Laying the groundwork
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BryanLGH has a history of union activity, and recent events have brought the issue to the forefront again.
By MARK ANDERSEN | Lincoln Journal Star
In towers of steel and glass, BryanLGH Medical Center built its image of a well-oiled health-care machine.
Nursing shortage coming
The 800-nurse shortage in Nebraska today will become a 4,000-nurse shortage by 2020 unless steps are taken, according to a report released in April by the Nebraska Center for Nursing.
Nebraska’s aging population, the impending retirement of nurses and the continuing departure of young nurses to other states are major contributors.
In the coming decade, more than a fourth of the state’s registered nurses will retire with other baby boomers, predicts the study, “The Supply and Demand for Registered Nurses and Licensed Practical Nurses in Nebraska Report.”
Nebraska loses about 100 registered nurses annually to out-migration. Those leaving usually are younger.
The ability to keep young nurses is influenced by such things as salary, benefits, flexible hours and respect. Currently, a registered nurse can expect to start at a salary of $40,000, but later growth is limited, according to Charlene Kelly, executive director of the Nebraska Center for Nursing.
The study also projects the number of licensed practical nurses will rise from the current 5,506 to 5,937 but says demand will exceed supply by almost 23 percent.
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Nowhere in that picture did hospital officials see a role for the International Association of Machinists, the union attempting to organize the hospital’s 1,038 nurses, both RNs and LPNs.
In their office a few blocks south of the hospital’s east campus, IAM organizers are making plans to ensure the union becomes an enduring presence.
“We’ve taken the approach that we’re here — here for the long haul,” said Darrin Nedrow, an organizer from the union’s Chicago office.
Hospital officials are working equally hard to see the union fail.
“We believe that speaking directly to our employees is really very important,” hospital spokeswoman Suzanne McMasters said. A union gets in the way of that, she said.
Nurses are choosing sides in a campaign with little middle ground.
And it’s all so familiar.
Represented before
For 13 years, ending in 1995, what was then Bryan Memorial Hospital had the only nongovernmental nurses union in Nebraska.
It was an acrimonious time for the hospital and its RNs, filled with complaints of unfair tactics, informational picketing and a handful of court challenges. It took seven months from the time union recruitment began before the hospital’s 400 nurses voted it in. It took seven more to negotiate the first contract.
The union survived decertification votes in 1983 and 1989 but, by 1995, the nursing shortage had ended. A restructuring of health care and insurance had led to nursing layoffs at hospitals nationwide.
By the mid-1990s, Bryan officials were giving nonunion LPNs a better benefit package than the union could obtain for its RNs. Hospital officials promised they could better address the nurse’s nonpay issues without interference from the union.
In addition to compensation, nurses had been prompted to form a union out of desire for professional respect and a larger say in patient care. They complained of nurse-to-patient ratios, long hours and lack of days off, lack of incentives for educational advancement and inadequate education and orientation programs for nurses who float to different units.
In the ensuing years, the union was forgotten amid a flurry of growth and mergers. Pushed by a profitable and growing heart-care market, the reformed BryanLGH thrived.
Nurses and administrators entered an amicable period. Just a few years ago, the hospital boasted of being named among the top 100 best places to work nationwide.
But behind the scenes, hospital officials already were addressing what would grow into serious challenges.
Groundwork for new union
Bryan’s merger with Lincoln General Hospital had reached the stage that officials were forcing the two hospital cultures to become one.
Medicare had squeezed payments to hospitals and doctors to reduce costs. The hospital’s partnership with local heart doctors deteriorated to the point that physicians opened a separate, competing hospital.
And then area bone doctors balked at being forced to practice at the hospital’s older west campus. Many orthopedic surgeons eventually took their profitable business to Saint Elizabeth Regional Medical Center and the Lincoln Surgical Hospital, both conveniently located along the 70th Street corridor.
Quickly, the hospital’s fat years became a memory.
Last September, BryanLGH cut the equivalent of 41 full-time employees, the culmination of a six-month efficiency review by outside consultant Wellspring.
Hidden within that announcement was that the hospital’s total work force had been reduced 10 times that amount through attrition and hiring freezes. Hospital CEO Lynn Wilson said then that the cuts would restore the nonprofit hospital to a 5 percent revenue surplus, the minimum necessary for a healthy hospital.
But by January, rumors were rampant that the beautifully remodeled surgical suites at BryanLGH West were sitting vacant. BryanLGH spokeswoman McMasters confirmed that hospital admissions, hospital stays and surgery numbers strayed furthest from budget projections that month. In plain words, business was agonizingly slow.
Admissions rebounded in the spring, pushed by tremendous growth in neurological and off-hour surgeries.
“We finished the year strong,” McMasters said. “The (hospital) census last week was over 400. That’s very high.”
The hospital ended its fiscal year in June on target with its budget.
By then, however, a group of about 30 nurses, their confidence in management shaken by a series of policy changes, had begun laying the groundwork for a new union.
Falling morale
Among some nurses, talk of restoring the union had never died.
As BryanLGH management struggled with setbacks, a series of job freezes, layoffs and other cost-saving measures pushed one group of nurses beyond talking.
As hospital positions went unfilled, the workload increased on those who remained.
As they had years earlier, nurses were emptying trash and running down halls after supplies, taking time away from the care of patients, union supporter Carol Loos said.
With much of the hospital empty of patients, nurses also were sent home, where they were paid $2 per hour to be on call.
To be able to pay their bills, nurses used vacation time to sit at home, union backer Jennifer Wells said.
“They use vacation time to eat,” she said.
In some cases nurses could temporarily work in unfamiliar areas of the hospital, a practice called float. Union supporters said the unfamiliarity makes nurses prone to making mistakes and endangers patients.
