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State: Nurse’s neglect led to nursing home death

State health investigators have concluded that a veteran nurse at a St. Louis Park nursing home failed to intervene properly for a patient who suffered breathing problems in January and died minutes later.

Health Department investigators also said the licensed practical nurse offered “inconsistent” versions of the event when she documented her actions in writing and when she was interviewed about the death, which occurred at the Texas Terrace Care Center.

The state report, released Thursday, said the nurse’s primary shortcoming was failing to call 911. “She did not follow standard nursing judgment,” the reported said.

The nurse, who was hired at Texas Terrace in 1994, is no longer employed by the center, said Mat Bedard, the facility’s administrator.

Neither the nurse nor the resident was named in the report.

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Fundamentals Nursing

The Development of Nursing in America

In North America, nursing and health services were slow to be established before the American Revolution (1775 – 1783). One notable organization was the Nurse Society of Philadelphia, which gave women minimal instruction in obstetrics to enable them to provide maternity nursing services in home settings.

During the American Civil War, several nurses emerged who were notable for their contributions to a country torn by internal strife. Harriet Tubman and Sojourner Truth provided care and safety to slaves fleeing to the North on the “Underground Railroad.” Mother Biekerdyke and Clara Barton (who is credited with founding the American Red Cross) searched the battlefields and gave care to injured and dying soldiers. Noted authors Walt Whitman and Louisa May Alcott volunteered as nurses to give care to injured soldiers in military hospitals. They chronicled their experiences in their writing as a permanent record of nursing’s contribution during this time.

The late 1800s was a time of rapid reform of nursing services in the United States and Canada. Schools of nursing with planned educational programs were founded. A number of their graduates became the early leasers in the profession. Isabel Hampton Robb is one example a young school-teacher in Canada. Robb decided to change her profession and entered the Bellevue Hospital Training School in New York. After graduation, she nursed in Rome for 2 years, and then she became superintendent of the Illinois Training School at 26 years of age. Three years later she went to Baltimore to organize a new school in connection with Johns Hopkins Hospital. Among her many accomplishment was to author nursing textbook, which became the standard text for nursing schools in America.

Mary Adelaide Nutting, also from Canada, was in the first class at Johns Hopkins. After graduation, she established a course of training for students prior to ward experience at Johns Hopkins. Later, she reduced the nursing training to 3 years.

Mary Agnes Snively graduated from Bellevue Hospital Training School and returned to Canada to take charge of the nurses’ training at Toronto General Hospital. She is credited largely with direction of Canadian nursing education and was the first president of the Canadian Nurses Association.

Two American graduates of the New York Hospital, Lillian D. Wald and Mary Brewster, were the first to offer trained nursing services to the poor in the New York slums. Their home among the poor on the upper floor of a tenement is now famous as a center of public health nursing: the Henry Street Settlement, school nursing was established as an adjunct to visiting nursing. Again, Wald was involved, along with Lina L. Rogers.

Linda Rochards, who graduated in 1873 from the New England Hospital for Women and Children Training School for Nurses in Boston, is cited by many historians as America’s first trained nurse. She is credited with reforming nursing in 12 major hospitals, some of which were specialized mental hospitals. She also founded the first training school for nurses in Japan.

Some, however, despite that Richards was the first trained nurse. Evidence in a seriese of reports if Women’s Hospital of Philadelphia suggest that Harriet Newton Phillips was the first trained nurse to receive a certificate from that hospital in 1864 (Large 1976, p. 50). Philips is also considered the first trained nurse in America to do community nursing, to do missionary service, and to take postgraduate training.

America’s first trained black nurse was Mary Mahoney. She trained at the same hospital as Linda Richards and graduated in 1879.

The need for concerted action by nurses was first felt in England during the late 1800s. In 1894, the Matron’s Council of Great Britain and Ireland was organized, followed by the American Society of Superintendents of Training Schools for Nurses of the United States and Canada. Alumnae associations joined to form the Nurses Associated Alumnae of the United States and Canada in 1897. These North American organizations were the predecessors of current national groups. The Society if Superintendents divided nationally and ultimately became the Canadian National Association of Trained Nurses in 1908 – now the Canadian Nurses Association (CNA) – and the National League of Nursing Education in 1912. The Nurses Associated Alumnae became the American Nurses Association (ANA) in 1911. In 1908, the National Association of Colored Graduate Nurses was founded by a group of nurses who felt such an association could further not only the nursing cause but also their own interests.

