Nurses and management at Good Samaritan Medical Center are entangled in a protracted conflict, due in no small part to a work environment that has negatively impacted both patient and nurse well-being. The financial pressures affecting the medical industry are also playing their hand, with rising medical costs, decreasing insurance and Medicare payments, and increased costs from regulation plaguing everyone involved, directly and indirectly. Rising costs of living, increasing insurance premiums and a stagnant economy have strained nursing staff’s pocketbooks. All of these financial pressures have turned a normally straightforward union negotiation into a quagmire.
To keep the doors open and bridge revenue shortfalls and financial uncertainties Sam health management has been working to diversify services offered via programs like Sam Fit, and the nurses have been working without a contract, having rejected a previous offer from Samaritan. Though money is certainly a factor in the impasse, nurses also have expressed concerns about understaffing and scheduling compromising patient well-being.
Additionally, a number of nurses that have stated they either do not trust the current management or do not believe they are being heard by them. Whether justifiable or not, this belief appears to be a playing a role in the current stalemate.
The nurses, represented by the Oregon Nurses Association (ONA), have already turned down one proposal which included a 5% pay increase over the next three years. Some nurses feel that this pay increase will not keep up with inflation and will be offset by anticipated increases in their cost share for health insurance premiums. Some nurses, who spoke on condition of anonymity, are also concerned because the contract offered had no cap on future premium increases and the insurer is, as is currently the case, Sam Health.
ONA took the unusual step of presenting the offer to the local nurses without making a recommendation; the offer was defeated narrowly. Negotiators from ONA have stated the rationales for voting no were quite varied among the nurses.
Overworked…. Worries About Patient Safety
Approximately one year ago the hospital changed nursing shifts from 8 hours to 12 hours in many of its departments. Multiple studies correlate these 12 hour shifts with adverse outcomes for nurses, and by extension patients. For instance 7 of 10 patient outcomes assessed in a recent study, done by the University of Pennsylvania School of nursing, were significantly worse when nurses worked longer shifts.
The 3 year study of 23,000 registered nurses found that nurses who worked shifts of 10 hours or longer were up to 2.5 times more likely than nurses who worked shorter shifts to report job dissatisfaction and burnout.
Making matters worse and skirting the legal line, Sam health schedules its nurses so that they quite often work 72 hours in only 7 days. For example, in a two week work period, a given nurse may work 3 days of the first week, have one day off and then work 3 days of the next week for a total of 72 hours in 7 days and the nurses interviewed claim that this is not limited to a fluke, but a common practice.
Not all the nurses felt this way, in Interviews some said that they accepted, or even preferred the 12 hours shifts. What they all seemed to agree on though is that 72 hours in a 7 day period is far too difficult, one nurse even characterizing this scheduling practice as a ‘killer.’
Compounding this, a number of nurses, and sources at ONA, report that the decision to changeover to 12 hour shifts was unilateral on the part of management and that some departments have seen a large increase in unsafe staffing reports and nurses leaving for other jobs since implementation of the policy.
Nursing on the Treadmill: A Vicious Cycle
It is a fairly well accepted and understood fact that the current fiscal environment is financially tough for the hospital and that management needs to make changes to save dollars where they can. So, it was understandable, when Samaritan moved away from keeping part-time nursing staff because the administrative costs of a part-time nurse staff are generally the same as for a full-time employee. This would reduce the administrative costs per hour of nursing, but at the costs of less flexibility to changing circumstance.
The problem is that eschewing part time staffing means a lack of flexibility that makes it much harder to find staff to fill in when nurses take much needed vacations, are sick, or need to take care of their family.
Some nurses, whose lives were based around a part-time schedule, were forced to move to full time hours if they wanted to continue working at all, which needlessly increased their stress levels, wholly separate from other financial pressures.
“Every day I receive multiple calls to come in and work, but I can’t, I don’t have child care set up and I’m already at or over full time. The way the scheduling works makes it incredibly difficult. And with my section, and others, being short, the [burden] falls to the nurses that are working, and it falls on the level of care the patients are getting,” says one nurse that wished to remain anonymous.
Many nurses stated that some departments go through periods of having dozens of unfilled shifts that, “nobody can take”, which explains many of the unsafe staffing reports.
Exacerbating this, insiders reveal that some departments have seen a quarter of their nursing staff quit since implementation of the 12 hour shifts and full time only policies. Managers can’t schedule nurses they don’t have, which only feeds the vicious cycle of burnout that limits nurses effectiveness and hampers patient care outcomes.
At this point, many nurses report feeling incredibly overworked, and many of them feel terrible about having to say no when asked to come in. The choice is sometimes as stark as knowing that though colleagues and patient outcomes may be compromised, but their family, child care needs, and even self-care obligations, must also be considered. Some nurses were so clearly torn by this work home life conflict, to the point of tears during the course of being interviewed.
