4,000 Kaiser mental health clinic workers launch 5-day strike in California


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Four thousand California mental health clinicians began a five-day strike Dec. 10 to protest what they call understaffing issues that lead to long wait times for therapy appointments.

The strike affects more than 100 Kaiser Permanente clinics and medical facilities, according to the National Union of Healthcare Workers, which represents psychologists, therapists, social workers, addiction medicine specialists and other mental health clinicians.

Workers are striking at Los Angeles Medical Center, Anaheim Medical Center, Fontana Medical Center, San Diego Medical Center, Fresno Medical Center, Sacramento Medical Center, San Francisco Medical Center and San Jose Medical Center.

“The situation inside Kaiser clinics has become untenable,” said Kenneth Rogers, a psychologist for Oakland, Calif.-based Kaiser. “We don’t have enough hours in the day to see patients and do all the preparation and follow-up work that goes into every appointment. Patients are suffering and unable to access clinically appropriate care.”

Union president Sal Rosselli told The Mercury News mental health workers also seek benefits and pensions that are equal to what about 100,000 other Kaiser employees receive.

John Nelson, vice president of communications at Kaiser Permanente, expressed disappointment about the strike.

“We are disappointed the leadership of the National Union of Healthcare Workers would ask our highly valued mental health staff to go out on strike, when we’ve been in active negotiations since the summer, having met in 16 bargaining sessions over five months, and with two more bargaining sessions scheduled for next week,” he told Becker’s last month.

“There are no takeaways in our contract proposal,” Mr. Nelson said. “We are offering guaranteed wage increases which would keep our expert therapists among the best compensated in their profession and continue to ensure that we attract and retain the most highly skilled professionals.”  

Kaiser told The Mercury News its medical centers and medical offices are scheduled to remain open during the walkout, although “some nonurgent mental health and other appointments may need to be rescheduled.”




300 nurses walk off job at Pennsylvania hospital


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More than 300 Indiana (Pa.) Regional Medical Center nurses went on strike on Nov. 26, according to a KDKA report.

Nurses walked off the job at 7 a.m., despite hospital leaders previously asking them to cancel the strike due to the $1.5 million in estimated costs to hire temporary workers.

Nurses initially scheduled a one-day strike. But hospital leaders have said striking nurses who don’t report to work Nov. 26 won’t be able to return to work for an additional four days because of a minimum five-day commitment required to hire temporary staff.

According to the report, no scheduled surgeries and appointments were canceled due to the strike.

The hospital has been in negotiations with the Indiana Registered Nurses Association, which represents about 380 nurses at the hospital. Health insurance costs and wages reportedly have been key sticking points in the negotiations.

Both sides are scheduled to return to the bargaining table Nov. 29.

UVM Medical Center, nurses reach tentative labor deal


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University of Vermont Medical Center in Burlington has reached a tentative contract agreement with the union representing about 1,800 licensed practical nurses, registered nurses and nurse practitioners.

The three-year tentative agreement, reached Sept. 19, includes a 16 percent average base salary increase over the life of the contract, according to hospital officials. They said raises for ambulatory nurses will be retroactive to the first pay period in September.

Additionally, the Vermont Federation of Nurses and Health Professionals conceded on its previously proposed increases to certain shift differentials as part of the deal.

The tentative agreement comes after six months of bargaining and demonstrations by nurses, including a 48-hour strike in July. Both sides said they were pleased they were able to make progress.

“We are looking forward to implementing the many positive changes that result from the new contract, which will enhance patient care, provide additional support for nurses and allow for new opportunities to advance the nursing profession,” hospital officials told Becker’s.

Molly Wallner, lead negotiator for the union, said: “We are proud of the unity, strength and perseverance our nurses have shown. This has been a long and difficult road for all of us, and we are proud of what we have accomplished. Our fight for patient safety is not over, and we will continue that fight through the [state] legislature.”

Nurses are expected to vote on the tentative agreement soon.



