Whatever it takes, as long as it takes, at UVM
Nurses and their supporters marched in Burlington, Vermont May 12 to draw attention to their demands in a contract fight with University of Vermont Medical Center.
The hospital's contract with Vermont Federation of Nurses & Health Professionals Local 5221 expires in June, and management has put forward nothing but insulting proposals--including a meager wage increase that doesn't come close to keeping up with the rapidly rising cost of living in Burlington. This despite the fact that the UVM hospital system is routinely surpassing revenue targets due to an increasing numbers of patients.
Nurses are also demanding the hospital do something about chronic short-staffing--the result of the growing patient load and management leaving large numbers of nursing positions unfilled. Nurses also want a $15 an hour minimum wage for everyone employed at the hospital. This would make jobs for support staff--who nurses depend on so they can concentrate on patient care--more likely to be filled.
A trio of nurses involved in this contract battle--Julie MacMillan, a nurse in the anesthesia care unit; Sarah Ferguson, a staff nurse in IV Therapy; and Tristin Adie, a nurse practitioner in primary care and a contributor to SocialistWorker.org--talked toabout what's at stake in this battle.
ONE OF the main problems at the hospital is understaffing. What does this look like at the hospital? What is a normal day at the hospital like for nurses?
Julie: What the day-to-day life of nurses looks like depends on the department you're in. For instance, in the operating room, they're supposed to start with 34 nurses per day, but now they're starting with 26. In the in-patient setting, it's generally four patients to one nurse on days, five-to-one on evenings, and six-to-one on nights.
Now our big problem is ancillary staff: we don't have enough aides, transporters and housekeepers. Nurses are constantly getting pulled away to do non-nursing functions, which can exacerbate the lack of RNs in general.
We have 180 vacancies at the hospital overall, and we can't keep nurses--we're hemorrhaging staff all the time. So another part of our platform is a $15 minimum wage for all support staff--to help keep people at the hospital and allow nurses to do what we're there to do.
Sarah: For the IV department, short-staffing means we aren't able to get to dressing changes on central lines or take out IVs that come from outside hospitals that have an increased chance for infections. We're seeing an increase in bloodstream infections from central lines and IVs because we don't have enough staff to get to those, and we've had patients who have died from it.
Tristin: Can you talk about breaks, too? I know people will go an entire day without a lunch break.
Julie: Most of us work 12-hour shifts. The hospital's position is you are entitled to one 30-minute break away from patient care, to which I respond: How much do you eat in 12 hours?
Additionally, in acute care settings, there's nobody to relieve you, so you can ask a colleague to watch your lights, but now you're doubling your colleague's assignments. Depending on what's going on with your patients, you may not want to double your colleague's assignment to take a break--so then you don't eat. If you don't eat, you get hypoglycemic and fuzzy, and that's how mistakes are made.
Our proposal is that all those units have a circulating nurse to go in and do break coverage. The lack of breaks is absolutely a problem.
Tristin: To add a little more regarding the outpatient world, the hospital system has a number of clinics that see patients for everyday care. We often have a couple of triage nurses who answer phones for a clinic that should really have six to eight nurses.
A lot of nurses work through lunch, go home late and still feel terrible when they leave, because they still haven't been able to answer some of the calls that are really important.
As a nurse practitioner, short-staffing means that I'm filling in for a lot of that, too. So I'll leave at the end of the day knowing there are 10 people who I really want to get back to, but I can't stay until 9 p.m.
So I'll go home, make dinner and then be on my computer to complete chart notes or answer patients' questions via the online portal until 10 p.m. at night, and Saturdays and Sundays as well.
HOW DOES the disparity in pay between the Burlington area nurses and nearby areas contribute to the short-staffing?
Julie: In our health network, we're the flagship medical center. We're the largest employer in the state, and the largest hospital in our network, so all of the smaller hospitals refer patients to us.
However, wages are less than at Champlain Valley Physicians' Hospital [in nearby Plattsburgh, New York]. Starting pay for RNs in their hospital is $2 more per hour than a starting RN at Burlington. Our wages have been kept stagnant for a decade, with modest cost-of-living increases, which really have not kept up.
New nurses will graduate, spend a year in our hospital, get a great orientation, and then they'll leave, sometimes doubling their salary.
We looked at contracts across the country, and we fall way below where we ought to for comparable academic medical centers and high cost-of-living areas. That means our retention is a huge problem. The hospital has been offering signing bonuses--$10,000 for an advanced practice registered nurse and $7,000 for a registered nurse--and we still can't hire. That to me says the salaries are too low.
Sarah: Some people outside the hospital will look at it and say we just want more money. Well no--we're aware that increasing salaries and having equity between outpatient and inpatient nurses will get us the best and the brightest. Who's going want to work here when they can go across Lake Champlain and make more money?
Julie: There's a lot of evidence that hospitals try to keep their labor costs down because labor is expensive, but when they decrease the amount of nurses, it increases the risk of complications. Every patient you add to a nurse's assignment increases the risk of a failure to rescue.
