Nurses take union to heart

RNs at Saint Mary’s are hopeful a union will end the nurse exodus to California

As Nevada hospitals struggle to keep nurses in the state, nurses at Saint Mary’s Regional Medical Center are hopeful a union can lower nurse-to-patient ratios and alleviate part of the cause of the exodus.

As Nevada hospitals struggle to keep nurses in the state, nurses at Saint Mary’s Regional Medical Center are hopeful a union can lower nurse-to-patient ratios and alleviate part of the cause of the exodus.

Photo by David Robert

“There’s no reason for disparity of care,” registered nurse Amy Barats said. “Our patients deserve the same care in Nevada as in California.” Barats is direct, assertive and a self-described patient advocate. Like many nurses, she wants to help patients and contribute to her community.

Barats, a graduate student and single mother of an 8-year-old son, has worked in the emergency room at Saint Mary’s Regional Medical Center for two years. Prior to that, she worked as an EMT while attaining her nursing degree. She’s found that many of her fellow nursing graduates have moved to California for better wages and working conditions.

“What I do hear from nurses is ‘I came to California because I heard about the nurse-to-patient ratios,'” Barats said. She investigated those ratios and working conditions for California nurses. She had no intention of adding to the exodus of nurses into California because she has roots in Reno. The people at Saint Mary’s are “like family” to her.

Six months ago, Barats’ desire to improve patient care and working conditions compelled her to invite the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) to organize a union at Saint Mary’s.

“CNA is run by nurses,” Barats said. “They know nursing issues.”

Saint Mary’s opened in Reno in 1908 and has never had a nursing union. CNA was established in 1906 at Saint Mary’s San Francisco and has negotiated contracts with Catholic hospitals for 50 years. The Saint Mary’s nurses in Reno voted this month to have union representation at the hospital.

In January, Catholic Healthcare West (CHW) bought Saint Mary’s hospital in Reno. Collectively, CHW hospitals agreed not to block union organizations in 2000, stating that this approach is more in line with the Catholic doctrine of social justice.

CNA/NNOC established an organizing agreement with Saint Mary’s, allowing RNs to organize on premises. Patients continue to receive quality care while relationships between nurses and management are worked out. Today, CNA represents nurses in 26 CHW hospitals.

Within the organizing agreement, the hospital gave up one full-time nurse to help with the CNA campaign. Barats was the logical choice. For six weeks leading up to the election, she’s educated nurses on union benefits in a right-to-work state.

“People feel like they’re at-will employees because that’s the way it’s always been,” Barats said.

From her perspective, the most important issue is establishing the same nurse-to-patient ratios as California. “It’s not safe for our patients,” Barats said of the current ratios. “If we could get ratios in our contract, we could get those ratios legislated.” Nevada nurses and patients would benefit.

Meet the Negotiator
Jill Furillo is the guru of nurse-to-patient ratios, with 25 years experience as an emergency room nurse. She’s a petite brunette who pays attention to details and smiles often. A fierce negotiator, Furillo has lobbied for nurses against hospital conglomerates, the pharmaceutical industry and insurance companies.

“You need to have the best interests of the people you’re bargaining for at heart,” Furillo said. “Don’t give up. You can prevail. Don’t let them intimidate.” That’s been her motto for 14 years as director of government relations, chief lobbyist and chief negotiator for CNA nurses.

All hospitals have ratios. What are the right ratios for patients and nurses? According to Furillo, it’s the ratios she helped write into California law in an eight-year battle that ended in 2004.

“Those ratios are proven through scientific studies to protect patients,” she said. “Standard ratios show there is lower morbidity, mortality and less nurse burn-out.”

Negotiations for the Southern California contract dragged on from the end of June until Labor Day. CHW came to the table prepared to offer the same contract negotiated previously with Service Employees International Union (SEIU), the union that represents Renown nurses. CHW in Southern California wasn’t going to give the same nurse-to-patient ratios won in Northern California.

“This was the summer from hell with CHW,” Furillo said. In the end, she won the nurse-to-patient ratios, along with retirement and health benefits for CNA nurses.

When Furillo bargained with CHW, an important contractual agreement was gained in tandem with nurse-to-patient ratios. When those staffing ratios can’t be met, nurses can request an “assignment despite objection,” which protects nurses and patients by ensuring that more nurses are brought in, or patients are diverted to the next hospital.

This bargaining impressed Barats. She says Saint Mary’s RNs are “putting our nursing licenses on the line daily” when stretched too thin providing patient care. A hospital emergency room often serves as a holding area for patients. At times, as many as four intensive care unit patients have just one nurse. The established ratio in California is one nurse per two ICU patients.

The Ballot, Vote and Results
Service Employees International Union (SEIU) intervened at Saint Mary’s to get on the ballot and increase the bargaining pool. The charges, filed with the National Labor Relations Board (NLRB), kept the election from moving forward in November. SEIU also filed charges of unfair labor practices, alleging that Saint Mary’s was giving favor to CNA/NNOC. The NLRB found no merit for this charge and proceeded with the Dec. 5-6 election dates.

According to Barats, RNs weren’t happy that the election date had been changed. After garnering a position on the ballot, SEIU campaigned little, even though Saint Mary’s provided a conference room to conduct organizing activities. On Dec. 5, the first day ballots were cast, SEIU requested that the NLRB drop them from the ballot.

“They stalled our election, and then they dropped out,” Barats said.

Saint Mary’s had 471 RNs in the bargaining unit and 393 cast ballots. On Dec. 6, the votes were counted: 252 voted for CNA/NNOC representation and 141 voted for the hospital.

Negotiations will begin to place Saint Mary’s RNs into the previously negotiated Northern California CNA contract. In mid 2009, all 10,500 registered nurses working in 26 CHW hospitals with CNA nurses go to the bargaining table to negotiate a new contract.

“We’ve always preferred a direct relationship with our employees, but we respect our nurses’ right to make that decision,” Saint Mary’s communications specialist Josh Charlebois said. “Patient care is really the bottom line. We are going to continue to work together in good faith.”

Nurses at Saint Mary’s hope to gain California nurse-to-patient staffing ratios, floating benefits, working equipment with newer technology, a pay scale to contract and better staffing. All of which will, hopefully, lead to higher RN retention at Saint Mary’s and end the exodus of nurses to California. Barats noted that since CNA has been on the premises, staffing levels have increased.

“Everybody has put up with a lot, and it paid off in the end,” Barats said, amid joyful screaming and crying co-workers when the election results were announced.

Victory in hand, Barats intends to take a break and savor the victory at Disneyland in Anaheim with her son and fiancé.