Nursing Home Worker

Nursing Home Worker

Not a typical target for union organizing. Stamford, New York is not a place one would typically expect to find an active organizing target, known as a “hot shop”. The community itself is a tiny rural village nestled in the Catskill Mountains approximately 25 or 30 miles east of Oneonta. The hospital itself is situated on a hill just off Route 23. From the parking lot you can look over the valley below. At the time, the hospital had 29 acute care beds as well as an additional 80 skilled nursing beds on an adjoining 2-story wing of the hospital. We came to know the hospital and its workers by accident, a fluke.

18 months working on the campaign.  It was late in December when I first received the assignment to try to help the nurses in Stamford. From the time I arrived until the time my work was finished there nearly eighteen months had elapsed. Over the course of the campaign, we were able to speak with workers through small group meetings arranged by committee members, house calls by organizers, and by telephone calls to workers’ homes. One goal of an organizing campaign is to have an organizer personally contact each member of the bargaining unit, and to follow up that meeting with another house call or telephone call. Detailed records of contacts with bargaining unit members are routinely maintained through out the course of the organizing campaign.

Company unions at the hospital. Even though the small hospital was located in a somewhat remote, rural farming village, the workers were all represented by one of two independent, or company, unions. The leaders of both unions would meet with members of the hospital’s administration from time to time to work out the terms and conditions of employment. In reality, the workers met with management and were told what their pay raises were going to be for the next year or so. Neither union had a treasury and, as far as we were able to determine, neither had ever filed a grievance. Both bargaining units had signed written collective bargaining agreements with the administration. One bargaining unit represented only workers in the nursing departments of both acute care and the skilled nursing facilities. The other unit represented the other workers in the hospital such as the housekeeping, dietary, and the maintenance departments of both facilities. This situation itself is a fluke because there is really no way that such bargaining units can exist under any National Labor Relations Board guidelines except by the design of management. If a union petitioned for such a bargaining unit configuration, it might be deemed insane. Yet both bargaining units existed for years complete with signed contracts with the hospital’s administration.

 Nurses demand meaningful bargaining.  At some point in time, a somewhat militant group of nurses was able to get elected to the leadership of the nurses union. During a subsequent contract negotiations the new leadership insisted on engaging in somewhat more meaningful bargaining than had gone on in the past. As a result, they met with stubborn resistance from administration. Having no resources in their independent union, the nurses had to acquiesce to management or find a new strategy. They chose the latter and contacted our local union. It was late in December when I first received the assignment to try to help the nurses in Stamford. From the time I arrived until the time my work was finished there, nearly eighteen months ad elapsed.

 The crooked path to create a real union. After a series of meetings during which we exchanged information and planned strategies, the nurses independent union voted to merge with our local union. Being the UFCW, a merger has become somewhat a routine for us. We had not experienced difficulty, nor large-scale resistance from employers fifty times larger and more powerful than the tiny hospital. But at Stamford, we would see that things were going to be different.

Following the merger vote of the two unions, the hospital administrator was notified of the change. The administration informed the union that it did not recognize the merger and, therefore, would not bargain with the successor local union. A simple matter! The union simply filed an unfair labor practice charge with the NLRB against the hospital for refusing to bargain in good faith. Unfortunately,, our charge ended up on the bottom of the pile in the Advice Office of the General Counsel of the NLRB in Washington, D.C. Because of the nature of the charge, coupled with the unusual composition of the bargaining unit, was, we were told, an issue not likely to be resolved anytime soon. Now we were perplexed. The issue before the NLRB might take forever, and time was running out.

If the two contracts covering the workers at the hospital were allowed to expire, there would no longer be a “contract bar” to an election. There was the very real possibility that we would lose the opportunity to represent the nurses, and be forced into an election with a traditional, or hospital-wide, bargaining unit. The independent union representing workers other than the nurses was not interested in merger, and many of the other workers were not interested in joining our local union. We had no choice but to abandon our unfair labor practice strategy and file a petition with the NLRB seeking to represent the nurses at the hospital. After a long arduous organizing campaign and much resistance from the administration, the union was finally certified as the exclusive bargaining representative, and the nurses had a real union. But, as we will see, the struggle to obtain a first contract from the stubborn administration was just beginning.