In 1893, the Nightingale Pledge was written and administered to the graduating class of the Farrand (Nurse) Training School in Detroit, Michigan. At the time, the pledge reflected the nurse’s commitment to moral and ethical values and principles in the practice of nursing. Despite modern criticism of the pledge as portraying the nurse as subservient to the physician, it continues to provide “a framework for clarifying moral and ethical values and principles needed for delivering health care and promoting the standards of nursing” (Calhoun 1993m p. 130).

After World War I, the Frontier Nursing Service (FNS) was established by notable pioneer nurse, Mary Breckinridge. In 1918, she worked with the American Committee for Devastated France, distributing food, clothing, and supplies to rural villages in France and taking care of sick children. In 1921, Breckinridge returned to the United States with plans to provide health care to the people of rural America. She had initially prepared herself by taking courses at Teacher’s College in New York (where she met Mary Adelaide Nutting and gained her approval) and midwifery training in London and by developing prominent social contacts for fund-raising. In 1925, Breckinridge and two other nurses began the FNS in Leslie Country, Kentucky. Within this organizations, Breckinridge started one of the first midwifery training schools in the United States.

From the beginning of formal organization of nursing if the late 1800s to the end of World War I, the general trend was rapid expansion in the establishment of hospitals, with nursing schools dependent on them for support, Hospitals in turn depended on the schools to carry the chief nursing load. During the war, greater numbers of young women were accepted for entrance, and less consideration was given to selection requirements. Most schools by this time had adopted 3-year program, but the 8-hour day originally proposed with those programs was less quickly adopted.

By 1920, the hospital system of educating nurses was coming under increasing criticism. In addition, the effectiveness of having nurses teach other nurses was being questioned. This, a special post-basic course was offered at Teachers College, Columbia University, New York, to nursing program was also developed, in response to the postwar influenza epidemic and the medical profession’s new emphasis on teaching the principles of healthful living to individuals, families, and community groups.

During the early 1920s, the Rockefeller Survey (Committee for the Study of Nursing Education) recommended that nursing schools be independent of hospitals and on a college level. As a result, two university schools of nursing were set up, on at Yale University, New Haven, Connecticut, the other at Western Reserve University, Cleveland, Ohio. The Purpose of these experimental schools was to prove the feasibility of planning both classroom instruction and ward practice in accordance with the educational need of the students. These schools emphasized the social welfare and health aspects of nursing and demonstrated the value of university standards in the nursing field.

Another far-reaching result of the Rockefeller Survey was the National League of Nursing Education’s comprehensive study of nursing education (1926 – 1934), which led to the grading of nursing schools. It was believed that grading would establish standards for education in these schools. This was the beginning of the accreditation function now carried out by the National League for Nursing (NLN).

During this period, the concept of the clinical nurse specialist arose. In the early decades of the 20th century, hospitals started to segregate patients according to their disease process. Nurses were called upon to acquire expert knowledge in the care of specific patient types. These nursing roles were called extended or expanded roles. In the early 1940s, it was thought that more emphasis needed to be placed on the clinical specialties in the advanced professional curricula of colleges and universities. Most advanced nursing curricula were preparing specialists in nursing school administration, teaching, and supervision in public health and in hospitals administration but were not emphasizing clinical specialties. These specialties gained prominence in the post – World War II society. Nurses returning from overseas were required to work in clinical areas not familiar to them. One such area was psychiatric nursing, which helped individuals readjust to civilian life. By 1946, many nursing programs in the United States were providing more clinical content. Today the clinical nurse specialist is a graduate of a master’s or doctoral program in nursing with a major in a clinical specialty. These nurses are responsible for increasing their own clinical knowledge and competence and for enhancing the quality of nursing care and the quality of the organizational climate of learning and research.

