Big Mother Is Watching Them

When nurses at Eden Medical Center stopped wearing these badges, were they protecting their privacy or overreacting?

Shortly after the Labor Day weekend, the annual holiday dedicated to the appreciation of the American worker, officers from the Alameda County sheriff’s department were summoned to Castro Valley’s normally placid Eden Medical Center to investigate the disappearance of $8,000 worth of equipment. There wasn’t much to investigate. Hospital administrators had a pretty good idea who had taken the equipment, and an even better idea about why. It had something to do with workers feeling unappreciated.

The missing items should have been the easiest things to find in the whole hospital — several dozen portable locating devices designed to keep track of the nursing staff as they made their rounds. Eden had purchased the locator tags as part of a $273,000 nurse communications system for its busy medical and surgical units, and administrators hoped that the new technology would improve communication between doctors, patients, and nurses. About 85 nurses, as well as several dozen aides, techs, and managers, were supposed to wear the tiny badges that would allow them to find and talk to one another when linked up to a new intercom system. A computer would record when they entered and exited each room, theoretically ensuring that patients’ calls were answered in a timely manner.

The system was designed to save time, trouble, and lives. While eliminating the noise and inefficiency of the hospital’s antiquated call-light and paging system, it would allow nurses to call for emergency aid without leaving their patients’ sides or having to step out into the halls and shout. Most of all, nurses could respond to one another at a moment’s notice. “In health care, things happen so quickly that every second counts,” says Eden spokeswoman Cassandra Phelps. “It greatly improves the ability to care for patients — there is no doubt about that.”

But the new system came with one big problem: Many nurses hated it. Some said the badges were useful, but others found being monitored from afar too Orwellian for their tastes. The main complaints were that the system could be used to invade employees’ privacy, or allow management to second-guess staff work habits in ways that might ultimately be used for job evaluations or disciplinary purposes. Of greater concern to patients, many nurses also saw the badges as symbols of an increasingly corporate industry’s efforts to routinize and speed up the complex work done by nursing professionals at a time of chronic understaffing.

As hundreds of US hospitals have installed similar systems in recent years, their presence has become the subject of heated national debate. Web forums such as are rife with the complaints of hospital workers who say they are being tagged like dogs and made to wear monitoring devices similar to those used to keep tabs on paroled prisoners. They scornfully deride the devices as the “Nurse Lo-Jack,” and complain that Big Brother — or, perhaps more appropriately in a mostly female profession, “Big Mother” — is watching. Nurses at some hospitals have expressed their distaste by consistently “forgetting” to wear their badges. Elsewhere, there are whispers of badges being “accidentally” flushed down toilets or dropped in patients’ bedpans.

At Eden, objections to the new system took some time to boil over. The California Nurses Association, a lobbying powerhouse that represents more than 45,000 nurses, first complained back in October 2001 that nurses had not been informed about the system during the contract negotiations held earlier that year. By this February, a petition from dozens of employees asked the administration to negotiate with the union over how the system would be used. Nurses also demanded that the hospital and the system’s manufacturer show proof that wearing the infrared badges would not produce long-term health effects. And there were scattered acts of individual defiance; some nurses flatly told their supervisors they would not wear their badges, while others took to leaving them in lockers.

The dissent reached a peak Labor Day weekend, when Eden’s staff became the nation’s first to refuse en masse to wear the badges. At the urging of union reps, more than fifty of the roughly 120 staff members instructed to wear the tags took them off and dropped them into a cardboard box.

Then the box disappeared.

Although the union said it had planned to hold a press conference the following Thursday — during which the tags would be returned to the hospital along with a firm refusal to put them back on — the arrival of the sheriff’s department changed the situation. Instead, a union rep simply tipped off administrators that the box was behind some tennis shoes in the nurses’ lounge closet. “What was done was not stealing them, but giving them back,” says CNA rep Allan Brill. Hospital spokeswoman Phelps dismisses the badges’ disappearance as nothing more than a “misguided publicity stunt.”

