Editor's Note: These bulletins and other articles of interest to health care,
nursing and labor activists are now being archived, in html (with links), on
a web page entitled 'Sandy's Links,' <
http://users.rcn.com/wbumpus/sandy>.
Bill Bumpus of the Somerville (Massachusetts) Labor Party Club has once more
come through in fostering thought and dialogue. While this unofficial page
should not be construed as representing the Labor Party's official positions,
it does contain articles which I've found relevant and Bill has found useful.
You can reach Bill and consider accessing his services through his web page
<www.unionwebservices.com> - quality web site development since 2000. --
Sandy Eaton, RN
------------------------------------------------
FOR IMMEDIATE RELEASE
June 20, 2000
Contact: David Schildmeier 781-249-0430 or (508) 426-1655 (Pager)
JAMAICA PLAIN, Mass. - Registered nurses (RNs) represented by the
Massachusetts Nurses Association (MNA) at Faulkner Hospital in Jamaica Plain
reached a tentative agreement today with hospital management, averting a
strike at the facility.
While the bargaining committee is not discussing the details of the pact at
this time, they are very satisfied with the four-year agreement, as it
addresses the nurses' key issues going into today's talks, and will recommend
the agreement to the rank and file membership for ratification. The union
will now work on getting a copy of the agreement to its members for review
and will schedule a vote for ratification next week.
On June 8, the nurses cast a 95% vote to authorize their union leadership to
call a strike if necessary. The nurses cast the vote as contract talks had
bogged down over the issues of staffing, mandatory overtime, salary
inequities and the nurses' call for reinstatement of their wage scale. All
of these issues were addressed satisfactorily in today's talks.
The nurses last met with management on June 13, 2000, with little or no
movement made towards a settlement. Following the talks, the nurses'
bargaining committee met with the rank and file membership and were given the
go ahead to deliver the strike notice at the end of negotiations today if an
agreement was not reached.
# # #
----------------------------------------------
N.E. nurses unions flex their muscle
by Anne Barnard, Boston Globe
June 22, 2000
Emboldened by a successful six-week strike at St.Vincent's Hospital in
Worcester, which won limits on mandatory overtime, health-care workers across
the region are flexing their muscle.
On Tuesday, Faulkner Hospital in Jamaica Plain averted a strike by reaching a
tentative agreement with its nurses, while in Providence, nurses and other
hospital workers at Rhode Island Hospital announced plans to strike beginning
June 30.
At both hospitals, union spokesmen said, the key issues were mandatory
overtime and staffing levels - the same issues that dominated the contentious
St. Vincent's strike. That strike ended in May with the hospital agreeing not
to force nurses to work more than 12 hours in row.
Though the Faulkner Hospital contract must still be ratified by union
members, David Schildmeier, spokesman for the Massachusetts Nurses
Association, was elated yesterday, saying that all the nurses' concerns had
been ''satisfactorily addressed.''
Health-care workers have increased leverage now because of low unemployment
and a growing nursing shortage that is making it hard to recruit and retain
nurses, said Hal Ruddick, staff director of Local 285 of the Service
Employees International Union. Ruddick negotiated a contract last October
that strengthened limits on mandatory overtime for nurses at Boston Medical
Center.
''It does give employees some more confidence that they have the ability to
fight back,'' he said. ''But people aren't taking a stand just because they
have more leverage. ... The work conditions for nurses and hospital workers
in general have been deteriorating in recent years. People are working
short-staffed.''
Staffing is a key issue in contract negotiations at Union Hospital in Lynn,
where nurses' and medical technicians' contracts expired 10 days ago; at
Whidden Memorial Hospital in Everett, where service workers are trying to
organize for the first time; and at Brockton Visiting Nurses Association, a
home health-care provider, unions said.
Meanwhile, the Massachusetts Nurses Association, which represents the nurses
at St. Vincent's as well as at Faulkner, is advising nurses at Rhode Island
Hospital, who once came up to support the picket line at St. Vincent's.
Linda McDonald, who heads the United Nurses and Allied Professionals local at
Rhode Island Hospital, said the hospital uses mandatory overtime not only in
crises but to cover routine staffing needs - a common refrain at both St.
Vincent's and Faulkner.
