The tight healthcare labor market on the West Coast, combined with workers' frustration at the hospitals where they work, have allowed a local nurses union to make strong gains in organizing and contracting.
On Aug. 23, the California Nurses Association won a 20% pay increase over three years for 1,200 registered nurses employed at four Columbia/HCA Healthcare Corp. California hospitals: Good Samaritan Hospital, Regional Medical Center of San Jose (formerly Alexian Brothers Hospital) and San Jose Medical Center, all in San Jose; and South Valley Hospital in Gilroy.
Together, they have 900 staffed beds and account for 22% of local market share.
About a week after the contract was signed, Columbia entered a tentative agreement to sell South Valley to Catholic Healthcare West (See story, p. 17).
The new contract also bans mandatory overtime, calls for a joint staffing committee and provides for group health coverage for retirees.
The nurses ratified the contract Aug. 31, with 96% voting for the deal.
While the contract sounds highly favorable to the nurses, it may actually trail recent wage gains for nurses at nonunionized hospitals in Northern California, said Claudia Rosenfeld of the Healthcare Association of Southern California.
"The financial settlements (with the CNA) that I've seen have not been leading the market," she said. "In some cases (the deals have) almost been holding the market back. They've been tradeoffs for other kinds of job security concessions, particularly trading off salary and benefits for (organizing new units)."
Before the new contract, experienced full-time nurses at the Columbia San Jose hospitals earned $27.99 per hour, or $58,200 per year, said Paul Estess, director of business development at San Jose Medical Center and Regional Medical Center of San Jose.
Under the new contract, full-time nurses will be paid $29.11 per hour, or $60,500 per year, retroactive to July 1. By July 2001, they will earn $33.59 per hour, or $69,900.
"The agreement gives us what we were looking for from the hospital's perspective-a three-year position of stability-and it lets us compete for nurses in an extremely tight labor market," Estess said. Nurse recruitment, especially in subspecialties, has been "challenging," he said. The new contract also opens the door to dialogue with the nurses about quality of care, he added.
Charles Idelson, CNA spokesman, said Columbia management angered nurses by forcing them to work double shifts and understaffing key units. Negotiations dragged on for months until the nurses authorized a strike three weeks ago, Idelson said.
The hospitals created this labor shortage over the past 10 years "by downsizing and creating such substandard staffing conditions that a lot of nurses voluntarily left hospital nursing or healthcare entirely from burnout," he said.
The CNA recently settled 10 hospital contracts in the Bay Area, all along similar terms, he said. Its threats to strike have proved effective in bringing hospitals to the bargaining table.
CNA organizing activity has also moved southward, at the invitation of nurses in Los Angeles County. Industries, including healthcare, in Southern California generally have resisted unionization more than industries in the northern half of the state.
But that may be changing, particularly in healthcare.
For example, about 200 nurses at Henry Mayo Newhall Memorial Hospital in Valencia, north of Los Angeles, recently organized and joined the CNA. The union is conducting a petition drive for an election at Long Beach Memorial Medical Center, which employs 1,200 registered nurses.
It is also trying to organize workers at Valley Presbyterian Hospital in Van Nuys and at Cottage Health System, which has three hospitals in Santa Barbara.
According to Rosenfeld, CNA contracts haven't been as favorable as the union advertises. In low-inflation boom economies with labor shortages, she said, employers don't like to give significant wage increases. Sometimes labor contracts will substitute a flat bonus for an hourly increase.
But over the term of the contract, nonunionized employers will gradually raise their scale to stay ahead of the union's rates. So by the end of the three years, the union contract will have to show a steep jump-of 20%, for example-to stay even with real market conditions. So the union contracts look more favorable than they really are, she said.
Rosenfeld also advised taking the CNA claims about the establishment of quality committees and bans on mandatory overtime with a grain of salt. The contract language isn't necessarily as firm as the nurses might like, she advised.
The situation in Southern California is aggravated by an increasing patient census and a flat or declining number of newly graduated nurses. In 1995, the state licensed 7,700 new nurses. In 1998, it licensed 6,800.
"Anytime you see an industry in turmoil, the workforce becomes more vulnerable to unionization," Rosenfeld said.
Meanwhile, the CNA's bill to mandate nurse-staffing ratios is making progress in the state Legislature, Idelson said. The CNA held a rally of 1,800 members last week in Sacramento and will hold another this week in Los Angeles to support the bill. The bill has passed both the House and Senate and is now headed for a conference committee.
The CNA also carried out a one-day strike last week against Sierra Vista Regional Medical Center, San Luis Obispo, Calif. The union won a representation election there several years ago, but the hospital, owned by Tenet Healthcare Corp., Santa Barbara, dragged its feet on negotiations, the CNA said.