But the protest’s impact lingers. Once a critical mass of people refused to participate, the tracking system was rendered useless. Currently, only a few Eden employees regularly wear the badges, most notably Eden president and CEO George Bischalaney, and fourth-floor nurse manager Priscilla Seiveno, who both donned badges after being challenged by the staff to prove that they’re safe. But their tag-wearing is more symbolic than anything, particularly in Bischalaney’s case. Not only are there no sensors on the floor where he works, but use of the system is suspended throughout the hospital while management and the nurses try to work something out.

By all accounts, the fourth and fifth floors of Eden Medical Center are stressful places to be a nurse. They comprise the hospital’s medical and surgical units, as well as its telemetry unit for patients who need to have their hearts monitored. Nurses who work those floors say they are constantly busy and have a high concentration of severely ill patients — particularly seniors seeking treatment for chronic conditions.

The medical and surgical units are the biggest units in the 275-bed hospital, and cover the most real estate, consisting of four wings arrayed in the shape of a large cross. Administrators say Eden’s cross-shaped building design is one of the reasons why the badge-and-intercom system is preferable to the most popular alternative suggested by nurses — cell phones set to the “vibrate” mode. They say the hospital’s shape creates reception “dead zones” in the hallways. In any case, cell phones are forbidden throughout the hospital because the waves emitted by them could interfere with machinery in the telemetry unit.

For all the new system’s controversy, a patient lying in an Eden hospital bed might be hard-pressed to pick out the components of the Hill-Rom Systems COMLinx Nurse Communication Module. The visible parts are subtle: a glowing orange call button at bedside depicting a svelte nurse in a cap, and a small white console on the wall the size of a household intercom. The badges are similarly unassuming: small rounded triangles of pale plastic roughly the size of a pager, featuring a tiny panic button enabling nurses to quickly summon their coworkers. Every few seconds, each badge emits a pulse of infrared light that is detected by sensors mounted on the walls and fed into a central computer system.

When a patient pushes the orange button, a call light goes on outside the room and a signal is sent to the main computer. When a badge-wearer enters the room in response, the console reads her badge, clocks her presence, and automatically shuts off the call light while recording exactly how long it took her to get there, and how long she stays. If the nurse needs the assistance of a specific coworker, she can find their location and page them directly using the wall-mounted intercom. Each console features a tiny digital screen and a dial that can be used to scroll through a listing of each badge-wearer’s exact location. People located in this manner know exactly where they are being called from and can go there at once. The system even links up with the programmable hospital beds, which alert the staff if patients get up or are lying in an unusual position.

Supporters say the system worked fine back when everyone was wearing the tags. “The call system is exactly what we wanted, because it met not only the patients’ needs but it also helped the nurses to increase productivity and reduce the stress of the load that they have,” says Seiveno. Although the hospital never activated the part of the system that captures data on nurse response times, Seiveno says it helped cut the need for overtime, and that doctors, patients, and their families had made positive comments to her about the promptness of service. Some physicians say that although they respect the nurses’ concerns, the system has the potential to smooth out some of the snarls of everyday hospital work. “If we are at the desk and need to ask a nurse about our patient, that would be helpful instead of looking in every room,” says Dr. Francis Johnson, a pulmonary and internal medicine specialist at Eden who is also a past president of the hospital’s medical staff. He points out that the hospital places a great deal of importance on reducing response times in order to boost patient satisfaction rates. “That’s been a bugaboo at Eden and lots of hospitals,” Johnson says. “If patients are not waited on and seen at the times they think they should be seen, they don’t perceive that as good care.”

Even the system’s most ardent opponents admit it has its positive points. People generally like the fact that the badges have an emergency call button and say that the system’s ability to track how many times staffers enter each room could be used to defend nurses if patients or their relatives claim that they weren’t getting enough attention. And all agree that Eden’s former system, seventeen years old at the time it was replaced, was obsolete. “We understand why they upgraded the system, that’s not a problem at all,” says Annette Bearden, who has been a nurse at Eden for 31 years. “You won’t find a nurse who won’t agree. But it’s the type of system.”