At St. Vincent's, the hospital agreed to limit mandatory overtime to four
hours a day, no more than eight times a year. At Faulkner, neither side would
release the details of the agreement, but the union said earlier that the
nurses were seeking limits somewhat less strict than those at St. Vincent's.
Nurses at Faulkner also wanted to reinstitute their ''step'' salary scale of
seniority raises, which they had agreed to forgo when the hospital was going
through hard times. But after Faulkner affiliated last year with Brigham and
Women's Hospital, where nurses still have a step scale, they wanted the
raises reinstituted.
Faulkner spokeswoman Stephanie Pfaff said the agreement ''allows us to move
forward with our agenda of growth and development."
Negotiations continued yesterday at Rhode Island Hospital. A strike by 1,700
nurses and health workers could hurt the hospital during the busy July Fourth
holiday weekend. The other union at the hospital - the International
Brotherhood of Teamsters, which represents 1,900 workers -could honor a
picket line, leaving the hospital with fewer than half its employees on the
job.
The union that represents nurses and other workers at Rhode Island Hospital
votes to give the hospital a 10-day strike notice sometime today.
By FELICE J. FREYER, Providence Journal
June 20, 2000
EAST PROVIDENCE -- The union representing 1,700 nurses and other
professionals at Rhode Island Hospital voted overwhelmingly yesterday to
authorize its negotiating team to give the hospital a 10-day strike notice.
The 1,017-to-53 vote brings the union and hospital closer to a strike, but
does not make one inevitable.
President Linda McDonald said the union will give the hospital the strike
notice, which is required by federal law, sometime today. A strike, if
negotiations fail, would begin July 1, she said.
Another membership vote would be taken on the hospital's final offer before a
strike begins. The contract expires June 30.
The key issue, union leaders and members said, is the mandatory overtime that
they say the hospital routinely forces on them, undermining their ability to
work safely and disrupting their lives.
Meanwhile, the two sides are scheduled to return to the negotiating table
tomorrow, and the hospital has asked for a federal mediator to help with
negotiations. Tomorrow's meeting is one of five bargaining sessions scheduled
before June 30.
"We're still two weeks from the conclusion of the agreement," said hospital
spokeswoman Jane Bruno. "A lot can happen in five sessions." Nevertheless,
the hospital has already hired an agency to provide replacement nurses and
has begun discussions with state Health Department officials on preparations
for a strike, an event that would likely shake Rhode Island's entire
health-care system.
Rhode Island Hospital, in Providence, is the state's largest hospital, the
primary teaching site for the Brown University School of Medicine, and home
to the region's only trauma center and children's hospital. It employs 5,000
people and offers specialty services not available elsewhere in the state.
The vote by members of the United Nurses and Allied Professionals (UNAP) was
taken by secret ballot at five meetings held throughout the day at the
Teamsters' hall in East Providence.
Time and again, union members interviewed as they left an afternoon meeting
raised the same issue that led to the recent strike at St. Vincent's Hospital
in Worcester: mandatory overtime. Nurses say the hospital is so understaffed
that the practice of requiring nurses to work an extra shift -- intended for
emergencies and unforeseen problems -- is used routinely to fill "known
holes" in the schedule.
The hospital has acknowledged it is short-staffed, but said it is working
hard to recruit nurses at a time when they are in short supply. The union
insists that nurses are plentiful but few will stay for long at Rhode Island,
where nurses say conditions are tough and wages below par.
Sue Pouliot, a nurse in the medical intensive care unit, said she had voted
for the strike and expected one to occur. "It needs to be done," she said.
"I'm a single mom. It will mean tapping into money I don't have."
"I'm scared. I just bought a house," said Amy Costello, a nurse on the same
unit. But she favors a strike because the hospital's proposals "are just
insulting," she said.
Kate Pinheiro said that often nurses are placed on mandatory overtime in
areas of the hospital where they have no experience. "It's not fair being
floated to other floors. Nursing is specialized. It's an endangerment
situation. ... Your kids are home alone and you haven't slept in 24 hours and
they tell you, 'Deal with it.' "
"Everyone is just so tired of how we're staffed and treated," said Patti
Carreiro, a nurse in pediatric intensive care. "There aren't many other jobs
that won't let you go home after eight hours."
Erica Agren, a mental health worker on the hospital's psychiatric unit, said
she had been on the job -- her first "real job" -- only six months. She
didn't want to say how she voted. "The whole thing is new and confusing and
scary," she said.
