Thompson was the first of several speakers to voice his support for Nurses United for Improved Patient Care at a public rally held in Swope Park last month. There, the nine-month-old grassroots organization unveiled the Community Coalition for Improved Patient Care, an alliance of nurses and community leaders. Slogans such as "Balance sheets shouldn't be more important than bedsheets" and "The patients are my bottom line" inspired the 60 to 80 attendants to applaud wildly.
Since the rally, Nurses United has received an average of three calls a day from nurses who wish to become involved in the effort, spokesman Michael Krivosh says. Because of the diverse nature of a nurse's workday, the calls come throughout the day and night. Krivosh says the group's Raytown office is staffed virtually around the clock. Volunteers answer phones and tend to the color-coded charts that line the walls, tracking which hospitals' nurses have been contacted or have volunteered to join the group.
According to Nurses United's mission statement, the organization aims to "achieve and secure the necessary balance between quality of care, patient safety, and cost containment." Krivosh says Nurses United decided that the best way to reach its goal would be to attain collective bargaining and a negotiated contract voted on by union members.
The group affiliated itself in October with the Federation of Nurses and Health Professionals (FNHP), an autonomous division of the million-member American Federation of Teachers that represents 53,000 healthcare professionals, including nurses at the University of Kansas Medical Center. Krivosh says this action provoked an immediate response from Health Midwest, the area's largest integrated healthcare delivery system, which operates 15 hospitals and employs 3,500 registered nurses.
"Right at the point when Nurses United announced its affiliation with FNHP, Health Midwest announced the first pay raise in two years, and even nurses who had already reached their top level of pay were given raises," Krivosh says. "At the same time, they rolled back a benefits cut. You could see they were thinking, 'Let's try to stop them now.' Then there were a lot of meetings where they asked, 'What are the problems here? Give us an opportunity to fix them.'
"That was phase one of the campaign. Phase two was absolute legal interference with employees' rights to distribute literature in the workplace."
Earlier this year, the regional office of the National Labor Relations Board (NLRB) issued a formal complaint, based on charges filed by Nurses United, against Health Midwest and several hospitals in the Health Midwest system. The complaint alleges 25 separate violations, most of which concern illegal restrictions on union activity. One of the incidents documented is the reprimand of Teresa Barnett, a registered nurse at Menorah Medical Center.
"We set up an information table in the cafeteria at Menorah Medical Center, and we were asked to leave," Barnett says. "I showed them a copy of their policy that states we could be there. They left, and then they came back with armed security guards. We were then told if we didn't leave, we'd be escorted out, and I pointed out to them that they were violating federal laws."
Barnett refers to Section 7 of the National Labor Relations Act, which states: "Employees shall have the right to self-organization, to form, join, or assist labor organizations, to bargain collectively through representatives of their own choosing, and to engage in other concerted activities for the purpose of collective bargaining." The National Labor Relations Act was passed in 1935, but healthcare workers were specifically excluded from the act until it was amended in 1974.
In responding to the complaint, Health Midwest can settle the case immediately by agreeing to post the cease-and-desist order from the NLRB on bulletin boards at all of its hospitals, promising to abide by the law, and removing all illegal reprimands from the affected nurses' files. If Health Midwest doesn't settle, the complaint will go to trial before a federal administrative law judge.
Krivosh emphasizes that the complaint does not constitute a guilty verdict, but rather that the NLRB has decided the charges cited by Nurses United are worth investigating. A hearing is scheduled for May 23 at the agency's regional office in Overland Park.
In the meantime, Nurses United has given Health Midwest a list of ground rules for conducting the union campaign, including stipulations that Health Midwest remedy the alleged offenses listed in the complaint, pledge that supervisors and managers will abide by federal labor law in the future, eliminate unnecessary meetings, and allow employees to "decide the question of union representation without interference, restraint, or coercion."
In a memo on policies, titled "Questions and Answers on Solicitation and Distribution in the Workplace," Health Midwest addressed many of these issues, reinforcing the rights of registered nurses to distribute literature in non-work areas during non-work time, to set up information tables in cafeterias, and to go to Health Midwest facilities other than the one that employs them to distribute literature in non-work areas.
Health Midwest spokeswoman Laura McCabe did not comment on the alleged violations specifically, saying, "Just as we want to deal with the union issue directly with the employees, we want to deal with this issue directly."
However, she says Health Midwest does not attempt to influence its employees as to whether they should join the union. "We respect their rights to consider the pros and cons, and we think that everybody has the right to hear what some believe is good about it and what some believe is bad about it and decide as they wish," McCabe says.
Nurses United also has concerns about Health Midwest's hiring of the Independence, Mo.-based Management Sciences Associates (MSA), which Barnett refers to as a "union-busting" firm.
