Nurses at BMC holding an informational picket earlier this year. The nurses' union says appropriate staffing is critical to patient care; the hospital agrees but sees the push for contracted staffing levels as part of a union effort for a ballot initiative.
PITTSFIELD, Mass. — In the middle of a strike authorization vote and the union filing charges against the hospital with the National Labor Relations Board, the Massachusetts Nursing Association and Berkshire Medical Center return to the bargaining table Thursday in hopes to come to an agreement on a new contract.
The nurses have been without a contract since September and the negotiations are threatening to lead to the first strike at BMC in years. The primary issue between the two remains staffing levels.
"We want protections in the contract to make sure there is enough staffing. It is fundamental, asking the hospital to be more accountable," said MNA spokesman Joe Markman.
The nurses have repeatedly said staffing levels at the hospital are insufficient to provide proper care. The nurses say they have documented hundreds of occasions when low staffing levels have jeopardized patient care and say they've brought their concerns to the administration multiple times to no avail. The union started talks by asking for a staffing matrix and patient to nurse ratio be embedded in the contract so if those occasions still occur, there is a grievance process in place.
The hospital, however, doesn't see it that way. Hospital administrators feel that putting in specific criteria takes away flexibility in staffing. Hospital officials have said the staffing plans are constantly reviewed and go beyond just the number of registered nurses to also include doctors and specialists who are on the floor.
"We can't totally give up the responsibility to staff the place and say you decide how many people we employ here. We are the people responsible at the end of the day," Arthur Milano, vice president of human resources, said on Wednesday. "What we've done is given them an offer that is a fair trade-off in terms of how we get them to the table, how we get their voices into the process of how we determine staffing levels, and we think that is very reasonable."
Milano said the hospital has offered to create a staffing committee to meet regularly with management, review data and come up with recommendations for any changes that would need to be made — giving the nurses a voice in staffing that they hadn't had before.
"It brings the leadership and the staff together on a regular basis, looking at data, and making decisions based on work environment, the population on the unit, the experience of the nurse, the other resources they have," Chief Operating Officer Diane Kelly said.
Kelly added, "I welcome their input. I think the voice of the nurse at the bedside is important to us. We do want to have a formal process in which we can hear that and discuss the data together, and they can understand our rationale and we can understand their rationale. We don't think this should just be by the book, one number, and that's it. We need flexibility but it would be better to come to that in a shared way."
Vice President for Acute Care Brenda Cadorette said the model is taken from the American Nursing Association. Adopting such a committee brings the hospital in line with that organization's best practices.
"It is very similar to what they have laid out for all nursing professions. This one item is really what would bring us to that standard," Cadorette said.
Cadorette says there are already unit councils who would take the lead first, and then the new staffing committee would take it from there.
"They would make recommendations to modify if they thought it was appropriate and those recommendations will go to the overall staffing committee that is comprised of MNA committee members along with managers, who would take all of those recommendations and present them to the chief nursing officer," Cadorette said.
The union said the committee plan doesn't provide enough language in the contract to ensure the staffing levels are actually addressed. Markman said the union dropped its push for a specific staffing matrix and instead presented an offer that still allows flexibility, but includes language holding hospital officials accountable for failing to provide sufficient staffing.
Markman said the nurses would still be willing to negotiate the staffing committee proposal, tinkering with the way it is comprised and adding language to ensure there is enough staffing.
"The nurses moved away from [the staffing matrix]," he said.
By the time the nurses put forth proposals eyed to move closer to the hospital's position, the administration had already put forth its "best and final offer," which the union rejected at the end of May. The two sides returned to the table in June, but little was accomplished as neither side budged much.
"We went over our best and final to find out from them why they didn't think it was a good offer. From our point of view, the best and final was a very good offer, both economically and in terms of meeting the staffing issues they presented to us," BMC's Milano said. "That bargaining session did not result in much and the union then went back and determined that they are taking a strike vote."
Markman previously called on hospital officials to return to the table in the wake of the rejection vote, but when the two sides met in June, he said the hospital didn't budge.
"They really didn't make a movement to reach an agreement with the nurses," the union spokesman said.
On Monday, union members began two days of voting, one day this week and one day next, on giving the bargaining committee the authority to call for a one-day strike. The following day, the union filed charges with the National Labor Relations Board alleging the hospital, and Milano, of interfering with the vote.
