Negotiations to heat up for 3,500
nurses and health professionals
It’s collective-bargaining time again at the state’s hospitals.
Union contracts covering about 3,500 nurses and other health professions at hospitals throughout the state will expire in coming months. Contract talks between the United Nurses & Allied Professionals and Rhode Island Hospital already are underway. That three-year contract, which covers 1,800 workers, expires June 30.
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Both sides say they hope to avoid the contentious stalemate that resulted in the union voting overwhelmingly to strike in June 2000. The strike was averted when the hospital invoked a binding arbitration clause.
Wages, health-care benefits and pensions all are expected to be on the table in all the negotiations. But union representatives say the talks again will center on improving working conditions by easing nurses’ workloads, which they say ultimately would help quell the ongoing nursing shortage.
“The focus of all these negotiations is on recruitment and retention,” said Linda McDonald, a registered nurse and UNAP president. “We have to figure out how to make our profession more appealing, which ultimately will improve patient care.”
The key sticking point during negotiations in 2000 was over mandatory overtime, the practice of requiring nurses to work additional hours after their scheduled shift is over. The union will again be pressing hospitals to prohibit its use.
But a new issue expected to emerge in these negotiations could prove to be a fresh flashpoint: nurse-to-patient ratios.
Union officials said they would prefer that the ratio issue be decided by lawmakers. Legislation now pending at the State House is the first attempt to create mandatory ratios of RNs to patients at hospitals in Rhode Island. The nation’s first law mandating nurse-staffing levels will take effect next year in California.
But absent passage of that legislation here, union reps will press to include nurse-patient ratios for certain units of the hospitals in its labor contracts. In the Rhode Island Hospital contract, McDonald said the union will seek to establish ratios for evening and night shifts on some medical and surgical units.
Hospitals both in Rhode Island and nationally have resisted nurse-to-patient ratios as an administrative quagmire that would pose huge staffing problems.
“A one-size-fits-all solution does not recognize the variables in staffing a patient unit from shift to shift,” said Edward J. Quinlan, president of the Hospital Association of Rhode Island.
The House legislation would set minimum nurse-staffing ratios for 19 areas of patient care, including intensive care (one nurse for every two patients); post anesthesia (one-to-one) and the emergency department (one-to-four). The bill is under consideration in the House Health, Education and Welfare Committee.
Union officials said they will be citing studies published in the past year that link more-intensive nursing care with better clinical outcomes. A study published in the Journal of the American Medical Association said that patients in hospitals with relatively few RNs on staff died more frequently than hospitals with lower nurse-patient ratios.
Union reps concede, however, that their demand to plant mandatory ratios within union contracts likely will be met with resistance.
“In the past we’ve talked about staffing issues with a broader brush, but we’ve never gotten down to the nitty gritty of numbers,” said Lynn Blais, an RN and president of the UNAP chapter at Our Lady of Fatima Hospital, which represents 325 nurses. “That’s probably the part they’ll have a problem with.”
Otis Brown, a spokesman for Fatima, said it’s too early in the process to discuss what key issues will emerge during the talks. The union and hospital officials had met once as of last week.
The Fatima contract expires on July 31. Other UNAP contracts set to expire include the Rehabilitation Hospital of Rhode Island and the state of Rhode Island (June 30); Memorial Hospital (Aug. 8); Landmark Medical Center (Sept. 30); and Westerly Hospital (Nov. 4). Combined, those contracts cover 1,700 RNs and other health professionals.
Use of mandatory overtime dips
Both the union and the hospitals seem to agree that the use of mandatory overtime has subsided since the imbroglio over the issue three years ago.
Quinlan said that mandatory overtime represents less than 1 percent of all nursing hours worked in the state.
“There is not a hospital administrator in the state who wants to use mandatory overtime,” Quinlan said. “It’s still the last resort, and I think we can all agree that mandatory overtime has been reduced.”
Jane Bruno, a spokeswoman for the Lifespan network, parent company of Rhode Island Hospital, said the 719-bed hospital has “virtually eliminated” the need for mandatory overtime in recent years. The hospital has been able to fill vacant RN positions through “aggressive recruitment and retention efforts,” she said.
McDonald agreed that the use of mandatory overtime has dropped. But she said the gap has been closed largely through the use of contract nurses, and that core staffing levels are still far too low.
“I think if you take contract labor out of the equation, mandatory overtime is as severe as it ever was,” McDonald said.
But Bruno said the hospital has cut its spending on contract nursing in half over the past year.
Statewide, the number of vacant RN positions at hospitals has dropped to 300 in recent months, from a high of 500 a year ago, according to the association.
Wages also are expected to be a central issue in upcoming sessions. UNAP – which also represents respiratory therapists and radiologic technologists – maintains that Rhode Island is losing workers to hospitals in Boston, southeastern Massachusetts and Worcester because they offer higher wages, union officials said.
The hospital association points to federal government data from 2000 that ranked Rhode Island’s RN wages the fifth highest in the country, at $23.10 per hour. A survey by the association in January put the average RN wage at $26.91 per hour, Quinlan said.
Officials at Rhode Island Hospital declined to discuss details of the negotiations, and Bruno said the hospital “comes to negotiations in good faith.” McDonald said early talks have been disappointing.
“We already feel what they’ve put on the table is not in the spirit of what
we had hoped for,” McDonald said. “Unless we start to see a different view on
these negotiations, we think it will become as combative as it did three years
ago.”
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