"They're waging a war against nurses," she says. "They use certain tactics to scare the nurses, to get conflict going in the workplace between the nurses, the managers, and the aides. They hold meetings and try to stop us. They've been soliciting grievances, but none of the nurses are biting. They've seen and heard it all before. It's very much transparent."
Barnett contends that MSA engaged in a campaign designed to discredit FNHP.
McCabe confirms that Health Midwest hired MSA, but her description of the firm's duties and goals differs significantly from Barnett's.
"When you have any union activity, there are obviously regulations set forth by the National Labor Relations Board," she says, "and we want to make sure that we're responding to their activities properly within the rules. We just want to ensure that our nurses have the ability to weigh pros and cons. We have engaged their (MSA's) consulting services to ensure that we're handling things properly and respecting all of our employees' rights, both those for and opposed to the union, as well as our rights and the rights of the patients. We're not trying to stop them from considering a union in any way. We respect their right to do that."
McCabe denies that nurses are being required to attend meetings on the subject of organizing, as Barnett implied during her speech at the rally.
"We meet with the firm, and they meet with the nurse managers and people who need to be educated on the regulations," McCabe says. "They're not meeting with the nurses who are deciding whether or not to join."
Although issues related to the union campaign are an essential part of Nurses United's activities, Barnett says, it's important not to lose sight of the organization's ultimate goal.
"A lot of times you get bad press about unions, and that all they want is more money, but nurses didn't go into their profession to make a whole lot of money," she says. "It's definitely about helping the patients get the care they need. With the costs so high and the quality so low, they're not getting what they deserve as human beings."
Barnett says that the conflict comes down to the question of patient care, and she says that overworked and understaffed teams of nurses can't provide the standard of care that they feel they should be able to give.
"They don't feel good about themselves when they go home, because they really haven't given the care they want to give, and they struggle with that internally," Barnett says. "More and more people leave the profession every day because of that, and because of liability issues that hospitals don't address."
"The connection here is the patient issues," says Community Coalition coordinator Katie Phelan. "We know patient care is going down because of short staffing, long hours, and a shortage of supplies. There's kind of a natural union between the nurses and the community because the nurses are saying Health Midwest needs to care about its nurses and its patients, and the community is saying it needs to care about its patients and its nurses."
McCabe says she prefers that employees take their grievances to Health Midwest directly.
"We definitely hope that any Health Midwest employees can come to us with any concern they have," she says. "We're in the business of patient care, and we plan to continue to provide a high standard of patient care. We would love to be able to work things out with the nurses involved. That's been our goal, and continues to be our goal."
At the rally, Sharon Apel, a registered nurse at Research Medical Center, told the gathering, "In all my 30 years of nursing experience, I have never seen the quality of care as compromised as it is at this point in time."
Her sentiments were echoed by several other speakers, including Barnett, who referred to a "national healthcare crisis" and cited cost-containment measures, managed care, merging health systems, and market-driven competition as the roots of the problem and increasing nurse-to-patient ratios and "an all-time high workload" for registered nurses as the effects.
Barnett painted a similarly grim picture in December, when she testified before the Interim Committee on Quality Nursing Services and Patient Care in the Missouri House of Representatives. She referred to a recent study that revealed that the number of patients who die each year as the result of injuries caused by errors during hospital treatment is at an all-time high. Barnett called for the state to protect whistle-blowers to ensure healthcare workers' rights to speak out about quality concerns without fear of reprisal and she lobbied for a ban on mandatory overtime for healthcare workers.
The FNHP alleges that cost-cutting staffing practices have increased the likelihood that patients will be cared for by people who have recently been transferred or "floated" onto units in which they have no experience or training and that patients are likely to receive less personal time and attention from licensed staff. The organization states that although it suspects a link between staffing and quality, too little data has been collected for a conclusion to be reached.
McCabe says the situation is not nearly as dire as it is being portrayed.
"We believe patient care has never been diminished or compromised in any way," she says. "Patient care as a hospital system is our main priority. It's our livelihood. It's what we do. We don't believe that patient care has been compromised in any way in the entire length of the system. We believe that we're all best served by direct communication between the two parties, so we hope that we can communicate directly with the nurses and not have a third party involved. I think that's also our reason for trying to communicate directly with them and not try to go point by point in the press, either."
Health Midwest would prefer to deal with the nurse situation internally. Nurses United seeks to take its case to the public and establish itself in the eyes of healthcare consumers as a group of patient advocates.
"We really want to do the right thing for patients," Barnett says.
Contact Andrew Miller at 816-218-6781 or firstname.lastname@example.org.