SAUSALITO, CA (ASRN.ORG) -- The specter of nursing strikes is looming on both coasts, as newly empowered nurses’ unions confront hospitals pressed to cut costs amid changes in health care financing.

In New York, over 6,000 registered nurses are poised to walk out of three of the city’s most prestigious hospitals before the year’s end, mainly over changes to their health benefits and what they say are strains in staffing. The hospitals — Mount Sinai, Montefiore Medical Center and St. Luke’s-Roosevelt Hospital Center — already are contracting for strike replacements at more than double normal wages.

In California, where 23,000 nurses represented by the California Nurses Association staged a one-day strike in September over similar issues, a new 24-hour walkout is set for December 22 at eight hospitals in the San Francisco Bay Area and one in Long Beach. Potential strikes in New Jersey and Minnesota are being advertised on the Web site of Healthsource Global Staffing, one of the largest strike replacement agencies, which promises “cool locations and hot paychecks” for nurses willing to fill in during a walkout.

In New York, the union, the New York State Nurses’ Association, has not yet given the hospitals a 10-day strike warning, which the law requires, and last-minute settlements are still possible. But its battle with the hospitals reflects common themes across the country.

The nurses, who voted overwhelmingly to authorize a strike, say they are being disrespected by a corporate hospital culture that demands sacrifices from patients and those who provide their care, but pays executives millions of dollars. Management officials defend executive pay as the price of competition for top leadership, and accuse the nurses of refusing what many other American workers have accepted: paying a share of their health insurance premiums, along with higher co-payments, deductibles and prescription costs.

Though finances differ, all hospitals face cuts in Medicaid and Medicare and uncertainty over budgets under new payment models. Among other changes are new measures of quality: hospitals will lose money if too many patients are readmitted  within 30 days, or if they score poorly on patient satisfaction surveys — two areas in which nurses play a crucial role.

For patients, the stakes are high, according to a recent study of 50 nurses’ strikes in New York State between 1984 and 2004. The study, for the  National Bureau of Economic Research, found that patient mortality was 19.4 percent higher during a strike, or that there was about one extra death for every 280 patients admitted, and that they were 6.5 percent more likely to be readmitted within 30 days.

The study resonated at a Sutter Health hospital in Oakland, Calif., where the death in September of a cancer patient was attributed to a medical error by one of 500 temporary nurses hired to replace those locked out for several days after their 24-hour strike. The death is still under investigation, but The San Francisco Chronicle reported that a dietary supplement was mistakenly fed into the patient’s intravenous line.

“Nobody wants a strike,” said Bruce McIver, president of the League of Voluntary Hospitals, who is negotiating for Mount Sinai and Montefiore, where nurses’ contracts expired last December.

Negotiations grew harder, both sides say, after management trustees of the union’s benefit fund won an arbitration decision in June requiring nurses to pay $25 to $400 a month toward premiums previously covered entirely by their employers.

Reduced coverage took effect Sept. 1 at two hospitals, and some nurses found they had to pay hundreds of dollars more for medication. For union leaders, elected this year on pledges of more forceful representation, modifying the changes in health benefits became a key goal, despite the arbitrator’s decision.

“They’re making demands at the bargaining table that are out of line with what others have been able to get,” Mr. McIver said. “Up and down the line, all health care workers have been asked to make sacrifices.”

Judy Sheridan-Gonzalez, a nurse and union leader at Montefiore, said the strike vote was driven by more than new fees. “As professionals we don’t feel respected,” she said. “This corporate model is being shoved down our throat.”

She said the hospital had hired costly consultants who handed nurses scripts to recite to patients in a bid to improve customer satisfaction scores, even as the nurses were left short-handed with more acutely ill patients, straining the staffing guidelines — one nurse to seven patients — they had negotiated a decade ago.

Jesse Derris, a spokesman for Montefiore, said that the hospital routinely hired experts to help employees at every level improve patient care, that its staffing exceeded national guidelines, and that it would continue to “do the best we can for a hospital that relies on Medicaid and Medicare for 80 percent of its funding.”

At Mount Sinai, nurses’ base salaries go from $75,000 to $95,000 after 20 years, and average close to $100,000 with overtime and advanced degrees. Jacklynn Price, president of the bargaining unit, said a management negotiator was dismissive of their resistance to reduced health coverage, saying: “We have the money. We just don’t have the will to give it to you.”

Ms. Price, a veteran nurse, said, “They go home with bags of money, what I call these nonprofit oligarchs.” She cited a $1.2 million bonus paid last year to the hospital’s chief executive, Kenneth L. Davis, which brought his compensation to $2.6 million. Mount Sinai responded that under the plan, nurses would pay about 20 percent of what its other professionals pay toward insurance.

“This is not an issue of respect,” the hospital wrote, “but rather an issue of fairness. We have great respect for work done by the nurses, but we also have great respect for the work done by all members of the health care team.”

But a surprise settlement last week by NewYork-Presbyterian, where a strike had been authorized, seemed to undercut that position and the arbitrator’s decision. The hospital will reimburse its 3,000 nurses for premiums, in exchange for other concessions, union leaders said. The trustees of the nurses’ benefit fund, divided between union and hospital representatives, are expected to vote on that arrangement Friday. If they reject it, the nurses could leave the fund, threatening its actuarial health. The settlement also includes 9 percent in raises over three years, and better staffing ratios.

NewYork-Presbyterian would not confirm those details. But the settlement’s terms clearly rankled the three other hospitals.

“We’re disappointed,” said Rick Pogue, an executive at Continuum Health Partners negotiating for St. Luke’s-Roosevelt. “But that is not going to change our position.”

“Presbyterian is the wealthy sister up the street, so to speak, that can afford to drive around in a Bentley,” he added. “And we drive a nice Ford, but we still get there.”

 

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