From its early days to the present, nursing has undergone change in very area. Rapid strides have been made in nursing education programs and in a wide variety of hospital and community nursing services. Throughout these changes, nursing has continued to provide a stable service to help people. Nurses have also been part of the larger societal changes that have influenced nursing. Twentieth-century nursing leaders in the United States have been active in women’s suffrage, civil rights, and health care reform movements. Nurses have been elected to office at local and state levels. In 1992, Eddie Bernice Johnson from Texas became the first nurse elected to the United States House of Representatives. The time line running throughout this article highlights selected people and events in nursing’s history, demonstrating that nursing is a profession for and influenced by women and men of all cultural backgrounds and all socioeconomic levels.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.7-11)
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Nurse says she was ‘stunned’ by infant’s injuries

A nurse was the first witness today in Olmsted District Court to describe her reaction seeing the severely swollen legs of an infant boy who was brought to the hospital emergency room days after being released to his parents.

“I was completely stunned,” said Lindia Stein, a nurse, of her reaction to seeing Jordan James, an infant boy who had 25 fractures to his legs, ribs and arms when he was brought back to the hospital on Jan. 11, 2007.

Stein’s testimony came this morning in the trial of Robert Lee Heck III, the biological father of the boy. Heck is on trial on charges of first-degree assault and aiding an offender, accused of causing the injuries to his son, who was born conjoined on Nov. 9, 2006, then separated at birth. Jordan was released from the Saint Marys Hospital on Jan. 3 and lived with his parents at the Ronald McDonald House so the parents could visit the twin, Jacob, who was still in the hospital.

Heck denies the allegations. His case is being heard by Judge Kevin Lund. The trial is expected to last through next Wednesday.

Stein testified she was on duty in the pediatric emergency room on the day Heck and Valerie James, the biological mother, brought their son to the hospital with concerns about swelling in his thighs. The couple thought it might have been from immunizations the infant received days earlier.

The nurse said she pulled off the blanket and saw “extremely swollen” thighs that were purplish in color. She said the thighs were so swollen, the skin was hard to the touch.

A doctor ordered X-rays be taken. Dr. Kristen Thomas, a consultant in radiology, read those X-rays, and testified this morning that Jordan had multiple fractures in his legs, ribs and arms. She said some fractures in the legs were showing signs of healing, indicating trauma had occurred on separate occasions.

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Nurse faked prescription, police say

Woman charged with stealing patient’s ID

Stacy Lynn Whisner

Nurse practitioners don’t often phone in prescriptions for “a huge quantity” of narcotic pain relievers on Sunday afternoons, the pharmacist thought.

Suspicious, Kevin Elick called the patient. She had no idea what he was talking about.

“That patient had never been in here before,” said Elick, a pharmacist at the CVS on London-Groveport Road in Grove City.

The woman who came to pick up the prescription was a certified nurse practitioner for the Arthur G. James Cancer Hospital pretending to be one of her patients, investigators say.

The pharmacy alerted Grove City police, who arrested Stacy Lynn Whisner, 36, of 5813 Birch Bark Court, Grove City, on Feb. 28 as she drove away with a bottle that contained mostly placebos, according to police reports.

Whisner was charged with identity fraud and deception to obtain a dangerous drug. The case will be presented to a Franklin County grand jury soon, said police Capt. Steve Robinette.

He said investigators are trying to figure out how many patient files Whisner might have accessed and how many identities she might have used.

“Maybe we caught her early, or maybe we caught her at the tail end of it,” Robinette said.

Hospital officials sent letters and made phone calls to about 20 James patients to tell them their medical records could have been breached, spokesman David Crawford said yesterday.

“All we know is that she misused confidential information,” he said. “They were probably patients in the clinic where she worked.”

Crawford said Whisner was fired shortly after her arrest.

Contacted at home yesterday, Whisner referred questions to her attorney, Bradley Koffel.

He said his client is “a classic example of folks who come under the spell of addictive pharmaceuticals.”

Whisner voluntarily placed her nursing license on inactive status and is trying to get help for her addiction to painkillers such as the hydrocodone – whose brand names include Lortab and Vicodin – described in the charge against her, Koffel said.

“There is not going to be any evidence that she was trafficking,” he said, adding that Whisner had been taking “lawfully prescribed pain pills” for back problems previously.

Koffel said he doesn’t know whether investigators have evidence of other patients’ identities being used.

