Today’s podcast is a perfect example of how the Iowa Writers’ Collaborative works.

On Monday morning, Collaborative member Douglas Burns published a powerful column on a major push to organize nurses in central Iowa. It’s an important story with statewide implications—and we are fortunate to have a veteran journalist of Doug’s caliber covering it. Look for more reporting coming soon from Robert Leonard and Jason Walsmith.

After reading Doug’s column, we decided to amplify the story the way the Collaborative was designed to do: through collaboration.

We invited Alex Wilken, an Iowa Methodist Medical Center critical care nurse and advocate for unionizing more than 2,000 central Iowa nurses, to join my noon Monday podcast call. The conversation added depth, clarity, and urgency to Doug’s reporting. The vote on unionization is scheduled for December 7–9 across four UnityPoint locations.

Alex asked to have his contact information shared here for those who have questions: [email protected]

You can listen to the full recording above.

Dr. Robert Shreck

Wow! I learned a lot.

Great topic and person--timely and significant. Below I have penned some thoughts on some of what I heard--

1. Common knowledge, but just to emphasize: the unions in Iowa City and at Broadlawns are (were) crippled by state legislation and can basically only negotiate salaries; this UnityPoint union can and will negotiate salaries plus any aspect of working conditions, which gives them real power;

2. The ability to strike is the nuclear option that enforces everything else;

3. Traveling nurses are paid approximately twice as much per shift as local nurses. We saw this in the pandemic and it is still a phenomenon (see #4);

4. The biggest problem in healthcare today is a lack of medical personnel of every type--physicians, nurses, PAs, ARNPs, lab techs, radiology techs, aides, etc. I will send you today’s Scott (cancelled) Adams offering to which we can all relate. This was a growing problem for a couple decades but it really hit the fan with the pandemic and has been answered by reduced staffing levels, shifting responsibilities to lesser-trained (and cheaper) personnel and asking more of everyone--a degradation of patient care and working conditions. The price of anything goes up as it becomes more rare;

5. If a UP union forces higher staffing levels it will be at the expense of other local medical institutions--there is not a reserve of healthcare workers in the wings ready to pick up the work. That said, long-term unionization may be beneficial by improving the workplace and encouraging more workers to gravitate to healthcare, but it could be a generation;

7. The large salaries of hospital administrators are bad optics but if they worked for free there would be no material impact on the $1.093 BILLION dollar budget of the four DSM UP facilities combined (they are half of one percent (~0.5%) of the budgeted expense);

8. Effective administrators are worth their weight in gold. Jody Jenner took Broadlawns from a bankrupt, failing institution to an enormous success with finances to cover its expanded services and, as we heard today, a union that volunteered to de-certify as they were pleased with their lot and tired of paying dues and officers. The larger the institution the harder this is to do, and UP and UIHC are giants compared to Broadlawns;

9. I don’t believe capitalism is the problem; au contraire, it is the solution. Case in point: our private, for-profit medical oncology practice in DSM (Mission: Cancer) grew from two doctors, two nurses and two secretaries in 1981 to 22 physicians, 45 ARNPs, 100 RNs, 350 total employees, five large central Iowa offices and 22 out-reach clinics in 22 county hospitals throughout Iowa, caring for a large fraction of all Iowa cancer patients by 2024. We were heroes to the insurance industry and state Medicaid program as our charges were substantially less than identical services at non-profit hospitals (Mercy, UP, UIHC, etc.). IMHO, the most successful, from the reputation and revenue aspects, group practice in the state. Enlightened administration was key as were intra-office relations with all levels of personnel;

10. But, Mission was purchased by UIHC last December, with assurances that “nothing” would change. Well, many things have changed. Out-of-pocket costs to patients and bills to insurers, including Medicaid and Medicare, have skyrocketed due to the addition of “facility” fees; outreach clinics and whole offices have been shut down; long-term workers and patients are leaving and its footprint in central Iowa is rapidly shrinking. It will survive, but as a shadow of its former self. Lots of really good people, friends and heroes of mine, but under new management.

So much for moving from capitalism to government ownership.

Thanks for listening. Watch for Dilbert.

Bob

More..

Also, here is a report about this story by O. Kay Henderson from Radio Iowa.

A Quick Behind-the-Scenes Look at How This Works

With many new subscribers joining us recently—welcome!—I want to share a bit about what goes into producing this coverage, and how the Iowa Writers’ Collaborative creates value for readers across the state.

I am one of 70+ writers who make up the group. Every Monday, I host a live Zoom conversation at noon Central through my personal Potluck column (this space). That morning, subscribers receive the guest announcement. After the event, I produce and upload the podcast version of the conversation. Today I used a new software tool because my go-to stopped working. This one allows captioning, but I haven’t figured out how to add the transcript yet. Sorry.

