story & photos by ARNO HOLSCHUH
A consulting group with
a record of keeping
A second wave of nurses in supervisory positions took a pay cut and stepped down at St. Joseph Hospital last week so that they could participate in an upcoming union election. Nineteen charge nurses from the medical-surgical unit, where patients recover from less acute illnesses and injuries, will be giving up responsibilities like bed assignments and accepting a 10 percent pay cut in return for the right to vote for union representation. Sixteen charge nurses from critical care made the same move for the same reasons Dec. 4.
The nurses say their action was prompted by hospital administrators who changed the nurses' job description to make them part of management, which would have prevented them from voting.
Hospital administrators said the nurses were always part of management and their job description was changed as part of a broader reorganization underway at the hospital.
What's behind the nurses' push to unionize? And what is the hospital doing to keep the union out?
"They had a better compensation
package than anyone and issues of patient care were addressed
properly by administrators," he said. If a nurse had problems
or concerns, "you could go to the sisters" -- the Sisters
of Orange, owners of the hospital and its parent organization,
St. Joseph Health System-Humboldt.
That was 1984. Last week, Batiste sat in Ramone's Café, across the street from St. Joseph, explaining why he is backing the effort to unionize the 350 registered nurses at the organization's three Humboldt County hospital sites.
"In the early '90s, things started going downhill," Batiste said. The hospital switched to a corporate style of management and "the warm fuzzy feeling" nurses had under the sisters began to dissipate. Pay increases for nurses started to lag behind other areas and a shortage of new nurses who wanted to work for St. Joseph Hospital developed. To top it off, nurses' ability to act as advocates for patients was diluted as management listened less and the patient load grew, he said.
"St. Joe's has a long-standing tradition of providing quality patient care to the community. The values the sisters had at the start were service, excellency, dignity and justice. Those values applied to employees as well as patients," Batiste said. "Now those values are no longer important as far as employees go. Now they treat us like cattle."
That is why a group of nurses from St. Joseph and Redwood Memorial Hospital announced Nov. 17 that they want to unionize with the help of the California Nurses Association. Seeking better wages, more nurses and job protections for whistleblowers, the nurses are collecting signatures to file for an election to make CNA their representative.
The campaign has been greeted with dismay by St. Joseph administrators who say the nurses will only hurt themselves by unionizing.
"We believe our values are about providing a just, respectable workplace," said Mike Purvis [see photo below] , chief executive officer and president of St. Joseph Health System-Humboldt County. "And we believe that can be done best in an environment that doesn't have a third party buffering between administration and employees."
To drive that argument home, St. Joseph's administration has begun distributing a bi-weekly newsletter with an anti-union message. They have even hired a third party of their own to help -- the Burke Group, a consulting firm that specializes in winning elections for management (see separate story).
Management, still dealing with
the aftermath of several years of operating losses, portrays
itself as reaching out at every opportunity, but many nurses
feel not respected and they are underpaid. Both sides are battling
for the hearts and minds of a majority of the nurses, because
in a matter of months, a decision will be made: Union yes or
Two trends are making the job of a nurse progressively tougher, both the result of managed-care cost-cutting. Because managed care discourages hospitalization of a patient until it becomes absolutely necessary, the facilities are dealing with sicker patients. Hospitals also have trouble keeping a full roster of nurses on staff, meaning the remaining nurses are being spread thinner. That makes their mission of care harder to fulfill.
While a union contract won't affect the flow of patients into the hospital, the CNA believes that it can at least protect nurses who speak up about problems. Without union support, their role as patient advocates could be compromised by the fear that management may not listen -- or, worse, may punish nurses if it doesn't like what they're saying.
Jacobs said when the CNA has negotiated contracts at other hospitals, one request is always to institute a professional practice committee. Such committees, made up of nurses, communicate to management what problems nurses face and make suggestions on how they can be solved.
In order to speak without fear of reprisal, it is also important that nurses be classified as "just cause" employees, not "at will." St. Joseph is an at-will employer, meaning management can terminate an employee without giving justification. A union contract could change that.
"When you have a collective bargaining agreement, you can only be disciplined for just cause," and blowing the whistle on problems in the hospital isn't just cause, Jacobs said.
Another important way nurses can have their voices heard is through the establishment of an "assignment under objection" form. If a nurse in a CNA-organized hospital is asked to do something that is not in the patient's best interest, he or she can file an official document that says so.
"Right now, if a nurse is asked to work in a unit where he or she is not competent or one with too many patients, the nurse can say so. And then the manager can say, `OK, but you have to do it anyway,'" Jacobs said.
That exposes the nurse to legal liability. Under California law, nurses are required to act in the best interest of patients. If something goes wrong, a manager can claim ignorance of a nurse's complaint. An assignment under objection form shows the nurse warned her superior about an unsafe condition. That protects the nurse from financial liability for someone else's poor decision, or from conditions such as critical short staffing.
Jacobs said she has not heard
of a nurse at St. Joseph being forced to face the legal consequences
of someone else's mistake. But in her experience, the benefit
for nurses has been that managers are less likely to assign nurses
to jobs they are uncomfortable with if it involves a written
McCrea, who was hired this summer for a newly created position, said she prefers a system of communications that was not based on legally binding documents.
"I have worked places where
nurses filed that [form] every time they felt they were inadequately
staffed," she said, and the document did not help solve
"That structure is already in place," she said. A council for the largest unit in the hospital, the med-surg department, was started in September. Nurses from the unit, where non-emergency injuries and illness are treated, meet every week with McCrea "to identify the top issues in their environment and how they will address them -- or they refer them to me."
