quite defined. But, in fact, we, the nurses of StVincent, were the union; we were MNA.

The decision to strike was the hardest thing that ourmore than 500 nurses ever had to do. The hospital gave usno choice but to strike, given that they were unmovable intheir position that an unlimited number of forced 16-hourshifts would be required of nurses. Mandatory overtimehad never existed at St Vincent’s before, and nurses hadpowerful feelings about beginning the practice of placingtheir patients, their licenses, and their livelihoods in dan-ger. The strike was authorized by a vote with a 3 to 1 mar-gin, signaling just how powerful those feelings were. Asdifficult as it was to strike and go without our pay andhealth insurance, the difficulty was tempered by thetremendous support we received, literally from around theworld. Electronic communication made a difference, andwe heard from other nurses as far away as Europe andAustralia. Nurses from around the United States joined uson the picket line, and financial contributions came infrom everywhere. At home, our entire community, from

10 JOURNAL OF EMERGENCY NURSING 27:1 February 2001

LETTERS

teachers to Teamsters, from priests to politicians, ralliedbehind our cause.

On the heels of our strike, federal legislation wasintroduced, co-sponsored by Massachusetts CongressmanMcGovern and California Congressman Lantos, to prohib-it the use of mandatory overtime for any health care work-er except for physicians. Pilots, truck drivers, and evenpostal workers are prohibited by law from working toolong, but up until now, nurses, who literally hold people’slives in their hands, were not.

Our strike was successful, and we are better nurses forit. We will not be forced to work overtime unless we feelwe are able to do so. Our contract mandates that the hos-pital work with us to resolve the staffing problems that arealways the underlying cause of mandatory overtime. Wehave received requests for our contract language from bar-gaining units all across the United States.

Massachusetts legislation gave us licenses to practicenursing and told us to be patient advocates. And that isexactly what we did. Thanks again. We appreciated thekind words.—Sandy Ellis, RN, BSN, St Vincent Hospital,Worcester, Mass; E-mail: SandraEllis@aol.com

18/64/113250doi:10.1067/men.2001.113250

Reply:I know that, within our emergency nursing commu-

nity, there are many strongly held views about unions. Iknow, too, that there are very well-intentioned and well-respected colleagues on both sides of the issue. I tried tokeep my editorial focused on one nurses’ strike. The moreI heard about what was going on at the hospital involved,the more I could not help but feel that there, but for thegrace of God, go all of us. It seemed important, and stilldoes, that when other nurses are fighting difficult battles,we support each other. This particular battle, and otherslike it across the United States, will ultimately have aneffect on all nurses.

After this editorial was published, a friend and long-time ENA member e-mailed me, asking if ENA’s positionwas pro-union. In case others are wondering, I should clar-ify. ENA does not take a position on unionization. As forthe Journal, while it is an official publication of ENA, theleadership of ENA has always given it the freedom to

express a wide range of views on many issues. My editori-al should not be construed as necessarily reflecting ENApolicy, nor should any content in the Journal.

We also received one letter from from an ED NurseManager who was not supportive of unions. (He did notwant his letter published.) Some of my colleagues who areED nurse managers have shared their difficulties in man-aging departments in hospitals with unions and havereminded me that there are 2 sides to the issue.

I believe that the particular strike I talked about wasbased on facts disturbing to most ED staff nurses andnurse managers. Ms Ellis has provided more of those facts,but I can imagine it is difficult to put everything in print.

We greatly appreciate Ms Ellis’ comments and thegood it did to raise consciousness about mandatory over-time. We welcome letters from others. It would be valu-able to hear, not so much about opinions of whetherunions are good or bad in the abstract, but rather reportsof the specifics of what emergency nurses are seeing, andwhat they are doing, individually or collectively, toaddress the current crises.

We need all the help we can get. Whatever the forum,it will be all the more important in the coming months toremember that we need to work together.—Editor

18/64/113329doi:10.1067/men.2001.113329

More on the Clinical Nurses Forum column

Dear Editor:I read your article on “Orthostatic Blood Pressure” in

the Clinical Nurses Forum column (2000;26:479-80) andwas dismayed to find that the answer was not based on evi-dence-based practice.

There are wide discrepancies in the literature regard-ing the magnitude of an orthostatic response. The lateststudies reveal that no relationship exists between orthosta-tic vital signs and volume status, yet “tilts” are still fre-quently used as indicators of intravascular volume status.Many normal patients may have what has been consideredin the past to be positive tilts consistent with hypovolemiaeven though they are not hypovolemic.

I believe that your readership would have been bestserved if the author had noted this fact (in addition to