McDonald, the UNAP president and a critical-care nurse, said that mandatory
overtime takes a frightening toll on union members. Unlike with some jobs,
hospital work doesn't necessarily wind down toward the end of a shift, she
said. "You can get two post-op patients in your last hours," she said.
Because of staffing shortages at all levels, McDonald contended, patients no
longer get the best care -- nurses don't have time to turn immobile patients
as often as they should, or give them their medications on time, or teach
their families how to care for them at home.
"They're abdicating their responsibility to staff responsibly," said Rick
Brooks, UNAP director.
Linda Shelton, a hospital spokeswoman, said that the hospital is pressed for
money. "We do have an economic dilemma that we face as well," she said,
noting that last year Rhode Island Hospital lost $33.9 million, and spent
$23.3 million on uncompensated care and $22 million on graduate medical
education.
"It's not an expense problem. It's a revenue problem," Brooks countered.
"They go after it on the expense side. They don't go after the HMOs
aggressively enough." Meanwhile, the hospital's parent company, Lifespan,
spends "tens of millions" on system expansion and consultants, Brooks said.
Year after year, Brooks said, the hospital budgets for a lower volume of
patients and the volume doesn't drop. The result is chronic staff shortages,
he said.
The union has proposed a measure permitting an employee to decline an
overtime shift if he or she does not feel physically or mentally able to
work. The hospital, according to the union, instead wants a series of
provisions that would make it easier for the hospital to resort to mandatory
overtime, including eliminating double-time pay.
The hospital has declined to publicly discuss the specific issues raised in
negotiations. "We value our nurses and our technical employees and the
critical role they play in health care," said Bruno, the spokeswoman. "We
believe that a good outcome is most likely in direct discussions with
negotiating teams."
McDonald says that the public's sentiments would be with union members if
there were a strike. "Anyone who has been through our emergency room, or been
in our ICUs or on our floors understands how hard we've been working and how
dedicated we are," she said.
Nurses give strike notice; hospital considers layoffs
By FELICE J. FREYER, Providence Journal
June 21, 2000
PROVIDENCE -- The union that represents 1,700 nurses and other professionals
at Rhode Island Hospital yesterday said it had issued "a formal notice to
Rhode Island Hospital of its intent to walk off the job at 7 a.m. on July 1"
if a new contract agreement is not reached by then. But the hospital, in a
letter to employees released late yesterday, said that the notice was
ambiguous. Hospital President Joseph Amaral said the notice referred to an
intent to "strike, picket or engage in other concerted protected activity."
"It is not clear from the notice what we need to prepare for," Amaral wrote.
Amaral also accused the union of failing to engage in "meaningful and
constructive negotiations." He said that if there is going to be a strike,
the hospital would have to start reducing services "almost immediately," and
that may result in layoffs even before July 1.
Members of the United Nurses & Allied Professionals union voted 1,017 to 53
on Monday to authorize the negotiating team to give the hospital a 10-day stri
ke notice, which is required by federal law. The hospital is expected today
to give the Health Department a plan for providing services during a strike.
Teamsters vote to honor nurses' picket line if strike is called
By Zachary Block, Providence Journal
Thursday, June 22, 2000 @ 4:30 p.m.
PROVIDENCE - The International Brotherhood of Teamsters, which represents
1,900 technical, clerical and housekeeping workers at Rhode Island Hospital,
voted today to honor a picket line if the 1,700-member United Nurses & Allied
Professionals walks off the job, as the nurses' union has pledged to do if a
contract settlement with the hospital is not reached by July 1. Rhode Island
Hospital, the state's largest medical center, encompasses Hasbro Children's
Hospital and runs the region's only top-level trauma center. The nurses'
union, in the final days of a three-year contract, wants administrators to
raise pay and abolish mandatory overtime. The hospital plans to hire
replacement nurses, reduce the number of patients, and lay off workers if a
strike is called. Nurses are rallying outside the hospital this afternoon.
The Almond administration and the General Assembly had grand ambitions. They
were going to reform health care.
After the collapse last year of Harvard Pilgrim, state government, disgraced
by the banking crisis, was going to redeem itself.
Christine Ferguson, Almond's director of health and human services, promised
nothing less than to make affordable health insurance available to all Rhode
Islanders.
