Agenda. The Numbers: Union Membership and Union Organizing in the U.S. in 2012 and Beyond. Presentation for the Wisconsin Rural Health Conference

Transcription

1 Presentation for the Wisconsin Rural Health Conference Union Organizing in an Era of Change: Healthcare Organizing in 2012 & Beyond Christopher Cimino, CEO Chessboard Consulting, Inc. June 28, 2012 Agenda 1. The Numbers: Union Membership and Union Organizing in the U.S. in 2012 and Beyond 2. Union Organizing in an Era of Healthcare Reform and Consolidation 3. National Nurses United: A Radical New Union for Registered Nurses 4. The Push to Mandate Staffing Ratios: Update & Review of Staffing Research 5. Why Collaboration is Better than Conflict: What Can Happen When Healthcare Workers Strike! 6. National Labor Relations Board Proposed Changes to Support Unions and Organizing 7. The Next Move: A Strategy for Reducing Vulnerability to Union Organizing The Numbers: Union Membership and Union Organizing in the U.S. in 2012 and Beyond

2 Union Membership Public vs. Private 40.00% 35.00% 30.00% 25.00% 20.00% Public Private 15.00% 10.00% 5.00% 0.00% Source: Bureau of Labor Statistics, percentage of union employees in public and private sectors, All RC Organizing and Elections Total RC Petitions Union win rate = 50% Union win rate = 65% Unemployment rate in 1998 = 4.2% Unemployment rate in 2012 = 8.3% Pre-EFCA period/obama election/great Recession Source: Labor Relations Institute, RC Petitions and Election 1993 to 2011 and National Labor Relations Board, Petitions and Elections Data. RC Petitions Filed Region Private Sector RC Petitions Filed in Region 13: 1993 to Rob Blagojevich elected Governor of Illinois Organizing in Illinois shifts to corporate campaigns and public sector organizing Pre-EFCA period/obama election/the Great Recession Labor Relations Institute, RC Petitions and Election 1993 to 2011 and National Labor Relations Board, Petitions and Elections Data.

3 Unions Representing Wisconsin Healthcare Employees 1. SEIU, Healthcare Wisconsin 2. AFT, Wisconsin Federation of Nurses & Health Professionals 3. Minnesota Nurses Association/National Nurses United 4. United Food and Commercial Workers (UFCW) 5. American Federation of State County and Municipal Employees RC Petitions Filed in Wisconsin 180 Private Sector - RC Petitions Filed in Wisconsin: 1993 to Organizing focus shifts to public sector Scott Walker elected Governor of Wisconsin Labor Relations Institute, RC Petitions and Election 1993 to 2011 and National Labor Relations Board, Petitions and Elections Data. Facts about Wisconsin Budget Law 1. Pensions: The law requires that public sector employees contribute 50 percent of the annual pension payment (5.8 percent of salary in 2011). 2. Healthcare: This law requires that state employees pay at least 12.6 percent of the average cost of annual premiums. 3. Collective Bargaining: The law limits collective bargaining for most public employees to wages (wage increases cannot exceed a cap based on the consumer price index (CPI) unless approved by referendum).

4 Facts about Wisconsin Budget Law 4. Collective Bargaining continued: The law limits public sector contracts to one year terms. Collective bargaining units are required to take annual votes to maintain certification as a union (struck down by federal court on 3/30/12). Employers do not collect dues and members are not required to pay (struck down by federal court on 3/30/12). Local law enforcement and fire employees, and state troopers and inspectors would be exempt from these changes. Facts about Wisconsin Budget Law 4. Collective Bargaining continued: The law repeals collective bargaining rights for State child care workers. The law repeals collective bargaining rights for employees of the UW Hospitals and Clinics. The law repeals collective bargaining rights for the faculty and academic staff of UW. Unions and Public Opinion A recent Gallup Poll found Americans more polarized by party affiliation than ever in their approval of organized labor. In 2008, a Gallup poll reported that roughly 59% of Americans approved of labor unions (about the same as did in 1978). By August 2009, Americans approval for unions had fallen to just 48%.