A substantial part of the system’s value seems to be in expediting the mundanities of hospital work — cutting down on the endless searching for supplies and coworkers that consumes so much of nurses’ time and energy. But hospital administrators also believe it is capable of making the difference in a life-and-death situation. For example, in the case of cardiac failure, one nurse could call for help without having to leave her patient, while other nurses have the crash cart on the way. Or if staff were attacked by a violent or psychotic patient, they could get immediate help.

But neither hospital management nor executives with the system’s manufacturer were able to provide examples of any particularly daring rescues performed thanks to the new system. At best, Seiveno offers a few examples of how the system was used to prevent accidents. One nurse was able to summon help while rushing to catch a patient who was falling over; another pressed the emergency button as a patient she was lifting from the bathtub began to pass out.

Then again, the system hadn’t been in place too long before staff members began refusing to use it. At first, the nurses wore the tags on cords around their necks. After health concerns arose about long-term exposure to the badges’ infrared pulse, some nurses took to attaching the tags to their clipboards or their shoes. Then some stopped wearing them at all. Then came Labor Day.

As the administration and staff wrestle with the issues raised by the installation of what nurses deride as a glorified surveillance system, one thing is certain: Everyone is now watching. The protest at Eden has turned a spotlight on worker concerns about privacy, employer trust, the corporatization of hospitals, and the advancing role of technology in healthcare. Is a locating badge the right way to combine the tireless accuracy of a machine with the skills and decision-making abilities of a trained nurse? Or is it simply one more step in the hospital industry’s pursuit of cheaper, more highly automated labor?

Nurses have a litany of complaints about the badges. For starters, some say, the system doesn’t work quite as well as promised. Many nurses complain that communicating with the new intercom can be just as loud and disruptive as the old overhead paging system. The voices erupting through the intercom are an unpleasant surprise, waking sleeping people, interrupting nurses while they are trying to comfort gravely ill patients and their families, or demanding that they halt what they are doing mid-procedure to take a phone call or answer a doctor’s page. “They just keep on calling and trying to find out where you are,” says nurse Elizabeth Aquino, who says she’s often been interrupted during painstaking procedures like inserting catheters. “They want you to come out when you’re not ready. Patients come first.”

But more to the point, nurses are less concerned about the system’s broadcasting than its capability for listening. After all, the main desk has the ability to listen to what is going on in most rooms at any time — including the nurses’ break room. Nurses worry that administrators will use this capability to eavesdrop on private conversations or rush them through an already too-short break. “I like my break and lunchtime to myself, not worrying that someone’s listening in,” says Bearden.

Despite workers’ evident uneasiness with being tracked and monitored, such employee surveillance is a growth industry. Hill-Rom Services has installed systems similar to Eden’s at approximately eight hundred hospitals, and estimates that it controls about a quarter of the market for nurse communications systems. And outside of the hospital setting, infrared badges and global positioning systems are used in a diverse array of job settings, monitoring employees in banks and factories, tagging parolees, and tracking the routes of delivery vans and city-owned snowplows. A survey conducted in 2000 by the American Management Association found that 73 percent of major US firms were using some form of employee surveillance, including monitoring phone calls, e-mail, Internet usage, or keystrokes, or using video cameras to capture images of the work environment.

Although an event like the Eden standoff puts employee surveillance issues onto the public radar screen, very few workers are expressing outrage over such monitoring, notes Lee Tien, senior staff attorney for the Electronic Frontier Foundation, a San Francisco-based nonprofit that studies civil liberties issues raised by new technologies. “There is a significant undercurrent of concern about workplace privacy that has grown over the years, but right now things seem to be so much more tolerant as a result of September 11 and fear of terrorism, which sort of interrupted or retarded the natural trajectory of concern,” he says.

