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St. Vincent's Strike
Backgrounder on St. Vincent's Hospital Nurses
Strike Regarding Mandatory Overtime Issue
Contents:
I. Overview of Relationship With
Tenet
II. Negotiations Update
III. Mandatory Overtime – Key Issue in Dispute
IV. Research on Mandatory Overtime Issue
V. MNA Contracts That Address Mandatory Overtime
I . Overview of St. Vincent's Hospital Nurses' Relationship
With Tenet Health Care
- Tenet purchased St. Vincent's Hospital in 1997,
and has also built the new $215 million Worcester Medical Center
in downtown Worcester, with plans to move most of the services
from St. Vincent's Hospital to Worcester Medical Center on April
1, 2000.
- 650 nurses at St. Vincent's Hospital voted for
union representation by the Massachusetts Nurses Association on
Feb. 5, 1998. They have been attempting to negotiate their
first contract with Tenet Health Care, a for-profit hospital chain,
for more than two years.
- The key issues driving nurses to organize their
union were those related to issues of safe staffing and their
ability to deliver safe patient care. The nurses were having
no success as individuals addressing their serious concerns about
their ability to practice safely under Tenet management and wanted
a voice in the decisions that impact their practice.
- The nurses claim that on a daily basis, nurse
staffing levels fail to meet Tenet's own written guidelines for
staffing. Nurses find themselves assigned too many patients
to care for safely. For example, RNs on the medical surgical floors
can be assigned to care for more than eight patients on the day
shift, and between 10 to 14 patients on the night shift.
A safe patient assignment is nor more than 6 patients on days
and no more than 8 patients on nights.
- According to the MNA, St. Vincent's Hospital has
the worst record of documented unsafe staffing reports of any
of the 85 hospitals where the MNA represents registered nurses
in the state. In the past 24 months, nurses have filed more
than 450 unsafe staffing reports, which are official reports,
nurses file whenever they feel "their patients are in jeopardy."
The nurses hand-delivered copies of all these reports to Bob Maher
last year to appeal for his help in addressing the staffing concerns.
Nothing was done by Tenet to respond to the nurses' documented
complaints about staffing.
- Back in November of 1999, the nurses of St.
Vincent Hospital had cast an overwhelming vote of "no confidence"
in the management of the Tenet-owned facility and began continuous
picketing of the facility to protest the delay in a contract settlement
as well as the facility' substandard staffing conditions for nurses.
- Tenet management has shown little interest in
engaging in good faith bargaining, according to the MNA.
In fact, last year, they were forced into a settlement with the
MNA over charges of bad faith bargaining with the nurses at Certified
Nursing Services, the home care arm of Tenet, which they later
closed because it was shown to produce too little profit.
In September the MNA bargaining unit at St. Vincent's Hospital filed
a charge of its own against Tenet, citing the organization for
failing to provide information due the MNA concerning the planned
move to Worcester Medical Center this Spring.
II. Negotiations Update
- To date, 49 negotiating sessions have been held
with the last several before a Federal mediator. The key
issues for the nurses included the hospital's demand for the unrestricted
right to assign mandatory 16-hour shifts to nurses. The
nurses have also been seeking a voice in the decisions surrounding
the move to Worcester Medical Center, including information on
the staffing levels at the new facility. They have a legally protected
right to negotiate over any and all changes in their working/practice
conditions resulting from the move to the new facility.
- The last negotiating session was held on Friday,
April 21, 2000. Talks broke down in little over 20 minutes
after the hospital refused to withdraw its demand for mandatory
16-hour shifts as a means of staffing the hospital in non-emergency
situations.
- The hospital also refused to stay and bargain
over other remaining issues, including the move the Worcester
Medical Center, and most importantly, issues related to staffing
levels in the new facility. Tenet negotiators said they
would only negotiate these issues after the nurses accepted their
mandatory overtime proposal and ended their strike. The
issue of staffing levels is inextricably linked to the issue of
mandatory overtime because the only reason mandatory overtime
becomes a problem in hospitals is when there is a shortage of
nurses on staff. The hospital has come to the table demanding
mandatory overtime, stating that they need this provision to staff
the hospital in the future.
