Hand sanitizer and right-to-work legislation

Nurses love hand sanitizer.  No, really.  We use it to the point where our urine contains traceable amounts of alcohol metabolites.  We use it to the point where it causes false positives on breathalyzers.  We have even used it to the point where it has set both nurses and patients on fire (with the help of static electricity).

Given our prodigious use of hand sanitizer, it is unsurprising that it is one of the staples of health care swag.  So when I saw a bag of promotional materials at a Washington State Nurses’ Association (WSNA) meeting, I thought to myself, “Sweet! I hope they have hand sanitizer.”

During the meeting, the WSNA organizer acknowledged the elephant in the room.  “I know some believe that unionization diminishes the status of nursing as a profession.” Nurses have fought persistently for years to be viewed as professionals. The recent history of being treated disrespectfully (not to mention sexually harassed) by other health care workers (let’s be honest, it was mostly doctors) makes this an issue fraught with emotion. As a result of this history, anything perceived to diminish the status of nursing is viewed with concern. Hence, the hesitancy surrounding union representation. The WSNA organizer’s rebuttal to this apprehension was that WSNA isn’t just a trade union like SEIU; it is a professional organization that represents the profession and plays a large part in expanding the scope of practice for nurses.  Though I already viewed unions as an effective means of addressing workplace issues that impact patient safety, she made me feel that WSNA was an organization for nurses by nurses. After all, the organizer was also a nurse; she spoke our language (something SEIU somehow still hasn’t figured out is really important). And then we were given our swag… 

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Again, because we can’t get enough hand sanitizer, every nurse took a bottle of WSNA hand sanitizer as they left the meeting. I sprayed my hands (because why not?) and was assaulted with a smell that made my nose hairs curl.  It was something reminiscent of an alcoholic wearing way too much cheap perfume.  I turned the bottle around to read the ingredients label.  “Ethyl alcohol 62%, water, glycerin, fragrance.”  First of all, what kind of ingredient is “fragrance”?  Second, nurses are extremely conscious about being scent free.  Home health nurses make it a common practice to visit patients who smoke at the end of the day so as not to expose other patients to the smell.  For many of my cancer patients, the slightest odor can exacerbate nausea. Many hospitals have even begun to implement fragrance-free policies for these reasons.

So what does this say about WSNA?  One, it provides a tangible, symbolic example of the disconnect between the actions and rhetoric of the organization.  Sure, it may be the professional organization representing nurses.  But can they truly be the voice of nurses if they can’t even get the right type of hand sanitizer?  More importantly, will they ever be able to convince nurses’ who feel negatively towards unions to come onboard? As long as WSNA makes decisions that every practicing nurse finds ridiculous (in this case, giving way hand sanitizer no nurse can use in a clinical setting), the answer is no.

What does this mean? Currently, most hospitals are closed shop, meaning all nurses’ must join the union and pay dues.  If the disconnect between nurses and “their” organization is allowed to persist, what will happen if right-to-work (for poverty wages) legislation is passed in this state as it has been in 23 others?  Would the 45% of nurses who have no opinion or a negative opinion of unions’ impact on the profession continue to pay upward of $800 a year in dues?  Or would they decline union representation and pocket the extra $800? Given the narrow margin of democratic victory in the last gubernatorial election, and the fact that the state senate is now in republican control thanks to two “democrats” choosing to caucus with republicans, this is something to be concerned about.

As the GOP sets its sights on unions, any successful fight against a right-to-work campaign in this state lies in the hands of unionized workers.  Will nurse resistance to such legislation be adequate if 45% of nurses have no opinion or a negative opinion of unions? Given the unprecedented attack on unions, WSNA must reflect on how to encourage nurses to more closely identify with the organization. Once nurses identify with an organization, an attack on the organization is perceived to be an attack on nurses, increasing resistance to as of yet hypothetical right to work legislation. Don’t get me wrong; WSNA has done a marvelous job representing nurses by hiring organizers who are also nurses and advocating for patient safety. But as nurses tirelessly work to improve the quality of care they provide, so should WSNA work to truly be an organization of nurses, by nurses, and for nurses. As we’ve seen in Wisconsin and elsewhere, their survival depends on it.

So the big question. How to get more nurses to identify with the organization? Hand sanitizer is a good place to start.

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By any means necessary…

“Wash me thoroughly from my iniquity, and cleanse me from my sin.”  – Psalm 51:2 

I was at Whole Foods (I know I know…) the other day using the restroom.  Someone in the stall next to me was clearly having a bowel movement.  No big deal, right?  People do these things.  Predictably, the toilet flushed and the stall door opened.  But then, the bathroom door opened.  The silence of the sink faucet was deafening.  I tried to rationalize.  “Someone else must have come into the restroom.  Who would leave without washing their hands?”  I turned to find the restroom frighteningly empty.  My mind started to race.  “Oh my God!  Have they done all their shopping?  Shit, I need kale.  What if they touch the kale? What if I check out using the same check out stand they did?”  Needless to say, I left the store carrying prepackaged kale and a bottle of (organic French lavender) hand sanitizer.

This, unfortunately, is not a rare occurrence.  Studies have shown that rates of hand washing are alarmingly low, 77% in men and 93% in women.  Given that so many diseases are spread through the fecal-oral route, this is something to think critically about how to improve.

As previously mentioned, the bathroom was completely empty (aside from me in a stall) when this person left.  They didn’t have to look at anyone, or really be accountable in any way to the fact that they walked into a store full of things people put in their mouths with E. coli (AKA poop) covered hands.  What if they had?  What if I had been washing my hands when they left the bathroom stall?  Research suggests that this may have changed the outcome.  While I don’t like to admit it, people are sheep.  We like to conform to what is expected of us.  This is true when it comes to hand washing as well.  When people are observed, they are more likely to wash their hands than if they are alone.  That being said, we don’t spend the majority of our days in the bathroom.  Public restrooms generally aren’t as crowded as the areas they service (thank God).  So we either need to find ways to get more people in bathrooms to increase peer pressure, or get people to wash their hands in public.  Given that many feel more comfortable in single occupancy restrooms, or unisex restrooms, getting more people into bathrooms isn’t a solution.

One beautifully simple way to do this is to remove sinks from bathrooms entirely and put them outside.  One grocery store has done just that (whether it was intentional or not I don’t know).  Like many grocery stores, this store has a seating area where people can sit to drink coffee, or eat lunch.  Right next to this area, and within full view of the large seating area, are the restrooms.  There is nothing special about them.  What is interesting is that the sink is outside the restroom, in full view of everyone in the store.  In order to leave the restroom without washing your hands, you have to walk by dozens of judging eyes.  While I would like to think people would wash their hands because it is the right thing to do, clearly they don’t.  If the only way we can increase hand washing rates is through guilt and shame, so be it.  Clean hands by any means necessary.  Good work unnamed grocery store.  I would eat your produce any day.