Labor experts: Nursing union strikes deploy unique strategies

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PITTSFIELD — Nobody likes upheaval at a local hospital. And nobody likes what appears to be a stingy employer, or a greedy nurses union.

Labor experts say these are just two factors that can help break an impasse like that between Berkshire Medical Center and the Massachusetts Nurses Association.

But after today's one-day strike and a four-day lockout, it might take time.

First, there will be continued discord, they predict, amid this week's labor action.

Registered nurses are different from other industry employees ready for a walkout, according to three academics who study labor issues.

How so?

Their skills make them indispensable in an increasingly complicated modern medical environment. They stand between life and death. They are the largest group of employees in a hospital, and it can't function without them.

"Nurses have a kind of unique strength," said John August, who specializes in healthcare labor relations at the Scheinman Institute on Conflict Resolution at Cornell University's New York State School of Industrial and Labor Relations.

But another expert, from Harvard University, notes that unions have a duty not to alarm the public.

August said it is their numbers and skills that can give a nursing union the influence needed to bring about compromises and concessions.

"Hospitals and communities want to keep their homegrown nurses, and everyone ultimately wants to get back to work," he said.

"Nursing is a very complex job and new recruits are willing and able to learn, but learning all the complexity in today's hospitals is very difficult, and the turnover rate of newer nurses is very high. Keeping staffing at appropriate levels is just hard," he said.

This nurse shortage is another factor.

"Most hospitals are staffed by veteran nurses," August said. "And they are the ones who recognize when there is unsafe staffing [levels]."

MNA called Tuesday's strike for its nearly 800 BMC members after 22 bargaining sessions since last fall hit a deadlock, mainly over the union's demand for increased staffing.

This is the union's third strike in Massachusetts this year. Both the Tufts Medical Center and Baystate Franklin Medical Center strikes, in Boston and Greenfield, were called on the same patient safety issue flagged by the union. None of the parties have reached agreements.

While wages and benefits were one area of disagreement, it is this nurse-to-patient ratio that is the union's battle cry.

But Berkshire Health Systems, the Pittsfield hospital's parent company, says rigid staffing levels are "impractical and unaffordable." And the company says its nurse-to-patient ratios meet or exceed nursing industry standards.

August said the staffing ratio debate will have to give if the Pittsfield contract is to be settled. He also said the success of that depends on the existing relationship between union and hospital.

"The MNA is a strong union that isn't going to back down from these kinds of fights," he said. "The nurse union says, `You may have that power, but is that really in best interest of patients?'"

It is indeed in their interest, said David Schildmeier, a spokesman for the MNA.

"This [strike] is a warning," he said. "[It says] `This is how serious we are.'"

Schildmeier said this is a long game, as were the Tufts and Baystate Franklin strikes. While strikes may not have an immediate impact on negotiations, they rally community support and put pressure on hospital management.

"Every political official of every stripe came out in support of us," he said of the Tufts strike. "It is not an open-ended strike but one to raise awareness, and that was accomplished."

Yet in the case of BMC, local politicians and state lawmakers haven't yet taken a position, according to Schildmeier.

"We've reached out to them, and we continue to reach out," he said. "It's early."

Too much power?

Barry Dorn, a lecturer and associate director of the Program on Health Care Negotiation and Conflict Resolution at Harvard School of Public Health, said he thinks the union's recent strikes are all about wages.

"They've got us because they talk about our lives," Dorn said. "You just don't abandon human beings [in a hospital]. If we're talking about money, just say it."

"You're dealing with human beings, so the sympathy is always with the nurses," he said.

Dorn added that perceived overwork and unsafe conditions should be addressed, if they are present.

BMC officials have said they believe the union's strike is part of an effort to win public support for a possible 2018 ballot vote on staffing ratios — a charge the union rebuts.

Dorn said unions in the U.S. have negotiated strong nurse-to-patient ratios, and other policies to their benefit. But he cautioned that the union's actions can put a hospital in jeopardy.

"I don't believe that the public realizes that [the hospital is] in the business to make money so they can stay open and serve the public," he said.

The way out

Kate Bronfenbrenner, a senior lecturer and director of Labor Education Research at Cornell, said it's up to a union to marshal outside backing.

"You build community pressure, an escalating campaign involving community allies, churches, politicians, patient groups, senior citizens groups," she said.

It also depends on how well the union has approached hospital donors, board members and other decision-makers.

"It's thinking bigger — who are the people that really matter to the hospital? — and talking to them about the future of hospital," Bronfenbrenner said.

She said mediators, required by law when a healthcare strike is called, aren't usually that helpful.

"A manipulative mediator hurts, a good mediator can't help much," she said. "Mediators are supposed to stop strikes, so they might go to the union, then the employer, and say `trust me' — they might manipulate what each side says, so the union will lower their bottom line. Sometimes they manipulate the unions into settlement."

But a particular community can also be a deciding factor. Bronfenbrenner said public opinion in a "small and progressive" area — places like Berkshire County, she added — can make a difference.

"In the end it's union strategy, strength, the democracy of the union and how it frames its issues," Bronfenbrenner said.

Reach staff writer Heather Bellow at 413-329-6871


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