Internal Bleeding

St. John's Mercy Medical Center alienated their RNs when they turned to less experienced caregivers to save money. Now they're paying for it.

A few months ago, administrators produced a video, Something Special, to answer nurses' questions about unionization. One after another, administrators talk of strained workplaces, rigidity, injustice and risk. "The people of St. John's Mercy have created a special working environment," the narrator intones. "A union has no place at St. John's Mercy. Not then. Not now. Not ever." There's footage of a smiling nun hugging a nurse and a paean to the Mercy values: dignity, justice, service, excellence and stewardship (and they don't mean the union kind).

The video closes with Weber, the hospital president, recalling an encounter on the elevator with a nurse who'd tried three times to make it through a snowstorm. She finally made it, and covered her floor all weekend. "She'd been working I don't know how many hours straight," he says, awed, "but she took the time to stop and, not complain, but tell me it was worth it because of the mission."

Crafton says, "If you didn't see the video screening, you'd meet one-on-one with your supervisor and watch it together, and if you didn't do that, they sent it to your home. After one session, supervisors said, 'We can have an open discussion; just feel free to say whatever you want,' and one woman stood up and said she was for the union and the supervisor said, 'I am deeply offended.'"

Crain insists that the answers to all problems lie "in the heads and the minds of the nurses who work here." Why is it that so many nurses don't share her confidence? "That's somewhat confusing to me," she admits. "When I look at the care that's provided here, the overall system, I believe that it's a very fine one." Does she think the nurses will vote to unionize? "I believe that they will make the best decision for nursing," she replies firmly, "which would be to not (unionize)."

Many agree already. "There are people who are part of the problem and people who are part of the solution throughout life, and the people who are not part of the solution are the people who are doing this," snaps Marsha Kenison, an oncology nurse who opposes the union. "They are always looking for something different that is not there. They think they have bad patient ratios." The agitators forget, she adds, that "this is a business. It's a hospital, but it's also a business."

"I had two people from the union come to my house, knock on my door and call me by name," continues Kenison. "I felt real invaded." Does she think the union will win? "It's a fear. I'm going to find it very difficult to work under a union. I'm not going to have the voice I have now, and I'm going to have less money because I'm going to put it out in union dues. Quite honestly, I think everything is going to be worse, because you will have people controlling your destiny that have no idea what you do."

Jessica Winning, a charge nurse in the burn center who's worked at St. John's for 13 years, doesn't think the union has a chance. "If you are willing to work and document your complaints, the system works," she says. "Maybe if the issues they were striving for had to do with salaries and benefits, maybe I could see where they were going. But this isn't even a money issue. This has to do with staffing and ratios and the climate of health care. No union is going to change the way we get reimbursed. (Insurers) are the ones pulling the strings."

Prade sums up other anti-union positions she's heard: "For some it's financial. 'St. John's isn't going to listen anyway, so why should I pay someone money?' Some are afraid the administration's going to find out they're doing this and get rid of them. Some are traditionalists; they don't believe in nurses and unions, ever. And some are just major suck-ups. Then there's all the negative stuff: 'If we get a union, we won't be able to work anywhere else'; or 'If the food workers go on strike, we are not going to be able to work, either.' They are taking industrial rules about foremen and applying them to nursing. People say the union will tell us to strike -- no! We vote on that. And we're having enough trouble getting 50 percent to vote on this -- how in the world do you think we're going to get a two-thirds majority (what most nurses' union contracts require to strike)?"

The hospital's basic argument is that a union can't do anything about staffing or patient care, because those are management issues. Unions can only tackle workplace issues -- benefits, salaries and so on. But in nursing, trying to disentangle money and workplace issues from the quality of nursing care is like trying to draw only plasma from a patient's arm. Pro-union nurses have heard of unions' getting staffing increased, minimum nurse-to-patient ratios established, policies changed, workplace conditions improved and, above all, patient-care committees established: committees of elected -- not handpicked -- nurses, to whose concerns the hospital must respond within a specified time.

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