The Oregonian, Feb. 5, 2002
Enough with the nurses' strike.
Enough with experienced nurses, who are in short supply, carrying picket signs rather than tending the sick and injured.
Enough with Oregon's busiest medical center, facing resurgent financial challenges, sinking close to half a million dollars a week into extra pay and housing for strike-breaking nurses.
This has got to stop.
Registered nurses at Oregon Health & Science University in Portland walked out 49 days ago. The employer and the union, after several aborted mediation sessions, now slip toward a losing endgame for both sides. If the strike drags on much longer, the medical center's strike-related costs and forgone revenue could exceed what nurses seek in higher wages or improved health benefits.
So what's the holdup? History.
This conflict goes back years. The strike is rooted in grudges that have hardened over time, and ultimately the worsening nationwide shortage of registered nurses emboldened union members to act. Now, an accumulation of hard-fought deals and historical circumstances bars paths to agreement. That much is clear from an analysis of six potential compromises that could end the strike immediately.
1) Put OHSU's latest offer to a vote among nurses In mid-December, amid last-minute negotiations, hospital administrators offered to raise wages by 6 percent annually for two years, and more than that in the first year for nurses at the top and bottom of the pay scale. That compares with annual raises of 2.5 percent to 3 percent in each of the past five years. Since then, administrators offered to add a third year with another 6 percent raise.
"We would like to see our nurses get a chance to vote on the proposal on the table," said Dr. Roy Magnusson, OHSU's medical director, after the latest talks failed more than two weeks ago. Administrators also rewarded individuals who crossed the picket line by paying them an extra $7.50 an hour -- until a state panel of judges declared the practice illegal.
OHSU's strategy: appeal to individual nurses, and wait for the union to buckle. The number of union members who have crossed the picket line has grown to 368, by OHSU's count.
Union negotiators say that asking nurses to vote now would be a waste of time. In its latest offer, OHSU makes no changes to the contract's first two years, the long-standing length of agreements. Those terms were rejected by more than two-thirds of the 1,100 nurses who cast ballots in the final vote. The union represents 1,500 nurses at OHSU.
"We don't have anything new to vote on," said Kathleen Sheridan, negotiator for the Oregon Nurses Association. She said union members will hold out until OHSU puts more money on the table in a two-year contract.
2) Then put more money on the table At least five hospitals or health systems in Portland pay nurses higher wages than what OHSU has proposed in the first year of its offer. A nurse with a bachelor's degree makes from 56 cents to $1.29 more an hour at Willamette Falls Hospital, a small nonprofit in Oregon City. Nurses at the Portland Veterans Affairs Medical Center earn from 35 cents to $1.86 more an hour. Striking nurses maintain that OHSU needs to bring its wages closer to the highest-paying hospitals in Oregon to be able to recruit and keep enough nurses to meet the growing demand for patient care.
"They have substandard staffing, substandard wages, and nursing is not a priority there," said Sheridan.
OHSU officials say that with benefits, their offer exceeds the average compensation package for nurses in Portland, and that the institution can't afford to pay more.
Like any business, OHSU is trying to keep its labor costs from rising above those of competitors. Officials say OHSU has other obligations, such as supporting the only schools of medicine and dentistry in the state.
"We have to be careful that all of our missions are appropriately funded," said Bonnie Driggers, OHSU nursing director. As an academic health center, OHSU handles a heavier load of uninsured and low-income patients than some of its competitors. The medical center also is investing in biotechnology to attract money and jobs to Oregon, and the venture hinges to some degree on OHSU meeting financial goals.
OHSU netted about $33 million in its latest fiscal year, but officials expect to break even this year because of increasing costs. The university also could lose millions in state funding this biennium as lawmakers attempt to pull the state budget out of deficit.
3) Shrink retirement funds to fatten wages OHSU pays nurses lower wages than many hospitals, in part because OHSU pours so much into employee retirement plans: 12 percent of earnings. Legacy Health System puts close to 6 percent of earnings into retirement, and Providence Health System contributes as much as 6.5 percent.
OHSU's unusually large retirement contribution started in 1979, when public workers across the state agreed to forgo wage raises and their employers agreed to pay workers' share of contributions to the Public Employees Retirement System. OHSU, having privatized much of its business, is no longer a public employer, but it has kept the PERS arrangement. So why not cut back on retirement money and front-load it into wages?