Growing Tension & Distrust
It became apparent in interviews that many of the nurses feel distrust towards the management of Samaritan. While not entirely universal in the nursing ranks, this tension was prominent in several of the interviews.
For instance, a natural question might be, “Why haven’t we heard more about this?” What we learned is that several of the nurses interviewed said they were afraid to speak out, for fear of reprisal, even under conditions of anonymity.
Sowing more seeds of distrust, some of the nurses believed that management should have informed the union during negotiations two years ago that they were considering the schedule changeovers, but preferred not to as the contract permitted them to make the decision unilaterally. In short, some of the nurses report that they feel management pulled a fast one at their expense.
Also, there is the management response to the frustration the nurses have expressed about their schedules—the hospital has threatened it could move to a ‘Write your own schedule’ plan that would have staff selecting their own schedules on a first-come-first-served basis at the beginning of six-week periods, thereby removing any hope of scheduling stable child care, or stable anything for that matter. Some nurses expressed this may be a rumor, but The Advocate confirmed with management that it is indeed considering the possibility.
Another rumor was that Samaritan was in talks to be bought out, but questioned on the matter, President and CEO; Larry Mullins flatly stated this was not the case and that in fact, the hospital’s efforts to diversify were aimed at the hospital working to stay an independent institution.
For one nurse the relationship has degraded to such a point that they claimed that management had, on at least on one occasion, lied about budget reporting in order to manipulate the staffing situation. Whether true or not, it seems that for this nurse, hostility is a barrier to accepting any contact from management. It is worthwhile noting however that Sam health keeps a copy of their annual report online for anyone to see.
The Bottom of The Well
“A lot of the issues that we’re talking about stem from all nurses being full time. They’re burning out. It’s hard to get time off, you can hardly plan a vacation. Filling in for others is really difficult, so is trading shifts. This results in more overtime, which creates more budget problems,” says an ONA insider. She continues, “The nurses are more than willing to work and do a lot, but people are reaching their limits. They’re at the bottom of the well.”
According to those inside ONA, so far they have accomplished a lot in negotiations, but this has mostly just been the staving off of some of the overreaching terms that Good Samaritan sought in the first contract. To quote one ONA representative, “I thought we got a lot… although in perspective the gains are not necessarily that great.”
When asked what the root of this situation was, including the slow move forward, the ONA source explained that the negotiations were difficult for a few reasons but were primarily due to the issues the nurses were concerned with being are “all over the place” and a general fog of mistrust towards management.
This story was sent to Samaritan for fact checking and comment prior to running, which is an unusual step. We received a response from their Marketing and Public Relations Coordinator, Janelle Iverson, saying, “I want to take this opportunity to reiterate that we greatly value every employee at Samaritan, and we work to maintain open relationships and consider feedback prior to making decisions. We make every effort to communicate with employees through many different avenues as we learn more about health care reform, and we will continue to do so in the future.”
Because of the widespread number of concerns, sources both inside Good Samaritan and ONA have confirmed that, while there is a definitive concentration on the well-being of nursing staff and patient outcomes, there currently isn’t even a working contract that contains a scheduling solution.
What’s Coming Next?
The nurses have already rejected one contract proposal and negotiations are ongoing.
One ONA source, again under condition of anonymity, said, “I think [Samaritan] generates half the problems we have. This isn’t about money, it’s about the fact that the vast majority of the nurses either love, or have loved their job, but (there is) an unnecessarily adversarial relationship. Who benefits from this climate? I don’t know. It is baffling. They need to save money? Sure, let’s work at it. But not at the expense of the staff. ONA and the nurses are just looking for fairness.”
It is worth noting that management seems to be interested in maintaining Samaritan as an independent hospital and appears to be open with its staff and the public over its strategy to do that. Mullins does invite staff to meet in open Q & A’s with him and reports are that the questions and answers can be quite frank. Some nurses have stated that there may need to be more of these and that they would like to see more action on their suggestions.
Samaritan and the nurses will eventually come to an agreement. The circumstances surrounding understaffing and work schedules should be concerning for both nurses and management, and also the public that may become patients—but currently there is no discussion regarding what exactly is to be done about that.
By Johnny Beaver
Tentative agreement has been struck between ONA and management with a vote by nurses scheduled for September 6. The new contract proposal contains no substantive changes in nursing schedules. ONA is said to be encouraging its members to communicate with the hospital over the matter.
The most material changes in the proposal over the one already rejected by the nurses; a cap on the nurse’s health insurance premiums and that ONA is now recommending a yes vote.