Archive for April, 2011

Nurses begin quest for professional recognition after World War II

posted on April 30, 2011

By Ginny McPartland

First in a series

Having played a significant role in the Second World War, trained nurses came home in 1945 expecting to be given the respect they earned in the armed forces. Many women had distinguished themselves by saving lives in combat zones, and many achieved the rank of officer.  

Nurses pose on the lawn of the Permanente Oakland hospital during World War II

Like other underappreciated groups who came home to a seemingly unchanged society, nurses were discouraged and hesitated to pursue their chosen profession due to low pay, low status and poor working conditions. Many nurses chose to be waitresses or factory workers where they could make more money and work more reasonable hours. The exodus from the nursing profession created a shortage of qualified nurses, which would intensify in later years.  

Home-front nurses had been content to work without making demands during the war emergency. But after the war, they wanted more. Alameda County nurses had affiliated with the California State Nurses Association (now California Nurses Association or CNA) in 1941 and relied on the association to represent them to East Bay hospitals administrations. But in 1945 these nurses realized that the statewide association had not been effective in bringing them better pay and working conditions.  

The association had developed employment guidelines for the benefit of nurses, but the association had no power to force hospitals to follow the voluntary rules. The East Bay Hospital Conference, made up of administrators from 12 hospitals, adopted a “Statement of Policy” regarding nursing issues in 1941, and dropped it after the war emergency was over.  

Alameda County nurses form their own guild 

Major Edith Aynes, a recruiter from the Army Nursing Corps, gave force to the East Bay nurses’ argument that their profession deserved a better status. Quoted in the San Francisco Chronicle in 1946, Aynes spoke about the military model of the registered nurse as someone who performed patient care, while other untrained staff performed peripheral menial tasks.  

“Instead of taking temperatures, serving (food) trays, making beds and carrying bath water, the nurse is free to change dressings, give medications, care for sick patients and in general supervise the entire ward,” Aynes said.  

Article published in the San Francisco Chronicle in 1946

Alameda County nurses took Aynes’ message to heart and decided to form their own nurses union in November of 1945. “The objective of the guild will be to establish standards relating to salaries, personnel practice and conditions of employment and to maintain an economic security program for registered nurses, members of the guild,” Kathleen Koepke, president of the guild, told the Oakland Tribune.  

In March of 1946, the guild asked the U.S Conciliation Service to recognize the guild as bargaining agent for the nurses in negotiations with the East Bay hospitals. In April of 1946, guild members voted to affiliate with the Public Workers of America (PWA) and the CIO (Congress of Industrial Organizations), a federation of unions. This was at the same time the CIO and AFL (American Federation of Labor), then separate groups, were fighting in Sacramento over political endorsements for state offices.  

Guild appeals to public for support 

Soon after joining the CIO, the guild began a public relations campaign to win community support for their demands for better pay and working conditions. “You Needed the Nurse…Now the Nurse Needs You” was the title of the pamphlet the new Nurses’ Guild of Alameda County’s leaders developed and delivered to 8,000 trade unions, teachers, doctors, dentists and other professionals in Alameda County.  

In the pamphlet, the nurses laid out their demands: “The immediate goal of the Nurses’ Guild is a collective bargaining contract that will guarantee the nurses a decent wage, reasonable amount of leisure, and fair working conditions …living symbols of our American Way of Life. Standing united, the nurses are determined that, no matter how long it takes, the hospitals must finally recognize the justice of the nurses’ case by signing the contract.  

Alameda County Nurses' Guild circulated this pamphlet in 1946.

“The nurses’ requests are for your protection!” the pamphlet declared, appealing to the public’s self interest in quality care. Specifically, the guild was asking for a better salary (minimum of $200 a month), a 40-hour work week, down from the standard 48-hour week for nurses, designated holidays, vacation with pay, reasonable sick leave with pay, adequate maternity leave, pre-employment and annual health examinations, protection under the Social Security Act and protection under the Unemployment Insurance Acts. The nurses also demanded the right of collective bargaining through “organizations of her own choosing without discrimination or intimidation and a job as an American Citizen, regardless of race, religion, color, ancestry or national origin.”  

The guild leadership invoked the words of a prominent economist of the time, Varden Fuller, to bolster their case: “There will be no real end to the shortage of nurses in Alameda County until nurses can be guaranteed decent working conditions in hospitals,” Fuller was quoted in a guild press release. “It’s no wonder that so small a percentage of nurses coming out of the armed forces are returning to hospital work. A nurse can go to work in a warehouse or a cannery and earn as much or more money as in a hospital.” The nurses augmented that claim in the pamphlet, declaring that a woman paring and peeling in a cannery made $202.50 and a grocery clerk made $241 per month, while nurses were making $175.  