These Monday conversations draw 4,500–5,500 views, reaching a statewide audience that includes policymakers, journalists, and community influencers. And the real magic happens when readers with direct experience—nurses, doctors, educators, public officials—join the discussion and enrich it with their lived expertise. Those numbers are more than doubled for the Iowa Writers’ Collaborative Roundup.

This is the cooperation at its best: journalists, readers, and frontline experts in the same room, deepening the public conversation together.

Correct me if I’m wrong, but I can’t think of another platform that offers this kind of reader engagement in Iowa. And no other state is doing anything that comes close to the Iowa Writers’ Collaborative.

Personal Update on Readership Trends

Readership of The Potluck continues to rise steadily, as does the audience for many members of the Iowa Writers’ Collaborative. The twice-weekly Roundup, featuring posts from members across the state, has also grown into a powerful shared platform.

A major driver of this growth is Substack Notes—which, if you haven’t used it, is a bit like what Twitter used to be (but much friendlier). Yes, I’ve noticed a few suspicious bots, but nothing like the swamp X has become.

Meanwhile, elsewhere in the social-media universe:Our member Chris Gloninger discovered that one of his climate-change posts—on mitigation costs in Florida—was banned from TikTok. Make of that what you will, my TikTok-loving (and tick-tock, the clock is ticking for freedom-of-speech-loving) readers.

Substack is one of the remaining refuges in contrast to platforms where billionaires who want to stay that way stifle content they don’t like.

On Subscription Fatigue

There’s a growing conversation across Substack about something called “subscription fatigue.”

Big names in journalism and celebrities continue to flock to the platform, which is wonderful for visibility but has sparked real questions among working journalists and writers about sustainability.

I experienced a brief dip in subscribers myself—no clear reason why—but numbers have been trending back up.

Still, it’s a moment of reflection for many writers. What does the future look like? If the pool of paid subscriptions falls, will this be another failed experiment?

Those are exactly the kinds of questions we’re wrestling with—and answering—together inside the Iowa Writers’ Collaborative.

When we meet on the 17th as a group before the holiday party begins, we will be tackling these issues.

No one has the answer, but know we are proving the value of being a collaborative of professional writers focusing on local news and commentary.

I’ve experienced social events where the news of the day is being discussed, and the source of information is from one of our writers. This is true around Iowa.

Would you miss us if we were gone?

If you’d like to be a part of the team that makes this potluck happen but don’t want to have a recurring subscription, pick whether you can buy a coffee, or a computer using this button:

The Economics of Writing

Like you, I am inundated with emails from great causes - from life-and-death issues for people and pets - to thousands of causes needing support. Literally.

But I want to tell you about why supporting writers is important. Most former journalists have been shielded by the business side of news. They bristle at the notion that they should be responsible for promoting themselves. Their reporting and writing is valuable, and it IS.

There used to be fences between journalists and advertisers. No one dreamed we’d see the day when the front page of a newspaper feature advertising, and the idea that stories might be buried because an advertiser wouldn’t like it was unthinkable.

Well….

Most writers were paid modestly, and their income is unpredictable. Compensation varies widely, but for many, writing is a patchwork of freelance assignments, teaching, editing, and side gigs.

Thanks to Story Summit, I’ve helped design courses on how to launch a successful Substack newsletter—though I caution anyone who listens: don’t quit your day job just yet. We’ll begin the series anew in January. It’s a terrific class thanks to my colleagues Debra Engle and Dana Kennedy.

I’m passionate about helping writers use this platform because it was built for writers. We monetize our words—not Mark Zuckerberg or Elon Musk. Substack takes a tiny cut, but only when the writer earns. That matters.

I’m equally passionate about filling the growing void left by legacy media—providing local, independent, and sometimes progressive commentary increasingly squeezed by corporate ownership and debt.

What does it cost to do this work?Time. Lots of it—seven days a week, most weeks.Technology. Software subscriptions, editing tools, upgrades—$250 here, $2,000 there.Travel. Reporting doesn’t happen from a desk.

It adds up. And if you appreciate the writers who bring you stories you enjoy or rely on, please don’t take their work for granted.

The Iowa Writers’ Collaborative

The Iowa Writers’ Collaborative

Paid subscriptions dip, but readership grows.

By the numbers, the downward trend in paid subscriptions is a cautionary tale. But readership continues to rise, demonstrating that Iowa readers are hungry for smart, local perspectives.

On this Giving Tuesday, if you have room in your heart and your wallet, please consider supporting the writers of the Iowa Writers’ Collaborative. Find the ones you love and let them know you value what they do.

I promise you—your support matters.

Sunday Roundup Group:

Flipside Edition Roundup:

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit okobojiwriters.substack.com/subscribe