Health field becomes battlefield
- Julie Connors leads picketers against Brockton Hospital, one of thousands of unionized nurses across the U.S. on strike over wages, mandatory overtime and inadequate staffing.
Hospital and nursing home executives have responded to the walkouts by flying in corps of highly paid temporary replacement nurses to keep their facilities running.
Strikers say management is trying to break unions and that the imported nurses provide substandard care, while hospitals contend that they are fulfilling an obligation to their patients.
Both sides agree that the use of replacements is prolonging nursing strikes.
"Without them, the strike wouldn't last as long because we would have to cave in," said Robert Hughes, vice president of Brockton Hospital.
That perceived advantage may help explain a 73-day strike at a hospital in Flint, Mich., last winter, a five-month walkout at a hospital in Nyack, N.Y., last fall and a strike under way in Youngstown that has stretched into its third month.
"We give [hospital and nursing home administrators] the time so they don't have to say the things they don't want to say," said Dan Mordecai, chairman and chief executive of U.S. Nursing Corp., a privately held Denver company that is by far the largest supplier of strike replacements.
The availability of replacements is a particularly valuable bargaining chip, given the tight labor market for nurses that strengthens the economic hand of unions. But it also risks deepening the divide between managers and nurses, experts say.
"The hospital is signaling we don't need the nurses. The nurses are signaling we don't need the hospitals," said Jack Needleman, who teaches economics and health policy at Harvard University. "That creates a real distance that is the exact opposite of the kind of team orientation and mutual respect among parties that is needed to make improvement happen."
Temporary nurses aren't a new phenomenon. Hospitals have long called on traveling nurses and small, local temporary agencies when short of staff or to work alongside non-union supervisors during strikes.
As recently as a decade ago, many hospitals responded to infrequent strikes by scaling back, canceling elective procedures and referring patients to other health care facilities. But U.S. Nursing, founded in 1989 by Mordecai, a former benefits consultant whose wife is a nurse, offers a ready force of nurses from around the country who can staff hospitals at full strength.
They don't come cheap. Replacements supplied by U.S. Nursing Corp. and a smaller firm, Nurse Bridge, often earn $40 an hour, double the rate of many regular nurses. The costs multiply once hotel bills, airfare and other costs are added in.
U.S. Nursing and some hospital executives would not discuss what the company charges, its profits or details of its contracts.
The average U.S. Nursing replacement works 12 hours a day, five or six days a week, and earns $3,000 a week, Mordecai says. Executives at Nurse Bridge, a subsidiary of Health Personnel Options Corp. of New Albany, Miss., did not return calls for comment.
Union officials say the total cost to hospitals is about $5,000 per week for each replacement. But the cost has not dissuaded hospitals from calling on the replacement firms.
U.S. Nursing staffed its first strike in Burlington, Iowa, in 1990 - for that job it dispatched 35 nurses. This year the company will employ between 4,000 and 5,000 nurses at U.S. strikes.
The increased role of replacements has seeded a new strain of tensions.
In Connecticut, Gov. John G. Rowland enraged union leaders this spring when he authorized the use of more than $20 million in state funds to pay replacements at 39 nursing homes targeted by a strike. The homes, which contracted with U.S. Nursing, ran up bills of about $1.2 million a day at the peak of the strike in May.
In Michigan, nurses at Flint's McLaren Regional Medical Center returned to work in January. But because about 100 nurses found work elsewhere and decided not to come back, hospital administrators have held on to a small group of U.S. Nursing replacements to work alongside lower-paid returning strikers.
"They are very open in talking with each other about how lucrative it is to be here, as they're standing there working," said Al Napier, president of the nurses union at the Flint hospital.
In Massachusetts and other states, unions deride replacements as dangerous, saying their lack of familiarity with hospitals and long working hours put patients at risk.
To illustrate, they point to St. Vincent Hospital in Worcester, where an 87-year-old woman died after gall bladder surgery during a strike in May 2000. A state investigation found that U.S. Nursing replacements misunderstood doctors' instructions about how the woman was to be monitored.
U.S. Nursing's Mordecai says such mistakes are rare and reflect the challenges all medical professionals must cope with.
"We do make mistakes. We have the same kinds of problems that, from time to time, occur in any hospital environment," he said.
Hospital executives praise replacements and defend their choice to call them in.
"We had to do everything in our power to be prepared to continue patient care," said Kathy Nimmo, chief nursing officer at McLaren.
At Brockton, 17 doctors signed a public notice declaring that the replacements "have our full respect and support. As licensed and experienced medical professionals, these nurses provide high-quality medical care in every department of the hospital."