California healthcare workers reevaluate contracts, pandemic pressures in mind

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Healthcare workers bemoan heavy workloads and limited staffing two years into the pandemic as hospital volumes pick up. Unions in California have been particularly active as more contracts expire and nurses and other staff have the opportunity to negotiate their working conditions.

About 5,000 nurses at two Stanford hospitals in northern California went on an indefinite strike on April 25 but returned to work on May 3 with new contracts with measures they say will lead to better recruiting and retaining nurses – a key issue that led them to strike in the first place.

On the same day, nurses returned to work, more than 1,000 Stanford residents and fellow physicians won a union election representation by the Interns and Residents Committee (CIR-SEIU).

Stanford staff aren’t alone in California

Some 8,000 nurses at 15 Sutter installations who went on a one-day strike on April 18 have still not reached an agreement on new contracts with the system, according to the union representing them.

And on May 9, hundreds of certified practical nurses, technicians, environmental services and food service workers at Cedars-Sinai Medical Center in Los Angeles began a five-day strike. They returned to work after the strike without reaching an agreement on new contracts, according to a statement from the system.

Although the state is the only state in the nation with mandatory nurse-to-patient ratios, current workforce challenges are changing healthcare workers’ perspective on what exactly safe and secure staffing means. about the kind of working conditions they are prepared to endure beyond the pandemic.

New York passed its own personnel law, prompted by the pandemic, but it does not mandate ratios. It stipulates the form of hospitals clinical staffing committees that include frontline nurses and other direct care staff when establishing annual staffing standards for units.

Stanford Cardiac Intensive Care Nurse Kimberley Reed said nurses had achieved several victories after their strike. This included competitive salaries to incentivize staff to stay and attract others to come and work for the system, better mental health supports and a greater focus on acuity during patient assignments.

Salaries are key in the context of current shortages, as burnt-out nurses quit or retire early, and better-paying shifts tempt permanent nurses to leave their current jobs.

Traveling and permanent nurses have seen their salaries rise amid pandemic-induced shortages, but not equally.

The median hourly wage for contract nurses has increased by 106% from 2019 to 2022, from $64 per hour to $132 per hour, while the wage for salaried nurses has increased by 11% over this period , dropping from $35 per hour to $39 per hour, according to a report by Kaufman Hall.

The Stanford nurses’ new contracts include a 7% salary increase in the first year of the contract, followed by two 5% increases in the second and third years.

It also stipulates that nurses in units caring for very acute patients that have been difficult to staff – such as emergency departments and intensive care units – will receive incentive pay.

The language around acuity-based staffing was another big win for nurses at Stanford.

California’s nurse-to-patient ratio law includes language to account for acuity and states that additional RNs must be added to minimum ratios based on a patient classification system used to measure the complexity and severity of the patient. a patient’s condition.

But that’s not enough in some cases, “leading to a lot of nurses being overworked,” Reed said.

Patients in the cardiac intensive care unit where she works “are extremely sick patients”, often requiring medical devices, frequent monitoring and trained staff to safely manage them and their conditions, it said. she declared.

The law also excludes a few units – but not intensive care units – from the mandatory ratios. Stanford nurses wanted to make sure the language applied to all units and got it in new contracts, said Kathy Stormberg, a Stanford radiology nurse and vice president of the union representing nurses.

Other recent industrial actions at Stanford have come from medical residents and interns who won an election for union recognition on May 3.

A majority — 835 residents out of 1,478 total — voted to unionize, and Stanford does not plan to challenge the election results, according to a statement emailed by the system.

These doctors in training will be represented by the CIR-SEIU and negotiations for their first negotiated contracts will begin in the coming months.

They will push for a number of things in their first contracts, such as salary increases to reflect the cost of living while taking into account the student loan debt many are carrying, said Philip Sossenheimer, a resident physician in internal medicine at Stanford.

When residents feel their clinical burden is unsafe or they are working too much, union representation will give them a mechanism to complain to the hospital, he said.

“We started to realize that things didn’t have to be like this, and that wasn’t necessarily the best way to train doctors or take care of patients, and that we could speak up and ask for something. better,” he said.

The pandemic has intensified unionization among residents and interns who have historically been less active on the labor front than registered nurses.

While CIR-SEIU is the largest national union representing residents and interns with 20,000 members, National Nurses United, the nation’s largest nursing union, has 175,000 members.

So far in 2022, interns and residents from four hospital systems across the country have obtained representation with the CIR-SEIU. That compares with five election wins in 2021, one in 2020 and two in 2019, according to the union.

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