By Ben Joravsky
In what may be a sign of things to come, today's union struggle in Chicago is being waged by nurses at Children's Memorial Hospital.
That's where a combative union campaign is heading toward a certification vote next week. Should the 600 or so nurses at Children's vote yes, they will become a guild represented by the Illinois Nurses Association, one of the fastest growing and most influential unions in the state. Should they vote no, as management fervently desires, they will remain as they are: an informal collection of employees with limited say in larger hospital matters.
"This election's about the future of health care and our profession," says Paul Baumann, a nurse at Children's. "We've always been a pretty passive bunch--getting nurses to stand up is like trying to herd cats. But times are changing and we have to keep up."
The talk of unions comes at a time of turmoil in health care. Under pressure from insurance companies to trim budgets, hospitals are shortening patients' stays. The shorter stays mean less money for hospitals, forcing them to trim payrolls with layoffs and by shifting jobs to less-trained employees.
Thus, advanced practice nurses making about $80,000 provide services usually handled by doctors who make close to $200,000, according to a recent article by Jim Ritter in the Sun-Times. And hospitals are hiring high school graduates for as little as $8 an hour to handle duties once restricted to nurses.
Children's has been undergoing its own changes. In some ways it's been a boom time, as the giant hospital at Lincoln and Fullerton, an international leader in pediatric cancer, AIDS, and heart and liver disease care, is in the midst of a five-year fund-raising campaign that promises to bring in $100 million by 2000.
Yet the hospital recently cut nearly 400 jobs in an effort to erase a $10 million deficit. According to hospital officials, most of the millions they've raised are earmarked for research and unavailable to meet daily expenses. "It's a bit of a paradox that while we have been successful at fund-raising, we can't use the money to run the hospital," says Paul Macuga, chief organizational development officer. "We still expect an operating loss for this current fiscal year."
To close last year's budget gap, the hospital has been reducing staff and replacing experienced employees with relatively untrained nurse's assistants. In 1996 the hospital required all employees to reapply for their jobs. That's when nurses began to organize.
"There was so much uncertainty, so much unsettling change," says Lynn Heald, a nurse in the HIV program. "We'd come to work and a person we'd been working with for years was suddenly gone. Some were let go, others transferred to different departments. We learned about the fiscal crisis in the newspapers because no one kept us abreast."
At first, Heald and several colleagues met informally to air grievances and share information. "We got into nursing to help patients, not to form a union," says Mary Ann Holland. "But we had to do something. There was such a feeling of powerlessness. We're not included in decision making. We're always in the dark."
Their main objective was to create a permanent committee of nurses that would regularly meet with administrators to set policy governing patient care. "This was never about money--we knew that a union would not mean much more money than what we now make," says Holland. "This was about the need to have a greater say in patient care and the future of our hospital."
They felt that they needed to organize to keep pace. "We see what's going on in our industry. Insurance companies dictate types of coverage. It's almost out of the hands of professional caregivers," says Stephen Frum, a nurse in intensive care. "Even doctors feel vulnerable. You watch--in time they will also be talking about forming unions."
One of the nurses' biggest complaints has to do with the increase in what officials at Children's call PALs--patient assistant liaisons. According to many nurses, the PALs are high school graduates being asked to handle duties usually reserved for nurses with college degrees. Ironically, their objections to PALs echo sentiments offered by doctors with regard to advanced practice nurses, whose roles and responsibilities the union wants to expand. "I know these arguments have been used against nurses, but frankly I think it's a dangerous trend to bring in unlicensed assistants," says Frum. "Cost cutters in the boardroom view nurses as overpaid housekeepers who feed babies and change diapers and can be replaced with people who get eight bucks an hour or whatever, because, well, women all over the world do this every day with their own kids. So now you have untrained people drawing blood, or helping feed infants, or putting catheters into patients. The PALs don't know what to look for--they don't know how to read the reactions of different patients to different things."
Last year the nurses began gathering signatures on a petition calling for a union certification election. In January the National Labor Relations Board set the election for February 19 through 21. So far the campaign's been relatively mild--at least there haven't been fistfights or catcalls. "I think both sides want to act like professionals," says Holland. "We don't talk about it while in front of patients."
But positions are hardening. At a recent meeting sponsored by the hospital, a surgeon offered an antiunion testimonial based on his encounters with secretaries who couldn't spell. "He said he had a secretary who didn't know the difference between 'to,' 'two,' and 'too' or 'there' and 'their.' He left us with the impression that the secretaries' union protected incompetent workers," says Holland. "It's odd. We want to increase professionalism and accountability by having a greater role in decision making. The hospital's hiring PALs out of high school, and they say the union's going to lower standards?"
In the campaigning, the administration enjoys a clear advantage. The union can't lobby in the hospital, but administrators can distribute flyers to workers at their stations and give them time off to attend "information meetings."
"Union contracts limit employees' options and flexibility," reads a typical flyer. "That is, if Children's nurses were to choose to be represented by a union, all of them would have to conform to the terms of its agreement, with no exceptions." The flyer says a union would force its members to depend on "someone else's 'voice.' Typically, it's the union's lawyers talking to the hospital's lawyers; does that really give nurses a voice?"
It also accuses unions of creating a setting in which "excellent performance may be discouraged. Pay often is based on longevity, not performance. Promotions often are based on seniority, not performance. Poor or marginal performers are frequently 'protected' by the union."
In addition, the hospital has been airing a video that features an antiunion nurse from Joliet telling the tale of a horrible 61-day strike at a local hospital that she blames on union recalcitrance.
Much of Children's strategy has been shaped by the Chicago-based law firm of Seyfarth, Shaw, Fairweather & Geraldson, which specializes in antiunion campaigns.
"Seyfarth has been employing typical union-busting tactics," says Kay Jones, a veteran INA organizer working on the Children's campaign. "It's almost a script--only the name's been changed to say Children's."
But hospital officials say they mean no harm with their strong words. "The hospital is not antiunion," says Macuga. "We simply want the nurses to make an informed choice."
Macuga says union activists have exaggerated the changes at Children's; only ten nurses have been laid off in the past two years, he says. And while some PALs have been hired, they are not actually so inexperienced, having completed a "rigorous five-week in-house training program. And we still have more RNs than PALs--the ratio's about 90 percent RNs to 10 percent PALs."
As for the committee of nurses, such a body already exists: "It's called our clinical governance model--over 150 nurses participate. They meet with people from administration so the nurses can make recommendations that are acted on. There's no need to bring in a union. A union is a third party that actually distances the nurses from administration."
But if the nurses don't need a union, why do administrators need Seyfarth?
"It's a very different situation. Seyfarth, Shaw has long been our employee-relations outside counsel. We have not hired them for this campaign. They are our attorneys, and like any other consultant they provide us with advice. But we still sit across the table from our employees."
Macuga's words hardly assuage union activists. "I think they're trying to subtly scare nurses into voting no," says Heald. "I think we'll win, but it will be close. Win or lose, something significant has already changed in how nurses view themselves and the hospital." o
Art accompanying story in printed newspaper (not available in this archive): Stephen Frum, Mary Ann Holland, Paul Baumann, Lynn Heald photo by J.B. Spector.