At Eden, nurses who don’t like the badges have been doing a lot of darkly humorous postulating: What’s next — implanted microchips? But Eden’s management insists that its new system is meant for locating nurses in medical situations, not as an employee surveillance device. “Our goal has never been to interfere with anybody’s privacy or use it for a disciplinary action either,” says Seiveno. “That hasn’t been our goal at all.”

Phelps also points out that many of the staff’s biggest worries about the communications badges center on potential uses for the devices never implemented at Eden. In fact, some of the more Orwellian powers ascribed to the badges turn out to be sheer media invention. For example, several newspaper articles following the Labor Day protest reported that the badges themselves were voice transmitters, implying that nurses could be eavesdropped upon wherever they went. In fact, the tags have no microphone; all they do is emit an infrared pulse that is sensed by the wall-mounted intercom system. Moreover, they have a limited transmission range: they only work on the hospital floor the nurse is assigned to and in the rooms containing sensors, which only have a range of thirty feet. If a nurse takes the elevator to another floor or walks out to the parking lot, her badge can no longer be tracked. Additionally, because the system transmits information via a relatively weak infrared signal, all a nurse has to do to take herself off the electronic map is to put her badge in her pocket. “It’s very easy to defeat the system if you want privacy,” says Kim Tipton, spokeswoman for manufacturer Hill-Rom.

And although administrators at the main terminal can listen to conversations happening in any wired room, the system does have built-in privacy protections. Whenever the intercom is activated, a light turns on and a tone is emitted to alert the room’s occupants that someone is listening. And nurses can ask the clerk at the main desk to set the room to “privacy mode” to prevent other staff from listening in on patients’ rooms during exams or confidential family visits. The room-to-room intercom connection automatically cuts off after a minute unless it is manually reactivated by the person in the room. “People would have a quick conversation and be done,” says Paul McDaniel, Hill-Rom’s engineering manager. “The system isn’t set up to open up a microphone and just listen.”

The hospital insists that it does not condone intercom abuses like snooping. “My concern is more for the person who would listen,” Phelps says. “I would be very angry if a supervisor came to me and said, ‘I was listening in on a conversation and I heard this.’ My goodness, that’s just wrong.”

Even if the hospital can assuage the nurses’ worries about eavesdropping, the staff still doesn’t like the idea that the system can be used to gather information on them. Nurses worry that if the hospital starts timing their responses to patient calls and using that information in employee evaluations, they could be penalized in cases where they let a patient wait to answer a call they deemed more urgent. “No technology can capture a nurse’s understanding about how sick one patient is versus the next, how much more care someone who’s quiet and perhaps practically unconscious may need versus someone else who may be agitated and calling a lot,” says Corinne Comer, the acute-care director for the California Nurses Association. After all, a computer can’t tell the difference between a patient who presses the button because they are having a seizure, and one who is calling for their third glass of juice that day. “Look at it this way: It records your eight-hour shift and where you spent your time, but it doesn’t record what you did with your time,” agrees nurse Chris Larsen, who chairs Eden’s Professional Performance Committee. She vows that she won’t wear a badge if the system ever comes to the intensive care unit where she works.

Some nurses worry that the eventual upshot of this technology might be to standardize performance times for each task. They can envision the day when each nursing function is timed and staff are chastised for not performing them quickly enough. CNA spokeswoman Liz Jacobs blames the trend towards clocking and standardizing tasks on the misapplication of management techniques developed for the manufacturing sector to health care, a much more variable setting with more highly trained workers. “This is a technological solution to a social problem,” she says. “Nursing is about using professional judgment in clinical situations where you have not widgets, but human beings.” Nurses worry that the routinization of their work heralds a new wave of industry cost-cutting. Veteran nurses such as those who led the protest at Eden have seen dramatic changes in health-care finances over the last decade, many of which have routed money away from patient care.

With the advent of managed care in the mid-’90s, many independent and nonprofit hospitals were acquired by larger or for-profit entities. Eden Medical Center was no exception. Founded in 1954 as a district hospital serving southern Alameda County, it was funded by public dollars and governed by a publicly elected board of directors. But in 1997, after a public vote, Eden became a full affiliate of the nonprofit Sutter Health chain, which also runs Alta Bates Medical Center in Berkeley and Summit Medical Center in Oakland.