Nurses perform highly technical duties, union backer Sheila Uridil said. “A nurse is not a nurse is not a nurse,” she said.
Management also reduced the higher hourly pay nurses earned by working nights and weekends.
For those under a certain age, regardless of tenure, the retirement package was changed from a fixed pension to a 401(k) program with employer contributions.
Administration responds
McMasters confirmed some of the changes and defended others.
In some departments reduced by attrition, she said, staff hours were added back.
Float always has been a part of practices, she said, and nurses only move to areas where they are competent to perform.
“Managers and nursing staff have been looking at improving the float policy,” she said.
Changes in the retirement program will allow younger nurses, who tend to be more mobile, greater portability. Any accumulated benefits due existing nurses will be moved to investment accounts controlled by the employees. Contributions to employee accounts will equal what would have been set aside for the fixed pension.
“They shouldn’t be losing anything by this,” McMasters said.
To nurses, the rapid pace of change grew discouraging. Changes appeared to be expedient for the hospital’s profitability and without regard for how they would affect nurses or patients.
Over the past five years, management changed a lot of things, union supporter Teri Feit said.
“They stopped listening, stopped caring,” she said.
The last straw for some was the hospital’s announcement in November that it planned to eliminate an incentive for what nurses call “add-a-shift.”
BryanLGH nurses typically work three 12-hour shifts per week. They are required to sign up for — although they may not be required to work — two extra 12-hour shifts in every two-week period.
They receive extra money for “add-a-shift” plus overtime once their hours accumulate to more than 40 per week.
With the incentive in place, nurses wanting extra money typically volunteered in sufficient numbers to cover those wanting to work only three-day weeks. With the proposed elimination, suddenly, both groups were unhappy.
Management already had reduced the incentive 18 months earlier.
McMasters, hospital spokeswoman, said the hospital scrapped its proposal to cut the incentive in response to the concerns nurses raised.
“But we’re still looking at changing it,” she said.
Union goes big red
Nebraska isn’t a hotbed of unions, IAM organizer Nedrow said.
“We wouldn’t typically go in and open an office,” he said, but the union knew there would need to be extended education.
Nurses and machinists union representatives mutually evaluated each other over several weeks.
“We wanted to make sure it wasn’t one or two folks,” Nedrow said.
The 400,000-member machinists union represents a wide variety of workers, including about 5,000 in health care, but it isn’t among the three large nursing unions, so why choose it?
Bryan nurses had tried the all-nurse union, supporter Beth Beecham said. “We really needed to go in a different direction,” she said.
The machinists were large, strong, diversified and had the staff to do many tasks in-house.
Thirty core nurses began undertaking 90-minute weekly meetings, learning about labor law and union processes.
The Capitol City Nurses Association opened its office at 48th and Normal on June 1 but kept things quiet until later in the month, when it was ready to launch its campaign.
Unions aren’t new to nursing, although there are none at Nebraska’s general hospitals, including Bryan’s main competitor, Saint Elizabeth Regional Center.
Roughly 20 percent of the nation’s 2.4 million nurses belong to unions. Overall, about 12 percent of the nation’s workers belong to unions.
In the 1960s, a third of the nation belonged to unions. To recover from those losses, unions have stepped up recruitment efforts among health care workers over the past five years.
The U.S. Department of Labor recently identified registered nurse as the occupation expected to grow the most in the next 10 years.
Demand for full-time registered nurses exceeds supply by nearly 170,000 this year, according to the American Hospital Association. That shortfall is expected to widen to more than 1 million by 2020. In Nebraska, an existing 800-nurse shortage could become a 4,000-nurse shortage by 2020, according to the Nebraska Center for Nursing.
It’s a growing work force. This nursing shortage should endure. And health care can’t be outsourced overseas.
OK, we get it
Pro-union nurses say BryanLGH administrators admit they made mistakes and are now willing to listen.
But among this group, there’s little trust left.
“We want security from our administration,” Uridil said. “The only way we can get that is through a professional contract and professional representation.”
Nurses who were interviewed all said they were proud to work at BryanLGH.
“We’re proud of the care we provide, but it’s going in the wrong direction,” Feit said.
It’s not an attack on BryanLGH or its administrators, nurse Barb Lacher said. “It’s about professional representation for RNs.”
Nurses want a business relationship, said nurse Tim Valdez. “That’s all we’re asking for, a business agreement between business partners.”
McMasters, the hospital spokeswoman, said not all nurses agree a union will make things better.
“I know they work very hard and they take very good care of our patients,” she said. “We try as hard as we can to address things appropriately. As complex as the hospital is, we’re not always able to do that.”
She added that when you think about a union and the difficulties it creates in communicating with employees, “I don’t see that’s going to enhance their ability to talk to us.”
In newsletters to employees, BryanLGH administrators focus on the potential divisiveness of unions, on the $35 monthly dues and on the possibility of a strike.
We don’t want to fight, Wells said.
“We want to end the hostility that’s there.”
Talk of a strike plays on the guilt a nurse would feel over abandoning her patients, she said.
Nedrow said the machinists union achieves the vast majority of its contracts without a strike.
Things are just getting started, he added.
“We’re not even focusing on a strike.”
Nurses cannot legally abandon patients, he said. A strike would require a two-thirds vote of union members, followed by a 30-day notice plus a 10-day cooling-off period.
But strikes do happen. Hospitals can hire companies, Nedrow said, that will replace hospital staff with traveling nurses.
For now, the union says there will be more of the same, more meetings, more talk. They’ve set no deadline.
Success could come either by the hospital acknowledging the union has nursing support or a formal nursing vote.
Only then could negotiations between the nurses union and hospital begin.
Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.
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