St. Vincent's Strike

St. Vincent's Hospital RNs Vote to Ratify Three-year Contract with Tenet Ending 49-Day Strike

Vote Ends More Than Two-Year Struggle by RNs to Negotiate Their First Contract to Improve Working Conditions, Boost Salaries and Provide Voice in Decisions Around Patient Care

WORCESTER, Mass.—The historic 49-day strike by 615 registered nurses at St. Vincent's Hospital/Worcester Medical Center officially ended today with a vote of 358 - 5 by the rank and file membership in favor of their first union contract with Tenet Health Care.   The vote follows a dramatic conclusion of talks at the 51st negotiating session hosted by Sen. Edward M. Kennedy and Congressman James McGovern on May 11, 2000 in the offices of Sen. Kennedy in Washington, D.C.  

While the nurses' contract contains traditional provisions for seniority and health insurance benefits, grievance and arbitration procedures, it also contains a number of provisions the nurses had sought when they first decided to organize their union—specifically, strong language that gives them a voice in decisions related to patient care and their nursing practice.  The pact, which will run from Jan. 1, 2000 – Jan. 1, 2003, includes strict limits on mandatory overtime, provides nurses with a voice in decisions around staffing and nursing practice issues, calls for the phase out of a controversial flex time policy, and provides the nurses with a protected voice and binding arbitration regarding issues related to their move into the new Worcester Medical Center facility.   The contract guarantees a $1.50 per hour raise for all nurses in the first year of the contract, places nurses on a 13-step salary scale, and grants a 4% across the board pay hike in the second year of the contract. 

"With this vote, our strike is officially ended and we begin the process of working with Tenet management to begin a new era in health care at Worcester Medical Center," said Anne Spellane, co-chair of nurses' bargaining unit.  "This contract was three years in the making, beginning with our campaign to organize a union at St. Vincent's Hospital in 1997, and continuing through the two-year process to reach this agreement following our successful vote to establish this union in 1998.  Our goal throughout this long process was to provide nurses with strong and protected voice in all decisions related to our employment and our nursing practice.  This contract guarantees us that voice."

According to Debra Rigiero, co-chair of the bargaining unit, "The biggest winner in this long struggle are the patients of St. Vincent's Hospital and Worcester Medical Center, who will now be assured care by registered nurses with the ability to advocate on their behalf to ensure the highest standards of nursing practice."

According to Julie Pinkham, Director of Labor Relations for the Massachusetts Nurses Association, which represents the St. Vincent nurses' bargaining unit, as well as nurses at 85 different health care facilities across the Commonwealth, "These nurses have not only negotiated a first contract, they have negotiated an incredibly strong first contract.  This agreement measures up to the standards of any of our seasoned contracts.  Their success in these negotiations is a direct result to the courage of these nurses and their willingness to make the ultimate sacrifice to achieve their goals.  In particular, the language surrounding this issue of mandatory overtime should be a flash point for nurses across the state and country – this language should be a minimum standard for all nurses and the patients they care for.

Below is a summary of key provisions of the contract:

Mandatory Overtime

The hospital, which had been insisting on the need for the right to be able to mandate 16-hour shifts since the strike began on March 31, 2000, agreed on May 11 to the  strict limits on mandatory overtime sought by the nurses.  The overtime language in the new contract limits the amount of mandatory overtime assigned to a nurse to no more than 4 hours, and limits the amount of times a nurse can be assigned overtime to 8 times per year (twice each quarter).  

Most important of all, the mandatory overtime language includes a landmark provision, which grants every nurse the right to refuse a mandatory overtime assignment if he or she feels to fatigued or ill to work safely.  While this right has been granted to nurses through an arbitration decision, to our knowledge, this is the first contract in the country to include language that explicitly grants nurses the right to refuse mandatory overtime under such circumstances. 

The language calls upon the hospital to exercise its best effort to maintain full staffing in order to prevent the need for mandatory overtime, and it requires the hospital to carefully document each and every instance of mandatory overtime, and to review those occurrences with a staffing committee made up of unionized nurses and management.  The goal of this process is to limit the use of mandatory overtime and develop solutions to correct conditions, such as inadequate staffing, that contribute to it.  If the two sides cannot agree on problems that arise, the language calls for the issues to be presented for expedited arbitration.  

"Our biggest concern was that this hospital would use mandatory overtime as a mechanism to staff the facility," said Sandy Ellis, member of the negotiating team and a spokesperson for the nurses' bargaining unit. "This language not only provides strict limits on the amount of overtime assigned, but also provides a rigorous process for ensuring that management address underlying staffing issues that cause mandatory overtime."  

Safe Staffing Language

To address the nurses' long-term concerns about nurse staffing levels under Tenet management, the new contract includes language that provides nurses with a voice in staffing decisions and the power to question unsafe staffing practices.  