Under managed care, hospitals are essentially cost centers. When the time comes to cut payroll expenses, administrators look to some of their costliest employees — registered nurses. After all, doctors at Eden, as at most hospitals, are private practitioners who are not on the company payroll, and registered nurses are well-paid compared with other hospital personnel. Jacobs estimates that the average Bay Area registered nurse makes about $55,000 a year.

Consequently, the 1990s saw massive nursing layoffs throughout the hospital industry. As admissions were trimmed and patient visits shortened, the reduced staff sizes meant that nurses had to juggle more patients with serious illnesses. Comer says this had a deleterious effect on patients’ quality of care and nurses’ quality of life. “Nurses see many many more patients over a week or even a shift than they used to, so there’s less time to catch serious complications of someone’s illness, drugs are hung much more quickly, labs are done much more quickly, there is not the same amount of time to assess a patient’s need,” she says. “With gravely ill patients, people are flying by the seat of their pants. Nurses are feeling compromised in their ability to be truly therapeutic.”

By the late ’90s, even nurses who had escaped the layoffs began to leave the nursing profession in droves, often citing unsafe staffing ratios and the excessive use of mandatory overtime as reasons for quitting. “The hospital industry is now bemoaning the fact that there is a national nursing shortage,” says Jacobs. “We say no, there’s not. The nurses are out there — they just don’t want to work in hospitals as they now exist.”

Nurses maintain that the best way to improve patient care is to make sure that there are enough people to get the job done promptly and skillfully — not to buy machines to clock staff performance. “If you have the appropriate staff dealing with the problem up front, there would be no need for the call bells to go off,” says Carol Bickford, senior policy fellow for the American Nurses Association.

But Eden administrators counter that their new locator badges are not much different from the other sensors and scanning devices that Americans happily rely upon in their everyday lives. “We don’t think twice about using our Safeway card at the checkout stand, knowing that somewhere data is stored on just how much junk food you just bought, or how many times you cross over the bridge using FasTrak,” Phelps says. “But this seems a little more pervasive I guess when it comes into the workplace. … Maybe staff think it’s a matter of questioning their ability, and it certainly is not.”

In fact, that is exactly what most of the nurses seem to resent about the COMLinx system. “We are a group of professionals as registered nurses, and I don’t think I need to be tracked while I am carrying out my duties at work,” says Bearden. “I don’t think we need a Big Brother watching out over us. Most professionals are not tracked at work, so why should I say this is okay?”

Many nurses feel that being monitored on a screen is demeaning, that their skills and work ethics are in doubt. They point out that no one would ever think of asking a doctor to wear a locator badge. At the very least, they say, the recent tussle has put pressure on already hardworking nurses to do their jobs faster and take fewer breaks. “It’s just another source of mental and emotional strain on an already overburdened nursing workforce,” says Comer.

Debates about employee tracking also tend to raise the sticky question of what information managers will rely upon in a disciplinary situation — the accounts of their staff, or the records of the tracking system. Tien of the Electronic Frontier Foundation warns that people tend to be swayed by numbers. “There is a strong tendency for that kind of decontextualized information to be given more weight than it deserves,” he says. “There is a sort of fallacy of objectivity that we often associate with computer-generated data: ‘The computer said it, so it must be true.’ It’s more valid than any observation.”

Eden administrators emphasize that the hospital has never activated the system’s ability to time nurses’ responses to patient calls, although they say it’s something they could do in the future. And they promise that if that part of the system is ever activated, call-response times will only be one part of how an employee is evaluated. “There are other issues that address patient satisfaction better than how long somebody’s been on a break,” says nursing manager Seiveno. Spokeswoman Phelps agrees, while also apparently reserving the right for the hospital to consider response time as one of several aspects of nurse performance. “This alone is not how anybody should be dealing with an employee performance issue,” she says. “This is just one small piece of that. But it’s very important to the patient. If you can imagine you’re the one in the bed — you want a response.”