5 Union Organizing in an Era of Healthcare Reform and Consolidation The Outlook for Healthcare: A Replay of the Late 90s? Hospitals are being required to cut costs and consolidate services to react to both short-term and long-term reductions in reimbursement. For example, some hospitals are dealing with: 1. Increases in the number of uninsured or under-insured patients, a problem related to long-term unemployment. 2. Weak demand by insured patients, driven by economic uncertainty. 3. State budget cuts and changes to Medicaid reimbursement. 4. Uncertainty around healthcare reform. 5. Uncertainty regarding current deficit reduction and further cuts to entitlements. Unions Offering Employees A Seat at the Table In , unions took up healthcare reform as an advocacy issue and were largely responsible for helping to elect the people who passed the Affordable Care Act. During the healthcare reform debate, one thing that all unions publically supported was a reduction in the cost of healthcare for consumers. Roughly 60% of a hospital s costs are for labor. So, it is unlikely that reform will succeed in reducing costs without curbing the growth of healthcare employers labor costs. What does healthcare reform mean for healthcare employers dealing with organized labor? 1. Unionized employers will face more contentious negotiations, increased grievances and arbitrations as unions resist cuts. 2. Organizing in healthcare will increase as non-union employees are drawn to unions who promise to protect them from the varying changes healthcare reform seeks to promote.

6 National Nurses United: for Registered Nurses A Radical New Union RN Unionization Rates Source: Bureau of Labor Statistics, percentage of union represented RNs, NNU in 2011, by the Numbers In 2011, NNU: 180, , , , ,000 80,000 60,000 40,000 20,000 0 NNU, Membership NNU was formed at the end of 2009, the result of a merger between the California Nurses Association, Massachusetts Nurses Association and United American Nurses (i.e. MNA) 2. Today, NNU has 165,000 total members. 3. Dues charged vary by affiliate (e.g. MNA charges 2 times the employee s base rate, at $35.00 per hour, dues = $70.00 per month or $ per year). Source: NNU filed LM-2 reports, NNU claimed roughly 60 employees (payroll $2,270, and benefits $162,157.00) totaling $2,432, in payroll/benefits.

7 NNU Increasingly Aggressive on Ratios, Magnet and Health Information Technology Over the past several years, leaders of the CNA and NNU have become increasingly hostile toward healthcare leaders and aggressive in: 1. Advocating for mandated minimum nurse-to-patient staffing ratios; 2. Attacking the Magnet Process and Shared Governance; and, 3. Questioning the use of Health Information Technology. The CNA and NNU have branded central management practices like shared decision-making as schemes or deceptions, and offered unionization and collective bargaining as the only real solution. NNU on Scripting and Rounding The NNU s latest warning to Registered Nurses has been about what they refer to as rounding and scripting customer service initiatives: Along with shared governance schemes and new technologies, many hospitals are now introducing scripted rounding schemes. As nurses, we are able to assess whether or not the care we re able to provide is safe, therapeutic and effective, and whether or not there are barriers [like unsafe staffing] to our ability to provide care. The focus on patient satisfaction is misguided because patients and their families are generally NOT qualified or sophisticated enough to make a determination about quality indicators. The apparent goal of the Studer scheme is to single out nurses, routinize their communications with patients, and provide unscrupulous employers a means for selectively evaluating (through surveillance) employees compliance and competence in implementing the employer s behavior standards. NNU on Scripting and Rounding In the second installment of their piece criticizing rounding and scripting, the NNU focuses on A.I.D.E.T. (a scripting process used by the Studer Group). AIDET stands for: Acknowledge the patient; Introduce yourself; discuss Duration; provideexplanation; saythank you. Where the danger lies in this scheme is that the RN becomes overscripted and is pressured to adhere to a script and so ceases using critical thinking skills and focusing on the individual needs of each patient. Why is all this necessary? Money! Patient satisfaction scores, rather than patient outcomes, have become a major driver of the corporate healthcare agenda. Rounding and other patient satisfaction schemes do nothing to improve actual therapeutic patient outcomes. They are short-sighted and are aimed at manipulating patients and visitors that staffing is adequate. In the August 2 nd CE class, NNU representatives translated this customer service initiative as: Asinine; Insulting; Demeaning; Egregious; Torture.

