Unions Battle for Nurses
Two groups vie to dominate the state's hospitals. Patients could see better service, higher prices.
By Ronald D. White
Times Staff Writer
August 3, 2003
After a 12-hour shift in the operating room, nurse Martha Salcedo left Monterey Park Hospital and walked toward her car in the parking lot. That's where a band of purple-shirted labor activists approached her.
"We're the union that brought Tenet to the bargaining table," said a representative of the Service Employees International Union, referring to the big hospital chain.
Another SEIU rep said: "We have a guaranteed salary increase." Then the rep offered Salcedo a union card to sign.
A few days later she again was approached in the parking lot by labor organizers. This time they were with a different union-the California Nurses Assn. These activists described the CNA as the real voice for registered nurses, and, denouncing the SEIU as selling out to management, implored her to join them.
On both occasions, Salcedo drove off without saying a word.
"I was too scared" of being seen by hospital administrators, she said.
Like it or not, Salcedo and thousands of other nurses in California have become targets of aggressive campaigns by two unions that are competing for labor dominance in the state's hospital sector.
In recent weeks, the SEIU and the CNA-two fast-growing unions with opposing cultures and agendas-have filed for union elections at about 20 hospitals owned by Tenet Healthcare Corp. and other companies. And they're just getting started.
With sights on organizing dozens more hospitals, they have taken their campaigns not only to hospital parking lots but also to nurses' break rooms, workers' homes and the National Labor Relations Board.
The battle has drawn national attention and left many in the labor movement cringing.
"This fight has turned very personal and very ugly," said Kate Bronfenbrenner, director of labor education research at Cornell University. "It's very unfortunate. It's only hurting the labor movement."
The stepped-up organizing by the unions could have broader repercussions, as hospitals face cuts in public funding, a nursing shortage and new state rules that will require them to add nurses next year.
Based on union and company estimates, 20% to 25% of the 1.3 million health-care workers in California are represented by labor unions, including employees at some of the biggest hospital chains-Sutter Health, Catholic Healthcare West and Kaiser Permanente.
About 275,000 of the union members belong to the SEIU, which is affiliated with the AFL-CIO and represents hospital janitors and respiratory-care operators as well as all types of nurses. The CNA, a century-old group based in Oakland and fiercely independent, has 50,000 members, all of them registered nurses.
In the next few years, industry executives predict, the percentage of health workers in the state represented by unions could double. Most hospital employees, given the chance, are likely to join one of the two unions, the executives say, in large part because of frustration over their working conditions and pay.
Patients and their families could stand to gain, because collective bargaining agreements offer better pay and working conditions, which could draw talented people to the health profession.
On the other hand, industry executives and observers agree that if unions win higher wages at Tenet and other major hospital chains, nonunion competitors will have to keep pace. And salary increases "obviously will be passed on to consumers, patients," said Fred Harter, a former hospital chief executive who is senior vice president of public policy at California Healthcare Assn., a hospital trade group.
By Harter's estimate, 55% to 60% of a hospital's operating budget is labor expenses. "If you look at hospital costs now, the No. 1 driver is labor, absolutely."
For years, neither of the unions had much success organizing employees of Tenet, the nation's second-largest hospital operator, which is widely known for its tough anti-union campaigns. But in May, the Santa Barbara-based company announced a pact with the SEIU that essentially opened the door for the union to organize Tenet's 40 hospitals in California and their 35,000 employees.
Wall Street analysts viewed the deal as a shrewd move by the company-under severe pressure from multiple government investigations of its business practices-to buy labor peace and quell criticism from a union with deep resources and strong political connections in Sacramento.
As part of the accord, Tenet agreed to provide raises totaling 29% over four years to employees at hospitals where a majority of workers had voted for the SEIU. Tenet's pact made the same pledge to a smaller health-care union, the American Federation of State, County and Municipal Employees.
But the company completely shut out the California Nurses Assn., which filed a complaint with the National Labor Relations Board seeking to overturn the Tenet-SEIU accord, which it called an "illegal, fraudulent" attempt to bribe Tenet employees. For its part, the SEIU wants the board to shorten its hearing process and hold hospital elections sooner. The NLRB is considering both requests.
For Mary Kay Henry, the SEIU's director of organizing in Southern California, the accord with the state's biggest private health-care company marked a breakthrough.