Rhode Island hospital workers encouraged to seek jobless benefits during lockout


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United Nurses and Allied Professionals Local 5098, the union representing 2,400 workers at Rhode Island Hospital and Hasbro Children’s Hospital in Providence, is encouraging members to apply for unemployment during a lockout, according to WPRI.

The workers, which include nurses, technicians and therapists, began a three-day strike about 3 p.m. July 23. They were willing to return to work at 3 p.m. July 26. However, Lifespan said it will not allow the workers to return until July 27 because of a commitment to  temporary staff hired during the walkout.

Norman Farias, RN, executive vice president of UNAP Local 5098, told WPRI the union is encouraging workers to apply for unemployment for the 24 hours ending at 3 p.m. July 27 “because this is a day they would be working, and the hospital’s telling them they can’t.”

It is unknown whether workers’ claims will be approved by the Rhode Island Department of Labor and Training.

According to hospital officials, the union was notified about the hospitals’ four-day commitment to temporary staff on July 13.



Massive UC workers’ strike disrupts dining, classes and medical services


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A massive labor strike across the University of California on Monday forced medical centers to reschedule more than 12,000 surgeries, cancer treatments and appointments, and campuses to cancel some classes and limit dining services.

More than 20,000 members of UC’s largest employee union, the American Federation of State, County and Municipal Employees Local 3299, walked off their jobs on the first day of a three-day strike. They include custodians, gardeners, cooks, truck drivers, lab technicians and nurse aides.

Two altercations involving protesters and people driving near the rallies were reported at UCLA and UC Santa Cruz. At UCLA, police took a man into custody Monday after he drove his vehicle into a crowd, hitting three staff members. They were treated for minor injuries at the scene and released, said Lt. Kevin Kilgore of the UCLA Police Department.

The system’s 10 campuses remained open, largely operating on regular schedules, and protests were peaceful and even festive.

At UCLA, workers marched through campus in green union shirts that said “We run UC” and held signs calling for equality, respect and more staff. Some brought children and walked dogs. Drivers honked in solidarity. Hundreds of workers rallied in front of the Ronald Reagan UCLA Medical Center, taking taco breaks under green balloons.

Oscar Rubio, a UCLA food services worker, said that staffing at some dining hall stations has been cut from five workers to three, leading to more injuries for those who remain.

Top UC officials “make more money … while we suffer,” Rubio said. “We’re not asking to make like they make. We’re asking to support us enough to pay our rent.”

The walkout is expected to widen Tuesday, when two other unions will join sympathy strikes. About 14,000 members of the California Nurses Assn., who work at UC’s medical centers and student health clinics, are set to walk off their jobs, along with 15,000 members of the University Professional & Technical Employees, who include pharmacists, clinical social workers, physical therapists, physician assistants and researchers.

The union and university reached a bargaining impasse last year. Subsequent mediation efforts have failed to produce an agreement on wage increases, healthcare premiums and retirement terms. A recent union study on pay disparities angered workers, said AFSCME spokesman John de los Angeles. The study used UC data, union officials say, to show that starting wages of blacks and Latinos were about 20% lower than white workers in comparable jobs.

“The strong showing sent a clear message to administrators that our workers are very concerned about inequity and they’re willing to be on the picket line until UC comes up with a proposal to address their concerns,” De los Angeles said.

UC officials say they cannot confirm the study’s accuracy. They criticized the union’s demands, which include a multiyear contract with annual pay raises of 6%, no increase in healthcare premiums and continued full pension benefits at the retirement age of 60. The university is offering 3% annually over four years, which officials say is equal to raises given to other UC employees. UC also wants to raise the retirement age to 65 for new employees who choose a pension instead of a 401(k) plan and to raise monthly health insurance premiums by a maximum $25.

“Unfortunately, the only thing union leaders accomplished today is hurt the care we provide our patients and the services for our students,” UC spokeswoman Claire Doan said in an email Monday. “It will do nothing to change UC’s position on AFSCME’s unreasonable demands for excessive raises and benefits.”