Crawford said that, so far, officials “don’t think that this person accessed their credit information.” But as a precaution, the hospital is offering credit protection for the next year.

Hospital officials and investigators praised the pharmacist for being alert.

Unfortunately, Elick said, he has plenty of experience working with police to catch people trying to pass fake prescriptions.

“We’ve got it down pat now,” he said.

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Interrupting a Nurse Makes Medication Errors More Likely

Distracting an airline pilot during taxi, takeoff or landing could lead to a critical error. Apparently the same is true of nurses who prepare and administer medication to hospital patients.

A new study shows that interrupting nurses while they’re tending to patients’ medication needs increases the chances of error. As the number of distractions increases, so do the number of errors and the risk to patient safety.

“We found that the more interruptions a nurse received while administering a drug to a specific patient, the greater the risk of a serious error occurring,” said the study’s lead author, Johanna I. Westbrook, director of the Health Informatics Research and Evaluation Unit at the University of Sydney in Australia.

For instance, four interruptions in the course of a single drug administration doubled the likelihood that the patient would experience a major mishap, according to the study, reported in the April 26 issue of the Archives of Internal Medicine.

Experts say the study is the first to show a clear association between interruptions and medication errors.

It “lends important evidence to identifying the contributing factors and circumstances that can lead to a medication error,” said Carol Keohane, program director for the Center of Excellence for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston.

“Patients and family members don’t understand that it’s dangerous to patient safety to interrupt nurses while they’re working,” added Linda Flynn, associate professor at the University of Maryland School of Nursing in Baltimore. “I have seen my own family members go out and interrupt the nurse when she’s standing at a medication cart to ask for an extra towel or something [else] inappropriate.”

Julie Kliger, who serves as program director of the Integrated Nurse Leadership Program at the University of California, San Francisco, said that administering medication has become so routine that everyone involved — nurses, health-care workers, patients and families — has become complacent.

“We need to reframe this in a new light, which is, it’s an important, critical function,” Kliger said. “We need to give it the respect that it is due because it is high volume, high risk and, if we don’t do it right, there’s patient harm and it costs money.”

About one-third of harmful medication errors occur during medication administration, studies show. Prior to this study, though, there was little if any data on what role interruptions might play.

For the study, the researchers observed 98 nurses preparing and administering 4,271 medications to 720 patients at two Sydney teaching hospitals from September 2006 through March 2008. Using handheld computers, the observers recorded nursing procedures during medication administration, details of the medication administered and the number of interruptions experienced.

The computer software allowed data to be collected on multiple drugs and on multiple patients even as nurses moved between drug preparation and administration and among patients during a medication round.

Errors were classified as either “procedural failures,” such as failing to read the medication label, or “clinical errors,” such as giving the wrong drug or wrong dose.

Only one in five drug administrations (19.8%) was completely error-free, the study found.

Interruptions occurred during more than half (53.1%) of all administrations, and each interruption was associated with a 12.1% increase, on average, in procedural failures and a 12.7% increase in clinical errors.

Most errors (79.3%) were minor, having little or no impact on patients, according to the study. However, 115 errors (2.7%) were considered major errors, and all of them were clinical errors.

Failing to check a patient’s identification against his or her medication chart and administering medication at the wrong time were the most common procedural and clinical glitches, respectively, the study reported.

In an accompanying editorial, Kliger described one potential remedy: A “protected hour” during which nurses would focus on medication administration without having to do such things as take phone calls or answer pages.

The idea, Kliger said, is based on the U.S. Federal Aviation Administration’s “sterile cockpit” rule. That rule, according to the Aviation Safety Reporting System, prohibits non-essential activities and conversations with the flight crew during taxi, takeoff, landing and all flight operations below 10,000 feet, except when the safe operation of the aircraft is at stake.

Likewise, in nursing, not all interruptions are bad, Westbrook added.

“If you are being given a drug and you do not know what it is for, or you are uncertain about it, you should interrupt and question the nurse,” she said.

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Ontario nurses say 2,000 jobs have vanished

Ontario has lost more than 2,000 full-time nursing positions — the majority in hospitals — over the past 12 months, the Ontario Nurses Association says.