"It is eminently doable," she said.
Ferguson looked right for the job. Not only had she worked on health reform
for the late Sen. John Chafee, but Ferguson, through her department, bought
more health insurance each year than anyone. And she indicated she was
prepared to use that buying power to force reforms.
The pace quickened after the state took over Harvard Pilgrim. Legislators
called hearings; Brown University organized a symposium; Ferguson and the
General Assembly held a summit; and two foundations promised half a million
dollars to help the effort.
Speaking to Rhode Island leaders in December, former Massachusetts governor
Mike Dukakis urged Rhode Island officials to think big. And it seemed that
they were.
Then, early this year, the process took a turn for the worse. RIte Care, the
state insurance program that had been quietly expanded in 1997 to cover some
middle-income families, was running in the red. Overnight, the existing RIte
Care program became Rhode Island's health-care solution, a solution, it
turned out, the state couldn't afford.
The retreat had begun.
Ferguson and the leadership started debating RIte Care with the hospitals,
the insurance companies, and the other stakeholders, in secret.
Why shut out the press and the public?
"It's very hard to get to resolution unless people feel comfortable being
very frank and blunt about things that they might not otherwise," Ferguson
said.
The governor's chief of staff dismissed a comparison between Ferguson's
secret meetings and those that got Ira Magaziner and Hillary Clinton into
trouble with a federal judge.
"I don't think anyone is contemplating a new plan," he said. "What we're
trying to do is make pragmatic modifications to the existing plan."
In other words, despite all the big talk last year, Rhode Island didn't
really intend to do much. I only managed to sit through about five minutes of
one of Ferguson's meetings before I was told to leave. That was enough to see
that there wasn't a firebrand in the crowd.
Last week, Ferguson and House Majority Leader Gerald Martineau finally
released their RIte Care fix. Only the title -- Health Reform RI 2000 --
echoed their old intentions.
The verb of the day was "stabilize," as in "our goal became how to stabilize
RIte Care." Those were Martineau's words. Ferguson and the governor said the
same kind of thing.
After a year of great expectations, the state's answer to the health-care
crisis is a complex set of rules and regulations to try to stem the rush of
lower-income people into RIte Care. (The Ferguson group also favors buying
cooperatives to lower health-insurance bills for small business -- an idea
adopted by the other New England states.)
I guess I could have seen it coming. Way back in January, Martineau gave a
pretty clear reading on how deep the state dared to go.
Ten days after Harvard Pilgrim closed down, Martineau proposed creating an
insolvency fund to pay doctors and hospitals.
Two groups of constituents hadn't gotten paid. That was crisis enough.
Nothing about the cost and quality of health care. Nothing about prescription
drugs or managed care. Nothing about top-heavy hospitals or overworked nurses.
Nothing then. Nothing now.
The administration and the General Assembly just weren't up to it. Their goal
was to not offend. So instead of trying to define and then represent the
public interest, the pols got the stakeholders together and tried to find
common ground.
Weren't they listening at their own hearings? There is no common ground in
health care. The parties are incompatible, and the system is spiraling out of
control.
Lifespan is losing more than $1 million a week. Insurance premiums are
soaring. Doctors' salaries are plunging. The nurses are ready to strike. The
Almond administration and the General Assembly got it right last fall. Health
care needs a revolution, not patch job.
Peter Phipps is deputy managing editor of The Providence Journal. You can
reach him by phone, at 277-7443; or by e-mail, at pphipps@projo.com
Daniel Mordecai has heard it all before, and it doesn't faze him one bit:
Scabs. Strikebreakers. Scum of the earth.
A thick skin is essential when you're in the business of providing temporary
nurses to hospitals in the throes of a labor strike.
When more than 1,700 Stanford nurses walked off the job last week demanding
better pay and working conditions, it was Mordecai's company, U.S. Nursing
Corp., that supplied the 500 or so replacement nurses that have allowed the
university's two hospitals to continue to operate with some semblance of
normalcy.
A privately held company based in Denver, U.S. Nursing deploys highly paid
strike replacement nurses -- some earning as much as $4,000 a week -- all
over the country, often on just a few days' notice. And it dominates what's
euphemistically called the ``crisis staffing'' business, a unique, lucrative
and highly controversial niche in the booming temporary-nursing industry.