8 NNU on Rapid Response Teams (June 2011) Since 2004, over 2,700 hospitals have implemented Rapid Response Teams (staffed with ICU-level clinicians) to prevent avoidable death and improve patient outcomes. NNU representatives have branded this approach another safety scheme that is penny wise and pound foolish. NNU representatives maintain that: Instead of placing the patients in a higher level of care based on their severity of illness and acuity, patients are admitted on medical-surgical units and cared for by nurses who do not have demonstrated competencies Prior to market driven corporate healthcare, direct care RNs generally had the required unit specific competencies and were supported by a Charge Nurse or Clinical Nurse Specialist. Compare this to California s safe staffing standards all California hospitals must first budget for the mandated ratio threshold which includes budgeting for meals and rest break relief and relief when RRT responds to a STAT call The RRT approach is not scientifically validated blatantly disregards studies finding an association between staffing levels and failure to rescue. Unlike the ratio solution, there is no empirical evidence validating the beneficial effects of rapid response teams National Standards: Standardizing Bargaining Demands On May 11, 2010, the NNU issued a Resolution on National Contract Standards because the healthcare industry continues to demand concessions in pursuit of a greater economic bottom line and increased control over its nurses and other staff and patient care practices. These standards emphasize the following demands: 1. Enhanced staffing (ratios and language to enforce ratios). 2. Restrictions on floating. 3. A ban on mandatory overtime. 4. Mechanisms to contain exposure of patients and nurses to pandemics and communicable diseases. 5. Improved retirement security through defined benefit plans (i.e. pensions). 6. Limits on introduction of new technology that displaces RNs. MNA vs. Twin Cities Hospital Systems The MNA s contracts covering 12,000 nurses working for six hospital systems (Allina, North Memorial, Health East, Methodist, Children s and Fairview) expired on June 1 st,2010. On May 19 th nurses voted to authorize a one-day strike set for June 10 th. MNA Demands: 4% in each year, 3% annual step Unit-based ratios Limits on the use of technology Limits on floating Proper equipment and planning for pandemics We have from the very beginning tried to get ratios through using legislation, but we were turned away based on a lot of lobbying by the hospitals. We were told to take this issue to the negotiating table, and we have. Laurie Bahr RN and Bargaining Team Member, Abbott Northwestern Hospitals

9 MNA vs. Twin Cities Hospital Systems The Twin Cities hospitals felt strongly that ratios are an outdated notion in light of the superior patient outcomes, quality of care and safety hospitals have already achieved. The hospitals reported needing more flexibility instead of more rigid work rules. Hospital Objectives: Reduction in citywide pension (from 1.7% to 1.2%). Greater ability to float nurses across units and campuses. Wages: 0%, 1% and 2%. "The community right now is asking us to have better quality of care and keep it at a reasonable cost, and this doesn't do either. In the Twin Cities it would cost about $250 million to hire enough nurses to meet the union's demands [with no evidence that there would be any positive impact on quality]. We really do see the NNU National agenda as a barrier in contract negotiations. Maureen Schriner, Spokeswoman for the Twin Cities Hospitals Surprise Settlement Announced on June 30th On July 1 st, the MNA released the terms of the settlement in which both sides made significant concessions: 1. Pensions unchanged. 2. No changes to floating, benefits eligibility, health insurance or on-call. 3. Wages: 0%, 1%, 2%. 4. No staffing ratios were negotiated. 5. All ULPs withdrawn. MNA: Pushing for Staffing Legislation 1. The MNA has returned to the legislature to seek minimum staffing ratio legislation. 2. Over time staffing legislation being proposed in many states is even more restrictive than previous versions. 3. The staffing language will most certainly come up again in the next round of negotiations between the MNA and Twin Cities hospitals.