Of course, even if current management promises not to use the system’s potentially more invasive capabilities or hand out punishments based only on statistics, future bosses may not be so mild-mannered. What if the hospital is sold or merges with another chain? “Just because you have it good this week doesn’t mean it’ll be good next week or next year,” Bickford cautions.

And finally, many nurses find the new locating devices literally too close for comfort. They’d been asked to wear a relatively new piece of technology close to their chests on a daily basis. Health worries soon spread; maybe continuous exposure to an infrared device could cause vision problems … or worse. After all, there is evidence that prolonged exposure to infrared light in the workplace can cause cataracts. For Bearden, the thoughts of long-term health risks were troublesome enough that she stopped wearing her badge last spring. When her manager confronted her about it in June, she resolutely handed it back and refused to wear it again. “I started thinking ‘What am I wearing a badge for?'” she remembers. “It could be detrimental to me, and not knowing any valid studies that the Hill-Rom company has done, I felt better not wearing it.”

To answer staff worries, the hospital had their radiation safety officer, Dr. Sharon DeWit, study the system for safety hazards. In a memo sent to staff last March, DeWit concluded that the tags emitted only nonionizing radiation, which does not produce the charged particles that can cause biological damage. Furthermore, the pulse, which is emitted every four to six seconds and lasts eight nanoseconds, is a directional beam that is pointed away from the body and cannot travel backwards through the badge.

Paul McDaniel, Hill-Rom’s engineering manager, says the badges were tested by Underwriters Laboratories and the American Council of Government Industrial Hygienists, and found to be well below any dangerous thresholds. Cases of cataracts due to infrared light exposure have been noted mainly among steel millworkers and glassblowers, where workers’ retinas would be burned because they were staring into a light source all day. (Infrared light isn’t visible to the human eye, so it doesn’t activate natural protective responses like blinking.) But McDaniel says no one using a nurse communications device would be exposed to that intense level of infrared light. “There’s no way the person will basically be holding the badge up to their eyeballs,” he says.

Hospital administrators also emphasize the ubiquity of infrared light, which exists in nature as well as in many household technologies. “You’re exposed to more by walking from your car to the hospital than you are by this,” says Phelps of the beam emitted by the badges. “It’s the same technology that you find in your remote control at home on your stereo, your TV, your garage-door opener.”

But since the badges are relatively new technology, and longer-term studies about their effects on wearers are simply not available, the nurses are still skeptical. “The problem is, you don’t wear a remote control on your chest for eight hours a day, for however long you’re a nurse,” Jacobs says.

Eden is not the first Bay Area hospital to deal with nurse locator issues. A less-complicated system was installed in the intensive care unit at Kaiser Oakland in the early 1990s, but only lasted a few years. Jerome McCockran, a CNA activist who has been a critical-care nurse at Kaiser Oakland for twenty years, says the system gradually fell into disuse without the administration and staff ever facing off on the subject.

McCockran remembers that some people openly refused to wear their badges, and others learned tricks to circumvent the system. For example, he says, if a particularly demanding or disoriented patient had been leaning on the call button all day, nurses could slide their badge under the patient’s door without actually going into the room, which would deactivate the sensor. Eventually, he says, the system faded into disuse. “From attrition of employees leaving the facility, batteries not being replaced, the basic system not being maintained, it just crumbled on its own merits,” McCockran recalls. “I never wore my badge and was never confronted with having to wear it, because it wasn’t in the contract.”

Labor negotiations obviously play an important role in determining how well a nursing staff will accept new technologies. At Washington Hospital in nearby Fremont, staff and the CNA were successful this July in getting administrators to sign a memorandum of understanding stating that badge-wearing was not mandatory, and that information collected via the monitoring system would never be used for disciplinary purposes, CNA activists say. They also secured a verbal agreement that the hospital would provide the staff with all possible information on the system’s long-term health effects.