KP’s chief physician Sidney Garfield makes history by signing first nurse contract 

The Nurses’ Guild leaders urged the public to write to the hospitals and “let them know you’re in complete sympathy with the nurses’ just requests.” On the list of hospitals whose nurses had voted to be represented by the guild was the (Kaiser) Permanente Foundation Hospital at Broadway and MacArthur in Oakland, the first Permanente hospital, opened in 1942. Permanente administration distinguished itself by being the only hospital representatives that allowed a secret ballot for its nurses to select an organization to speak for them in labor negotiations. Sidney Garfield, MD, Permanente’s founding physician, was also the first to sign a collective bargaining contract with the newly energized nurses’ organization.  

The nurses’ initial campaign for labor representation came to a close on August 1, 1946, with the announcement of Garfield’s signing. “Permanente’s historic contract gives working nurses a 40-hour work week for the first time in Alameda County hospitals,” the Guild press release stated. “Besides reducing the former 48-hour work week to 40 hours, the Permanente agreement raises the former basic wage of $175 to $185. The basic rate will go up to $190 on October 1 and $200 monthly on January 1, 1947.” Meanwhile, the California State Nurses Association was negotiating with other East Bay hospitals. Spokeswoman Edna Behrens told the Tribune their contracts called for a 44-hour work week beginning July 1 and a 40-hour week as of January 1, 1947. She said the shortened week would not mean a reduction in the minimum salary of $200 per month.  

While nurses felt empowered after the war to pursue higher positions in the field of medical care, not everyone was anxious to embrace them in new roles. A case in point is neurosurgeon Howard Naffziger, who spoke in 1947 at a two-day conference of the Association of California Hospitals at Hotel Claremont in Oakland. “Highly specialized nurses should be called something else, because they have specialized themselves right out of the care of the sick.” He said nurses could learn all they needed to know in two years, or even one year of training. “The needs of the public for nurses exceed the ability of the public to pay,” the renowned neurosurgeon said.  

Marguerite McLean, then superintendent of nurses at Highland Hospital and later director of the Permanente School of Nursing, countered his remarks: “Doctors …have had to spread themselves so thin that one wonders what would happen if nurses hadn’t been qualified to step in and take care of the situation,” McLean told the Oakland Tribune. She added that even the practical nurse with less training would need a living wage, which would have to be close to the $200 basic monthly pay of the trained nurse. “Nurses feel they are best qualified to know and understand nursing requirements.”  

(Next time: In 1966, Kaiser Permanente nurses stage first work action in California history.)

For more on Kaiser Permanente nursing click here.

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Celebrated farmer urges Kaiser Permanente doctors to further healthy food traditions

posted on April 5, 2011

By Grace Emery

Heritage correspondent*

Joel Salatin, celebrity farmer. Photo by Rachel Salatin.

When I heard that famed farmer Joel Salatin had come to Oakland to speak with Kaiser Permanente (KP) doctors, I felt like this event almost constituted a brush with celebrity. I wrote my senior thesis on food movements in the Bay Area, and my longtime interest in food politics had introduced me to Salatin and his work to bring sustainable food to America’s tables.** While some may be puzzled at the idea of a “famous farmer,” I leapt at the chance to write about a veritable hero of the food politics world, and I was anxious to learn more about where KP doctors and Salatin crossed paths.

Thanks in part to Michael Pollan’s discussion of Salatin in “The Omnivore’s Dilemma” and his appearance in the 2008 popular documentary “Food Inc.,” Salatin has become a renowned advocate of sustainable food and farming, and somewhat of an icon in the healthy food movement.

During his visit, Salatin, who raises beef, pork, and poultry at his Virginia family farm, Polyface Inc., spoke of the challenges small farmers face at the intersection of healthy food and politics. Locally grown food is often healthier and more sustainable, but small farmers struggle when selling their products to large institutions, preventing the large-scale adoption of a local food system.

Salatin started his visit with a stop at the birthplace of local food sales—the farmers market. Preston Maring, MD, a KP physician in Oakland, Calif., founded the first Kaiser Permanente farmers market at the Oakland Medical Center in 2003, and today there are more than 35 KP farmers markets in several regions, demonstrating Kaiser Permanente’s commitment to total health through nutrition.

After a visit to the market, Salatin spoke to a group of KP physicians on the topic of “Local Food to the Rescue.” His message served to both validate the work Kaiser Permanente farmers markets and hospital cafeterias are already doing, and to inspire Kaiser Permanente officials to supply hospitals with even more locally sourced food.

History of healthy eating

Kaiser urged wartime shipyard workers to eat healthy, even grow their own vegetables, as this 2009 poster illustrates. Design by Pam Zachary, KP Multimedia Department.

Kaiser Permanente has long focused on the link between healthy eating and prevention. Before Kaiser Permanente was synonymous with health care, war workers flocked from all parts of the U.S. to Richmond and Oakland, Calif., where they helped to build ships in the Kaiser Shipyards during WWII. Henry Kaiser quickly realized that to build ships at a fast pace his workers had to be healthy and strong, and that meant they needed to eat nutritious foods. He saw that well-nourished workers translated into less absenteeism, more productivity, and happier employees.