The union is accusing Milano of sending a letter to members "misrepresenting" the consequences of a strike and threatening lockouts, halting health insurance coverage, and more, as well as "implying that the charging party [the union] would deliberately miscount the votes so that a strike could occur even though a majority of the nurses did not vote to do so."
BMC Spokesman Michael Leary responded to the allegations saying the hospital had not misrepresented anything.
"We are following the letter of the law and also the language contained in the current contract," Leary said.
Next week, the union plans to conclude its vote on giving the strike authorization. Markman said the two days of voting, spanning both before and after Thursday's bargaining session, was done to maximize membership participation.
"In the summertime, workers often have time off and this way they can get the most turnout," he said. "The vote, if approved, would give the bargaining committee the authority to issue a 10-day notice of a strike."
Markman said the union specifically wants hospital management to come away from the final offer and continue negotiations. And he believes a strike would send the message that the majority of the nurses, numbering some 800, support that push.
"The goal of voting for the strike itself is to show the hospital that the majority of the membership supports the bargaining agreement," he said. "It shows the hospital that we would not accept the best and final offer. The nurses don't want to go on strike unless it is necessary."
If a strike is authorized, hospital administration is prepared. Kelly said a contract is in place to bring in replacement nurses.
"Once anybody starts talking about a strike, my priorities very clearly shift and that is to provide uninterrupted, high-quality care for the community. We will do that. Do we have plans to do that? Yes, we do," Kelly said.
Cadorette, the vice president for acute care, said the replacement nurses will ensure that all of the patient care and appointments will continue uninhibited by the strike.
"These are all nurses who are licensed, highly skilled, have experience and specialties. They offered services at Tufts and Baystate. They are highly professional and work well as a team with the physician and all ancillary staff," she said.
Nurses at Tufts and Baystate are in contract battles, both of which focus on staffing levels. BMC officials say the focus on the staffing levels doesn't appear to be in relation to Berkshire Medical Center but to a statewide agenda put forth by the Massachusetts Nursing Association.
"There are really a number of signs here that this is really not about what is happening at Berkshire Medical Center but is much more germane to the statewide agenda of the MNA," Milano said.
One example Milano gave is that the offer from BMC to the nurses included 10 percent raises over three years: 3 percent the first two years and 4 percent in the final year. Yet, the nurses responded with a shorter length contract, foregoing the most financially rewarding year. At the same time, in 2018, the MNA is looking to place an article on the state election ballot for staffing ratios.
"We are losing money from state and federal sources on a regular basis. By year three, that 4 percent is going to look really good but yet they are willing to give it up," Milano said. "Ask them why? The answer is because the contract would be up just before their statewide vote on the ballot in November 2018."
Hospital officials say the staffing push locally is following the path of other hospitals and are all related to the statewide agenda. Markman rejects that argument and says while many hospitals have concerns with staffing levels, each bargaining group individually chose how to approach the subject.
"All across the state nurses are seeing and experiencing that hospitals are not providing adequate staffing," Markman said. "It is a common issue but the nurses approach it locally."
As both sides enter negotiations on Thursday, a lot hangs in the balance. Next week the strike authorization vote will be complete. The union is hoping on Thursday the hospital goes further toward meeting them on the staffing issue. The hospital is hoping the union will reconsider its offer.
"We have given them our best and final offer. It is a very good offer and we hope they will look at that offer and seriously consider it," Milano said. "We know the staffing issues are a significant issue for our nurses and we responded to that. We've given them specific language in that contract, language that goes over a process and the process shows how we will determine staffing levels and they will have a voice."
Markman said a hospital can't run without registered nurses so if negotiations fail, the union is prepared to use the strength workers are empowered with when joining a union.
"The strike authorization is a tool they have, it is a piece of their strength," Markman said. "Joining a union is all about the empowerment of the workers."
Berkshire Medical Center has presented what it says will be its "best and final offer" to settle a contract with the nursing union. A letter sent out by President David Phelps and Chief Operating Officer Diane Kelly was released on Wednesday outlining the hospital's offer. The Massachusetts Nurses Association and BMC have been at an impasse as the two sides try to negotiate a new three-year contract. The current one expired in September.
Nurses and supporters paced back and forth along North Street and Wahconah, holding signs, chanting "if we're out here, something is wrong in there." On the otherside of those walls, the administration is reviewing data showing Berkshire Medical Center ranking in the top when it comes to patient safety and preparing a forum to celebrate those numbers with employees. Outside, the nurses chant that the staffing levels are unsafe. Inside, a staffing office is reviewing the personnel on hand to m
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