At UC’s request, a Sacramento County Superior Court judge issued a temporary restraining order Friday barring certain essential employees, such as pharmacists and respiratory therapists, from participating in order to protect public health and safety. AFSCME also assembled a “patient protection task force” to respond to life-threatening emergencies.

UC’s five medical centers hired contract workers to fill in during the strike and scrambled to reschedule exams and treatments. UC San Francisco rescheduled more than 12,000 appointments for surgeries and treatments, including chemotherapy and radiation.

UC Davis rescheduled several hundred appointments, including more than 100 cancer surgeries and 150 radiology exams. But campus spokeswoman Kimberly Hale said 78% of UC Davis health workers showed up for work. UC San Diego directed emergency room patients to other hospitals.

At UC Santa Cruz, where more than 150 protesters assembled at both entrances Monday, Chancellor George Blumenthal canceled most morning classes. Services were limited for hours at the student health center and some libraries and dining halls. Santa Cruz Metro buses did not enter the campus, dropping riders off at the entrance.

Samuel Walcoff, a sophomore studying computer science, said he had to trek up the hills to get to his afternoon lab and scrounge for food.

“I’m not at all opposed to people protesting and striking, but to have students who are powerless pay the price is extremely unfair,” he said.

At UC Berkeley, however, freshman Ella Smith said she supported the workers even though there was no Peet’s Coffee service inside the Golden Bear Cafe.

“Us not getting our morning coffee does not compare to the injustice UC workers face due to the inequity and inequality in their work experience,” she said in an email.

Some faculty members chose to teach off-campus to avoid crossing the picket line or to use the strike to discuss labor rights.

Paul Spickard, a UC Santa Barbara professor, has invited striking workers to speak Tuesday to the more than 300 students in his modern world history class.

“The UC system has been starved of money by the state,” he said in an email. “We have chosen to pay even lower wages to staff … than to faculty. That is shameful. They are our colleagues and the university would not run without them.”

Reyna and Dennis Avila both work at UCLA Medical Center — he as a hospital assistant, she as a secretary, monitor technician and nurse’s assistant. To juggle their schedules with one car and different work shifts, the couple leave their home in Inglewood at 2:45 a.m. Dennis starts work at 4 a.m. while Reyna sleeps in the car until her shift begins at 7 a.m. He takes the car home, and she returns by bus.

Reyna said her pay increases over two decades at UCLA have not kept up with rising rent.

“It’s gotten harder to make ends meet,” she said.




18k Kaiser nurses vote for option to strike at California facilities


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Tens of thousands unionized registered nurses at facilities owned by Oakland, Calif.-based Kaiser Permanente voted for the option to call a strike if an agreement is not reached on issues such as staffing and patient care, according to a California Nurses Association news release.

The CNA — which represents 18,000 RNs who work at more than 20 Kaiser Permanente medical centers and dozens of medical clinics and office buildings in California — said nurses are calling on the healthcare giant to improve patient care standards.

“With this vote nurses are making it absolutely clear: We are ready to strike to make sure our patients get safe care,” said Zenei Cortez, a South San Francisco Kaiser Permanente RN and co-president of CNA.

Union officials said nurses specifically are calling on Kaiser Permanente to support their proposals regarding staffing and patient care standards. These include bringing in a charge nurse on each unit, as well as resource nurses to assist other nurses so they are able to take breaks. The union said nurses also propose “interventions with pharmacy to expedite patients receiving correct medications,” and “increased staffing when needed due to emergent conditions and heightened patient volume.”

Additionally, the CNA said nurses are opposed to Kaiser Permanente’s proposal to move from the existing GRASP patient classification system to Epic Acuity, which nurses contend is less transparent. Nurses are also opposed to what they said are Kaiser Permanente’s plans to cut pay for new hires by 10 percent in the Sacramento region, and 20 percent in Fresno and the Central Valley.

