At stake in nurse union fight: Patient care

By Megan McCloskey

Thursday, Sept. 11, 2008 | 2 a.m.

Two unions are battling to represent the bulk of the state’s nurses — and the outcome could shape how Nevada deals with patient care issues.

Most registered nurses in the Las Vegas Valley are represented by the Service Employees International Union, but the California Nurses Association is challenging the SEIU with takeover attempts at several hospitals.

Their common ground is a claimed concern for patient care. But the two diverge on how best to improve it.

Competition between the two in Nevada kicked off in earnest in fall 2007 when they targeted a nonunionized hospital in Reno. The California union won and turned to wooing nurses in Las Vegas.

The California union, part of the National Nurses Organizing Committee, said it had been turning away SEIU nurses in Nevada because of a no-raiding agreement between the two unions. But that courtesy — those types of agreements are largely symbolic — ended after the fight in Reno.

Jill Furillo, Nevada director of the California union, said it is in contact with nurses from every hospital in the area.

“We’re in the process of building a strong momentum in the state,” she said.

The California Nurses Association nearly won representation at three St. Rose Dominican hospitals when it collected the most votes in an election in May. However, it didn’t win a majority vote, which is required for victory (400 voted for the California union, 377 voted for the SEIU and 26 voted for no union). Nurses and ancillary staff are working without a contract while the two unions bicker and fight over a runoff election.

Nurses at other local hospitals — including University Medical Center, where nurses can opt out of SEIU membership in October — are having their own debate about the merits of each union.

A key issue for nurses — and patients — is nurse staffing levels. Health care experts nationwide worry that nurses are overworked and unsafely assigned too many patients, and that as a result care is suffering. Nursing practice calls for specific nurse-to-patient ratios.

Staffing levels are high on the list of priorities for both unions, but fundamental differences between the unions could affect the issue.

Ariel Avgar, an associate professor at the University of Illinois who studies labor issues in the health care industry, said the California group and its national parent have a much broader public policy focus beyond day-to-day workplace conditions.

“Most unions don’t operate on that level,” he said.

Unlike the SEIU, which as one of the largest unions in the nation has a broad constituency including other hospital staff, the California association represents only nurses. This affords it a more narrow focus.

The SEIU is a strong force in the health care industry but faces increasing competition from other unions, according to Harry Katz, dean of the Cornell University School of Industrial and Labor Relations.

“Employees that think of themselves in more professional terms tend to drift toward a union that represents just that profession,” Katz said.

Health care-related research backs that up in terms of nurses, and the California union has been using that point to sell itself as the better union.

Whether nurses in Nevada agree could affect how the state deals with staffing ratios.

Nationally, nurse staffing issues are being resolved either with unions on a hospital-by-hospital basis or by state law. Twelve states and the District of Columbia have passed legislation in the past few years requiring hospitals to have nurse staffing plans. California is the only state to mandate staffing ratios.

Shauna Hamel, president of SEIU Local 1107, said that although SEIU supports basic legislation, it prefers to tailor nursing ratios to each hospital through contracts. Employing that hospital-based strategy last month, the SEIU filed a complaint with the Nevada Licensure and Certification Bureau alleging 84 incidents of understaffing at Valley Medical Center and Desert Springs Hospital. The union filed a similar complaint in 2006. (The hospitals denied the veracity of both complaints and called the latest one a publicity stunt to help ward off the California union’s invasion of the market.)

The California Nurses Association, on the other hand, is pushing to make the staffing ratios law.

How that plays out in Nevada could depend on who wins the union showdown.

The SEIU did present a bill during the past legislative session, but it didn’t make it out of the Health Care Committee. Assemblywoman Sheila Leslie, chairwoman of the committee, said the SEIU failed in its presentation at the bill’s hearing.

The testimony was emotional with plenty of “horrendous stories but short on practicalities,” she said, adding the SEIU was unable to “answer the basic questions of how this would work in Nevada.”

With the nurses association’s experience getting legislation passed in California — albeit a much more liberal state — it might have more success moving the issue forward in Nevada.

If the union turf war ends in a draw with the two unions divided among the hospitals — not an unlikely scenario because the health care industry isn’t overwhelmingly dominated by one union — the best chance of getting legislation passed is to have the unions work together.

“The unions need to be pragmatic,” Leslie said, adding that two separate proposals will effectively kill any chance of getting legislation passed.

But in the current contentious atmosphere, collaboration is unlikely.

In these types of battles, Katz said, “sometimes unions reveal more animosity toward each other than you see them revealing toward management.”