BANGOR, Maine — With the second nursing strike in six months looming next week, the rhetoric is heating up between administrators at Eastern Maine Medical Center and the approximately 830 unionized registered nurses who work there.
The nurses’ threatened one-day strike is set for May 5, with a previously scheduled contract meeting planned for May 3. But Tuesday evening, the two sides announced they will resume talks with a federal mediator on Wednesday in yet another effort to avoid the planned walkout.
If Wednesday’s talks fail, hospital administrators say they will bring in replacement nurses for five days, May 5 through 9. That’s a significant upping of the ante from the previous walkout in November of last year, when the hospital contracted with replacement nurses for the one-day strike and additional two-day lockout.
Nurses, represented by the Maine State Nurses Association and California-based National Nurses United, have said the hospital’s adamant refusal to include staffing language and other key issues in the new contract undermines patient safety and erodes job satisfaction. The hospital criticizes the nurses for pushing a “national agenda” set by out-of-state organizers rather than seeking solutions that reflect local realities and the changing face of health care.
Despite the war of words over staffing levels, the two sides indicated on Tuesday that language regarding the issue has been tentatively endorsed.
But the fracas in Bangor is emblematic of a much larger debate. In conversations on Tuesday, seasoned negotiators in touch with national trends weighed in on the changing relationship between hospitals and nurses across the country.
“This issue is national,” said Barbara Lambarida of Bangor, the lead contract negotiator for about 1,400 unionized nurses working at six hospitals and one home health agency in Maine.
“That’s what drives nurses to our unions,” she said. “They see us advocating for safe staffing, and they want to be part of that fight.”
Before moving to Maine in 2008, Lambarida spent 14 years with the California Nurses Association, widely recognized as one of the most powerful and politically aggressive nursing unions in the country. The CNA, which has now morphed into National Nurses United, sent Lambarida to Maine in the fall of 2007 to help negotiate a new contract with EMMC. The Maine State Nurses Association had joined forces with the California organization the previous year. Lambarida says she “fell in love” with Maine and moved here permanently after those negotiations concluded. She remains on the NNU payroll.
According to its website, NNU now represents more than 160,000 U.S. nurses with units in every state and the District of Columbia. Its goals include:
- Advancing the interests of direct care nurses and patients across the country.
- Organizing all direct care RNs into a single organization capable of exercising influence over the health care industry, governments and employers.
- Expanding the voice of direct care RNs in public policy, including the enactment of safe nurse-to-patient ratios and patient advocacy rights in Congress and every state.
The MSNA now represents nurses at Maine Coast Memorial Hospital in Ellsworth, Down East Community Hospital in Machias, Calais Regional Hospital, the Aroostook Medical Center in Presque Isle, Houlton Regional Hospital and Home Health Visiting Nurses of Southern Maine.
Lambarida says nurse staffing is a common concern in all contract negotiations, reflecting changes over time in the way hospitals staff patient care units. While bedside hospital nursing has always been a high-stress job, she said, hospitals have been making matters worse by reducing support staff, cutting orientation periods for inexperienced new graduates, imposing time-consuming new technologies and demanding longer hours from registered nurses.
At the same time, patients are being sent home earlier than in the past or cared for in outpatient settings, leaving hospitals filled with “the sickest of the sick,” Lambarida said. The situation often leaves nurses spread too thin, trying to care for more patients than they safely can. It’s a formula that sets the stage for mistakes and accidents while undermining nurses’ professional satisfaction in providing high-quality care to each patient.
“Historically, there have always been days that are just impossible for nurses, “ Lambarido said. “Now that’s become the norm, and that’s the tide we’re trying to turn.”
But while the concerns may be national in scope, she said, the nature of local contract negotiations are determined by input from rank-and-file nurses.
“Hospitals are having a field day playing up the so-called national agenda, but to the extent there is one, I don’t apologize for it,” she said. “The fact that these issues seem to have a national impact reflects the reality that these are issues nurses are facing everywhere.”
Hospitals throughout the country are facing difficult times, too, according to G. Roger King, a partner with Jones Day, a corporate law firm with more than 2,500 lawyers on four continents. The firm provides labor-related legal advice to the American Hospital Association. King specializes in health care law and frequently serves as the principal negotiator for hospitals negotiating labor contracts with nurses.
He has no official connection to the negotiations between Eastern Maine Medical Center and the nurses who work there, but he says he has been following the progress of the contract talks.
With national health reform changing the health care landscape, he said Tuesday, hospitals must remain administratively flexible. Nurses’ efforts to dictate staffing levels and other issues through contract negotiations are simply unacceptable, he said, and their claiming of the “patient safety” high ground doesn’t help.
“It’s very easy to raise patient safety as an issue,” he said. “Nobody can be against patient safety. … [but] patient safety is paramount for any provider. And [health care] quality will become more of a driver under the Affordable Care Act.” That means hospitals will feel more pressure to provide top-level care in order to get paid by private insurance companies and public programs like Medicare, he said.
Adequate nurse staffing is an essential tool to providing that care and is in everyone’s best interest, King said.
While every hospital faces unique challenges in negotiating labor contracts, he said, the NNU is “taking over” state-level unions like the Maine State Nursing Association and using them to advance larger political and economic aims at the local and regional level.
“Any employer has the right to decide how many employees it hires,” he said, and hospitals must be run in accordance with good business practices.
“The NNU is really pushing the envelope,” he said, and thorny contract debates like the one unfolding in Bangor are likely to become more common.
In addition to the strike pending at Eastern Maine Medical Center, NNU nurses are threatening to strike next week at Tufts Medical Center in Boston, St. Vincent’s Medical Center in Worcester, Mass., Children’s Hospital in Oakland, Calif., and Range Regional Health Services in Minnesota. The cluster of strikes threatens to make it more difficult for hospitals to line up replacement nurses to care for their patients.
In a statement Tuesday evening, EMMC took a harsh stance against the national union.
“The fact that EMMC’s employees, patients, and their families endured a strike at the hands of National Nurses United in November was inexcusable,” said Lorraine Rodgerson, chief nursing officer and vice president for patient care services. “The fact that this same union is now targeting patients and the hospitals that care for them across the country with a coordinated strike is nothing short of disgraceful.”
Lambarida denied that the EMMC strike is deliberately timed to coincide with the others.
“We have no control over what other hospitals do or the decisions of their bargaining teams,” she said. “The nurses don’t want to strike; the nurses have been forced to strike. If the threat of a strike brings the hospital back to the table, we are very pleased.”