By Nadia Oehlsen
In early January nurses on the postpartum ward of the University of Chicago's Bernard Mitchell Hospital were handed "personal locators," tracking devices the size of card decks that were to be worn on cords around their necks, in their pockets, or pinned to their shirts. The locators feed signals to infrared sensors installed every 12 to 15 feet on the ceilings of the hallways, patients' rooms, and break and conference areas--everywhere but in the bathrooms and the manager's office. By constantly feeding data to a computer, the locator system allows anyone at a nurses' station to type in a name or rank and learn the whereabouts of any nurse or unlicensed nursing assistant on duty.
The devices were first distributed just hours after the nurses had approved a new contract, and they've been a source of contention between the hospital and the Illinois Nurses Association ever since. Hospital management says the system will get nurses to patients faster and cut down on intercom pages, creating a quieter environment. The union says nurses resent being monitored so closely. They fear the system will put them on a time-management treadmill and take away some of their discretion in treating patients, or help management find ways to replace some of them with unlicensed staff, or allow management to eavesdrop on them. "We knew we were going to get a new system," says one nurse, who asked not to be identified. "We had no idea they were going to be tracking us like animals."
The union says the system has already been used to check up on nurses. The nurses are often too busy to take scheduled breaks, so they've come up with solutions such as designating one person to pick up lunch for everyone while others care for her patients. According to several nurses on duty when the locators were first activated, the director of the postpartum and labor-and-delivery units, Sharon Broderick, sought out one nurse who'd gone to the cafeteria for her colleagues and told her that the system had logged her absent for 30 minutes, twice as long as permitted, and she'd have to make up the time. That's when some nurses went to Larry Basem, a registered nurse and labor relations specialist at the Illinois Nurses Association.
Basem says Broderick denied the conversation took place, though he says several nurses overheard it. Larry Volkmar, a hospital vice president and chief nursing officer, responds that Broderick spoke to the nurse because she was caring for the only patient approved for discharge that morning. "They needed that nurse to come back to discharge that patient," he says.
Basem wrote a letter to Diane Samuels, director of labor relations, claiming that putting in the locator system without first notifying the nurses was an unfair labor practice under the National Labor Relations Act. Volkmar counters that Broderick had discussed the locators with nurses at staff meetings last October and November. Yet one nurse says she knew nothing about them until she was handed one on January 7. She consulted other nurses, read the minutes of past staff meetings, and concluded that the information was there but vague and easy to miss. She says, "It was really brief and not very descriptive."
Basem says all but a handful of the nurses stopped wearing the devices in late January, and management didn't press the issue until late March. Union representatives demanded meetings, and for another two months both sides tried to reach an agreement about how the locators and the data they produced would be used. Basem says that the INA got management to agree in writing that the system's software would be set to always emit a warning tone when the intercom was activated, so that it couldn't be used for eavesdropping. "We said, 'We think that's great--it goes in the right direction,'" says Basem. "But we couldn't sign off on a signed letter, which included only that and a very general statement. We needed more detailed protections in place for the nurses."
The "very general statement" was that management wouldn't use the locator system or data "to interfere with or undermine the professional responsibilities of nurses." Basem says, "We couldn't figure out exactly what it meant, and that's why we didn't accept it as a counteroffer. We felt it was far too general, and virtually anything they wanted to do would be allowed under that very general language." (He says the INA also wanted the hospital to promise it wouldn't require nurses to pay for lost or damaged locators, which cost $65 to $80 each.)
"It's not my intent to use these for discipline," Volkmar says, though he adds, "I would not be above looking at locator data for that." He says the union is correct in asserting that management can't provide examples of nurses being disciplined for managing their time poorly before the locator system was in place. "That's a credit to the nurses, not a discredit to the managers," he says. "I think the nurses do a great job of caring for patients. I want this to be viewed as a way to help nurses."
Nurses were required to begin wearing the locators again on July 13. Shortly thereafter, according to one nurse, a manager chided an employee who didn't show up on the computer. "It turns out she was in the bathroom, where the locator doesn't track you," the nurse says. "That's the very thing they promised not to do with it."
In late July the INA distributed a one-page letter around the Hyde Park neighborhood describing the locator system and detailing how its data might be used. "Beyond tracking the nurses, this locator system...records in real time every detail of their movements," the letter said. "The Hospitals may use this tracking data to: justify further reductions in the numbers of nurses available to care for the patients; justify budgeting fewer hours of nursing care (less professional service) for a variety of illnesses and conditions; discipline nurses and other staff for alleged violations of Hospitals' policies."
The letter went on: "The Illinois Nurses Association has sought voluntary commitments from the Hospitals that would protect patients and nurses from abuses of the locator data. Without these protections, these locator devices are surveillance tools that will create an intolerable climate of suspicion. Without such protections, locator data could be misused to undermine the integrity of nursing judgment and the quality of nursing care....This is not a strike, a picket, or a withdrawal of services of any kind. Our goal is to simply inform the public generally and the Hyde Park community in particular about an issue that troubles us both personally and professionally as nurses."
When the union told management that it planned to distribute the letter, Volkmar responded by writing a letter to the nursing staff touting the benefits of the new locator system and noting that Rush-Presbyterian-Saint Luke's Medical Center uses a similar locator system. (Bob Mazzone, manager of electrical services at Rush, says he's heard no complaints from nurses there.) "New and efficient approaches to patient care will constantly be developed, and we will continue in our commitment to improve the quality of care we provide through the use of technology enablers," Volkmar wrote. "Normally, an implementation such as this would not require you to receive a letter from me. However, we have been notified by the Illinois Nurses Association of their intent to informational picket the Hospitals regarding this technological advancement."