10 For NNU an Important Step Forward In May 2005, the California Nurses Association (CNA) through their national group, the National Nurses Organizing Committee (NNOC) won the right to represent 1,800 nurses in the Cook County Health System (CCHS). Although CNA/NNOC did successfully negotiate one contract, the nurses at CCHS have now been working without a contract since November On May 20, 2010, National Nurses United (NNU) won the right to represent nurses at the University of Chicago Medical Center (UCMC). On June 3, 2011, NNU announced a new contract settlement with UCMC which includes: Staffing: 16 new patient care support nurses to assist with admissions, discharges and relief for meal and rest breaks. Professional Practice Committee: RNs elected by their peers to meet with management on patient care issues. Rotating shifts and low census: Limits rotation to two night shifts every six weeks. Scheduling preferences will be given to UCMC RNs over agency in times of low census. Wage increases of 15%: 3% in 2011; 3% in 2012; 4% in 2013; 3% in Senior nurses >16 yrs. received an additional 2% increase (April 2011). The Push to Mandate Staffing Ratios: Update & Review of Staffing Research Staffing Research To date, the following studies have been published related to California s minimum nurse-to-patient staffing ratio legislation: 2005/2007 The Collaborative Alliance for Nursing Outcomes (CALNOC, formerly known as the California Nursing Outcomes Coalition) found no direct link between mandated staffing ratios and improvements in quality as measured by two nursing sensitive quality indicators (i.e. falls or hospital-acquired pressure sensitive ulcers). The CALNOC studies did find that in response to ratios, California hospitals put more resources toward nursing care hours, while dramatically reducing hours of other ancillary employees California Healthcare Foundation (CHF) studies point to problems with implementation (i.e. loss of autonomy and support) and increased costs to healthcare providers Linda Aiken study (based on surveys mailed to 80,000 nurses in California, New Jersey and Pennsylvania) found California ratios resulted in lower patient mortality and greater nurse retention. Aiken maintains that if ratios in New Jersey and Pennsylvania were equal to ratios in California, the predicted probabilities indicate a likelihood of fewer surgical deaths in NJ and PA.

11 Health Affairs Study, July 2011, Aiken Study A study published on July 17, 2011 in Health Affairs, examines nurse staffing ratios for California hospitals for the period Study findings: 1. Registered nurse staffing measured as hours per adjusted patient day was, on average, higher in California hospitals compared to other states examined. 2. The skill mix in California hospitals did not decrease (i.e. reflect a higher percentage of LVNs) following the implementation of the staffing ratios legislation as was originally feared. 3. The California ratios seem to have resulted in an additional half-hour of nursing care per adjusted patient day beyond what would have been expected in the absence of the staffing mandate. 4. Researchers point out, For the fourteen states that, as of March 2011, had some form of nurse staffing legislation proposed or under study, our findings demonstrate that higher nurse-to-patient ratios can be achieved through a policy design featuring a fixed ratio mandate. This study brings home once again what California nurses could readily tell you. Deborah Burger, Co-president of National Nurses United New England Journal of Medicine, March 2011, Needleman and Buerhaus Published in March 2011, this study examines the association between mortality and patient exposure to nursing shifts during which staffing by RNs was 8 hours or more below the staffing target. Study findings: 1. Patient mortality risks increased as patients were exposed to shifts in which RN staffing was 8 hours or more below targeted staffing levels and/or where there was high patient turnover (e.g. admissions, discharges, transfers, etc.). 2. For hospitals that generally succeed in maintaining staffing levels consistent with patient needs, this study underscores the importance of flexible staffing practices that consistently match staffing to patient needs. 3. Study findings suggest that nurse staffing models that facilitate shiftto-shift decisions on the basis of an alignment of staffing with patient needs and the census are an important component of the delivery of care. Staffing Research in Summary To date, the vast body of research around ratios has focused on different variables and has employed different methodologies. Summing it all up: 2005/2007 CALNOC found no direct link between mandated staffing ratios and improvements in quality (i.e. falls or hospital-acquired pressure sensitive ulcers). But did find that in response to ratios, California hospitals put more resources toward nursing care hours and reduced hours of other ancillary employees CHF studies point to problems with implementation (i.e. loss of autonomy and support) and increased costs to healthcare providers Aiken study found California ratios resulted in lower patient mortality and greater nurse retention Aiken study found California ratios increased RN staffing and did not result in reduced skill mix and 2011 Needleman/Buerhaus advocate a focus on nurse engagement and maintaining flexibility in staffing to match staffing to patient needs.