"There was a bunch of us who never thought that private health care here would ever go union," she said, noting that the bulk of the SEIU's members at hospitals are public employees. "We're at a tipping point now, where other health-care employers are beginning to view unions as inevitable."
Henry and others at the SEIU dismissed criticism that they sold out to Tenet to gain an edge over rival CNA.
"The most common strategy, targeting employees at individual hospitals, was going to take decades," said SEIU spokeswoman Lisa Hubbard. "We needed to be strategic There had to be a better way by negotiating at the top, and Tenet agreed."
The SEIU quickly went to work, dispatching its mobile organizing center-a 38-foot purple Winnebago-to hospitals in the Southland. (The Winnebago now is parked outside Centinela Hospital Medical Center in Inglewood.)
With Tenet's blessing, SEIU organizers set up booths inside hospitals, passing out pamphlets with salary schedules and dues and offering free food to prospective members.
On a recent afternoon in a conference room at Monterey Park Hospital, registered nurses were invited to an SEIU welcoming over a spread of grilled chicken, rice, corn and beans. It was in that much more relaxed atmosphere that Martha Salcedo decided to join the SEIU. There were plenty of takers, though not everyone warmed to the idea of voting for the SEIU.
The California Nurses' Assn. has fought back. In early June, the group formed a statewide council of nurses at 24 Tenet hospitals to try to force the company to the bargaining table. It since has filed petitions with the NLRB to conduct a union vote at Tenet facilities including Alvarado Hospital Medical Center in San Diego, Midway Hospital Medical Center in Los Angeles and Doctors Medical Center in Modesto.
(A union can qualify for a representation election if it obtains signatures of support from at least 30% of the workers in the proposed unit. But under NLRB rules, a competing union can add its name to that same ballot by getting just one worker's signature.)
Rose Ann DeMoro, the CNA's executive director, said Tenet's deal with the SEIU goaded her group to step up its activism.
"We could never have achieved this kind of momentum without the duplicity of Tenet and the SEIU," said DeMoro, a former supermarket checker who joined the CNA in the mid-1980s and took the helm in 1993.
Tenet executives declined to comment on the competing organizing drives.
The CNA's tactics: Swarm the hospitals at shift changes, during lunch hour and work breaks, portray the SEIU as the union that sold its soul to align with Tenet, and maintain a steady drumbeat of negative publicity against both.
"Disgruntled members, expensive dues, partnerships with management. What kind of union is this?" says one of CNA's campaign missives.
Members of SEIU Local 399-the union's main health-care local in Southern California-pay 1.6% of straight-time wages in dues, according to SEIU officials. The CNA says its union dues amount to 1.2% of comparable wages, although it is contemplating an increase.
With Los Angeles-area nurses in the private sector earning more than $30 an hour, according to a Labor Department survey last year, the unions have a lot riding on their campaigns. Not that either group is suffering: Both SEIU Local 399 and the CNA have seen a surge in dues revenue in recent years-Local 399 reported revenue of $15.3 million last year and the CNA more than $17 million, according to filings with the NLRB.
"You have two unions battling now not for just organizing at specific Tenet hospitals but all of the hospitals in the state that haven't been unionized," said Gerald F. Kominski, associate director at the UCLA Center for Health Policy Research.
Who will win?
The CNA has lost ground in some circles, say nurses who ask how it can back them up at work when its organizers aren't allowed to enter Tenet's hospitals. Still, the union appeals to nurses who feel trapped between a troubled company and a giant union.
Earlier this year, Tenet held an "informational meeting, talking about the evils of unions, saying that unions promise more than they can deliver and they didn't need to join one," said Alvarado intensive-care nurse Susan Gorney, 46. "Then suddenly, Tenet was pitching a union, the SEIU, saying that this one was OK. It didn't make sense."
In the end, Gorney decided to sign up with the CNA. Part of her reason: Tenet had never listened to the suggestions of nurses when it was on a sound financial footing, and she was concerned about what might happen if the company's fortunes continued to fall.
"There comes a point when you realize that you'll have to go this route to get what you deserve, which is a voice for nurses," Gorney said.
Wrong, said 42-year-old San Fernando Valley resident and registered nurse Eugene Ruffin, who has worked at hospitals and facilities run by Tenet, Kaiser and Catholic Healthcare West.
Ruffin viewed the CNA as "too elitist," with its sole emphasis on registered nurses. "They want to be separate. They're the old guard."
He added: "With the socio-economic climate we're in, all health-care workers and all unions should be working together."