Tenet welcomes unions to Texas

There hadn't been a nurses' union in Texas since the 1970s – until last month's vote brought one to a Houston hospital. Now it looks like Dallas will be the next battleground. It was Dallas-based Tenet Healthcare Corp., the nation's third-largest publicly traded hospital system, that opened the door to nurses' unionization in this business-friendly, right-to-work state.

A March 27 vote at Tenet's Cypress Fairbanks Medical Center in Houston was the first successful union vote in Texas history, although an existing nurses' group here once operated as a union.

A 2003 union vote in Longview, Texas, failed.

But last year, Tenet signed a so-called peace accord with the California Nurses Association, one of the nation's largest nurses' union, as well as the Service Employees International Union, the largest health care union. Under that agreement, Tenet must allow those unions an opportunity to organize employees in certain states, including Texas.

Following its Houston victory, the CNA is hoping that agreement will give it enough leverage to push its way into D-FW, where Tenet owns Doctor's Hospital at White Rock Lake, Centennial Medical Center in Frisco and Lake Pointe Medical Center in Rowlett. From Dallas, the union says, it plans to head into unaffiliated hospitals throughout the state, bringing Texas in line with other states where nurses are organized.

In February, the CNA asked for the names, phone numbers and addresses of the 2,500 nurses at Parkland Memorial Hospital, which had to provide them because Parkland is a government-funded hospital.

What's more, the union already has a handful of paid organizers in Dallas drumming up support for a union here.

If the CNA succeeds, health care here could change dramatically. Whether those changes will improve quality – or just raise costs – depends on whom you ask.

A look at issues

Money isn't the issue – it's the workload, says Rossia Avery, a registered nurse with a staffing agency in Dallas and chairwoman of the Dallas-Fort Worth National Nurses Organizing Committee, an arm of the CNA.

Local registered nurses already can make more than $38 an hour, which works out to just over $79,000 a year based on a 40-hour week, said Ms. Avery, a frequent speaker at rallies who says she does not get paid for her organizing efforts.

"They won't give us more help, but they'll give us more money," Ms. Avery, a nurse for 28 years, said of hospital executives.

Still, union membership does usually mean bigger paychecks. Last year, nonunion registered nurses nationally earned $28.71 an hour. That's 48 percent less than the $42.60 an hour that unionized registered nurses in California made, according to NNOC statistics.

Although California has a higher cost of living and wages in general, union nurses there still made 18 percent more than their nonunionized counterparts.

But it's not as if hospitals are refusing to hire more nurses, says Doug Hawthorne, chief executive of Texas Health Resources, the largest hospital system in North Texas. There just aren't enough nurses to hire, he says.

"There are plenty of people who want to become nurses," he said. "The problem is we lack enough qualified instructors to train them."

More than 11,000 qualified applicants were turned away from Texas nursing schools in 2006 because of a lack of teachers. The average age of nursing faculty in Texas is 54, according to the Texas Hospital Association; almost 57 percent of all nursing faculty will reach the traditional retirement age of 65 within 10 years.

Relationship fears

Local hospital executives and nurse representatives, who are a part of the executive team, say unions will fracture the good-natured relationship between nurses and hospital managers as they work together on staffing issues.

The Texas Nurses Association is more of a professional organization that works with the Texas Hospital Association to draft legislation benefiting both groups. (The TNA did operate as a union, beginning in 1974, when the National Labor Relations Act was amended to cover registered nurses. But in 1979, the members voted to drop union status.)

In last year's legislative session, hospitals and nurses joined together to get $14.7 million to expand nursing education programs. Lawmakers also earmarked $4.1 million from the state's tobacco settlement funds for grants to increase enrollment in undergraduate and graduate nursing programs.

Meanwhile, states with nurses' unions have seen strikes, with pickets trying to steer patients away from hospital doors.

California, for example, has had nurses' strikes that lasted for days.

At one San Francisco hospital, police were called in because striking nurses were upsetting patients with their noise and blocking traffic, said Jan Emerson, spokeswoman for the California Hospital Association.

Strikes are "always the last resort," said Ed Bruno, NNOC national organization coordinator. And, under the 1974 Health Care Amendments to the National Labor Relations Act, the union must give a 10-day notice before a strike so the hospital can line up temporary staff – something Ms. Emerson says hospitals have been able to do.

Staffing concerns

Nurse-to-patient ratios can depend on a litany of variables, including the health of the patients, the nurses' skills and the working environment.

In California, the first state to pass laws setting nurse-to-patient ratios, the numbers are determined more by political negotiations among nurses, insurers and hospitals than by scientific evidence.

In October 1999, Assembly Bill 394, dubbed the California Safe Staffing Ratio Law, established minimum nurse-to-patient ratios for acute-care, acute psychiatric and specialty hospitals. The ratios range from one nurse per patient for trauma patients in the emergency room to one nurse per six patients in psychiatric wards. For general patient care, the ratio is 1-to-4.

The ratios apply at all times, including during nurses' meals and breaks, and offer no leeway in high-volume periods such as flu season, said Jennifer Banda, a THA lawyer and public policy director. That means hospitals must overstaff, Ms. Banda said.

It's uncertain whether patient care is better because of the ratios.

Attentive nurses long have been identified as the best way to prevent pneumonia, postoperative infections, pressure ulcers and urinary tract infections in patients. However, in states with nurse staffing ratios, studies are mixed on whether they've made a difference.

In August 2005, the California Nursing Outcomes Coalition – a union and management partnership that measures quality improvements – published the first report tracking the success of staffing ratios.

In the first six months after the ratios were implemented, there were no statistically significant changes in patient safety or quality outcomes, it found.

Joan Clark, a chief nurse executive who joined Texas Health Resources last month, has worked for union and nonunion hospitals throughout her 35-year career.

Ms. Clark, who opposes unionization, said nurses typically join unions because they feel excluded from hospital decision-making.

She says she's never seen unions improve hospital operations or quality of patient care.

Ms. Avery of the organizing committee disagrees: "Nurses have left the bedside because of the conditions they are working in, and they won't return until they improve."


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