“That is equating out to over four million hours of nursing care,” ONA president Haslam-Stroud said Monday. “The fact is that it’s across the province. It’s a virus happening and they’re cutting the nurses to balance the budgets and impacting the care that we’re able to provide.”

ONA released a report that identifies 2,045 positions that are on the chopping block with more on the way.

Health Minister Deb Matthews said the layoff notices do not necessarily mean a nurse is headed for the unemployment line.

As the health care system modernizes, some responsibilities are shifted from one environment to another, she said.

“Some nurses are getting layoff notices but then they will be immediately hired in a new position at a different hospital,” Matthews said.

Overall, the province has almost 10,000 more nurses than in 2003 when the Liberals first gained government, she said.

“So there are lots of opportunities for nurses; we actually need more nurses working full time,” she said.

Matthews noted there are hundreds of nursing positions on Workopolis, the job-hunting website.

Haslam-Stroud said not all posted nursing jobs materialize, and community-based nursing jobs don’t usually come with the same security, pay and benefits available in the hospital sector.

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Nurses blamed for hospice cutback

Stubborn nurses who refuse to follow orders are being blamed for the temporary closure of Hastings’ Cranford Hospice in-patient service.

A special audit shows there are not enough highly skilled staff, and nurses are driving doctors away. Patient safety would be at risk if a “culture of blame and mistrust” was not resolved.

Staff now face losing their jobs as the hospice is restructured.

A nurses’ union has branded the report “absolute rubbish” and said management was just trying to get rid of “old driftwood”.

The report by consultants was ordered by Hawke’s Bay District Health Board after a complaint by a staff member to the health and disability commissioner in January.

Hospice in-patients would be moved to Hawke’s Bay Hospital for six months while “radical action” was taken to repair the relationship between management and staff.

However, the report said staff could not work together and it was unlikely the differences could be resolved.

“Therefore [management] will have to make some difficult decisions about future staffing of Cranford Hospice at all levels.”

Health board chief executive Kevin Snee said the board would not instruct the hospice on how to change its culture, but “radical action” was needed.

“Highly resistant nurses … need to look at themselves and the organisation and see whether they want to be part of the future or the past.”

About 70 per cent of the hospice’s funding comes from the board.

The hospice’s management, Presbyterian Support East Coast, said some nursing staff had been at the hospice for 20 of its 25 years and were uncomfortable with modern drugging practices of terminally ill patients.

Chief executive officer Sean Robinson said some staff had refused to nurse patients as directed, driving away specialist doctors and nurses who found the battle to administer modern-day palliative care “too tiring”.

Nurses Organisation organiser Manny Downs said nurses were “shocked, angry and feeling shafted” after reading the report.

Accusations that they were unwilling to upgrade their skills were “absolute rubbish”. “A number of staff have asked if they can go on courses for just this type of thing and been turned down.”

Changes management had tried to implement since 2007 had been mishandled, Mr Downs said.

“They’ve been bullied, harassed – some say it’s a dictatorship.”

Former Cranford medical director Kerryn Lum said the report’s claims against the nurses were distressing.

“The public should be absolutely confident in these nurses, and back them. They’ve put their heart and soul into this community.”

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Motorists should not be allowed to drink ANY alcohol before they drive, say nurses

Nurses want a zero alcohol limit for drivers: It would mean that one glass of wine would be out of the question

Drivers should not be allowed to drink any alcohol before getting behind the wheel, nurses said yesterday.

They called for drinking even a single unit before driving to be made illegal.

Rod Thomson, vice chairman of the Royal College of Nursing, said: ‘Ideally it should be illegal to drink half a pint of beer.

‘People find messages confusing – they think one glass of wine is a unit and that it is OK to drive after two or three.

‘Telling people that they could not drink at all before getting behind the wheel would make the message much clearer.’

Some countries already have absolute zero limits, including Estonia, Malta, Romania, Slovakia, Czech Republic and Hungary.

But critics said the suggestion – raised at the Royal College of Nursing conference in Gateshead – was unworkable and unfair.

If the law were changed, a woman who had consumed three large glasses of wine in an evening could be stopped for drink-driving on her way to work the next day.

