Contract win for D.C. nurses

THE PEOPLE who provide health care in the U.S. have been feeling the wrath of austerity, like other working people--along with attendant national against unions. Public and private hospitals alike are squeezing their budgets and cutting nurse staffing levels. From Massachusetts to California, understaffing and the resulting decline in patient safety have been at the center of a larger attack on nurse unionism.

Until last week, the prognosis for labor relations and patient safety at the largest hospital in the nation's capital appeared to be getting worse.

Last Wednesday, however, the nurses' union at the Washington Hospital Center (WHC) in Washington D.C., announced it had reached a tentative agreement on a new contract with the hospital, which was then ratified by the end of the week. The nurses' previous contract expired last spring.

The new contract represents a partial victory for the nurses after more than a year of attempts by hospital management to harass the union and unilaterally impose concessions. Nurses won on most of the key issues they have been struggling for, which included higher nurse-to-patient ratios, shift differentials and the reinstatement of nurses fired early last year.

The agreement codifies a new system designed to raise the level of nurse staffing and also requires the hospital to meet regularly with the nurse committee to improve patient care.

After more than a year of bitter struggle by nurses and sharp anti-union attacks by management, the latest contract secures raises of up to 9 percent for most nurses' hourly base rate over the course of three-and-a-half years. The nurses also won restoration of pay differentials for evening, night and weekend shifts, reversing the hospital's unilateral elimination of differentials made in March.

"As the ratification vote shows, nurses are pleased with what we were able to achieve in this agreement, which is superior to what management previously imposed on us," said Emma Bioc, a nurse at WHC and member of the negotiating committee. "This was a long and difficult struggle. I am proud that the nurses stood in solidarity with each other and for our patients."

The collective bargaining agreement also includes the reinstatement of the eight remaining nurses out of 18 who were terminated after not reporting to work during last year's mammoth blizzard that shut down the city for nearly a week. Prior to the agreement, National Nurses United (NNU), the nurses' union, had won back the jobs of the other 10 nurses through arbitration.

"I am so glad that those of us who were unjustly fired after the snowstorm have won our jobs back," said Linda Buckman, one of the fired nurses. "It is only because we have a strong union that my coworkers and I are able to return to work with dignity and care for our patients."

The new contract overall represents a remarkable victory considering the hospital's ongoing hostility and obstinacy to this point. On the issue of shift differentials, however, the union did make a significant concession to management. Nurses will be giving up the restored levels of differential pay in the final year of the contract, meaning a return to a flat hourly rate that would amount to a pay cut ranging from $2,000 to $20,000 a year for many nurses.

THIS LATEST agreement comes on the heels of heightened tensions between NNU and hospital management, which has engaged in behavior that can only be described as union-busting.

After registered nurses passed out leaflets to patients and visitors in the cafeteria and entrances of the hospital campus a few weeks ago, management's retaliation was fierce. The next day, the hospital disrupted a union meeting and told nurses they were no longer permitted to hold union meetings at the hospital. Nurses were also barred from passing out handbills to visitors and forbidden from holding a strike vote in the SEIU union office on site.

So what was so nefarious about the nurses' leaflets that prompted such a response? The leaflet was meant to inform visitors of the high turnover rate among nurses at WHC and its impact on patient care and safety, referencing an internal hospital document in which management itself acknowledged the scope of the problem.

"On average, every eight days, a WHC patient is significantly harmed due to preventable errors. Every 45 days, a patient dies due to preventable errors," according to the internal document.

It was a shocking admission by the hospital about the consequences of understaffing that confirms what the nurses and their union have been protesting against for years. But when nurses attempted to raise awareness about the issue, hospital managers resorted to attacking the nurses' union.

"The hospital's blatant union-busting must stop," nurse Geri Lee told a delegates meeting of the Metro Washington Council, AFL-CIO back in April. Lee, a 27-year veteran nurse at the hospital, was one of the 18 nurses that WHC fired last year after the snowstorms. She was reinstated with back pay in December.

After management shut down their meeting on April 15, NNU immediately filed Unfair Labor Practice charges against WHC with the National Labor Relations Board, calling the hospital's actions unlawful. Beginning on Friday last week, the nurses were planning on holding informational pickets, which were later called off following the announcement of the new agreement.

The 1,650 nurses at WHC have been fighting for over a year to win a decent contract that addresses understaffing and other issues which have caused worsening working conditions at the hospital. But MedStar Health, the $3.8 billion "non-profit" health care chain that owns WHC, has been relentless in its offensive against the nurses.

Punitive firings, severe understaffing, harsh work rules and unilateral pay cuts have contributed to deteriorating working conditions and a high turnover rate among WHC nurses.