The contract states that "the hospital will ensure safe registered nurse staffing levels on all shifts within each patient care area."  It also establishes a staffing committee made up of union nurses and hospital managers who will meet on a monthly basis to review staffing issues.  This committee has the power to make recommendations on staffing issues to the Vice President of Clinical Services.   If the nurses believe the hospital is not meeting its mandate to ensure safe registered nurse staffing levels, the nurses will have the right to take their concerns to an independent third party through the contract's grievance and arbitration procedures.  

Protections Regarding Inappropriate "Floating"

"Floating" is a term that refers to a process of moving nurses from unit to unit to cover for staffing shortages in a particular area.  As hospitals cut back their staffing levels, many have engaged in inappropriate floating practices where nurses are shifted to floors or departments without proper orientation, or are assigned patients for whom they lack the skills or experience to provide adequate care. 

The St. Vincent's Hospital nurses' contract regulates floating by ensuring that nurses are properly oriented to the floor they are assigned when floated.  It also gives the nurse the right to refuse sole responsibility for a patient assignment that he/she feels unprepared to properly care for that patient.  

Delegation to Unlicensed Personnel

The contract includes specific protections the nurses sought to prevent them from having to delegate nursing activities to unlicensed assistive personnel (UAP).  As hospitals have become more short staffed, many administrators have attempted to deliver nursing care by replacing nurses with unlicensed personnel and assigning those personnel duties traditionally performed by nurses.  These practices have met with strong opposition from the nursing community in recent years.  With the prospect of a looming nursing shortage, the danger exists that these practices would be employed in lieu of recruiting needed nursing staff.

The nurses have successfully negotiated a provision governing the "delegation of nursing activities," which gives the nurse the power to decide if, when and to whom they will delegate any nursing activity.  This language, which has been included in a number of MNA contracts in recent years, guarantees patients that only nurses will decide how their care is delivered, as well as provides a roadblock to administration attempts to implement staffing plans that replace registered nurses with lesser qualified caregivers.

"Taken together, our staffing, mandatory overtime, floating and delegation provisions provide the nurses of St. Vincent's Hospital with a series of protections that allow them to protect the integrity of their practice and take steps to ensure our patients access to appropriate nursing care," said Rigiero.   

Salary and Health Insurance Benefits

The contract guarantees a $1.50 per hour raise for all nurses in the first year of the contract, places nurses on a 13-step salary scale, and grants a 4% across-the-board pay hike in the second year of the contract.  The nurses' salary scale will be frozen for the first two years of the contract, but in the third year, nurses will begin to advance to the next step on the scale, granting them an additional 3% increase.  Also in the third year, an additional 14th step will be added to the scale.  The contract calls for a salary re-opener 60 days prior to the end of the contract's third year to negotiate an additional salary increase for the third year of the contract. 

To help increase the pool of per diem nurses at the facility (a key to preventing mandatory overtime), the contract raises the per diem rate paid to nurses to make it competitive with area hospitals.  Specifically, the contract allows Tenet to offer per diems rates up to 5% higher than those offered at UMass/Memorial Health Care.  

The contract calls for the hospital to provide nurses with access to its flexible benefits program, which includes access to its health and dental insurance plans, with Tenet picking up 90 % of the premiums in the first year, 85% in the second year and 80% in the third year.  Nurses who choose to, may also be eligible to access disability and life insurance paid for by the hospital.  

The contract also offers all nurses $25,000 of insurance coverage for work-related occurrence of HIV and Hepatitis C.  

Protection on Issues Related to Move to Worcester Medical Center

As the nurses were preparing to strike, the hospital was making plans to move most of its patient care services from the St. Vincent's Hospital facility to the newly built $215 million Worcester Medical Center.  The hospital actually moved its operations two days after the strike began on April 3, 2000.  Throughout the two-year process of negotiating their contract, the nurses had been seeking information from Tenet concerning the working conditions for the nurses in the new facility.  Tenet's failure to provide that information was the subject of unfair labor practice charges filed by the union, and developing a process to resolve issues related to the move has remained a sticking point to the negotiations.  

The nurses' contract provides both sides with a 60-day period to negotiate these issues, after the nurses have returned to work.  In the event that the nurses and management fail to reach agreement on any issues in that period, the unresolved issues shall be submitted to binding arbitration.  

Back-to-Work Agreement

The contract provides a process to govern the return to work of the striking nurses.  Under the agreement, the parties agree to begin immediate negotiations over issues concerning the nurses' return to work, returning all the striking nurses back to their positions prior to June 11, 2000. 

The hospital also agreed to pay the nurses' costs for health and dental insurance benefits, which had been cut once the strike began. 

"The entire community should share in this celebration, and be proud of what we have accomplished through this process," Ellis said. "The nurses owe a huge debt of gratitude to our Mayor and City Council, to our legislative delegation, to the entire labor community of greater Worcester, to all the community groups who joined our cause, and most importantly, to each and every citizen who honked their horns, flashed their lights, wore a blue ribbon, visited our picket line, wrote letters to the editor or to Tenet and donated to our strike fund."

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