None of the nurses interviewed for this report had heard of the new council, but Purvis said that was just timing.
"I just don't think the
employees have had an opportunity to see it work," he said.
"In today's hospital environment, we can't do our job because we have too many patients who are too sick to provide each of them with adequate patient care," Jacobs said. "We can't do the things that make us feel like we're doing a good job -- comforting patients, expediting their recovery, making sure they don't have complications."
St. Joseph administrators and the CNA agree that the nursing pool is shrinking, but differ on why and what can be done about it here.
Nurses say St. Joseph just doesn't pay enough -- about 40 percent less for starting nurses than in urban areas.
"We can't recruit and retain nurses because we aren't competitive," said emergency room nurse Roxanne Spencer, who has been in the profession for more than 25 years. She said she can understand why young nurses would choose to work elsewhere.
"I now make less than my daughter, who has been working as a nurse in San Diego for two years. We need to bring the wages up."
The two nursing schools at Humboldt State University and the College of the Redwoods produce about 60 registered nurses a year. Last year St. Joseph convinced just 12 of those to become staff nurses.
Spencer said she comes into contact with a lot of nurses rotating through the ER as part of their training and while many want to stay in the area, few do. The reason they leave is simple, she said.
"Money." Nurses in Humboldt may have to pay less for rent, but they have the same amount of tuition debt to pay off. "While they are offered maybe $17 an hour here, they tell us they can get around $24 in other areas."
"I think it's dangerous to say that someone is going someplace else because of higher pay," replied Purvis. "Keep in mind that at Humboldt [State University], you have a student base that is not predominately from Humboldt County. If a student comes in from San Francisco or Los Angeles, that doesn't mean they want to live their life here as a nurse."
And the nursing shortage isn't confined to Humboldt County. McCrea said it is a national problem that will only get worse. The nursing workforce is "a baby boom workforce," she said, and about to retire. To make matters worse, fewer young people want to become nurses.
"There have been reductions in applications to nursing schools," McCrea said, which will only compound the shortage problem. It's even hard to find faculty to teach in nursing schools, she said.
While it would seem the obvious answer is to offer higher wages, McCrea said she believes "relationships" are more important than dollar signs. St. Joseph plans to expand the training offered to new nurses and, "We're building partnerships with the faculty and the students."
Purvis also believes local pay scales match the local economic situation.
"St. Joseph provides very competitive wages for the area," Purvis told the Journal. "The cost of living index shows a substantially lower cost in this area. We just don't believe it's realistic for us to match the compensation in the [San Francisco] Bay Area."
Spencer said she isn't convinced
that the lower wages for Humboldt County are being shared equally
by management. "Is Mike Purvis making less? Is Mary Anne
The backdrop to the salary debate is a very real question about where extra money should come from. St. Joseph, like most of the hospitals in California, faces a tough financial situation. As recently as 1999, the hospital was losing millions a year in operating costs (see chart). By last spring, the hospital put its head above water -- barely.
"Our financial health is improving, but we still have a lot of challenges," Purvis said. "There are no extra dollars."
But Jacobs argued the hospital's tenuous financial situation could be helped by reducing the reliance on temporary nurses.
St. Joseph has been relying more and more on "travelers," temporary nurses who travel to hospitals on demand to make up for staff shortages. Travelers are flexible, qualified and currently keeping St. Joseph at safe staffing levels -- but they are also much more expensive per hour than staff nurses.
"You pay for their flexibility," McCrea said.
Just how much more expensive they are is unclear. Purvis said the cost to the hospital is around $50 an hour -- about 50 percent more per hour than an experienced staff nurse with benefits. The CNA estimates they cost as much as $90 an hour.
"Our goal is that traveler use is minimal," Purvis said. But the reality is the use of travelers continues to rise. Travelers' compensation doubled from 6 percent of the total nursing budget last year to 12 percent this year.
It's a widespread trend, Purvis said. And although St. Joseph is using more travelers, it still uses fewer than other California hospitals, where travelers make up 25 percent of the nursing budget.
Batiste thinks that extra money
should be going to better compensation to attract staff nurses.
"Nothing against travelers," he said, "but with
two nursing schools in the area, we should be able to hire nurses."
"We feel like this organization has 90 years experience in successfully listening and responding to employees," he said. He concedes that "communication can occur with employee representation as well," although it would be "harder and less effective."
"I think [nurses' demands] are reasonable, although it might be an issue of timing. We would like less travelers, we want competitive wages, but we also want positive operating income."
In Purvis' view, many of the problems he is hearing about from nurses can be traced to management turmoil over the past two years. The hospital underwent a lot of stress as it tried to get back into the black while completing the purchase of General Hospital, its primary competitor, in October 2000.
"We have gone through a huge change in our organization. Some very important leadership positions were vacant during that transition," Purvis said. "While I don't hear many people complain about that lack of leadership, in my view it comes back to that." Now that the new management team is taking over, those problems should sort themselves out without unionization, he said.
"It's just entire new layers of managers," Spencer said. Once a department manager herself, Spencer said the new management structure "is not a good idea for a hospital our size. With those extra layers of management, I don't think they're going to hear our voice."
It's just one more reason for Spencer to vote union yes. Even if St. Joseph were to offer better pay, cut down on traveler usage and institute better safeguards for nurses critical of the hospital, she said she would support the CNA.
"I think we need a solid voice -- and now is the time."