- Immediately following the April 21st negotiating session, the
MNA filed an unfair labor practice charge against Tenet Health
Care for their refusal to supply staffing information and bargain
over the move to Worcester Medical Center.
- On March 16, the nurses voted by a nearly 3
to 1 margin to authorize the union's negotiating committee to
call a strike.
- On March 17, the nurses issued their official
notice of their intention to strike as of March 31, 2000 at 6
a.m.
- On March 25, the nurses opened a strike office
in the Carpenters Union Building at 29 Endicott Street in Worcester.
The office is open 24 hours a day, seven days a week. It
serves as the control center for the strike, where nurses organize
their picketing, provide information to their membership, sign
up nurses for per diem work at other hospitals to supplement their
income, as well as provide career and financial counseling to
rank and file nurses.
- The two sides negotiated on March 29, 2000,
which ended with no significant movement on the issue of mandatory
overtime, causing the nurses to issue their official notice to
strike on March 31, 2000. The nurses walked of the job at 6 a.m.
on March 31, 2000, beginning their strike. Picket lines
have been established at both St. Vincent's Hospital and the new
Worcester Medical Center. The nurses and management did
agree to a three-year phase out of the flex time policy.
- Tenet was scheduled to open the new facility
and move the patients into it on April 1, 2000. The move was postponed
for two days because of problems with care being delivered by
more than 120 replacement "scab" nurses provided by U.S. Nursing
Corps, a Denver-based firm that specializes in providing strike
breaking nurses to hospitals involved in labor disputes.
- The replacement nurses are paid more than $4,000
per week as well as food and lodging. The move to Worcester
Medical Center took place on April 3, 2000. The MNA has
received numerous reports from employees and physicians inside
the facility, as well as from patients leaving the facility that
the nursing care being provided is very poor, and that the hospital
is in a state of chaos.
III. Mandatory Overtime – Key Issue in Dispute
- Tenet management is demanding that the
nurses agree to work mandatory 16-hour shifts with one hour's
notice.
- What is important to remember is that the St.
Vincent Nurses have never had mandatory overtime in the past,
and never had a problem meeting the needs for staffing the hospital
by use of the voluntary overtime policy now in place.
- Tenet management has specifically demanded the
right to use mandatory overtime as a means of staffing the hospital,
not in times of emergency, but specifically to fill staffing holes
in the schedule.
- It is the hospital's responsibility to have
enough nurses on staff to cover the shifts they are required to
staff. But Tenet is refusing to hire the nurses required
to cover those shifts, and wants the right to force nurses against
their will to fill the holes left by nurses they refuse to hire.
- It is important to remember that mandatory overtime
is not an accepted practice in the nursing community nor is it
a "standard" of the industry, as Tenet claims.
- Mandatory overtime occurs in institutions when
there is not enough staff on hand to meet the needs of patients.
It is a problem caused by hospital's cutting too far back on their
nursing staff. No one in the nursing community has ever
endorsed this as an acceptable means of staffing a hospital.
- This use of mandatory overtime is not acceptable
to the nurses because it placed themselves and their patients
in jeopardy. Studies have shown that when a worker (especially
a health care worker) exceeds 12 hours of work, and is fatigued,
the likelihood of their making an error increases. We have
cited some studies below that support the nurses position.
- The Boston Globe editorial page on April 7th
supported the nurses' position in this dispute and cited the Institute
of Medicine's report on Medication errors, where the experts who
compiled that report specifically recommended that safe staffing
and limits on mandatory overtime are a component to preventing
medication errors.
- For their part, the nurses have made a significant
concession on this issue, by offering to accept up to 4 hours
of mandatory overtime. The hospital has the right to assign
up to 2 hours of mandatory overtime. The nurse could work
an additional 2 hours if she felt capable of doing so safely.
This proposal complies with repeated claims by CEO Bob Maher that
Tenet does not envision mandating overtime for more than 2 – 3
hours at a time. All we are doing is making them put that
commitment in writing.