A plan to get the administration to the table. It is one thing to be able to keep a group of workers together long enough to win an NLRB election. It is another thing to be able to hold their attention and motivate them to do the things necessary in order to get that first contract. Oftentimes it is possible to get a contract with a strike, or just the threat of a strike. However, if the nurses had any weakness at all, it was the fact that they made it very clear that there would not be any strike talk. This was, after all, a hospital. Worse for the union was the fact that the administration knew how the nurses felt. Clearly, we had to come up with an alternative plan. Stamford itself, as well as Delaware, and neighboring counties, are very conservative areas. So conservative that I don’t believe that any Democratic candidate for anything has ever carried those counties in New York State. While the nurses at the hospital wanted a contract very badly, they also felt that they needed to develop a plan that would not alienate them from the conservative community. Collectively, we had to come up with a suitable plan to force the hospital administration to come to the bargaining table. The ultimate solution was a long term community based pressure campaign. The strategy would include nurses bargaining unit members interacting with other workers in the hospital and with the community at large. As a bargaining unit, the nurses had to be able to agree among themselves as to what types of activities would be appropriate and acceptable to participate in. While there was much solidarity among the workers when it came to the union and dealings with the administration, there was a certain degree of animosity between some of the various groups of workers within the bargaining unit.

RNs, the prima donnas. A certain degree of animosity between groups.  In the Nursing Department there were a few Registered Nurses, some Licensed Practical Nurses, and the bulk of the unit were Certified Nurses’ Aides.  In the nursing department hierarchy, Registered Nurses are at the top, followed by Licensed Practical Nurses, and then Certified Nurses Aides. On the acute care side of the facility, the RNs work primarily in the operating rooms and in critical care units. They have responsibility for the nurses’ stations located throughout the hospital and are also responsible for directing patient care and administrative duties such as maintaining patients’ medical charts.  On the skilled nursing side (of the hospital), the RN is in almost every respect the charge nurse, responsible for what goes on in the facility on her shift. But RNs on the hospital side also have the role of supervising both the LPNs (Licensed Practical Nurses) and CNAs (Certified Nurses’ Aides) as their activities relate to the direct care of patients assigned to each RN. (Footnote:  Registered Nurses are generally not in the same bargaining unit as LPNs and CNAs. RNs are more appropriately placed in a “professional” bargaining unit under NLRB guidelines. But, because of the peculiar bargaining unit arrangements at this facility, RNs in effect supervised and evaluated the work of union sisters and potentially brothers.) The RN’s were considered “prima donnas” because they were the highest paid, and because of a nurse shortage at the time, were allowed to work 12-hour shifts three times a week. In effect, they worked 36 hours a week and were paid for forty. The LPNs and CNAs only got to work 7.5 hours a day and were looking to change that to a full 8-hour day in their contract. RNs got to take off more weekends than the others because there were fewer of them needed at one time. This was especially true on the skilled nursing side of the facility where animosity between the different wings and various shifts was the most prevalent.

Each shift says they have it the toughest- days, evenings, nights. Workers on the evening (3pm to 11pm) and the night (11pm to 7am) shifts feel they work much harder than the folks who work the day shift (7am to 3pm). They think it is because during the day “the time management” is around, and since management wants to look good and have no problems the day shift gets the most workers. The folks on the evening shift think they have it toughest because they are responsible for getting the residents their evening meal and for getting them into bed for the night. The night shift feels they have it the toughest because there are fewer of them and they have the responsibility for getting the residents up out of bed, dressed, and ready for breakfast in the morning. The day shift thinks they have it the toughest of all because there is always more work to do with management around all day, not to mention aggravation.

Containing arguments. Then there is the animosity between the different wings. “Red One” thinks “Red Two” has it easier because a greater number of its residents are ambulatory. “Gold Two” thinks they have it bad because they have a disproportionate number of dementia residents. If that’s not enough, there is the personal animosity that exists between individuals. Sheila, an LPN, has a son who is married to the daughter of a CNA, Dot. The young couple is having some marital difficulty. The two moms are having difficultly not discussing it at work. On any given day, someone on the evening shift is likely to call in sick, leaving the rest of the workers to “work short”. When that worker returns to work, she is given the toughest residents to care for. She knows it but is willing to pay the price for a precious evening with her family. These types of issues are standard in many, if not all, bargaining units. But, in our situation, we had to try to keep them to minimum and prevent them from becoming divisive. It is one thing to have arguments among ourselves, but we didn’t want other workers in the hospital carrying stories back to the administration.

Deskilling of nurses, a source of resentment.  Increasingly, there is a certain amount of overlap in the work performed by the RNs and the LPNs. LPNs are the ones who have a lot of responsibility for direct patient care, especially routine care.  These are the people who regularly take temperatures and blood pressures, as well as answer calls when patients ring their bedside bells.  More and more LPNs are also given the responsibility for “passing meds”, a reference to the function of giving medications to patients as directed by the patients’ doctors.  In some respects the fact that LPNs are being given responsibilities formerly reserved for RNs resembles the deskilling of jobs in other industries.  For example, meat cutters in grocery stores(also represented by UFCW) are being replaced by meat clerks who don’t require the same level of skill or pay.  The same appears to be happening with the nurses. RN work is being shuffled to the LPNS, whose work in turn is being shuffled to the CNAs.

