Thursday, December 05, 2013

Is a different kind of collective bargaining possible?

The New York Professional Nurses Union has an interesting history.  Among other things, it accomplished something unusual, decertifying the SEIU, which had previously represented its members.  From its website:

The Registered Nurses at Lenox Hill Hospital were first organized into a union in 1980 by Local 1199, the Health Care Workers Union. By 1984 a number of the staff nurses were disillusioned with the representation provided by Local 1199. They considered affiliating with other unions, but ultimately decided that the best union for Lenox Hill staff nurses would be one devoted exclusively to representing them. Thus, the New York Professional Nurses Union (NYPNU) was born.

The staff nurses then launched a drive to decertify Local 1199, and the National Labor Relations Board (NLRB) ordered an election in December 1984. The options on the ballot included Local 1199, no union, and NYPNU. NYPNU won a majority of the votes cast and the NLRB certified the Union as the exclusive bargaining agent for staff nurses in early 1985.

The union has not been shy about standing up for its members, and there is an example currently at play.  The Executive Director recently wrote her membership:

The union started getting calls from both Delegates and members over the last few weeks alerting us that most or all units in the Critical Care Division/all units with monitors, will be required to sit for an EKG exam over the next few weeks. Our position is that the Hospital does have the right to assess competencies of its employees, or in other words – they have the right to give us a test.  However, what we object to is to, and what we will vehemently fight against, is what has been coined T-cubed: Testing/Transfer/Termination.

NYPNU is meeting tomorrow (12/5) with leadership from the Human Resources and Education Departments about this issue. While LHH may have the right to compel nurses to take this EKG interpretation exam, we want to ensure that there is appropriate opportunity for in-person education.  And if a nurse does not pass (there is still clarification needed to determine if a passing grade is 90 or 95 per cent), there should be collaboration between the nurse and Education Department to receive appropriate review and education of material to give that nurse all the tools necessary to pass the exam.

It is isn't often that we get to see these issues splayed out for the world to see, and my purpose here is not to take sides.

I'm struck mainly by an environment that results in a combatative approach when the objective is so clearly in the interest of patients.  Most of us would think that nurses and hospital admininstrators would agree on the need for competency training and assessment in the interpretation of critical clinical data. Here, the union appears to have a belief that such assessments may be used as a excuse to transfer or fire nurses. I don't know the background, but perhaps the union has evidence that such might be the case.  If so, is it because the normal procedures for personnel assessment and progressive discipline are so difficult or lacking in effectiveness because of other provisions of the hospital-union contract?  Or is it the case that hospital managers are just not very good at carrying out the kinds of human resource policies that one would hope for.  We can't know from this short excerpt and without understanding the long-term relationships between the parties. And, as I said, I am not taking sides.

But what makes me sad is to think about the lost opportunity for earlier collaboration--what might happen in an alternate universe--one in which the hospital and the union had together designed and implemented this training and assessment protocol. Imagine if the front-line staff had been consulted on lesson plans and other pedagogical details.  Perhaps, then, it would not have felt like a case of compulsion, but rather an opportunity for personal growth and professional advancement.  And taking it a step further, imagine a process in which patient advocates were also engaged. After all, patients have a rather large interest in the manner in which tests are taken and results are communicated to them.

I don't think there is anything inherent in the concept of unions that would preclude such an approach.  But it takes two to tango.  Both sides, early on, must believe in the need to establish an atmosphere of such cooperation.  Then, ongoing practice with such collaborations is necessary to build and maintain confidence.  Maybe this specific case will help send that message for future clinical initiatives.


Aditya P said...

This just completes the picture for me. A few days ago, I had looked up the Leapfrog Group's safety scores for hospitals in Manhattan and had noticed Lennox Hill Hospital to be the only one to be rated "D".

Given the combative and dysfunctional culture that seems to prevail there, I now have a reasonable understanding of what goes on there and I will actually be very scared if any of my friends or relatives are to get admitted there.

Anonymous said...

Unfortunately your post points out that the 'interests of patients' are not the primary objective of either the union nor the hospital. And they are not alone.

nonlocal MD

Barry Carol said...

It seems to me that the union vs. management culture is inherently adversarial and often confrontational. It’s just a matter of degree. When the nurses voted to decertify the SEIU, they presumably felt that they needed an alternative union as opposed to no union at all because they perceived that the latter would leave them worse off in the areas of wages, benefits and working conditions.

The challenge for managements in all industries is to create a culture that offers fully competitive wages and benefits plus fair and respectful treatment that eliminates the perceived need for union representation. The problem at least in the professions is that the employee evaluation process includes a significant subjective element. Moreover, it turns out that for some employees, their natural abilities and personality are just to a good match to the requirements and nature of the job. They may need to be told to find alternative employment and union job protections make that harder than it should be.