 2001 AJN Table of Contents
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Issues Update
American Journal of Nursing -
August, 2001 - Volume 101, Issue 8
Collective Bargaining Agreements
Current trends in RN contracts bring huge gains for nurses.
Nurses belonging to the United American Nurses (UAN), the labor arm of the ANA, have taken the lead in negotiating trend-setting collective bargaining agreements, winning significant gains in patient care, health and safety, and compensation. Some of the issues dealt with to date will likely serve as predictors of trends in the future.
Patient Care
The single most important issue being negotiated in current UAN collective bargaining agreements is inadequate staffing; in discussion are contractual measures designed to correct and help nurses cope with the consequences of too few nurses caring for too many patients. A contract between the District of Columbia Nurses Association (DCNA) and Howard University Hospital in Washington, DC, calls for the use of the ANA’s
Principles of Nurse Staffing to determine the appropriate staffing level. The principles address patient acuity, the physical environment of the unit, and patients’ unique needs. Last fall, to combat employer abuse of mandatory overtime, the DCNA waged a successful strike at the Washington Hospital Center that imposed strict limits on the use of forced overtime, securing—for all nurses—the right to refuse overtime due to personal illness, fatigue, or other extenuating circumstances.
Other UAN member states have also developed strong staffing language. The New York State Nurses Association (NYSNA) recently bargained for RN-to-patient staffing guidelines based on patient acuity levels and the number of RNs and non-RN personnel available to staff the unit, enforceable through arbitration. The nurses also are guaranteed regular patient census reviews.
The agreement between the Washington State Nurses Association (WSNA) and Northwest Hospital in Seattle requires the hospital to involve WSNA representatives, including the affected nurses, in proposed changes to nurse-to-patient ratios or staffing skill mix before changes are made. Changes made unilaterally by the hospital are subject to the grievance process.
The Illinois Nurses Association’s agreement with the University of Chicago incorporates the ANA’s
Principles of Nurse Staffing
and includes “rapid response” language, requiring management to respond to staffing concerns within 72 hours.
The Oregon Nurses Association’s recent agreement with Sacred Heart Medical Center in Eugene calls for a written hospital-wide patient staffing system, based upon acuity classification, for determining and measuring the effectiveness of nurse staffing. The required nursing care is based on patients’ aggregate and individual needs and is the primary consideration in determining the number and categories of nursing personnel needed. The staffing system pro vides for minimum numbers of RNs per unit and shift, and is regularly evaluated using patient outcome indicators and data from staffing request documentation forms.
Health and Safety
UAN states are in the forefront of negotiating strong health and safety contract language. For example, the Ohio Nurses Association negotiated innovative language dealing with presumptive compensability. When a nurse who has been exposed to blood or bloody fluids while on duty, and has reported the incident according to established guidelines, acquires a potentially fatal, debilitating disease, she may continue to work so long as she, her physician, and the hospital believe it safe. Incapacity for duty stemming from such circumstances is recognized in the contract as grounds for a workers’ compensation claim.
The DCNA has compiled an impressive record of achievement in the area of health and safety. At their various facilities DCNA nurses enjoy contract protections that include full expansion to a needleless system, a latex-free environment, and use of a modified work assignment program. DCNA has also bargained successfully on issues related to prevention of workplace violence and heightened facility security.
Compensation
Through much of the past decade registered nurses covered by collective bargaining agreements have typically negotiated annual wage increases in the 2% to 3% range. This is changing dramatically and reflects in part the new militancy nurses are demonstrating at the bargaining table. A few examples from recent settlements negotiated by UAN members indicate the scope of these wage gains.
The NYSNA, a national leader in compensation, is currently settling contracts with annual wage increases of around 5%. NYSNA-represented nurses with no experience have average starting salaries in excess of $50,000 a year and can earn more than $65,000 annually with 5 years or more of experience. After 25 years, nurse salaries can reach well over $90,000.
The Michigan Nurses Association (MNA), in an agreement with Borgess Medical Center in Kalamazoo, won annual increases of 9% per year and 27% over three years. Under terms of a new agreement with the University of Michigan, MNA nurses capped the number of hours of mandatory overtime at 16 per nurse per month, and negotiated an hourly rate of two and one-half times the normal pay rate for mandatory overtime.
Recent negotiations between the Illinois Nurses Association (INA) and the University of Chicago ended in an agreement giving nurses a 17.5% wage increase over two and one-half years. In comparison, nurses not represented by INA are seeing wage increases of around 3%.
Nurses represented by the Minnesota Nurses Association are the highest paid in the state, earning across-the-board wage increases of 4% to 5% statewide. Mid-contract wage re-openers are producing increases of some 7% to 8%, with new steps being added to the salary scale to retain experienced nurses. In the recently concluded Twin Cities multi-employer contracts, MNA won nearly 20% increases over three years, plus annual longevity bonuses and reduced health insurance premiums.
The recent WSNA contract with Virginia Mason Medical Center (VMMC) that provides wage increases of between 28% and 36% over three and one-half years is a path-breaking agreement. On top of these substantial across-the-board gains, WSNA also won increases in night shift differential, on-call, and preceptor pay. The most extraordinary aspect of the agreement, however, came in the area of longevity recognition where VMMC will credit newly hired nurses for all of their experience prior to being employed at VMMC, plus credit those who hold a BSN degree with two additional years and nurses with an MN or MSN degree with one additional year. VMMC also agreed to review all currently employed
nurses and credit them for all their years of service, whether at VMMC or elsewhere. Current VMMC nurses who hold or obtain a BSN will be credited with two additional years and nurses who hold or obtain an MN or MSN with one additional year. Unlike other contracts, there is no limit to the wage increases that could result from this review. Throughout the state, only WSNA-represented nurses enjoy this type of hiring parity.
Two other compensation aspects of RN contract settlements are noteworthy. First, employers appear more receptive to negotiating mid-contract wage increases. For example, the NYSNA recently encouraged management at facilities in Schenectady and Oneida to offer mid-contract wage sweeteners as both a retention strategy and a means to attract new nurses from a dwindling labor force.
The second notable phenomenon is the reappearance of signing bonuses. As hospitals across the nation scramble for RNs, nurses report to the UAN that the recruitment battle is turning into a bonus war. Skyrocketing bonuses are problematic, however, because they tend to create or intensify wage disparity among the affected nurses.
Future Trends
The Minnesota Nurses Association is setting the pace in patient care initiatives. In the Twin Cities agreements, MNA won the right for RNs to close a unit to new patients when too few staff are available to care for more patients. This landmark innovation to deal with excessive workloads could set a new direction in collective bargaining.
In the area of health and safety, there is growing interest among frontline nurses to protect themselves and their livelihood from work-related injury and illness. This concern is likely to intensify and become a dominant issue at the bargaining table. With few standards and only voluntary guidelines to fully protect nurses from the many hazards in their work environment, the need for strong contract language is all the more important.
The tight RN labor market is clearly a response to the deplorable working conditions many nurses confront daily. While it is unlikely that wage increases alone will induce more RNs to remain employed in nursing or return to the active labor force, adequate compensation is a step in the right direction.
Edmond Bronder is a senior policy fellow at the United American Nurses.
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