VNA of Boston RNs Issue 10-Day Notice to Strike Over Salary, Benefits and Workload Issues
Notice Delivered at End of Yesterday’s Negotiating Session, Plan to Strike on Dec. 10th
Management Demands 5% Cut in Benefits After Nurses Have Already Given Back 8% of Their Wages in Their Last Contract, While Their Workloads Have Increased by 40%

After a day of fruitless contract negotiations, the registered nurses at the Visiting Nurse Association of Boston (VNAB), the state’s largest home care agency, yesterday presented management with a required 10-day notice of their intention to strike. Unless management changes its position, the nurses will walk off the job on Dec. 10, 1999.

The 188 nurses of the VNA of Boston, who are represented by the Massachusetts Nurses Association (MNA), have been negotiating their new contract since August of 1999. The existing contract will expire today, November 30th. On Nov. 3, 1999, 96 percent of the nurses voted to authorize their leadership to call a strike. The parties have met four times since that vote, with the last two negotiating sessions before a federal mediator. The parties are far apart on a number of issues.

The agency is demanding the nurses accept no salary increase, along with a 5 percent cut in their benefits. The benefits cuts include taking away two holidays and a full week of vacation time; elimination of life, HIV insurance and tuition reimbursement, and decreasing reimbursement for mileage by 50%. The agency is also eliminating its contributions to the nurses dental benefit, while the nurses will be expected to pay more for their health insurance benefits The nurses, who agreed in their last contract (1997) to freeze their wage increases, have already given back 8 percent of their salaries by this action. They have seen their workload increase by 40% over the last two years and are firm in their commitment to accept no reductions in salary or benefits.

The Nurses’ Position

The nurses are seeking strong language to create a diverse nursing staff to reflect the communities the VNAB serves, fair language involving the assignment of weekend work while respecting seniority, and a cost of living raise in each of the next two years of the contract.

“The last thing we want to do is go out on strike, but our nurses are firm in their resolve that we be treated with the respect and dignity our service and sacrifice to this agency warrants,” said
Theresa Kane, RN, chair of the MNA bargaining unit at VNAB. “We have broken our backs for this agency; we have sacrificed financially, professional and personally under extremely difficult practice conditions and we cannot to sacrifice any longer. If there is a strike, it is because management wants a strike and does not want to acknowledge the value and contributions of those who make this agency run.”

The salary issue has taken on added significance in light of the increasing difficulty of nurses to practice in the current health care environment. In recent years, the Balanced Budget Act of 1997 has placed a financial burden on home care agencies as reimbursements to agencies have been cut. The VNAB has compensated for this cut by putting greater pressure on the nurses to increase their productivity under deteriorating and stressful working conditions. For example:

• Nurses’ patient assignments have increased by 40%, rising from five patient visits per day to 7 per day.

• The acuity level of their patients has increased. Due to earlier discharges of patients from hospitals, the patients receiving home care are more acutely ill and in need of more intensive nursing care (at the same time that nurses are expected to see more patients each day).

• The nurses’ geographic areas of coverage have been expanded to include suburban populations outside of Metro-Boston, forcing nurses to travel farther distances in the same day.

• Nurses’ paperwork has increased dramatically. This paper work is required in order for the agency to receive reimbursement for the care the nurses deliver. On average, 30 – 35 documents per patient must be filled out for reimbursement to occur.

Prior to this year, at the state level the agency has repeatedly failed to request Medicaid reimbursement rate adjustments appropriate for the unique population and geographic area they serve. Earlier this year, the agency, along with others in the state, had negotiated a small increase in their Medicaid rate. Yesterday, the agency testified, along with other home care advocates, for a more significant adjustment. While the nurses believe this is an appropriate action, they question the agency’s use of the nurses’ labor dispute as a strategy to achieve the Medicaid increase. The nurses believe the agency has proposed the salary cuts and pushed the nurses to strike as part of a strategy to force the state’s hand. If unsuccessful in achieving the needed rate increase, the nurses fear the agency will use the strike as an excuse to drop its commitment to care for Medicaid clients altogether.

“It is unfortunate that the agency feels it needs to put the nurses in the position of a strike to achieve its financial goals,” said Kane. “We want the public to know that we believe the agency’s motives are ethically questionable, and the nurses should not be used in this fashion.”

The nurses point to action on the federal level, which should result in a significant increase in funding for home care services under Medicare, which had previously been cut under the Balanced Budget Act. “The climate is changing and the assumptions the agency has used to demand these severe cuts no longer apply,” said Patricia Williams, associate director for the MNA representing the nurses at the bargaining table. Management needs to realize that these nurses are the backbone of this agency. They need to focus their management expertise on helping them to be able to do their jobs, not demoralize them and exploit them.”

“Home health nursing is among the most stressful and complex types of nursing, especially in this health care environment, where patients are being sent home too soon, with tremendously complex needs for nursing care,” said Jo Ann Fergus, RN, vice chair for the MNA bargaining unit. “Adding to this pressure is the fact that our nurses service some of the poorest and frailest members of our society, and work in some of the most dangerous neighborhoods in the city. We are proud of the care we provide our patients and this city and only wish to continue to do so. But we cannot accept or abide a cut in our salary to do so, especially after having forgone salary increases in the past.”

The nurses are willing to negotiate up until their strike deadline on Dec. 10, 1999. The nurses hope the agency will do the right thing and settle this contract so a strike is not necessary.