By BRIAN TIERNEY
May 6 -8, 2011

DC Nurses and the Fight for Health Care

As working-class people around the country brace for more budget cuts that, among other things, will further restrict their access to health care, the people providing that care have also been feeling the wrath of austerity – and its attendant national offensive against unions.

Public and private hospitals are squeezing their budgets and cutting nurse staffing levels. From Massachusetts to California, understaffing and the resultant decline in patient safety have been at the center of a larger attack on nurse unionism.

And until this week, the prognosis for what has ailed labor relations and patient safety at the largest hospital in the nation's capital appeared to be getting worse.

But on Wednesday, the nurses' union at the Washington Hospital Center (WHC) in Washington DC announced it had reached a tentative agreement on a new contract with the hospital. The nurses' negotiating team is recommending ratification of the settlement, the details of which are being withheld pending membership approval. The nurses' previous contract expired last spring.

This latest announcement comes on the heels of heightened tensions between the union and hospital management which has engaged in behavior that could only be described as union-busting.

After unionized registered nurses passed out leaflets to patients and visitors in the cafeteria and entrances of the hospital campus a few weeks ago, management's retaliation was fierce.

The next day, the hospital disrupted a union meeting and told nurses they were no longer permitted to hold union meetings at the hospital. Nurses were also barred from passing out handbills to visitors and were forbidden from holding a strike vote in the SEIU union office on site.

So what was so nefarious about the nurses' leaflets that prompted such a response from the hospital? The leaflet was meant to inform visitors of the high turnover rate among nurses at WHC and its impact on patient care and safety, referencing an internal hospital document in which management itself acknowledged the scope of the problem.

"On average, every eight days a WHC patient is significantly harmed due to preventable errors. Every 45 days, a patient dies due to preventable errors," according to the internal document.

It was a shocking admission by the hospital about the consequences of understaffing that confirms what the nurses and their union have been protesting against for years. But when nurses attempted to raise awareness about the issue, hospital managers resorted to a brazen attack on the nurses' union rights.

"The hospital's blatant union-busting must stop," nurse Geri Lee told an April 25 delegates meeting of the Metro Washington Council, AFL-CIO where she described the hospital's attack.

Lee, a 27-year veteran nurse at the hospital, was among 18 nurses that WHC fired last year when she failed to report to work during the mammoth blizzard that virtually shut down D.C. for nearly a week. She was reinstated with back pay in December thanks to the union's victory in arbitration on the firings.

After management shut down their meeting on April 15, the union immediately filed Unfair Labor Practice charges against WHC at the National Labor Relations Board, calling the hospital's actions unlawful. Beginning Friday, the nurses were planning on holding informational pickets, which have now been called off.

"As patient care advocates, we have the right and responsibility to ensure that patients receive the best care possible at our facility," the union said last month in a statement on its website. "We will not be gagged by hospital managers from publicly raising issues about patient care."

The 1,700 nurses at WHC have been fighting for over a year to win a decent contract that addresses understaffing and other issues that have worsened working conditions at the hospital. But MedStar Health, the $3.8 billion "non-profit" health care chain that owns WHC, has been relentless in its union-busting offensive against the nurses who are represented by National Nurses United (NNU).

Punitive firings, severe understaffing, harsh work rules, and unilateral pay cuts have contributed to deteriorating working conditions and a high turnover rate among WHC nurses.

Back in October the nurses voted overwhelmingly to affiliate their independent local union with NNU, the largest nurses union in the country that was formed through a merger of several regionally-based unions in 2009. NNU represents 160,000 registered nurses nationwide and its formation signaled a turn to a more unified and militant approach to nurse unionism.

But the ruthless union-busting by management at WHC has tested the mettle of NNU and its representation of nurses in D.C.

In March, the first one-day strike by NNU at the hospital was followed by a four-day lockout imposed by WHC. Pickets were held throughout the strike and lockout and a rally of local labor activists and supporters who came out in solidarity with the nurses was addressed by AFL-CIO President Richard Trumka and U.S. Rep. Dennis Kucinich. Meanwhile, the hospital flew in up to 300 scab nurses to replace strikers.

Instead of negotiating with the union and addressing understaffing and pay cuts, WHC tried to break the union and – according to its spokesman Matt Brook – implement a year-long budget-tightening program. But there was still evidently enough room in that budget to spend an estimated $6 million back in March to fly in and house hundreds of subcontracted nurses during the lockout.

The profit margins that MedStar Health maintains have also belied management's insistence on the necessity of budget cutting. While WHC continued to argue that its imposed cuts in pay, benefits and shift differentials were reasonable and "above market value," the union pointed out that MedStar Health reported $57 million in profit between October and December of 2010 – the largest three-month profit earnings in the hospital's 53-year history.

All of this would seem to suggest that there is no legitimate excuse for budget-tightening and the consequent understaffing, nurse turnover and unsafe patient care. Grueling working conditions at the hospital have led to a 16 percent nurse turnover rate, further exacerbating the problem of understaffing and an influx of less experienced nurses.

Back in November NNU filed a report with the D.C. Health Department calling for an investigation of understaffing at the hospital. There were 50 incidents included in the report in which nurses documented unsafe patient care caused by understaffing; dozens more incidents have since been brought to management's attention.

Last week the hospital sent RIF (Reduction in Force) notices to 200 employees, including 19 RNs. According to one source, however, the hospital has a large number of openings, so none of those nurses are likely to lose their jobs.

On April 20 nurses were set to vote on holding another one-day strike until their meeting days earlier was shut down by WHC. The union postponed the strike vote and was looking for an alternative venue to conduct the vote. In the meantime, NNU was forced to hold general membership meetings outside at the corner of 1st and Irving Street near the hospital.

In light of all of these attacks by hospital management against the union, it is difficult to imagine that the flared tensions will be quickly cooled by the tentative agreement now being proposed. And whether the new agreement is approved or not, WHC's actions and the response of unionized nurses over the past year fit into a pattern seen at hospitals around the country.

At Tufts Medical Center in Boston, nurses are preparing for a 24-hour strike on Friday in response the hospital's refusal to remedy staffing and workloads that the nurses say are unsafe for both patients and nurses. Understaffing issues brought on by budget cuts have come to a head at St. Vincent Hospital in Worchester, Mass., too, where nurses are also scheduled to strike on Friday. And in California, nurses who have seen sharp cuts to their health care coverage at the Children's Hospital Oakland are preparing for a five-day strike beginning on May 5.

Other nurse strikes last year hit Wilkes-Barre General Hospital in Pa., Kaiser Permanente's Los Angeles Medical Center, and 14 hospitals in the Minneapolis-St. Paul area.

NNU Communications Director Chuck Idelson told Healthcare Finance News this week that the uptick in strike action among nurses nationwide is a result corporate greed at hospitals.

"Hospital corporations are putting their bottom line ahead of patient safety and nursing standards," he said.

This new wave of strikes at hospitals around the country over the past year reflects the militant strategy adopted by NNU. And while it remains to be seen, the latest agreement at WHC in Washington DC may serve as further proof of the effectiveness of this new militancy.

"We are pleased to have achieved an agreement with the hospital that strengthens our ability to effectively advocate for our patients and protects RN professional and economic standards," said Lori Marlowe, a cardiac nurse and member of the union's negotiating team.

As WHC nurses prepare to vote on the latest proposed agreement, the struggle that they have waged in Washington DC represents a pivotal flash point in the broader fight for union rights and health care in an age of corporate greed and austerity.

Brian Tierney is a labor journalist in Washington, DC. Read more of his work at Subterranean Dispatches.