12 Why Collaboration is Better than Conflict: What Can Happen When Healthcare Workers Strike! Strike Histories: CNA vs. Other SNAs 70 Number of Strikes by SNA Source: Labor Relations Institute, work stoppage database, strikes involving state nursing associations, 1990 to present. Do Nursing Strikes Kill Patients? Evidence from NY State Employees working at acute care hospitals were not formally given the right to organize until 1974 because of substantial fears about the effect hospital strikes would have on patients. Research conducted by MIT professor Jonathan Gruber analyzed data collected on hospital strikes in New York during a 20-year period (1984 to 2004). The results of Gruber s research: Patients admitted to a New York hospital during a nursing strike (between 1984 and 2004) suffered a 19.4% higher rate of inhospital mortality and were 6.4% more likely to require readmission within 30 days.

13 CNA/NNU vs. Sutter Health On September 22, 2011, 29,000 nurses and other caregivers struck 34 hospitals in California. The one-day strikes against Sutter and Kaiser facilities were a coordinated effort by the California Nurses Association/National Nurses United; the National Union of Healthcare Workers and the International Union of Operating Engineers, Local 39. Sutter nurses were striking over protracted collective bargaining negotiations for renewal of expired contracts and over concessions management sought over sick time and health benefit contributions. Sutter warned nurses that they would be locked out for a minimum of five days due to arrangements with agencies that supply replacement nurses. Nursing Strikes and Patient Mortality On September 24, 2011, a replacement nurse reportedly gave a patient being treated for ovarian cancer a nutritional supplement intravenously rather than through a feeding tube. At the Sutter facilities, nurses struck to protest demands for contract concessions involving sick leave and healthcare coverage for both RNs and their families. The CNA/NNU was quick to blame the hospital for locking nurses out. The hospitals pointed out they would not have had to hire replacement nurses if the CNA/NNU had not struck the hospital. After the strike, both sides returned to the bargaining table. On December 22, 2011, the CNA/NNU again struck eight Sutter hospitals including Sutter s Alta Bates Summit Medical Center, the very same facility that suffered the medication error and patient death. There is still no contract settlement between Sutter and CNA/NNU. National Labor Relations Board Proposed Changes to Support Unions and Organizing

14 The National Labor Relations Board Important Facts about the NLRB: The NLRB is a five-member panel (quasi-judicial body deciding cases based on facts and precedent), appointed by the President to five-year terms (with Senate consent or by recess appointment). The five-member board consists of two Republicans; twodemocratsandachairman(whoisofthesame political party as the President), which makes the Board an inherently politically charged entity. In early January, President Obama made three recess appointments to the NLRB; these appointments are currently being challenged. The NLRB currently has five members: Mark G. Pearce (D) Sharon Block (D) Richard Griffin (D) Brian Hayes (R) Terrence Flynn (R) The Employee Rights Poster Beginning April 30, 2012, the NLRB will require employers to post an 11x17 notice of employee rights under the National Labor Relations Act. The current Board apparently believes that many employees protected by the NLRA are unaware of their rights under the statute. The intended effects of this action are to increase knowledge of the NLRA among employees, to better enable the exercise of rights under the statute, and to promote statutory compliance by employers and unions. The NLRB on Facebook, YouTube and Twitter The NLRB is engaging in a modern outreach and education strategy aligned with the contemporary workforce and workplace