In a 1943 memo written by Cecil Cutting, MD, a founding Permanente physician, there is a clear emphasis on the importance of nutrition. With healthier meals, Cutting hoped to “bring about greater vitality, greater psychological effect and consequently increased productivity.”

In “Ships for Victory, author and historian Frederic Lane discusses the Maritime Commission’s initiative to improve in-plant feeding at America’s shipyards in 1943. Many shipyards received additional funds to provide more hot meals and make sure workers had access to healthy food in the workplace. In the Kaiser Shipyards on the West Coast the emphasis on good nutrition even spilled over into the Kaiser-run child care centers where children were fed three square meals, and mothers could pick up prepared meals when they collected their children at the end of the work day.

After the war when Kaiser established a health plan open to the public, nutrition and prevention were among the core principles. “Kaiser health planners supported concepts of holistic preventive care,” writes Rickey Hendricks in “A Model of National Health Care: The History of Kaiser Permanente.”

A focus on healthy food comes to Kaiser Permanente hospitals

Nutrition education was big in the WWII Kaiser shipyards, as highlighted in this poster created in 2009. Design by Pam Zachary, KP Multimedia Department.

A 1972 article from the publication “Institutions/Volume Feeding” highlights Kaiser Permanente hospitals’ progressive commitment to providing patient meals with higher nutrition at a lower cost.  Hospital dieticians were consulted so that every meal had optimal nutrition and calorie content for a patient’s needs. Kaiser Permanente even began to serve meals with an accompanying pamphlet that explained the nutrition information of the meal so that patients could “begin to learn more about the foods that they eat” while in the hospital.

Quality nutrition was at the center of meal planning, and administration felt that when it came to cost “it was of the utmost importance to separate patient feeding from other food-service activities necessary in a hospital.” While the development of an efficient system came about slowly, Kaiser Permanente never strayed from a focus on the healing power of healthy meals.

Oakland: an epicenter of progressive food movements

In my thesis research on the bay area, I was surprised to find that the city of Oakland has also long been a center of progressive food movements. In the 1970s, the Black Panther Party provided a free breakfast program and other “people’s community survival programs” in Oakland, serving residents hot meals with a side of political activism.

The effort of the Black Panther Party members to address hunger in their community was seen as revolutionary and empowering. Soup kitchens and free breakfast programs drew attention to the fact that the local food system was not currently meeting the needs of the West Oakland community. In “A Panther is a Black Cat,” (1971) author Reginald Majors explains that rather than wait on city officials, residents intended to subvert the power dynamic of the community by taking matters in to their own hands.

The free breakfast program for school children went hand in hand with revolutionary ideals and food became an expression of political power. Majors explains, “The Panthers would be betraying their own beliefs by not pushing a little political orientation along with the grits, bacon, and eggs” they dispensed each morning.

Today there are several West Oakland farmers markets in action that echo these themes of racial empowerment. My thesis focused on several of these markets, like “Mo Better Foods” and “Phat Beets Produce,” which provide both locally grown food and social empowerment within a community many residents believe to be historically disenfranchised.

Kaiser Permanente’s continued progress and inspiration

Given Kaiser Permanente’s nutritional history coupled with Oakland’s revolutionary food movement past, Joel Salatin could not have delivered his somewhat radical message to a better group in a better location. Kaiser Permanente initially focused on healthy food in hospitals, and then on bringing local, sustainable food to the community through the Kaiser Permanente farmers markets in Oakland.

What follows logically is a bridging of those two ideals: bring even more local and sustainable food in to hospital meals. Kaiser Permanente hospitals already bring in over 600 pounds per week of sustainably grown vegetables on patient entrée plates at 21 Northern California Kaiser Permanente Hospitals, and Salatin hopes his talk will encourage them to expand that trend and do even more. When he visited Oakland in January, Salatin said:

“The idea of bringing local food right into the façade of a hospital — there couldn’t be a better match. . . If anyone should lead the way in bringing this nutrient-dense food, food that heals people, heals the soil, heals communities, it should be the hospital. Every sphere of its existence should be healing.”

*Grace Emery is an intern with Kaiser Permanente Heritage Resources. She is a graduate of Whitman College in Walla Walla, WA, and is pursuing a career in public health.

**Grace Emery, “‘Feeding Ourselves’: Power and Participation in West Oakland Food Movements.” Senior Political Science thesis for Whitman College. Winner of the 2010 Whitman College Robert Fluno Award for Best Politics Thesis.

For more about Joel Salatin’s visit to Oakland Kaiser Permanente, http://xnet.kp.org/newscenter/aboutkp/green/stories/2011/021511joelsalatin.html

To learn more about Kaiser Permanente’s green programs:

http://xnet.kp.org/newscenter/aboutkp/green/factsheets/healthyfood.html

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