As the final moments neared for announcement of the vote, National Labor Relations Board officials insisted on silence. It wasn’t easy.
After three days of voting ending on Sept. 27, the tally was scheduled to be announced at 9 p.m. Velvet Nelson and 35 of her fellow nurses at Renown Hospital—formerly known as Washoe Medical Center—struggled to contain their excitement. Then came the announcement: 491-213 in favor of forming a union with Service Employees International Union (SEIU). Once the meeting adjourned, Renown RNs danced, hugged and gave one another high fives.
“This is just the tip of the iceberg for healthcare in Northern Nevada,” Nelson says. “It’s good to win, but it’s really good to win big.”
About 50 Renown administrators turned out for the announcement. Hospital administrator Ron Laxton did not. And the hospital consented to no interviews afterward.
“All along, we have supported the right of nurses at Renown to vote independently and privately on the matter of union representation through a process protected and supervised by the NLRB,” Renown spokesperson Don Butterfield said in a statement.
That name change
Huge sums were spent changing the name and letterhead from Washoe Medical Center to Renown Regional Medical Center. Many nurses were upset that so much money went toward this venture while, they say, staffing ratios were not addressed. After the name change, nurses lost parking spaces and education days, but they say the name change didn’t solve the problems they faced from day to day.
Since March, frustrated Renown registered nurses pushed for union representation. A ballot initiative undertaken from July 15-17 brought nurses to the polls. With 56 percent of the nurses voting, 467-8 voted in favor of union representation.
Renown didn’t accept the majority vote and began an anti-union campaign, making, producing and mailing three DVDs to nearly 900 nurses, starring Laxton. (There is some confusion about why the July vote was held—federal labor law allows only one vote on unionizing a workplace in a year.)
The hospital purchased four weeks of full page newspaper ads in the Reno Gazette-Journal after the second election date was set. Nurses were encouraged to vote against the union and give Laxton a year to make changes. They responded that they had no guarantee that Laxton would stay to implement changes because he’s left once and returned.
“The problem is he doesn’t know what to do,” Velvet Nelson says of Laxton. For six years, she’s worked as a pre- and post-surgical RN at Renown. She’s a fifth generation Nevadan, nursing full-time, raising a 15-year-old son as a single parent while attaining a nurse practitioner master’s degree. Prior to the second union election, Nelson put in additional hours encouraging other Renown RNs to vote for the union.
Staffing ratios and nurse retention
Washoe County doesn’t have a problem recruiting nurses. Renown RNs say retention is the problem. They believe that establishing maximum staffing ratios for nurses to patients would resolve this problem.
Renown puts the attrition rate at 18 percent. From March to August pro-union nurses tracked the attrition rates, pulling 100 cards because nurses had left, indicating a disparity in the quoted attrition rate.
“We know how many [leave] because we work extra and overtime to fill those holes,” Nelson says.
Moreover, merely establishing a number doesn’t really get at the issue. The hospital says nurses leave; the nurses say hospital policies drive them away. Insufficient staffing levels affect patient care. Patients could wait for medications, to be fed and to be discharged. RNs say that high patient ratios don’t provide the best or safest care for patients.
Nelson recalls an 84-year-old woman waiting on a gurney in post operation from 6 a.m. until 9 p.m. Renown didn’t have enough nurses to care for her upstairs. “She should have been in her own bed where her family could visit her,” she says.
Nurses traditionally work three 12-hour shifts from 7-7. They are taking on an extra day, coming in early and staying late at Renown to ensure adequate staffing. “It’s burning nurses out,” Nelson says. “We’re tired. We’re overworked. We don’t have adequate staffing.”
Nelson says nurses are not equitably paid for services, and Renown ignores this problem, which is one factor pushing nurses to leave and contributing to under staffing. She wants pay based on years of experience.
Stu Talley has been a nurse for 23 years, working in 13 different hospitals. He’s tired of hopping around. He says he can’t complain about his pay, but he realizes the pay scale isn’t fair for other people.
“We got all these people streaming in the front door, but they never tell you how many are streaming out the back door,” Talley says. “Nurses get tired of having all the responsibility and none of the authority. Decisions are made by people who have never done, nor could ever do, my job.”
The Las Vegas effect
SSEI Local 1107 in Las Vegas established the Southern Nevada Pay Scale, ending the system of nurses moving from hospital to hospital for sign-on bonuses. Today, eight out of 10 nurses make the same pay based on experience and skill.
Catholic Healthcare West (CHW) collaborated with SEIU to create ratios based on the level of patient illness. Nevada became the first state to establish staffing ratios without legislation. CHW created a committee of nurses to address patient care problems, banning mandatory overtime and floating nurses beyond their area of expertise.
“In the bigger picture, nurses are saying their patients matter enough to take a stand,” Shawna Hammel says. She’s an ICU nurse at St. Rose Sienna Hospital and a vice president of SEIU Nevada. Sienna nurses have seen “great gains in patient standards” since SEIU began negotiating their contract. Within three years, the ICU night shift at Sienna went from 80 percent traveling nurses to a full-time staff.
SEIU wants Northern Nevada nurses to achieve the same gains and hopes Renown will work with them. “The people who are doing the work are the best people to recognize the challenges and be part of a problem solving process,” Hammel says.
The union didn’t fare as well in negotiations with Las Vegas’s United Healthcare Services (UHS), which reportedly fired a nurse for promoting the union, locked-out union nurses, suspended 39 nurses for wearing union pins and refused to accept maximum staffing ratios. Nurses say UHS sttill fights union nurses, implementing the highest nurse to patient ratios in Las Vegas, sometimes as high as 11 patients to one nurse, and so struggles to retain nurses.
During the Reno campaign, labor activist Andrew Barbano wrote in his Sparks Tribune column that the problems date back many years: “The nurses at Renown/Washoe Medical Center have for more than 20 years been forced to battle both maladies and management.” RNs voted in 1999 to unionize with an Operating Engineers affiliation. Renown later refused to recognize SEIU as successor union to Operating Engineers.
There was not a lot of news coverage of the union election. Where it appeared, it was poorly informed. One television station portrayed it as simply a vote on changing unions.
“You can’t be an RN in America and not be tough,” SEIU Executive Director Jane McAlevy says. She negotiates contracts between the union and hospitals and will be bargaining the Renown nurses’ contract.
“We respect the nurses’ decision on this matter,” spokesperson Butterfield said. “We expect negotiations to resume shortly and will continue to negotiate in good faith.”
SEIU Nevada represents 16,000 healthcare and public services employees. They want to establish a union at St. Mary’s and assist RNs working in long-term care facilities attain union representation.