The union interpreted Volkmar's letter as a veiled threat because nurses could be disciplined or fired for striking or picketing before their contract expires in April 2001. A letter to Basem from JoAnn Shaw, chief human resources officer of the U. of C. hospitals, was more direct: "We believe that any activity on INA's part or on the part of INA members to challenge the locator program other than filing a grievance and proceeding to arbitration will violate the contract and thereby subject INA and/or its members to liability."
Volkmar says he doesn't know if the union's distribution of the letter would constitute picketing; he says he's seen union handbills distributed only once before in his five years at the hospital.
Basem insists that handing out informational flyers isn't picketing. He claims that management showed bad faith by keeping quiet about buying the locator system until contract negotiations ended. "The hospital knew exactly what it was doing in this case. The timing was completely intentional. If this issue had arisen during contract negotiations, there's no doubt it would have resulted in an offer across the table--which means they would have had to immediately produce all kinds of information about it, and it would have affected the timing and nature of the final settlement. Now they're free to implement without our having any additional recourse. When the contract expires we can put a proposal on the table, and if we and the hospitals can't reach agreement, conceivably it can be the basis of a strike vote."
Volkmar responds that management didn't discuss the locators during the 11-month contract negotiations because technology issues have never been part of the nurses' contract. Management also notes that one reason the locators were needed was that 40 to 50 percent of patients who completed comment cards between October 1996 and August 1997 had complained that their needs weren't being met promptly. Basem counters that only 166 out of 3,235 patients completed the comment cards, too few responses to draw conclusions from.
Volkmar admits that the survey response was small, but he says the hospital has always received complaints from patients about too much noise from the former intercom paging system. He points out that administrators chose the postpartum unit for the locator pilot program because it has the largest area of all the units in the hospital and because sleeping newborns and their mothers could benefit most from a quieter environment. He adds that if someone can use the new system to find a nurse at a patient's bedside, and page only at a particular bed rather than across the entire ward, then "You're only interrupting one patient and one nurse."
But a nurse from the ward says that intercom pages are still necessary because nurses aren't always at patients' bedsides and because the new system often malfunctions. She says nurses in some hospitals carry cell phones, which she considers more effective than the locators. Patients can use their bedside phones to call the nurses directly, and nurses can better assess the urgency of the calls. The university hospitals had previously tried a system that used digital personal pagers, but it was soon abandoned because of technical problems.
Even when the new locator system seems to be working, Basem says, nurses have recorded instances when the locators showed them being someplace after they'd left. They also complain that the new system's software can be configured so that the standard warning sound won't go off when someone activates the intercom, which could allow eavesdropping. And they say that the intercom has turned itself on when no one activated it.
Volkmar concedes that the system still has some bugs, and he says management has considered other ways to reduce intercom noise on the ward. "We were doing this on digital pagers. People lost them right and left. We tried that for months and months." He says the digital codes were too complicated for staff to remember, but says new alpha-numeric pagers might prove useful if their cost drops. He also says that cell phones might be possible too, if their prices drop. "They weren't bad. They weren't cheap."
At $67,000, the ward's new locator system, made by Executone Information Systems in Milford, Connecticut, wasn't cheap either. (The company had been paid $980,000 to replace the entire hospital's call-light intercom system in 1996.)
"At some point there will be implementation of this technology for patients," Volkmar says. He says management still believes the locator system will decrease noise, increase staff efficiency, and get patients' needs met more quickly. "It'll be interesting to see if this is the right answer," he says. Soon the hospital will install a locator system in its labor-and-delivery unit.
Volkmar says the INA is creating a false impression that most nurses on the postpartum unit are wary of the locator system. "I'm sure it's very important to some of the nurses, and I'm sure it's important to the union staff representative," he says. "It doesn't look to me like the bulk of nurses have a problem with this."
The University of Chicago hospitals and the INA aren't the first to grapple with how staff locators should be used in hospitals. Hospitals in the Minneapolis-Saint Paul area began using them in 1995 and 1996, according to Kate Kline, a labor relations specialist with the Minnesota Nurses Association. "The nurses here are relatively comfortable with it," she says. The union has won ad hoc written agreements that limit how locator technology can be used from all of the metro hospitals where its members work.
"Essentially," Kline says, "our agreement says they're not going to use this information for discipline or evaluating people." The hospitals have agreed not to collect data or create a record of staff activity, not to gather information that could be used to analyze employee movement, and not to use data to document the whereabouts of staff or the time they spend in particular places. The locator system was also made a mandatory bargaining subject in contract negotiations; whenever the technology is added to a unit, management must first explain it to nurses so they can understand it and voice their concerns.
Kline suggests that such written agreements--similar to the one the INA is seeking--could alleviate the union-management tension in Chicago. "If they deal fairly with the employees and work it out, it won't be a problem," she says. "It's not really treating somebody as a professional when you watch them like that."
One nurse from the Bernard Mitchell postpartum unit concedes that the locator system is useful on her ward when it works. "We're not opposed to them using it as a locator," she says. "If you simply want to know where we are so you can give us some direction, that's fine. But they haven't been willing to put down in writing that that's all they're going to do with it, and we don't have a real good history with them doing the things they say they're going to do."
Art accompanying story in printed newspaper (not available in this archive): photo by Jim Alexander Newberry.