On November 14, 2002, nurses working at Northern Michigan Hospital (NMH) in Petoskey, Michigan, walked off the job, enlisting Teamsters Local 406 as their bargaining representative. More than 500 days later, the two sides are still at loggerheads (making this nursing strike perhaps the longest in U.S. history).
"The most important outstanding issue for the nurses is to have a voice in patient care," says Andi Shafer, a nurse who was care coordinator at NMH before the strike. Shafer says that while nurses serve on various hospital committees, their input is for the most part ignored. Other issues lingering on the bargaining table, she explains, are nurse-patient ratios and economic considerations such as wages and pensions. Hospital administrators confirm that economic questions are stalling talks, but they paint a different picture: the union, they say, wants to force all NMH nurses to join the Teamsters and pay dues, or to pay a service fee equal to 95% of dues. Failure to do so would translate into a loss of employment, a condition the hospital finds unacceptable.
After the Governor's Blue Ribbon Panel Report released in September 2003 presented the possibility that patient care at NMH was being compromised, U.S. representative Bart Stupak (D-MI) asked the Centers for Medicare and Medicaid Services (CMS) to join the Michigan Department of Consumer and Industry Services in conducting an inspection of the hospital. The inspectors found several shortcomings, including poor oversight of nursing care, a failure of nursing staff to keep current nursing care plans for each patient, lapses in the preparation and administration of prescription medications, a failure to ensure that "outdated or mislabeled medications were unavailable" to patients, and inadequate infection control.
Hospital administrators counter that the only problems cited by the CMS survey were procedural and that in no instance was a patient actually harmed. Since the strike began, they say, the rate of infections tracked by the Centers for Disease Control and Prevention has remained stable or decreased. But Stupak challenged this claim. In an editorial in the Petoskey News-Review, he wrote, "It is reckless to dismiss the infection control problems at NMH as just 'policy, procedure, and process issues.' . . . The hospital's own infection control documents, the Blue Ribbon Panel Report, and the CMS report all document . . . infection control concerns."
Since the strike, the hospital has had to rely in part on several travel nursing companies, which, according to a report by the Teamsters Local 406, boosted costs of nurse staffing by about $9 million from the onset of the strike through July 14, 2003. (Travel nurses are paid at a much higher hourly rate than permanent staff.)
Why would the hospital be more willing to take on a heavy financial burden than to compromise? "The hospital wants to bust the union altogether," says Shafer. "Just look at the law firm they've selected to represent them," she says. "It's the Fishman Group, and their specialty is keeping employers union free." Indeed, the words "keeping employers union free" appear as part of the firm's self-description on the Michigan Chamber of Commerce Web site.
While police and firefighters can turn to binding arbitration-calling on impartial consultants for help in negotiating a contract-nurses don't have such automatic recourse, and in this case, the hospital has rejected the option. "The Teamster call for binding arbitration is nothing more than a move to avoid responsibility for what has occurred," the hospital said in a statement. "The union is responsible for its strike choice, and does not need the hospital's agreement to binding arbitration to undo that choice. . . . We are unwilling to give up our authority to an interest arbitrator."
This strike is a reflection of larger problems in nursing, Shafer says, such as mandatory overtime, that drive nurses from the profession. "If such problems are not resolved, hospitals will lose their nurses. And guess what? No nurses, no health care."-Dalia Sofer