Business is booming. There were 21 nursing strikes at U.S. hospitals in 1999,
compared with four in 1995, according to the Bureau of National Affairs, a
private research firm. And increasingly, hospitals are attempting to conduct
business as usual during labor strikes that can last weeks or even months.
U.S. Nursing's only competitors appear to be HPO Staffing, with offices in
St. Paul, Minn., and Milwaukee, and San Francisco-based Travel Nurses
International, which has provided Stanford with 25 replacement nurses.
Some see sordid business
Many of the nation's nurse agencies are happy to avoid what many nurses
regard as a somewhat sordid business.
Joan Meehan-Hurwitz, communications director for the American Nurses
Association, an umbrella organization of nurse unions that recently picketed
U.S. Nursing's Denver office, says that U.S. Nursing ``undermines the nurses
who go out on the picket line, and it encourages lengthy strikes'' because
hospitals with replacement nurses are less motivated to return to the
bargaining table.
U.S. Nursing doesn't need to advertise; its services are well-known among
hospital executives. It was born in 1988 when Mordecai, then a hospital
financial consultant, was asked to provide nurses to several San Francisco
hospitals undergoing strikes.
Ever since, he's built his business on word of mouth. Mordecai was
closemouthed about his revenues and the number of nurses he represents, but
he did say that last year, the company placed more than 1,500 strike
replacement nurses at hospitals around the country.
`We're not scab nurses'
Mordecai, who is 68, describes U.S. Nursing as a lifesaver for hospitals,
such as Stanford Hospital and Clinic and Lucile Salter Packard Children's
Hospital.
``We're not strikebreakers, we're not scab nurses,'' says Mordecai. ``We're a
company that performs an emergency staffing service. If we didn't, the
hospital would not be able to care for its patients and the community.''
Unfortunately, he says, ``we become the focus (of verbal attacks). My nurses
who are vilified as being incompetent or worse are very, very good nurses.''
Typically, hospital executives call U.S. Nursing immediately after unions
file a 10-day strike notice. Mordecai likens the task of mobilizing hundreds
of licensed nurses, flying them to the site, establishing their credentials,
and arranging their housing and transportation to setting up a field hospital
in the heat of battle.
He would disclose few details of what he characterized as his ``proprietary''
mobilization process. But he noted that in his 12 years of arranging housing
for nurses everywhere from Manhattan to pricey ski resort towns, he's never
had a harder time finding hotel rooms for his nurses than in Silicon Valley.
``It's been a logistical nightmare,'' he said from his temporary office at
Stanford.
The nurses who work for him are willing to endure long hours, unfamiliar
working environments, and scorn from their union counterparts in return for
weekly salaries of up to $4,000 -- roughly four times what many Stanford
nurses earn -- and the opportunity to travel. Mordecai says they thrive on
the challenge.
From out of state
Replacement nurses interviewed by the Mercury News declined to give their
names, but they shared the same philosophy: They believe patients need
uninterrupted service while hospitals and union nurses sort out their labor
disputes.
``I was stuck in a rut and wanted more variety, I guess,'' said one nurse
from Mississippi. ``It's been great. I'm really impressed with the facility
and the faculty here.''
The company avoids hiring local nurses, instead flying in replacements from
other states.
Mordecai acknowledged that to earn the top rate of $4,000, a nurse would have
to work between 60 and 80 hours weekly. That concerns nurses on the Stanford
picket line, who worry about patient care within the hospitals even as they
disparage the U.S. Nursing replacements.
``We're still hearing about medication errors and problems with equipment
they don't know how to run,'' said Kim Griffin, spokesman for the Stanford
hospitals nurses union. ``These are people who don't have permanent nursing
positions right now and you've got to ask yourself why. Is that the kind of
nurse you want taking care of you?''
Some have questioned U.S. Nursing's ability to adequately screen nurses.
Stanford hospital officials dismissed one nurse whose credentials appeared
false, and let go three others whose skills didn't match what was needed in
the intensive care unit and other wards. In 1992, the California Department
of Health Services cited U.S. Nursing for failing to properly check
credentials and orient nurses during a strike at Summit Hospital in Oakland,
problems that led to stricter state laws regulating credentialing for
temporary nurses, said agency spokeswoman Lea Brooks.