Driggers says OHSU's agreement with PERS doesn't allow putting less toward retirement and more toward wages; the university could stop paying the employee's 6 percent share, but then the employee would be obligated to make the contribution. For more flexibility, the nurses would have to get out of PERS, and Driggers says she doubts nurses would want that.
"It hasn't been something either side has brought up," said Sheridan, the nurses' negotiator. She says nurses might consider it, but that OHSU is unlikely to drop the arrangement because it avoids payroll taxes on the compensation dollars it puts into retirement plans.
"You have to remember, it was very good for the employer to put this money toward PERS rather than toward wages," she said.
4) Elevate nurses with two-year degrees Most hospitals in Oregon make no pay distinction between nurses with two- or three-year degrees and those with bachelor's degrees. OHSU does, paying about a dollar an hour more to those with a bachelor's degree. Because of this, one third of the nurses working at OHSU -- lacking the four-year degree -- earn a lot less than they could make at competing hospitals. That creates the large discrepancy in median pay -- a significant issue for the union -- between OHSU and other institutions.
After the first raise in OHSU's offer, nurses with two-year degrees would still earn from $1.49 to $2.42 less an hour than their counterparts at Willamette Falls Hospital, and from $1.21 to $1.94 less an hour than those at Providence Portland Medical Center.
About 65 percent of the nurses in Oregon do not have a bachelor's degree, according to the state licensing board. "Which means none of them are going to want to work at OHSU," said Sheridan.
The nurses, however, haven't proposed equalizing the pay. Sheridan says that would be futile because OHSU refused to budge on the issue three years ago, when a strike was narrowly averted.
OHSU asserts that the pay scale difference is meant to attract nurses with more years of schooling.
"The hospital would like to continue, as an academic setting, to acknowledge the educational differences," Driggers said.
5) Launch a lower-cost health plan Drastic rises in the costs of health insurance are a leading reason why nurses at OHSU walked out. Premiums increased 14 percent in one plan, and as much as 55 percent in another, among the options available to all nurses. By the union's reckoning, health insurance will devour about half of the annual raises offered by OHSU for the average nurse.
Health benefits, like retirement funding, are another legacy from OHSU's days as a public employer. The medical center offers a menu of five health insurance plans with broad and generous coverage typical of public employers. But OHSU no longer has the combined buying power of the public employee system. Since it became an independent corporation, OHSU's premiums have been based solely on the costs its employees incur.
In the latest strike-settlement talks, administrators offered to start a new, more affordable health plan that would use OHSU hospitals and clinics as its preferred providers. The proposal failed to sway union negotiators, who say it would do nothing to shield nurses from cost increases during the two-year term of the contract. OHSU's timetable wouldn't get the plan running until 2004.
6) Give nurses more say in the workplace Many nurses say the strike is about the unrelenting stress of the job and a sense of hopelessness about improving work conditions. Hospitals across the nation are struggling with this problem.
"Nurses today are carrying a lot heavier load. They are doing a lot more things in less time, and probably working harder than they have ever worked," said Frank Brady of Brady & Associates, a hospital management consultant in Kansas City, Mo.
In response to union pressure, some employers are giving nurses more authority in the workplace. Kaiser Permanente, for instance, signed contracts with unions nationwide that spell out shared decision-making rules.
"I would be really happy to work at the same wage if the working conditions were good, if the staffing was reasonable, if they treated nurses with respect; that would be enough," said Shawn Schmelzer, a striking nurse who's worked in intensive care at OHSU since 1994.
Although nurses insisted OHSU doesn't listen to its concerns, Driggers says the medical center is committed to improvement.
"We want to hear about the issues nurses have, and work on them," she said.
At OHSU, managers and union nurses have spent many hours in mediation fighting over such things as rules for sending union-related e-mail, and how union representatives must report their presence on campus to the administration.
Both sides insist they are working on the relationship. Their latest mediation talks attempted to build on an existing task force to settle differences between labor and management.
Those talks came to nothing. They ended in a fight over who would be responsible for distributing the minutes to nurses.