Five-and-a-half years after their collective bargaining rights were stripped in the aftermath of Act 10, registered nurses working for the University of Wisconsin Hospital & Clinics Authority (UWHCA) on Thursday confronted the board of directors demanding recognition for a new union.
“Unacceptable changes to staffing levels, nurse/patient ratios and the dissolution of key nursing departments have left thousands of professional nurses without tools they need to provide the level of care we are capable of providing, and that our patients expect and deserve,” a delegation of nurses declared in a statement presented at the board’s regularly scheduled meeting Thursday afternoon. A copy of the statement was obtained by the Wisconsin Examiner.
With more than 2,000 nurses employed by UWHCA, the union drive is believed to be the largest union-organizing campaign in Wisconsin in years.
It could also mark a test as well of a little-known provision in the controversial law that launched Gov. Scott Walker’s first term. Besides slashing most collective bargaining rights for most public employees in the state, Act 10 also eliminated collective bargaining rights at UWHCA — which has not been a part of the state government since 1996.
In a statement released late Thursday afternoon, hospital management pointed to that change in the law: “State statute eliminated collective bargaining at the University of Wisconsin Hospitals and Clinics Authority following the expiration of pre-existing collective bargaining agreements.”
The statement also asserted that since that time, “UWHCA has successfully implemented many processes to obtain direct employee feedback, such as forums, the Employee Advisory Council and employee surveys. These avenues have provided valuable feedback that has helped shape the decisions and direction of the organization, enabling us to provide remarkable healthcare to our patients. UWHCA will continue to support our robust existing system of employee and nurse engagement, through which UW Health has earned the designation of Magnet nursing status.”
The statement, however, did not address one specific demand in the union letter, which called on the UWHCA management to “meet and confer” with the union to discuss grievances raised by the group. And nurses interviewed by the Examiner have painted a sharply different picture of the relationship than the statement reflects.
In interviews, nurses employed at UW Hospital and active in the union drive say it is the culmination of changes in the operation over the last several years, beginning with the authority’s 2014 decision to withdraw recognition of union representation.
In the years since, the nurses say, changes in management, financial priorities, and organizational culture at the hospital have led to deteriorating working conditions accompanied by growing shortcomings in patient care — all amid an increasingly discordant atmosphere and a loss of respect and collegiality.
“It was an excellent place to work,” says Shari Signer, a 17-year veteran of UW Hospital who is currently a general nurse assigned to different responsibilities and areas day to day. Even as union representation and collective bargaining were necessary and helpful, hospital management respected nurses as “a part of the hospital.”
Reduced training, increased workloads and changes in pay systems have strained relations, Signer says. Nurses who once had 45 minutes to get to work after being called in during their time off now must arrive in 30 minutes. Some employees rent hotel rooms or camp out with friends on their call days.
Before the loss of collective bargaining, “It was a very remarkable hospital,” says catheterization lab nurse Chuck Linsmeyer. “Nurses were very empowered, because of our union, to be fearless patient advocates. There was a collegial and collaborative relationship between nurses and doctors” — an attitude that extended to hospital management, he added.
“You felt respected,” agrees Mariah Clark, a colleague in the emergency room. “Your manager knew you by your name.” In the years since, she says, “there is also a loss of respect in how we’re treated.”
After the union was eliminated, hospital management embarked on a major reshaping of the organization — focusing more on some programs and shrinking others. Changes in how staff were deployed increased workloads, putting a strain on employees, union organizers say.
While the UW Hospital system remains highly regarded, nurses point to an increase in the number of patients to whom they are assigned. Some fear that could lead to compromises in care.
“We don’t want there to be a ‘sentinel event,'” says Kate Walton, using the term for when something goes wrong in a health care facility from which a patient winds up suffering. “We’re at the bedside — the eyes and ears on the patient all the time. [But] we’re not supported. We’re not given any sort of voice to make any changes.”
One flashpoint has been the UW Hospital’s emergency room, which has been the scene of repeated backlogs from patients waiting to be transferred within the hospital or to other facilities. While agreeing that the backlogs exist, hospital management and employees have disagreed on their severity and frequency.
“We’ve nearly coded patients in the hallway because we had no room to put them,” Walton says, while moving patients to other hospitals is complicated and time-consuming. “I’ve had patients wait for three hours for an ambulance to be available.”
Along with the reorganization of the hospital system’s departments and clinical emphases, nurses who spoke with the Examiner describe a cultural evolution in which financial matters have risen to the top of organizational priorities and further colored the workplace atmosphere.
A so-called “lean staffing” approach has led to an increase in nurses being sent home when patient loads fall off — and having to go without pay or to use vacation time, says Clark. She recalls training programs refer to patients as “customers” and focus on subjects such as “minimizing non-productive time.”
“But we’re not talking about patients,” Clark says. “We’re not talking about care. We’re not talking about outcomes.”
The statement presented to the board on Thursday echoed the themes that nurses expressed in interviews. The document expressed pride in “the unique nursing culture at UWHCA and … the tradition of outstanding direct patient care we have provided” — a culture “rooted in a long-standing tradition of mutual respect among our hospital system’s administration, board of directors, and organized registered nurses.”
The message decried “a shift away from a core value of fully supporting top quality nursing care, and towards a value of prioritizing maximum corporate profits.” It continued: “Unacceptable changes to staffing levels, nurse/patient ratios and the dissolution of key nursing departments have left thousands of professional nurses without the tools they need to provide the level of care we are capable of providing, and that our patients expect and deserve.”
Demanding “that the administration respect and collaborate with professional nurses, rather than ignoring us,” the statement declared that a majority of UWHCA registered nurses had signed union cards with SEIU Healthcare Wisconsin.
It demanded that the board voluntarily recognize the union, meet and confer with the union to discuss and resolve staffing and scheduling concerns, and to restore previously existing standards requiring just cause for firing and the right to union representation for individuals called into potential disciplinary meetings with supervisors.
“The nurses are ready to say enough is enough,” Signer told the Examiner. Recalling the system’s atmosphere and practices in the pre-Act 10 days, she adds, “We need to get that back. The way to do that is to have a voice for the nurses.”
This story has been updated to include a response from UWHCA that was emailed at 4:52 p.m. Thursday, Dec. 19.