If hospital administrators figure out that the CNAs can do all the functions of the RNS and LPNs then they can find a way to replace workers who earn $16-$20 an hour or $11 to $15 an hour with workers who earn $6-$10 an hour. Of course there are licensing boards who have rules against such practices, but with the skyrocketing cost of health care, anything is possible if it looks like it might help lower the cost of healthcare. At any rate, it is a consideration for workers who see it happening before their eyes. This put a strain on the working relationship between the various tiers of nursing department workers. LPNs, with a large patient load, began to resent the lone RN on the shift because she is not able to assist in procedures that have been deemed appropriate for the LPN to do solo. Similarly, an LPN might resent an RN’s critical evaluation of her procedures in a specific case. The same is true of the relationships that exist between all of the different workers in the nursing department. LPNs and CNAs have favorite RNs with whom they prefer to work. Some consider one RN more professional than another.

Bonds of attachment to residents.  On the skilled nursing side of the facility, the patients are more commonly referred to as residents. This is because it is, essentially, a nursing home housing elderly people who live there the rest of their lives. There is a big difference in caring for these individuals and caring for patients on the acute care side, who are there for a relatively short period of time. Workers on the skilled nursing side oftentimes form bonds or attachments to residents they regularly care for. Many times it is the residents themselves who become attached to the workers. Such relationships are often considered in the assignment of work. Some residents have been known to become belligerent, even combative, if someone other than a regular caregiver approaches them. It is often a difficult time for a resident, as well as caregiver when, for example, the worker is transferred to another unit. Similarly, it can often be traumatic for workers in the skilled nursing facility when an elderly resident they are especially found of dies.

When shifts overlap can be an eventful time. On each unit, “the girls” as they commonly refer to themselves, receive their caseload at the beginning of each shift. Because the facility is staffed around the clock, there is necessarily an overlap in the changing of the shifts. This brief period, usually fifteen to thirty minutes, is used to give “reports”. The shift that is leaving fills in the shift that is reporting for work as to the status of each patient/resident. For example, the day shift may tell the evening shift that Mr. Smith had to be placed on a respirator, the doctor and family members were notified and he was given the “Last Rites”. This exchange of information between the workers allows for the continuation of care without a lapse caused by the change in personnel. This can be an eventful time because it affords workers the opportunity to question and critique the work of the co-workers.

Sometimes you may have to break a rule to care for residents.  One of the biggest problem areas for workers is absenteeism and “working short”. Nursing home work is physically and emotionally exhausting. it is common for workers to call in sick, oftentimes on short notice. Typically, the administration makes little or no effort to replace these workers even though it maintains a list of “per diem” workers for just such situations. Working short means that the workload for each worker who does show up for work is increased.    This in turn requires the nurses to take shortcuts, work faster themselves and skip breaks and meal periods in order to get everything done. For example, there may be a rule requiring that two workers assist a non-ambulatory resident into and out of the bathtub. But on a particular occasion, perhaps when the unit is working short-staffed, someone breaks the rule, and one CNA does the job by herself. Even though a number of workers, maybe even all of them, would do the same thing in the same situation, the “girl” who did it would be chastised by the others. Other workers may say she was foolish to take the risk, or that she should have waited for help, or she should have let the administration worry about it. But, the alternative for the worker would be to follow the rule and wait until another worker was available. However, there is a good chance that the resident would not get a bath. This is not acceptable to “the girls”.

If you call in sick, you may be punished by those who showed up. It is important that all of the workers in any unit work closely together to ensure that everything, especially tasks directly related to patient/resident care, gets done. When a situation arises that has the effect of putting the resident in jeopardy, there is the chance that the resident, or a family member, may complain to the health department with a call to the “Hot Line”. Such complaints are generally investigated very thoroughly and the administration cracks down on units and individual workers who bring the hardship upon the facility. This is ironic because it is sometimes the administration’s fault that the rules are broken. In most instances, the administration would prefer to have the rules obeyed even though it may result in a resident not getting a bath or shower.  The workers however, would much prefer to see that the needs of residents are met, rules notwithstanding.  This creates animosity between the workers who showed up and the worker who took the day (or night) off.  The offending worker is likely to be “punished” unofficially on her next scheduled shift by being given the most difficult residents to care for or some of the least desirable jobs on the unit. This is a well-known and common practice, but it seems to be worth it for a precious day or night off to spend with the family

Health care professionals.  The administration benefits by the ability of the nursing department workers to police themselves and keep themselves, more or less, in line.  The administration seems to have figured out that it is in the workers’ caring about the wellbeing of the patients and residents that keeps the facility running smoothly.  All of the workers in the nursing department, whether they are RNs, LPNs, or CNAs, consider themselves health care “professionals”, and express a desire to conduct themselves “professionally”. This is precisely the reason it took so long to get a contract. Their sense of professionalism and duty to the residents and patients prohibited them from even entertaining the notion of exercising a basic right of workers, the right to strike. In fact, there were a few who thought it was unprofessional for nursing workers to be in a union at all.  These were not truck drivers, or factory workers, or construction workers.  These were the nurses, and the needs of patients and residents had to be put above everything else.