There's also evidence suggesting that not having nurses in the clinics impacts patients when they don't get a call back--so they go to the emergency room. That's the last place that they need to be--they need to be at a primary care office.
It's interesting that the hospital continues to use Band-Aids to fill the staffing holes, but it really needs some sutures to stop the hemorrhage.
The idea of being in the union is that the employer doesn't want to share power with us, so we need power through solidarity--power in numbers. We're 1,800 nurses, and our hope is that we can make our voices heard through that.
THE UNION has made a $15-an-hour minimum wage a part of the platform. Can you talk more about working with support staff and why you've made improvement of their conditions part of the contract?
Julie: We have a proposal that licensed nurses aides would be allowed to organize and join our union. They've tried a couple times to organize, and the hospital squashed it through intimidation.
The wage proposal is for all ancillary staff, including environmental services, who in the future I would also like to see join in the union, for the strength in numbers.
One thing that I'm hearing as I'm out rounding is how people really respect and rely on our housekeepers, LNAs and transporters. It saddens us when we see them have to go to the food shelf because their wages are low. There's a lot of our support staff that's part of the immigrant community, so we would to like to leverage our power in our union to help advocate to move that issue forward.
The hospital has the money to raise the minimum wage without question, so we will continue to push them on that.
WHAT HAVE your conversations with your co-workers looked like surrounding the negotiations?
Julie: We started with a survey about priorities with our 1,800 members, and we got over 1,100 responses. As we go out and talk to people, I find a lot of people are frustrated now, due to more of the same disrespect from the hospital. I've been quite surprised at the level of anger that is bubbling up--including the level of anger with our settlement three years ago that people are still unhappy with.
Sarah: There are just a lot more conversations going on in general. I think it's because people are pissed--they're not happy about what we got three years ago. I think they're finally starting to realize that the hospital is going to continue to play the same games unless we show our anger. Even people who didn't say two words three years ago are already saying, "No, this will not stand."
Tristin: People who you don't expect to are saying things like "They said what?" and "When are we going to talk about striking?" The hospital needs to know that we're pissed, because we're tired of being treated badly. Those were the types of conversations that were happening at the very end of negotiations three years ago, and now they're happening at the start.
Sarah: And it's not just union members, either. I've had doctors come up to me and show support, which is a really nice feeling to know that we've got that support.
Julie: I think that, with nursing being historically a female-dominated profession, nurses are very good at advocating for our patients, but not as much for ourselves.
A third of our membership has been at the top of the pay scale, which means they've been at the hospital for more than 24 years. These are people who are committed to our community, so it's time to reward the people who are here and are doing the hard work, who are taking care of a million patients a year.
WHY DO you think this time is different? What's making nurses so angry?
Julie: I think it's the lack of a real raise. They've been giving little 2 percent bonuses that are once a year and that are taxed at 40 percent, which boils down to about 900 bucks. There's always been the idea that "nurses aren't going to go on strike." But now, we're really angry and looking at the California nurses.
The only way to combat organized greed is organized labor. When you're faced with organized greed, you have to say, "We have a right to withdraw our labor as a result of this, and this is not okay."
Sarah: I don't think we feel like the work that we put in is really respected. The nurses and the entire staff at the hospital don't feel like they're really worth anything. They feel like the hospital thinks they can be replaced.
We do so much. We give so much. When's the last time one of the executives went home and cried over one of their patients? That's something that nurses do all the time. They should make us feel like we're worth something.
WHAT DO you expect the hospital to do in these negotiations? Do you think a strike will be necessary?
Sarah: As far as a strike, we're doing whatever it takes. Nobody wants to strike, but we want a fair contract and we're willing to do whatever it takes, for as long as it takes, to get that.
Julie: The hospital's non-economic proposals have been disrespectful. We've put time and energy into our staffing proposals, and they just crossed it all out and filled in their idea that they'll form these committees, and we're supposed to trust them to do the right thing.
I heard yesterday that a cross-country travel agency reached out to a friend of mine about coming up here if we go on strike. The fact that the hospital is already thinking about that, two months away from contract expiration, says that we ought to be getting our ducks in a row.
Nobody wants to strike, but we're willing to do what it takes to get what we need. Our proposals are well researched, it's what our patients need, and it's what our nurses need.
Tristin: What was clear to us from the negotiations three years ago was that, by themselves, good research, good presentation and making the best argument did nothing. None of this is going to come down to logic or doing the right thing. It comes down to organized greed versus organized labor.
All we have is our numbers and our ability to strike, so we did start talking much earlier in the game this time about what it would look like to strike and what we need to do the get ready for that. We've been realistic that we might have to strike. We don't necessarily want to strike, but if we do strike, we plan to win.
WHAT CAN people do to support the nurses?
Julie: We've decided to do a pledge drive. We're trying to get a thousand people together to go rally support from the community.
Tristin: A number of us have gone around to talk to other unions and ask them to write resolutions in support of us. We've taken pictures we put up on our website.
If we actually succeed in getting a decent raise and bring everyone's wages up at UVM, it makes it easier for people with lower wages in more vulnerable positions to form a union and get better working conditions. This isn't just our fight--this is everyone's fight.