The average man’s liver takes about an hour to remove one unit of alcohol from the bloodstream – although it usually takes longer for women.

This means that if a woman were to consume six units in an evening – two or three large glasses of wine – she could still have alcohol in her bloodstream by the time she woke up in the morning.

Nurses, however, said drivers can turn their cars into ‘potential killing machines’ by consuming only one or two drinks with lunch or over the evening.

They said even one unit of alcohol can greatly impair a motorist’s reaction times and concentration.

Andrew Frazer, an emergency care nurse from East London, told the conference: ‘You would not drink two pints of beer before going to work so why would you do it before getting behind three-quarters of a tonne of steel capable of going 100 miles per hour?’

The Department for Transport is considering reducing the current legal limit of 80mg of alcohol per 100ml of blood.

It means a man can drink up to two pints of beer or three small glasses of wine and still drive – although experts warn size and metabolism can greatly affect how worse for wear an individual feels.

Ministers could reduce the limit to 50mg, as is the case in much of Europe. This means one pint could put a man over the limit.

They believe this could prevent up to 65 deaths and 230 serious injuries on the road every year.

But Neil Williams, from the British Beer and Pub Association, called instead for better enforcement of the existing limit.

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Nurses blame Holby City for unrealistic expectations

Television hospital dramas like Holby City are leading patients’ families to expect medical “miracles” with injury lawyers exploiting their unrealistic hopes, a nursing conference has heard.

Medical dramas fuelling a culture of litigiousness at the Royal College of Nursing’s (RCN) annual conference in Bournemouth.

Nurses also warned that a fear of being sued could lead staff to leave the profession and make it more difficult to recruit trainee nurses in the future.

The NHS spent £807 million settling claims in 2008/09, up from £661 million in the previous year, figures from the National Health Service Litigation Authority show.

John Hill, a nurse from Scunthorpe, told RCN’s annual conference in Bournemouth: “In A&E it is sometimes a fact that sadly we cannot get people through the trauma they have received.

“Unfortunately, unlike in Holby City, I am a mere mortal and cannot perform miracles.

“But many relatives believe because of that, you can.

“And the injury lawyers assure them that if you don’t they will get recompense for it.”

There were 8,885 clinical and non-clinical claims made in 2008/09, although less than one in 20 of these go to court.

The Litigation Authority has previously warned that fees from no win, no fee cases are affecting NHS patient care.

RCN delegates also claimed that fears over becoming embroiled in litigation claims could drive nurses from the profession.

Jane Bovey, a nurse from Wiltshire, told the conference: “I’m concerned that nurses will be afraid to continue in this profession.

“I’m also afraid that we will fail to recruit future nurses as the fear of litigation will be so that they will question their decision.”

Marcia Turnham, a nurse from Cambridgeshire, warned that patient care was being compromised because nurses were spending so much time documenting their actions, to protect themselves in the case of future litigation.

She said: “One of the main concerns is that there’s too much documentation associated with the care we have to give.

“A big part of that is those documents associated with indemnity insurance for the trust.

“Every time a patient is admitted it can take a nurse 40 minutes to fill in the paperwork.

“That’s time that a nurse could be spending with the patient.”

Howard Catton, head of policy with the RCN, agreed that there was a problem and said that the fear of litigation could lead nurses to become “defensive”.

He said: “People talk about being risk averse in their practice to the point of becoming defensive.

“There is a consequence that through becoming defensive you don’t move forward and you don’t improve.”

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Temple and nurses settle strike

DAVID SWANSON / Staff Photographer Temple University Hospital technician Selena Hodge applauds with the crowd after a contract agreement was reached.

After four marathon days of negotiating, Temple University Hospital and its 1,500 nurses and allied health professionals reached an agreement Tuesday to end a 28-day strike that began March 31.

The employees plan to return to work at 7 p.m. Friday, assuming the proposed contract is approved during three ratification votes that will occur Wednesday, at 10 a.m. and 3 and 7 p.m.

After the members of the Pennsylvania Association of Staff Nurses and Allied Professionals vote, the proposal will be presented to the management of the Temple University Health System.

