Mergers, staffing ratios nudge nurses toward union

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By Livia Gershon Special To The Worcester Business Journal

The Massachusetts Nurses Association has been on the move in Central Massachusetts in recent months. In July, registered nurses at Nashoba Valley Medical Center in Ayer voted to join the union. Two months later, RNs at Athol Hospital did the same.

Meanwhile, MNA nurses have been fighting staff cuts across the UMass Memorial Health Care system — most prominently at the flagship Worcester hospital, but also in Leominster in Marlborough — and picketing over contract negotiations at Saint Vincent Hospital in Worcester. Statewide, the union was also instrumental in pushing for a new law setting rules for staffing levels in hospitals' intensive-care units.

MNA spokesman David Schildmeier said the common thread in all of the union's activities is nurses speaking up over changes in the health care system — from staffing cuts to mergers and consolidations — that place focus more on the bottom line than on patient care.

"Nurses want a voice in the decisions that impact their practice of nursing, and they see that nurses who don't have a union have no voice," he said.

But to hospital managers, the story is different.

"The leadership of hospitals, which includes clinical leadership — nurses and physicians, as well as others who are caregivers — are already focused on patient safety and the quality of the care, and that is true of every single hospital in this state," said Tim Gens, executive vice president of the Massachusetts Hospital Association.

The current climate in health care puts the question of who's really looking out for patients' best interests in the spotlight. Everyone, from businesses and employees shelling out for insurance premiums to state and federal officials, is worried about health care costs, but no one wants savings to come at patients' expense. Meanwhile, driven in part by their own rising costs, some hospitals are joining forces with larger systems.

That last element was in play at both Athol and Nashoba Valley in recent years. In 2012, in the face of a rough financial situation, Athol Hospital joined forces with Gardner's Heywood Hospital, merging their administrative offices. A year before that, the rapidly growing, private equity-backed Steward Health Care acquired Nashoba Valley from its previous owner, Essent Healthcare.

Schildmeier said the new ownership structures made nurses more comfortable joining the union. The MNA already represented RNs at Heywood and at most Steward hospitals, so nurses who worked at sister institutions were able to visit their counterparts and explain how having a union affected their jobs.

In general, Schildmeier said, the longstanding movement away from locally based community hospitals to big organizations that own hospitals in many locations has encouraged nurses to unionize. Nurses who lose a trusted CEO or nursing director and see shots being called from a faraway office are more likely to be interested in unionizing to protect their own interests and those of their patients.

Gary Chaison, a labor union specialist at Clark University in Worcester, said the key to thriving nurses' unions is the RNs' sense that they need to speak up for their patients.

"This is really an age-old conflict," he said, "The conflict between those who provide health care services and what they call the bean-counters."

Chaison said nurses who are worried that hospital management is putting profits before patient care are more likely to unionize as a way to be heard. On the flip side, though, if they see union nurses going on strike, it's a big turnoff from unionizing since they worry about abandoning their patients.

When RNs do unionize, Chaison said, they're in a great position to speak out on all kinds of issues because the public tends to trust them.

"When people leave a hospital, they usually talk about how good the nursing care was," he said. "They never say 'that hospital was well administered.' So the nurses know where they stand."

That's what the union is counting on as it continues to work for mandated nurse-patient ratios. The new law governing intensive care units, which took effect in September, was a compromise reached after the MNA agreed to stop pushing two ballot initiatives. One would have mandated staffing levels across hospital floors, while the other was designed to promote hospitals' financial transparency. But Schildmeier said the union will continue to work for more robust laws on these issues. Already, nurses at hospitals that include Saint Vincent and UMass Memorial Medical Center have won rules on staffing ratios as part of their union contracts.

Gens said the state's hospitals remain firmly opposed to laws setting staffing levels, which he said try to substitute formulas for the situation-specific judgment of nursing leaders.

"There is no evidence that mandated staffing ratios work, and in fact we firmly believe that they're detrimental to the provision of care in hospitals," he said.

The question for nurses remains whether to trust hospital leadersto make the right calls on staffing and other patient care issues, or whether they need to take matters into their own hands. Chaison said the more instability RNs see in the hospital landscape, the more likely they are to take the second route.

"I think what we have over here is reaction to uncertainty," he said. "People react to uncertainty by trying to have a seat at the table at which decisions are being made."