Back in October, the nurses voted overwhelmingly to affiliate their independent local union with NNU, the largest nurses union in the country that was formed through a merger of several regionally based unions in 2009. NNU represents 160,000 registered nurses nationwide, and its formation signaled a turn to a more unified and militant approach to nurse unionism.

But the union-busting by management at WHC tested the NNU and its representation of nurses in D.C.

In March, the first one-day strike by NNU at the hospital was followed by a four-day lockout imposed by WHC. Pickets were held throughout the strike and lockout, and at a rally of local labor activists and supporters in solidarity with the nurses, AFL-CIO President Richard Trumka and Rep. Dennis Kucinich were among the speakers. Meanwhile, the hospital flew in up to 300 scab nurses to replace strikers.

Instead of negotiating with the union and addressing understaffing and pay cuts, WHC tried to break the union and, according to its spokesman Matt Brook, implement a year-long budget-tightening program. But there was still evidently enough room in that budget to spend an estimated $4 million back in March to fly in and house hundreds of subcontracted nurses during the lockout.

The profit margins that MedStar Health maintains also belied management's insistence on the necessity of budget cuts. While WHC continued to argue that its imposed cuts in pay, benefits and shift differentials were reasonable and "above market value," the union pointed out that MedStar Health reported $57 million in profits between October and December of 2010--the largest three-month profit earnings in the hospital's 53-year history.

All of this suggests that there is no legitimate excuse for budget-tightening and the consequent understaffing, nurse turnover and unsafe patient care. Grueling working conditions at the hospital have led to a 16 percent nurse turnover rate, further exacerbating the problem of understaffing and an influx of less experienced nurses.

Back in November, NNU filed a report with the D.C. Health Department calling for an investigation of understaffing at the hospital. There were 50 incidences included in the report, in which nurses documented unsafe patient care caused by understaffing; dozens more incidents have since been brought to management's attention.

But again, instead of addressing these incidents, the hospital appeared to be more interested in implementing policies that would further compound unsafe staffing levels. Two weeks ago, the hospital sent RIF (Reduction in Force) notices to 200 employees, including 19 RNs.

Nurses were set to vote on April 20 on holding another one-day strike. That vote was postponed after the hospital barred the union from conducting the vote at the union office. In the meantime, NNU was forced to hold general membership meetings outside at the corner of 1st and Irving Street near the hospital.

WHC'S ACTIONS and the response of unionized nurses over the past year fit into a pattern seen at hospitals around the country.

At Tufts Medical Center in Boston, a 24-hour strike was just barely averted last week when the hospital and nurses' union rushed to reach a tentative agreement--but the issue of understaffing there remains unresolved. Nurses in Worcester, Mass., declared victory last week when the threat of another strike at St. Vincent Hospital proved sufficient in forcing management at that facility to agree to substantially improved nurse-to-patient ratios.

And in California, nurses who have seen sharp cuts to their health care coverage at the Children's Hospital Oakland returned to work this week following a five-day strike during which the hospital relied on about 125 subcontracted nurses.

Other nurses' strikes last year hit Wilkes-Barre General Hospital in Pennsylvania, Kaiser Permanente's Los Angeles Medical Center, and 14 hospitals in the Minneapolis-St. Paul area.

NNU Communications Director Chuck Idelson told Healthcare Finance News last week that the uptick in strike action among nurses nationwide is a result of corporate greed at hospitals. "Hospital corporations are putting their bottom line ahead of patient safety and nursing standards," he said.

This new wave of strikes at hospitals around the country over the past year also reflects the militant strategy adopted by NNU. But at WHC, the concessions made by the union on pay differentials in the last year of the contract will result in considerable pay cuts for many nurses later on. It will also make winning back differentials in the next contract that much more difficult.

And in terms of NNU's escalation of tactics at WHC, there are still questions about the extent to which the union was able to mobilize its members around such actions. For example, the Washington Post reported that the hospital estimated up to 700 nurses crossed the picket line during the strike in March. If true, this undoubtedly put the union in a weaker position when negotiating on shift differentials, and it means that NNU will need to build stronger cohesion within the bargaining unit in order to prepare for the fight ahead when it's time to negotiate a new contract.

Still, the latest agreement at WHC suggests that increased militancy is working. Strong solidarity and more determined job actions are helping nurses win key demands and make significant gains against otherwise anti-union hospital bosses.

"We are pleased to have achieved an agreement with the hospital that strengthens our ability to effectively advocate for our patients and protects RN professional and economic standards," said Lori Marlowe, a cardiac nurse and member of the union's negotiating team.

As WHC nurses oversee the enforcement of their new contract, the struggle that they have waged in Washington DC represents another pivotal flash point in the broader fight for union rights and quality health care in an age of corporate greed and austerity.