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The Honolulu Advertiser
Posted on: Sunday, January 12, 2003

New pacts for nurses may bring cost cuts

By Robbie Dingeman
Advertiser Health Writer

Nurses may emerge from the long strike at three O'ahu hospitals with double-digit raises and changes in working conditions but could feel an aftershock if their employers consider cost-cutting moves to ease the effects of the newly negotiated labor agreements, analysts say.

On Friday, about 200 nurses at Kuakini Medical Center voted to ratify a new three-year contract. Some 800 nurses at The Queen's Medical Center reached a tentative agreement but have yet to vote on ending a strike that began the first week of December. About 330 nurses remain on strike at St. Francis Medical Center.

The interim dean of the University of Hawai'i's school of nursing and dental hygiene said there were wins and losses for both sides. Dean Barbara Molina Kooker said: "In my opinion, nurses have won some recognition for improvements in patient care. However, the loss of personal income to each striking nurse over these weeks must be substantial."

Associate professor Gerard Russo, who specializes in health economics at UH, sees negative results for both sides. He said nurses may have gained individually from improved working conditions and better pay, but risk other losses when hospitals take action to trim their costs. "These strikes are always, I think, lose-lose situations," Russo said.

With hospitals getting back less money from the federal government for treating Medicare and Medicaid patients, "their long-term financial situation is going to be difficult." With the strikes increasing financial pressure, Russo predicts more consolidation of hospitals under larger companies.

And he said hospitals already facing a nationwide nursing shortage will likely try to replace some higher-paid nurses with more technology and lower-skilled, lower-paid assistants.

Each hospital negotiates separately with the nurses union and has different salary schedules. Nurses at the three hospitals earn between $20.55 an hour up to as much as $38.86 an hour, which translates to an annual salary, before overtime, ranging from $42,744 to $80,829.

Strikes were averted at Kaiser Permanente and Kapi'olani Medical Center, as each reached agreement with the union after strike votes had been taken but before any strike began.

Nurses and management have insisted that pay wasn't the big issue keeping union members on the picket line. That became more believable last week when nurses at two of the three striking hospitals (Kuakini and Queen's) settled for pay packages very similar to those accepted at Kaiser and Kapi'olani — 21 percent and 20 percent over three years. At St. Francis, both sides are far apart with no new talks scheduled.

The president of the American Nurses Association in Washington, D.C., said she believes that most nurses strikes result in improved patient care, making the community long-term winners in such disputes.

Barbara Blakeney's association represents the nation's 2.6 million registered nurses. "Overwhelmingly, strikes begin because of concerns about patient care," she said. "I have yet to see a nurses strike in the country that was solely about money."

However, Russo said the working conditions package can't be separated from the pay issue because the staffing and benefits come with costs. When hospitals merge, the work force often is reduced.

He said both sides share responsibility for the outcome. "I think both parties should have tried to settle earlier on."

At the nurses' union, Hawai'i Nurses' Association collective bargaining director Sue Scheider predicts one long-term result involves lost trust and will result in many nurses resigning from the three hospitals where strikes occurred.

An official with the American Hospital Association said he believes the traits that attract people to the medical professions will help to mend rifts created by a strike. "When the strike is over, the nurses are glad to be back doing what they do so well," said senior vice president Rick Wade.

Wade said a lot of the impact will depend on the first few weeks of transition back to working together. "These are all professionals that are in human service," Wade said. "My experience ... is that these things heal themselves because they're there for the healing of others."

Wade and Kooker see potential for patients gaining in the aftermath. "The only clear winners are the patients who will reap the benefits of safer patient care, which the nurses and the facilities both want, but have different ways of approaching," Kooker said.

At Queen's, the union fought the proposal to combine vacation and sick leave into a new system — called "paid time off" — that rewards people who rarely call in sick with additional vacation days. The rallying cry on the picket line was "no paid time off." But negotiators agreed to accept the system after it became clear that management would not back down.

Managers say that having the PTO system can help reduce so-called mandatory overtime because it will mean fewer unscheduled absences. Nurses say they face job-related illness and injury that made such a system unfair.

It's not clear what the strikes have cost hospitals. Hospital management at Queen's has declined to comment on union claims that traveling nurses hired to work during the strike cost about $1 million a week or on how much was saved by not having to pay the strikers.

Queen's spokeswoman Lynn Kenton discussed some of the broad issues created by the strike, suggesting that the cost to the hospital was not excessive, but she declined to provide figures. She said general hospital operations "were not impacted due to diligent round-the-clock planning once the nurses' union issued its 10-day strike notice" that included detailed orchestration of at least 250 replacement nurses so that patient care would not be affected.

Kenton said the hospital continued all services. "The hospital has seen an increase in patient volume during this period and this trend continues," she said, which has helped to offset some of the costs of the strike.

At Kuakini, the nurses' union had cited mandatory overtime, staff issues and retiree medical coverage as key factors in the negotiations.

At Queen's, nurse negotiator Bill Richter said management stuck to its position on some crucial points: "It's not that far from their last, best and final offer. There's not a whole lot of difference,"

Still, Richter said he thinks more union members are ready to go back to work. "I think everybody's going to be real happy to be getting back to doing what they do best, and that's being at the bedside, taking care of patients."

Kenton said Queen's believes the contract "will help improve the continuum of care for patients. Additionally, we hope that our wage package reinforces our respect and commitment to the nursing profession."

At Kuakini, union members had pushed for an end to mandatory overtime, where nurses who had worked a 12-hour shift are sometimes forced to stay another four hours for a 16-hour workday.

Scheider said the breakthrough came with management agreement to cap a work shift at 14 hours.

Blakeney said the community should care about the aftermath of a nurses' strike because studies show that nurses make a critical difference in the lives of patients. "Nurses keep bad things from happening to patients," she said.

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.