Nurses take care of nurses. The cement that bonds the nurses together.  With all of the apparent conflicts between the different levels of nursing workers, an outsider might have difficulty believing that any solidarity could exist in such a group. But the fact that they were all nursing employees is actually the cement that bonded them together. All the conflicts and disagreements remained in the nursing department.  They were not allowed to “spill over” into other areas of the facility where they did not belong.  If problems were to be solved, there were solved within the department with no need to involve administration, or personnel, or human resources people.  These were business people, not nursing people. These folks counted money and paid the bills.  They weren’t invited to stick their noses into the nurses’ business. If a nursing employee got out of line, the discipline would come from the nursing department, not personnel.  This was not characteristic of other areas of the hospital, such as dietary, or housekeeping. If a nurse went to the personnel office, it was only to check on her personal days, or her vacation, or some other administrative issue, but certainly not to resolve any issues that belonged in the nursing department. This special bond is what made this bargaining unit so unique, and enabled them to stick together and accomplish their collective goal.

 It’s as if the others worked for a different employer. The other workers in the hospital seemed to be very supportive of the nurses’ efforts to negotiate a contract. But it was as if the others worked for a different employer, or were treated better by management than the nurses. It seemed at the time that they were removed somehow and didn’t share the nurses’ burden. We didn’t encounter any of the other workers taking the nurses to task for what they were doing to the hospital, but we didn’t encounter any of the others looking to join in the nurses’ struggle either. It seemed that the attitude of the other workers was that the nurses had to do what they had to do.

A nurse, also a prominent farmer, has access to community leaders. What the nurses had to do was to bring a stubborn employer to the bargaining table with a view towards achieving an acceptable contract. The militancy that served the union’s purpose during the election campaign didn’t seem to fit the bill in the campaign to secure a contract. This meant that the leaders in the campaign to win the NLRB election had to take a back seat to new leadership. Mary, an RN, had been the driving force in the election campaign. Smart, articulate, and fearless of management is the only way to describe her. But it was widely felt that the tactics necessary to get a contract would require a little more finesse. Corinne, also an RN, was not a likely union activist. She wasn’t even necessarily pro-union. She was, however, pro-nursing. And she knew the nurses were not getting a fair shake from administration. Corinne was a little older, maybe in her late fifties or early sixties. She and her family had moved into the mountains from New York City years before. They had bought a large dairy farm, and her husband did much of the farm work while Corinne supplemented the family income by nursing. When not on duty at the hospital, Corinne could be found in the dairy barns helping with the milking or out in the fields taking in the hay. Because they were prominent farmers in a predominantly farming community, Corinne had access to the community leaders that the other members of the bargaining unity simply didn’t have.

 Driving a wedge between the community and the hospital administration. Corinne’s presence gave the nurses’ struggle for a contract a certain amount of credibility in the community at large. This was important because, while the hospital was governed by an elected board of directors, there was also an organization called the “hospital society” which was open to anyone who wanted to join. Its function was purely social. Many of the most prominent and wealth citizens of the county belonged, attended meetings, networked and just rubbed elbows. The nurses thought it was a perfect place to “drive the wedge” between the community and the hospital administration. They were right. Soon, all of the nursing workers were being encouraged to join the hospital society. This required a trip to see Ardy, the administrator’s secretary, who also did personnel work. Ardy was the wife of a prominent insurance agent in town and very active in the community socially. She belonged to everything, including the country club. Ardy was shocked when so many nurses began to show an interest in joining the hospital society. Her shock turned to horror at the next meeting of the hospital society when the nurses, all seated together, began to question why the hospital administration was being allowed to drag its feet in contract negotiations. Temperatures rose and the embarrassment could be felt throughout the room as the society leadership realized their society had just been taken over by a group of nurses. While that one event didn’t bring the administration to its knees, it did have the effect of bringing the nurses’ struggle before the entire community. Eventually they got their contract.

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Iles Minoff received his doctorate in anthropology from Princeton University. He taught at St. Xavier College in the Chicago area and taught a class in the anthropology of work at the George Meany Center for Labor Studies in the 1990s. He worked for the labor movement for 28 years, first with the Human Resources Development Institute in the early 1980s where he worked on retraining programs for displaced workers, and later for Union Privilege where, for over 20 years, he developed benefit safety net programs for union members and their families. He has a wonderful and amazing wife, three great daughters, and two, soon to be three, of the cutest grandchildren on the face of the earth.

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