Nurses in Seattle who mounted a one-day strike against Group Health Cooperative of Puget Sound have charged that the HMO locked them out when they tried to return to work.
District Local 1199NW of the Service Employees International Union called the March 22 strike after contract negotiations reached an apparent impasse. When nurses showed up for work at Central and Eastside hospitals early on March 23, the HMO sent them home. All shifts through March 31 were canceled.
On March 27, four days after the nurses tried to go back to work, the two Group Health hospitals were still not admitting patients.
The union said the co-op was retaliating for the strike by locking them out. It filed a complaint with the National Labor Relations Board.
"It's true that they need some time to start back up," said union officer and nurse Chris Bodin, "but the fact that they have refused to admit patients, when there was no reason not to, seems irresponsible to the patients."
Group Health spokesman Marc Osborn said there was no lockout and called the charge "a publicity stunt."
"The one-day strike was over yesterday," Osborn said on March 24, "but there were no patients in our hospitals. If there are no patients, there's no need for a full nursing staff. There isn't work. That staff level is always determined by how many people we have in the hospital. It's ironic that the union would use a situation it created against the cooperative."
The cooperative, too, filed a complaint with the NLRB.
Group Health shut down its two hospitals before the strike, moving patients to eight other community hospitals. Elective surgeries were postponed. Urgent care was restored on March 24, and patients needing more intensive emergency care were transferred elsewhere by ambulance.
Osborn said the HMO intended to bring back employees "in an orderly fashion while the census goes back up."
Union organizer Karen Zytniak responded: "There isn't a reason they can't admit patients the next day. That they haven't acted yet to bring patients back to the hospital is wrong. They're just lying about this.
"By locking us out, they're locking out patients and holding them hostage to this dispute."
Strikes by hospital nurses have been infrequent in recent years, but as hospitals and health systems pursue economies by trimming their staffs, the prospect of labor unrest could increase (See related story, p. 44). The American Nurses Association reports great unease among registered nurses as providers restructure the way they organize care.
The nurses say that staffing cuts, combined with changes in the skill mix, are eroding standards of patient care. Increasingly, the nurses say, qualified, experienced registered nurses are being replaced by less-skilled unlicensed personnel who are doing tasks for which they are not trained. For registered nurses, patient loads are increasing to unbearable levels that may affect patient care (Feb. 13, p. 38).
The Seattle union said these are its main reasons for insisting on a strike against Group Health. The union local did not seek a pay increase but initially asked for a limit of 10%, or 140 employees, on further staff reductions. It later dropped this proposal in favor of asking the cooperative to consider quality of care in future staffing decisions.
The union also wants Group Health to conduct layoffs by seniority. It wants to set up a retraining fund so laid-off nurses can find new work within the co-op.
Further, it wants protection for the union contract if Group Health merges with another hospital, Virginia Mason Medical Center in Seattle. The two organizations entered into a strategic alliance in 1993 (Nov. 29, 1993, p. 28).
With 510,000 enrollees, Group Health Cooperative of Puget Sound is the largest HMO in the Pacific Northwest. It was founded in 1947 by labor groups that wanted to create a prepaid alternative to established medicine.
Group Health is governed by an 11-member board of trustees who are chosen by voting members of the co-op, making it the largest consumer-run healthcare organization in the United States.
The co-op's fully integrated program of care comprises 30 primary-care clinics, six specialty centers and two hospitals: Central, which has 146 staffed beds, in Seattle, and Eastside, which has 76 staffed beds, in Redmond, Wash. The strike affected the whole Group Health system, but only the two hospitals had to shut down.
After the union contract expired last July, no serious negotiations took place until March 1. After a second fruitless negotiating session a week later, the union gave 14 days' notice that it planned a one-day strike. The cooperative set about closing its hospitals.
Osborn said Group Health could not accept several of the nurses' contract demands, including a successor clause and use of training funds.
"For example, if we wanted to merge with a hospital, if the union had gotten what they wanted in a successor clause, they would have the ability to approve or reject that relationship," Osborn said. "That's something a union should not be able to do. The whole organization would be beholden to one small group."
As to training funds, Osborn said the union wants Group Health to train Local 1199NW nurses for positions that are now occupied by less-senior Group Health staff.
"The less-senior person would not have a job. The co-op is saying, `Look, that doesn't make business sense, to spend a whole bunch of money training somebody.......when there are already people trained for those jobs.' "
Osborn said the union was also demanding that Group Health not contract out or transfer any services that would lead to layoffs of Local 1199NW nurses.
"This restricts what the co-op can do; it restricts our ability to be flexible and provide care in the changing marketplace," he said.
In rural areas south of Olympia, Wash., Group Health doesn't have medical offices but is starting to offer coverage by contracting with local doctors. If those services resulted in a falloff of patients coming to Group Health's staffed medical office in Olympia, Osborn said, the union nurses could object if that clause were in their contract.
Group Health already reduced its head count of nursing and administrative positions. In 1994 120 nurses lost their positions. Of those, Osborn said, only 21 were let go involuntarily. The rest were retrained or reassigned to other duties. The same year 88 administrative personnel lost their jobs.
By March 27, Group Health had started doing outpatient surgeries. It planned to start admitting overnight patients on March 29-the same day the cooperative and Local 1199NW were scheduled to meet with a federal mediator.