Registered nurses at 45 Kaiser Permanente hospitals and clinics in Northern California have authorized a strike on April 16 to protest what they call "escalating patient-care abuses."
The strike would involve 7,500 Kaiser nurses represented by the California Nurses Association, which in 1995 broke away from the American Nurses Association because the CNA viewed the national group as not militant enough in fighting healthcare industry restructuring.
The CNA also said it intends to picket at Kaiser facilities in Santa Clara, Santa Teresa and Walnut Creek on various dates in March.
The contract between Kaiser and the union expired Jan. 30.
Rose Ann DeMoro, executive director of the CNA, said the union hasn't decided yet what form the strike could take. She listed three possibilities:
A one-day strike against all Kaiser facilities.
A series of one-day strikes at separate facilities.
Regional strikes by geographic cluster.
The nurses say Kaiser's patient-care standards are declining rapidly and that they alone stand between the patients and a money-mad Kaiser management.
In its contract proposal, Kaiser has tied pay increases to improvements in patient satisfaction surveys, which the CNA opposes on principle.
Tom Debley, Kaiser's media relations manager for Northern California, said Kaiser has made two contract offers: one covering 60% of the CNA nurses; the other covering the rest.
For the 60%, there would be a four-year freeze in basic pay, then a 1% increase in each of the next two years of a six-year contract.
Nurses could earn an additional 2% of their base pay each year in a lump sum if patient satisfaction surveys reached a desired threshold.
For the other 40% of nurses, who are mainly in the Sacramento Valley and Santa Rosa areas, Kaiser is asking for wage givebacks. Nurses' pay would decline 2.5% each year for six years. Nurses also would be eligible for the performance bonus for patient satisfaction.
"All of this is being done in the context of trying to bring our wages in line with the marketplace," Debley said. In the Sacramento Valley and Santa Rosa areas, Kaiser nurses are paid as much as 40% above market pay scales, he said.
"If we took the average salary outside Kaiser Permanente in that area, and we took 2.5% off our average hourly, which is $29 an hour, for six years, and if the other nurses got 2.5% increases, we'd meet in the middle after six years," Debley said.
The nurses say Kaiser is trying to unilaterally impose a contract on them. DeMoro said Kaiser wants to tie its economic proposals to an improvement in patient satisfaction because Kaiser is frightened of losing enrollees due to poor service and quality of care.
But she said patient satisfaction shouldn't be used as a substitute for real quality of care. Before its unsuccessful ballot initiative to rein in the HMO industry last fall, the CNA ran a series of healthcare horror-stories-of-the-day, each submitted in writing by a member of the public. The CNA says half the accounts came from Kaiser patients or families.
By tying pay to patient satisfaction, the CNA alleges, Kaiser turns the nurses' first loyalties away from the patient and toward the HMO.
Further, Kaiser has eliminated 1,400 registered nursing positions in three years, some 15% of its skilled-nursing work force, the union said.
"The nurses are in the way of their business plans," DeMoro said. "They are the only group that are licensed to advocate in the interests of the patient, instead of the interests of the corporation."
Kaiser spokesman Debley said the contract proposal is part of the HMO's goal in California to introduce a pay-for-performance component. "Virtually everyone else in the state in Kaiser Permanente has done this," he said.
He added that Kaiser's ratio of nurses to patients has actually increased over the past few years because the inpatient census has declined so dramatically.
"While there have been layoffs (of nurses), it's because there are fewer patients requiring hospital care," he said.
Kaiser presented its "best and final offer" at the last scheduled bargaining session on Jan. 30. It has not received any response from the nurses union. Kaiser is willing to go back to the bargaining table with federal mediation, he said.
DeMoro gave no indication the disagreement would be easy to patch up.
"This fight has been going on for four years," she said. Collective bargaining is just one arena for what she called "the ultimate conflict: Should there be accountability to patient needs, or should corporations dictate standards of care with profits being the motivator?"