Earlier this year, Massachusetts state legislators sought stricter oversight
of strike replacement nurses after three U.S. Nursing nurses were fired at a
Worcester hospital, two for leaving a surgical patient unattended in a
recovery room. A third nurse was fired after she gave a newborn baby to the
wrong mother for nursing.
Good reviews
Yet despite the lingering criticisms of U.S. Nursing, top doctors at Stanford
-- and state health monitors -- say they're satisfied with the company's
performance so far.
``The medical staff feel the quality of their services is excellent,'' said
Dr. Ken Cox, pediatrician and chief medical officer for Packard Children's
Hospital. ``We've been impressed with the medical skills of the nurses. Our
first choice would be not to strike and to have our nurses here. But I
practice in the surgical area and medical area, and I've not had my care
compromised.''
Similarly, monitors from the state health department -- on site at Stanford
since the beginning of the strike -- have found no major problems with the
replacement nurses, Brooks said.
Entrenched at Stanford
In any event, it appears that U.S. Nursing may be entrenched at Stanford for
a while. The first talks since the strike began broke down Friday, with both
sides far apart on key issues including pay. Both sides are set to meet again
today.
Long strike, short strike, it's all business as usual to Mordecai, and when
Stanford's strike ends, there will be plenty more around the country for him
to staff.
"We're just doing what we have to do,'' says Mordecai. ``Eventually this will
settle down and we'll go away.''
LONDON (Reuters) - France, Italy, Singapore and Oman provide the best overall
healthcare in the world, the World Health Organization said Wednesday in a
report assessing health systems around the globe.
For the first time, the WHO has evaluated health system performance on a
value-for-money basis to give countries data on how they can provide better
health with available resources.
''Global health has become an issue of economic growth and human security,''
WHO Director-General Dr. Gro Harlem Brundtland told a news conference.
``We hope the World Health report will shift the focus from opinion and
ideology toward evidence and knowledge.''
San Marino, Andorra, Malta, Spain, Austria and Japan round out the top 10
performers is the WHO assessment of 191 nations.
The assessment is based on healthy life expectancy, efficiency and equality
of the health system and whether it responds to the social and financial
needs of the people it is designed to serve.
Sierra Leone, Myanmar, the Central African Republic and the Democratic
Republic of the Congo are at the bottom of the WHO scale.
OMAN IS EXEMPLARY
Among the surprises in the study were how well some developing countries are
using their resources while wealthier nations are lagging behind.
Although the U.S. is the top spender and scores well in responsiveness, it
falls short on effectiveness and healthcare equality, pulling down its
overall ranking to 37.
In contrast Oman, just two decades since the time when 23 percent of children
died before their fifth birthday, spends a fraction of what the U.S. does and
scored eighth on the list.
``The way health systems are designed, managed and financed affects people's
lives. The difference between a well performing health system and one that is
failing can be measured in death, disability, impoverishment, humiliation and
despair,'' Brundtland said.
Saudi Arabia (26), the United Arab Emirates (27) and Morocco (29) were other
nations in the Middle East and Africa which fared well.
Colombia has one of the best health systems among Latin American nations,
reaching a much broader segment of the population than before. Chile (33),
Costa Rica (36) and Cuba (39) also scored high marks in the region.
In Asia and the Pacific, Singapore at number six and Japan at 10 offer the
best healthcare, far ahead of Australia at 32 and New Zealand at 41.
China (144) and Sri Lanka (76), two Asian nations formerly regarded as
exemplary models of good healthcare, have not fulfilled their promise.
Despite huge economic growth, healthcare has barely improved in China in the
past 20 years and a dismantling of the insurance system means many people no
longer have medical coverage.
Political turmoil has taken a heavy toll on healthcare in Sri Lanka.
PRE-PAYMENT BETTER FOR YOUR HEALTH
The report found that a pre-payment system is better than paying
out-of-pocket. In countries where citizens pay out-of-pocket some households
are spending more than 50 percent of their disposable income on medical care.
It identified $60 per capita as the absolute minimum to provide effective
healthcare. An estimated 41 countries with a combined population of 800
million have expenditures below that minimum.
``To bring health spending up to this threshold would cost about $6 billion a
year. The potential payoff...is an increase in (healthy) life expectancy in
those 41 countries of about eight years,'' Brundtland added.
Copyright 2000 The New York Times Company
Copyright 2000 Reuters Limited.
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