- The nurses cannot accept the 16 hour limit proposed
by the hospital, and any settlement must allow the nurse the ability
to refuse to work mandatory overtime if she is too fatigued or
if she feels that working under such conditions would jeopardize
the care her patients receive. Why is this so? Because
the Nurse Practice Act, which is the law of the Commonwealth that
governs nursing practice states that nurses are held personally
(not Tenet) accountable for the safety of their patients.
In other words, if a nurse accepts a patient assignment, and something
bad happens to that patient on that shift, the nurse is personally
liable under her license and could lose her license. Nurses
should not be forced into a dangerous assignment (working beyond
his or her capacity to provide optimal care) without the right
to refuse that assignment.
- Tenet has said their proposal is based on similar
proposals negotiated by other MNA hospitals. The hospitals they
cite are not appropriate comparisons. The proper comparisons
to make are with other city-based hospitals where staffing problems
have matched those being faced by the nurses at St. Vincent's Hospital/Worcester
Medical Center. For example, MNA bargaining units have negotiated
strong limits on mandatory overtime at Boston Medical Center,
Cambridge Hospital, and Carney Hospital. Similar limits
are being negotiated at U. Mass Memorial, where mandatory overtime
is also a problem. (See listing at end of this document).
IV. Research on Mandatory
Overtime Issue
Nursing and workplace research supports the
nurses' concerns for patient and nurse safety under conditions of
excessive, unplanned overtime.
- For example, a study of nurses in Massachusetts
conducted by the American Journal of Public Health in 1992 found
that nurses who work variable schedules (such as mandated overtime
shifts) were twice as likely to report an accident or error, and
two-and-one-half times more likely to report near miss accidents.
It concluded that these conditions were associated with "frequent
lapses of attention and increased reaction time, leading to increase
error rates on performanceof tasks."
- In a 1989 article published in the Journal
of Occupational Health & Safety, the author stated, "Once
a shift exceeds 12 consecutive hours, acute fatigue sets in, a
worker may still be able to perform routine tasks, but his brain
waves exhibit a pattern of stage one alpha sleep. Errors
made in this state are frequently major, since the worker tends
to perform the opposite of the correct action."
Nurses are intimately involved in medication
administration in hospitals, as they are the ones who are ultimately
responsible for ensuring that patients get their medication, receive
the right amount of medication, and receive it at the appropriate
time. Most important of all, nurses are responsible for assessing
the patient to make sure the patient is responding appropriately,
or to spot any adverse reactions to medications and take immediate
steps to address problems that may arise.
The report clearly states that designing safe medication administration
systems for hospitals requires that nurses work with appropriate
staffing levels, and that they are well rested. The report
states, "Designing jobs with attention to human factors means
attending to the effect of work hours, workloads, staff ratios,
sources of distraction, and inversion in assigned shifts (which
affects worker's circadian rhythms) and their relationship to
fatigue, alertness and sleep deprivation.."
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to Safe Staffing Page
V. MNA Contracts That Address Mandatory Overtime
Hospitals claim that what the nurses are asking
for, limits on or no mandatory overtime, does not exist in MNA contracts.
Here is a selection of recent agreements.
- Boston Medical Center (the University Hospital
Campus, where we represent the nurses) Mandatory overtime can
only be used in unforeseen emergencies (such as a fire or bus
crash). There is a cap of 4 hours and a limit on the number
of times a nurse can be mandated. There is also a strict
process the hospital must follow before mandating.
- Cambridge Hospital: can only occur in
unforeseen emergencies, and it is capped at nor more than 5 hours,
and no nurse, even 12 hour shift nurses can work more than 13
hours.
- Carney Hospital has won an arbitration award
that caps mandatory overtime to no more than 2 hours.
- St. Elizabeth's Hospital has a cap for four
hours, and wants to improve that language.
- Quincy Hospital has a strict procedure in place
before Mandatory overtime can be assigned.
- Good Samaritan Medical Center has language,
but solved a huge problem they had with mandatory overtime by
hiring more than 50 nurses. Once that was done, the problem
went away.
- Many other hospitals we represent are now attempting
to mitigate the crisis caused by unsafe staffing and the use of
mandatory overtime by negotiating some form of language when their
contracts come up for negotiation.
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