But part of what encouraged the protest action at Eden was the feeling that administrators would not let things slide, as they had apparently done at Kaiser, or bargain with the union, as they had at Washington. In fact, there was a bit of bad feeling engendered because the nurses at Eden had wrapped up contract negotiations just a few weeks before the Hill-Rom was installed. “We had even asked them if they had any plans for putting a tracking system in and they flatly denied it,” says Larson, who serves on the negotiating team, “and right after negotiations two weeks later boom, they put it in. It’s like they lie right to our faces.”

Both sides of the debate say the friction is fairly uncharacteristic for the small hospital, which had a history of amiable relations between administrators and nurses. Brill believes Eden administrators are hiding behind semantics. “Their response was, ‘We did not install any kind of nurse surveillance or locator system, we installed a nurse communicator system.’ And we just looked up at them and said, ‘That is pitiful.’ Of course it communicates, and everyone knows what it is.”

Phelps counters that the hospital wasn’t at all devious. As long ago as early 2001, Eden assembled a multidisciplinary task force — which included nurses — to evaluate the purchase. The hospital also held open workshops with Hill-Rom Systems explaining how the system worked. And the system wasn’t brought up during contract negotiations this year because the talks were supposed to be confined to five issues previously agreed upon by the hospital and the union. In fact, Phelps says, initially there was very little concern from Eden nurses, who were happy to see the previous system replaced.

But then, long before the Labor Day protest, several Eden nurses stopped wearing their tags — whether out of health concerns or because they resented the badge’s implications. Elizabeth Aquino recalls that she had not worn it for several months, but would put it on her clipboard whenever her manager told her to. Was it useful there? “It’s helpful to track down where your clipboard is,” she recalls.

As time passed, union representatives say, hospital managers began to pressure employees to put their badges back on. “They were starting to focus in on certain people that were less assertive and really riding them that they should wear them,” Brill says. “Managers were calling down the hall saying, ‘Susan, where’s your button? It doesn’t show that you’re on the screen here.’ So it was uncomfortable for those nurses. … We felt it was important to take a collective action.”

Eden’s Phelps blames the recent troubles on agitation from outsiders. “The union official is the one who sort of stirred the pot on this issue and tried to use it as a negotiation issue for other things,” she says. Still, she noted that no disciplinary action has so far been taken against any of the nurses who removed their badges.

In any case, it wasn’t until the $8,000 worth of locator tags disappeared, only to be followed by union e-mail saying that the badges would be returned if the hospital would agree to negotiate over their use, that Eden officials took the dramatic step of calling the cops. “That is not how we negotiate,” says Phelps of the union’s tactics. “A staff member refusing to wear it, that’s one thing, but this is an outside person removing patient-care equipment from the unit.”

Although many of Eden’s nurses have made it clear that they don’t want to wear the badges, the hospital is about to acquire more of them. The medical center has already received approval to install another nurse communications system on the second-floor maternity unit next year. Administrators say it will be the last system purchased — not because of pressure to do away with the badges, but because the hospital’s other units are too small to need their own systems. “The bottom line is this is the right thing to do for our patients, and we need to do it,” Phelps says.

The protesters are no less adamant that they won’t wear the badges without some changes. “Real patient care is provided by real people who have independent nursing judgment, and no amount of technology and remote care will substitute for a professional nurse who can actually act to save your life,” Comer says.

Both sides have repeatedly said they are eager to talk with one another, yet neither seems inclined to concede its major point. In the meantime, the badges sit in a box and the expensive new system goes unused. Of course, some compromise seems possible: Administrators say they’ll consider getting rid of the intercom in the break room if it will ease nurses’ minds, and some nurses say they would feel more kindly about the system if they could get more proof of its long-term safety and a promise that its tracking capabilities would never be used against them. Others suggest that even without the badges, it could still be used as an ordinary intercom.

But the money is already spent, and the hospital has no intention of scrapping its new equipment for something less controversial. “We’re not switching,” says Phelps. “This is where technology is going for the communication systems in hospitals, and we’re going to move forward, not backward.”

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