Regarding the union’s claims about staffing, Debora Catsavas, senior vice president of human resources for Kaiser Permanente Northern California, said in a statement: “Our nurse staffing meets, and often exceeds, state-mandated staffing as necessary for patients, based on the complexity of their medical conditions. We employ more than 18,000 nurses, and have hired more than 2,000 nurses in multiple key specialty areas over the last three years, and continue to hire more as needed.”

As far as the move to Epic Acuity, Ms. Catsavas said the move addresses various issues nurses have raised about the existing GRASP patient classification system.

“GRASP is a system from the 1980s based on studies of nursing work flows conducted nearly 50 years ago. Epic Acuity is an up-to-date, comprehensive system that directly reflects the care provided and allows nurses to spend more time at the bedside,” her statement reads. “Epic Acuity uses clinical information directly inputted by the nurses into our electronic medical record.”

She said Kaiser Permanente also offered nurse representatives paid time to talk about and review Epic Acuity’s implementation.

Furthermore, Ms. Catsavas said there are no proposed wage cuts or wage reductions for current nurses. However, she said Kaiser Permanente last October proposed a new wage scale for new nurses hired in the Sacramento, Central Valley and Fresno areas on or after Jan. 1, 2019, “to more closely align with the lower cost of living in these markets.”

She noted Kaiser Permanente nurses in Sacramento, the Central Valley and Fresno earn 24 percent, 37 percent and 45 percent more than non-Kaiser Permanente nurses, respectively.

While the Kaiser Permanente nurses have authorized a potential strike, no strike date is set. For a strike to occur, nurses would have to provide at least 10 days notice.

Ms. Catsavas said Kaiser Permanente anticipated a strike authorization might occur but believes an agreement is within reach.



Nursing strikes can cause harm well beyond labor relations


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hen officials at Tufts Medical Center in Boston refused to allow nurses just off of a one-day strike return to their jobs, the footage spread across TV news programs and social media. Boston Mayor Martin Walsh, a former labor leader, spoke in favor of the striking nurses and the hospital found itself in an uncomfortable spotlight.

About 1,200 nurses went on a one-day strike after their union, the Massachusetts Nurses Association, and Tufts couldn’t come to a new contract agreement after more than a year of negotiations. Tufts, in turn, locked out the nurses when they attempted to return to work the next day.

Officials said the lockout was required because they needed to give at least five-day contracts to 320 temporary nurses brought in to fill the gap. The nurses are back on the job now without a new contract, but the strike and subsequent lockout got the public’s attention.

Hospital strikes aren’t that common — usually, the sides agree to a new contract. Strikes or threatened strikes in recent years have typically involved conflicts over pay, benefits and staff workloads.

When strikes do happen, however, they can hurt a hospital’s reputation, finances and patient care.

Strike’s effect on patient safety

study on nurses’ strikes in New York found that labor actions have a temporary negative effect on a hospital’s patient safety.

Study authors Jonathan Gruber and Samuel A. Kleiner found that nurses’ strikes increased in-patient mortality by 18.3% and 30-day readmission by 5.7% for patients admitted during the strike. Patients admitted during a strike got a lower quality of care, they wrote.

“We show that this deterioration in outcomes occurs only for those patients admitted during a strike, and not for those admitted to the same hospitals before or after a strike. And we find that these changes in outcomes are not associated with any meaningful change in the composition of, or the treatment intensity for, patients admitted during a strike,” they said.

They said a possible reason for the lower quality is fewer major procedures performed during a strike, which could lead partially to diminished outcomes. The study authors found that patients that need the most nursing care are the ones who make out worst during strikes.

“We find that patients with particularly nursing-intensive conditions are more susceptible to these strike effects, and that hospitals hiring replacement workers perform no better during these strikes than those that do not hire substitute employees,” they wrote.

Allina Health’s Abbott Northwestern Hospital in Minneapolis faced a patient safety issue during a strike last year that resulted in the CMS placing the hospital in “immediate jeopardy” status after a medication error. A replacement nurse administered adrenaline to an asthmatic patient through an IV rather than into the patient’s muscle. The patient, who was in the emergency room (ER), wound up in intensive care for three days because of the error. Allina said the error was not the nurse’s fault, but was the result of a communication problem.

