St.Vincent Strike

St. Vincent's RNs and Tenet Fail to Reach Agreement As Talks Break Down Over Mandatory Overtime Issue And Tenet's Refusal to Negotiate Move to Medical Center:  Nurses Intend to Strike on March 31st

WORCESTER, Mass.—After a marathon 13-hour negotiating session, talks between the St. Vincent's Hospital nurses and Tenet Health Care broke down late last night over the issues of mandatory overtime and the hospital's refusal to allow the nurses to engage in protected negotiations over issues related to the move to Worcester Medical Center. While the nurses were willing to stay and continue negotiating, the hospital broke off the talks at 11 a.m.  If Tenet management fails to come back to the table to address the two outstanding issues, the nurses intend to strike at 6 a.m. on March 31, 2000. 

The issue of mandatory overtime is the single most important issue of concern to the nurses. Currently, the hospital does not use mandatory overtime.  Under the new contract, the hospital is demanding the right to mandate double shifts for nurses, forcing nurses against their will to work up to 16 hours straight, something nurses believe is dangerous to patient care. 

The nurses want to place strict limits on forced overtime to prevent the practice from being used as a means of compensating for a lack of safe staffing at the facility. The nurses also want the right to refuse overtime if they feel fatigued or incapable of providing safe care.  The hospital would only agree to allow a nurse to refuse mandatory overtime once every quarter. 

"Tenet's stance on this issue says everything there is to say about this corporation's lack of commitment to quality patient care," said Sandy Ellis, RN, spokesperson for the nurses' bargaining unit.  "If we concede this issue, we concede everything we stand for as nurses, and as legally-mandated advocates for our patients' safety.  We cannot allow this organization to staff this hospital by doubling the workload of its nurses, thereby placing patients in the hands of exhausted practitioners.  Nurses have a hard enough time making it through there regularly assigned shifts under current staffing conditions, there is no way we should be forced to make it through an unplanned double shift.  It's a recipe for tragedy, and we cannot and will not abide a contract that sanctions this practice." 

The second unresolved issue concerns the nurses legal right to negotiate over the impact of the move into the new Worcester Medical Center.  The union has already filed a charge against the Tenet with the National Labor Relations Board for its refusal to provide information the nurses need to bargain effectively.  The hospital has also flatly refused to allow the nurses' union representative to enter the building and tour the facility.

The nurses have been trying to negotiate over the move for months, but Tenet has stonewalled the process, leaving little time to address the issues as the date of the move fast approaches.  The nurses offered a concession to the hospital whereby they would negotiate all aspects related to the move after it had taken place, thereby allowing the new hospital to open without a strike. However, the nurses wanted to retain their union rights for a process of dispute resolution should issues remain unresolved after the move.  Specifically, the nurses wanted to maintain either their right to strike, or the right to submit unresolved issues to interest arbitration.  The hospital refused. 

"We offered to help them get this process done and expedite the move into this new facility," Ellis explained.  "But they refused to grant us our most basic union rights to allow that to happen.  What we want to know is why?  What are they afraid of?  Why won't they provide us with the information we have every right to receive about staffing levels and work assignments in the new facility?  Why won't they let our representative tour the facility?  It leads us to believe they are not ready to open this facility, or that they have something to hide from us."

The parties did come to agreement on some other key issues for the nurses, including the issue of nurses' hours of work and shift assignments.  Both sides made concessions on the issue.  The hospital originally wanted the unrestricted right to unilaterally change a nurse's hours of work and shift assignments.  Last night, they agreed that before any change is made, management would need to negotiate over the change, and if a resolution was not reached, the issue would be subject to expedited arbitration by a neutral third party. The parties also came to an agreement on Tenet's controversial flex-time policy, whereby the hospital has the right to send nurses home when they believe census is low, forcing the nurses to use their vacation time in lieu of lost pay.  The compromise reached tonight limits the amount of flex time assigned and phases out the policy after three years. 

The two sides last negotiated on March 17, 2000, which ended with no significant movement, causing the nurses to issue their official notice to strike on March 31, 2000.  On March 16, the nurses voted by a greater than 2 to 1 margin to authorize the union's negotiating committee to call a strike. 

This week, the nurses opened a strike office in the Carpenters Union Building at 29 Endicott Street in Worcester. The nurses have planned a pre-strike rally for March 30, 2000, from 6 – 9 p.m. at the Vernon Hill American Legion Post on Providence Street.  A number of nursing and labor leaders, as well as political officials have agreed to attend the rally to support the nurses as they prepare to strike on the following day. 

The nurses have been using the collective bargaining process to address their number one concern at the facility, which is to improve staffing levels and working conditions at the hospital.  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." 

Recent Research Supports Nurses Concerns for Patient Safety Under Mandatory Overtime 

Nursing and workplace research supports the St. Vincent's 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 performance of 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."

The Institute of Medicine just last Fall published a report on the dramatic rise in medication errors in United States hospitals, which causes the death of between 48,000 and 98,000 patients each year, depending on the study cited. 

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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