15 NLRB and Social Media On January 24, 2012, the NLRB General Counsel (GC) issued his second report on social media. The GC continues to view employees use of social media as a tool to engage in protected concerted activity - a right which is covered under the NLRA: The NLRB GC has now released two reports on Social Media: August 11, 2011 and January 24, No protection for individual gripes. 2. An employee acts in concerted activity if the worker acts with or on the authority of other employees and not solely by and on behalf of the employee himself. NLRB and Social Media The NLRB GC has now released two reports on Social Media: August 11, 2011 and January 24, 2012 Based on NLRB guidance, here are some examples of social media policies that would likely be viewed as overly broad: 1. Prohibiting employees from making disparaging comments when discussing the company or the employee s supervisors, co-workers or competitors. 2. Prohibiting gossip and discussions regarding the company s business and/or its employees. 3. Prohibiting any communication that constitutes embarrassment of the employer, employees, board members, etc. 4. Prohibiting the use of language or action that is inappropriate or of a generally offensive nature, and rude or discourteous to a client or co-worker. 5. Prohibiting the employee from using the company name, address, or other information. NLRB and Specialty Care In Special Healthcare the NLRB determined that a petition for a single job classification (e.g. Certified Nursing Assistants) in a long-term care facility was appropriate. In Specialty Healthcare, the Board rejected the long standing community of interest standard in favor of a standard that requires the employer to show an overwhelming community of interest. On December 30, 2011, the NLRB applied the Specialty Care case (i.e. the overwhelming community of interest standard) in a case involving 31 rental car service agents. There are two steps post Specialty Care which now apply: 1. Assess whether employees in the petitioned-for unit share a community of interest; 2. If so, the employer must show that employees it seeks to add (to the petitioned-for unit) have an overwhelming community of interest -such that there is no legitimate basis upon which to exclude certain employees because the traditional community-of-interest factors overlap almost completely.'

16 NLRB Revised Election Process Petition Filed On December 21, 2011, the NLRB announced eight specific amendments to NLRB case-handling procedures which will result in the following changes, effective April 30, 2012: 14 days Stipulation of Unit and Election Date 7 days Excelsior List Due days NLRB hearings will be expressly limited to determining whether a question concerning representation (QCR) exists (i.e. whether or not the union has petitioned for an appropriate unit). Where a QCR exists, NLRB hearing officers will have the authority to limit testimony to relevant issues and to decide whether or not to accept post-hearing briefs (and on the content and timing of such briefs). Election Where a hearing is held, the NLRB will eliminate the requirement that elections be scheduled at least 25 days from the Decision and Direction of election. Also, all appeals of NLRB Regional Director decisions will be consolidated into a single post-election request for review, which will be discretionary (meaning the full Board could accept or reject the request). The Next Move: A Strategy for Reducing Vulnerability to Union Organizing A Strategy for Reducing Vulnerability Building a Culture of Collaboration/Engagement 1. Use patient-care committees and shared decision-making practices to provide nurses a meaningful voice in staffing and clinical practice. 2. Aggressively address any potential problem areas/departments. 3. Conduct surveys/climate assessments now, ahead of new DOL rules. Building Trust and Credibility 1. Leverage a robust communications strategy to build trust and credibility with staff at all levels of the organization. 2. At the unit/department level, leverage communication and rounding to gain employee buy-in and acceptance for organizational policies and decisions. Preparing for Healthcare Reform 1. Develop and implement communication strategies that actively engage all leaders around change issues (i.e. healthcare reform, consolidation, cost-cutting, etc.). 2. Add/preserve resources at the bedside (match census fluctuations to resources). 3. Focus on workload and outcomes instead of numbers (i.e. ratios).

17 A Strategy for Reducing Vulnerability Preventative/Strategic 1. Establish/re-vitalize communication response teams (i.e. Communication Resource Teams). 2. Review policies and compliance (i.e. no solicitation/no distribution, social media, meal breaks/lunch periods, employee access to the premises when not scheduled to work, etc.). 3. Review job descriptions and bargaining units. 4. Conduct union awareness training for leadership. 5. Ensure all managers and security personnel know how to respond appropriately to unauthorized visitors. Questions?