Two of the Boston area’s major medical centers were on the brink of nursing strikes this month, following protracted collective bargaining sessions between the hospitals and their nurses’ union, the Massachusetts Nursing Association (MNA), an affiliate of the National Nurses Union (NNU).  Although the union filed legally required 10-day strike notices at both hospitals, the parties reached agreements on new contracts just hours before the strikes were to begin. 

NNU has made contractual nurse-to-patients staffing ratios a national issue by aggressively pressuring health care employers, pushing for legislation, and coordinating strikes.

Negotiations over a contract extension covering 1200 nurses at Tufts Medical Center in Boston began last fall.  The parties reached agreement on an 18-month contract extension at 2:30 a.m. on the morning of the called strike.  The deal does not include mandated staffing ratios.

Over 700 MNA-represented nurses at St. Vincent Hospital in Worcester, MA also provided notice of their intent to strike, prior to reaching a new 3-year agreement two days before the scheduled strike.  In contrast to Tufts, St. Vincent already had contractual nurse-to-patients ratios, but the union nonetheless made “safe staffing” a rallying cry during many months of negotiations. 

We spoke with Anita Polli and Tony Rizzotti, Littler shareholders in Boston and chief negotiators representing Tufts and St. Vincent, respectively.

What were the major sticking points in the negotiations? 

Anita Polli: The biggest issue at Tufts Medical Center was mandated staffing ratios; in other words, the union wanted the authority, rather than hospital administrators and supervisors, to decide how many patients each nurse is required to take care of on every unit in the hospital. 

Tony Rizzotti: Staffing ratios started as the main issue, but St. Vincent already had ratios in its contract.  In early 2011, the hospital put on the table a very comprehensive staffing proposal, which addressed this issue.  At the end of the negotiations, it came down to financial issues.  

What was the hospital's strategy for enduring the negotiations battle? 

TR: St. Vincent was careful to communicate well both internally and externally.  The MNA continually said the dispute was about patient safety and that St. Vincent was not a safe hospital.  St. Vincent is nationally recognized for safety, quality, and patient satisfaction, and the hospital needed stakeholders to understand that.

AP: The strategy at Tufts also focused on clear communications externally as well as internally to the nurses themselves, other employees, and management.  We relied on providing factual, lawful communications directly to the nurses about what we were proposing so that there was no misunderstanding.  While the hospital wouldn't agree to mandated staffing ratios, we spent considerable time talking with the bargaining committee about quality and safety issues.  We were able to prepare and distribute fact sheets that showed many of the statements made by the MNA were untrue.  

Was the hospital prepared for a strike? 

TR: Very prepared. We settled on May 4th, with the strike set to begin on the 6th, so we had no choice but to have a strike plan in place.  Many nurses from other states were already on the way to Massachusetts to fill in for striking nurses. 

AP: Absolutely.  The only way to avoid a strike is to be prepared for a strike. Tufts had excellent replacement nurses ready to go.  It was an expensive effort, but Tufts was ready to operate the hospital in a high quality and safe manner. 

How did the union attempt to put pressure on the hospital?

AP: The union held rallies and organized flash mobs inside the hospital, with union members dressed in black scrubs to “mourn the death of safe staffing.”  The union also held picketing events and candelight vigils outside the hospital.  The ultimate leverage was the 10-day strike notice.  At that point the hospital needed to start  flying in replacement nurses to prepare a staffing plan.  Nevertheless, the Medical Center would not agree to mandated staffing ratios. In the end, the MNA did not have the support of the majority of the nurses for the strike.

TR: At St. Vincent, the union also organized flash mobs in the hospital, with signs reading “safe staffing now.”  They picketed the hospital, and at one point they were there nearly every day for a month.  In print and in broadcast media, the union made statements critical of care at the hospital, and they tried to get politicians to speak out against the hospital.  The union’s message, however, just didn't ring true, and, ultimately, the support for a strike was not there. 

How did the major issues get resolved in the final contract?

AP: The union abandoned the staffing ratio proposal, and the hospital agreed to put some limits on mandatory overtime and floating.  Generally, the hospital agreed to maintain the staffing plan it currently has.

TR: The hospital made a last, best and final offer that was fair, comprehensively addressed the issue of staffing and provided a modest pay increase, which the MNA ultimately accepted. 

What do you think other hospital employers can take away from these negotiations?

TR:  The big takeaway is that nurses unions affiliated with NNU are going to be very well coordinated and very aggressive and will try to use the issue of patient safety in negotiations.  Health care employers need to be prepared and have a solid strategy to respond to NNU’s efforts.

AP: The best  strategy is to take the high road and make the NNU, or any union, stick to the facts as opposed to anecdotes and hyperbole.  In a situation like this, there is no such thing as over-communicating with all of the hospitals’ stakeholders in a positive and professional way about what really is going on at the bargaining table.  Finally, be overly prepared for every eventuality.