As Temple’s chief negotiator, Bob Birnbrauer, signed the last paperwork about 9 p.m. just outside the bar at the Holiday Inn in Old City, happy technologists chanted, “Hey, hey, ho, ho, it’s back to work we go,” over celebratory martinis.

Sitting nearby at the hotel where the two sides had been negotiating since Saturday, U.S. Rep. Bob Brady watched the celebrations with a smile.

He had helped engineer the deal over coffee at the Four Seasons hotel Tuesday morning with Edmond F. Notebaert, Temple’s senior executive vice president of health sciences. Notebaert was not at the bargaining table.

Birnbrauer would not comment on the contract Tuesday night.

“We are pleased that the two parties returned to the bargaining table so that we were able to reach agreements,” Temple’s chief executive, Sandy Gomberg, said in a statement. Gomberg reports to Notebaert.

The new contract, which expires in October 2013, includes wage increases and provides some tuition reimbursement for dependents, according to sources familiar with it. Both sides declined to detail the terms until the members’ meetings Wednesday.

Tuition reimbursement for dependents became the most important issue and one of the last to be resolved.

The contract expired at the end of September, but employees continued to work under its terms while unproductive negotiations continued.

By the time the union gave its legally required 10-day advance strike notice, outstanding issues included wages, health benefits, a new clause forbidding employees from disparaging the hospital, and the withdrawal of tuition reimbursement for dependents, a longtime benefit.

Management said that it was already paying at the top of the scale and that the union’s requests were unrealistic given the economic and market realities for hospitals.

Over the last two years, the hiring situation for nurses and allied health professionals has changed from shortage to glut, as area hospitals have laid off workers and, in some cases, closed.

The strike began at 7 a.m. on a beautiful, sunny day. Though in high spirits as their picket line spilled onto North Broad Street, nurses and other staff members also expressed concern about their patients.

The hospital imported more than 850 replacement workers, who flew in from all over the country and double-bunked at the Sheraton Philadelphia City Center, all expenses paid. Working 12-hour shifts for days on end, they racked up overtime. Some had been laid off in their hometowns.

While Temple administrators said the hospital was being run smoothly, striking workers relayed reports of poor care from sympathetic colleagues inside.

Stacy Mitchell, deputy secretary of the Pennsylvania Department of Health, said that her agency had investigated “a lot” of complaints about the hospital since the strike began but that the results of those investigations would not be available until mid-May.

As the strike continued, the union pulled in support from other labor organizations. At one rally, leaders read a letter from the filmmaker Michael Moore, whose movie Sicko criticized the U.S. health system.

Wendell Potter, a former top health-insurance executive and now an advocate for policies that would rein in health insurers, also spoke to the group. The union rallied at City Hall and, as recently as this weekend, outside a Temple fund-raiser at the National Constitution Center.

By the end of the first week, hospital board members had reached out to Brady, who often mediates labor disputes.

But political pressure on management started before the strike.

On March 24, 11 Pennsylvania legislators sent a letter to Temple University president Ann Weaver Hart and Notebaert urging them to “return to the table with a new openness on the issues,” and pointing out that employees “have indicated their desire to avoid a strike by working for a significant period of time beyond the expiration of their agreement.”

Once the strike began, Brady said he would become involved. Two brief days of talks ensued on April 6 and 7, the first negotiations since before the strike. But they broke off quickly.

There were no further talks until Saturday. Earlier last week, union officials visited Harrisburg to speak to Philadelphia’s delegation. The hospital is partly funded by the state.

Meanwhile, behind the scenes, there had been some contacts between Philadelphia legislators and the hospital leadership, including Notebaert. Brady had also been in touch with Hart.

The statewide union is headed by Patricia Eakin, an emergency-room nurse at Temple. The executive director is Bill Cruice.

On Friday, shortly after those contacts, there was an announcement that negotiations would resume Saturday. Since then, there had been long days at the Holiday Inn, where negotiators had been holed up. Brady himself spent some time at the hotel Monday and had been in touch with both sides.

Negotiators met at 10 a.m. Sunday and finished at 2:30 a.m. Monday before reconvening at 11 a.m. Monday for a session that ended at 1:30 a.m. Tuesday. The two sides resumed shortly after 1 p.m. Tuesday. The agreement was reached about 9 p.m.

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