The CMS accepted the hospital plan of correction, which included having a nurse observer when needed and retraining ER staff to repeat back verbal orders.

A strike’s financial impact

Hospitals also take a financial hit during strikes. Even the threat of a one- or two-day nurse strike can cost a hospital millions.

Bringing in hundreds or thousands of temporary nurses from across the country is costly for hospitals. They need to advertise the positions, pay for travel and often give bonuses to lure temporary nurses.

The most expensive recent nurse strike was when about 4,800 nurses went on strike at Allina Health in Minnesota two times last year. The two strikes of seven days and 41 days cost the health system $104 million. The hospital also saw a $67.74 million operating loss during the quarter of those strikes.

To find temporary replacements, Allina needed to include enticing offers, such as free travel and a $400 bonus to temporary nurses.

Even the threat of a strike can cost millions. Brigham and Women’s Hospital in Boston spent more than $8 million and lost $16 million in revenuepreparing for a strike in 2016. The 3,300-nurse union threatened to walk out for a day and much like Tufts Medical Center, Brigham & Women’s said the hospital would lock out nurses for four additional days if nurses took action.

At that time, Dr. Ron Walls, executive vice president and chief operating officer at Brigham and Women’s Hospital, said the hospital spent more than $5 million on contracting with the U.S. Nursing Corp. to bring on 700 temporary nurses licensed in Massachusetts. The hospital also planned to cut capacity to 60% during the possible strike and moved hundreds of patients to other hospitals. They also canceled procedures and appointments in preparation of a strike.

The Massachusetts Nurses Association and Brigham & Women’s were able to reach a three-year agreement before a strike, but the damage was already done to the hospital’s finances.

Richard L. Gundling, senior vice president of healthcare financial practices at Healthcare Financial Management Association, told Healthcare Dive that healthcare organizations need to plan for business continuity in case of an event, such as a labor strike, natural disaster or cyberattack.

“Business continuity is directly related to the CFO’s responsibility for maintaining business functions. The plan should include having business continuity insurance in place to replace the loss associated with diminished revenue and increased expenses during the event,” Gundling said.

These plans should provide adequate staffing, training, materials, supplies, equipment and communications in case of a strike. Hospitals should also keep payers, financial agencies and other important stakeholders informed of potential issues.

“It’s also key to keep financial stakeholders well informed; this includes insurance companies, bond rating agencies, banks, other investors, suppliers and Medicare/Medicaid contractors,” he said.

“Business continuity is directly related to the CFO’s responsibility for maintaining business functions. The plan should include having business continuity insurance in place to replace the loss associated with diminished revenue and increased expenses during the event.”

Richard Gundling

Senior vice president of healthcare financial practices, Healthcare Financial Management Association

Impact to a hospital’s reputation

Hospital strikes, particularly nurses’ strikes, can also wreak havoc on a hospital’s reputation. Nurses are a beloved profession. They work hard, often long hours and don’t make a fortune doing it. The median registered nurses’ salary is about $70,000, according to the Bureau of Labor Statistics.

Nurses’ contract disputes involving staffing levels are a sticky situation for hospitals. Nurses will almost always win the PR battle against hospital executives.

If a hospital can’t avoid a strike, Seitel said two keys for the organization are telling the truth and not being passive about untrue statements from the other side. They don’t want to be adversarial and escalate the situation, but go with a more measured approach.

Fraser Seitel, president of Emerald Partners, a communications management consulting company, told Healthcare Dive there are two ways that hospital leadership can avoid a strike.

“The best way to prevent a strike is by the management of the hospital having a robust communications program with the staff of the hospital as well as keeping competitive in terms of salaries and benefits,” said Seitel, who has helped hospitals during times of labor strife.

Seitel said labor issues often crop up when management isn’t communicative. Communication, transparency and competitive compensation are the best preventative medicine for a strike, he said.