State of the Union:
The Fletcher Allen Health Care Nurses' Union Five Years On

By Amy Lilly

When nurses at Fletcher Allen Health Care (FAHC) agreed to unionize in a second vote in the fall of 2002, the union - United Professions of Vermont (UPV), the state affiliate of the American Federation of Teachers (AFT) - broadcast the news in a triumphant press release. According to AFT President Sandra Feldman, the union was necessary because of nurses' "desire to improve standards of patient care, secure a healthy and safe working environment, and establish equitable wages and benefits for front-line health care workers." The release also quoted Peg Coon, a registered nurse (RN) at FAHC and union organizer, as saying: "Everything in this campaign boiled down to nurses' concern over quality patient care. There aren't enough nurses to care for patients, and having a voice in patient-care decisions will make a big difference. Also, competitive wages and benefits will improve recruitment and retention, which will in turn improve patient care."

Are there enough nurses now at FAHC to care for patients? And if so, can the union claim some responsibility? Five years on, are the nurses at Fletcher Allen - now one of five of Vermont's 14 hospitals to have unionized nurses - glad they unionized, for their own and their patients' sakes?

While the press release placed wages last in their lists of reasons to unionize, increased pay is generally the first thing nurses mention when asked about the pros and cons of being unionized. Regina Helias, an RN from St. Albans, has been a night nurse for 19 years in FAHC's Medical Intensive Care Unit and Coronary Care Unit (MICU-CCU), and she worked for 11 years before that in Tucson, Arizona. For her, the pay increase is "just about the only positive thing about the union."

According to Helias, nurses have received "steady salary increases and much more with each increase" since unionizing. Before, they received a two percent cost-of-living raise, and a performance evaluation could lead to promotion up the clinical ladder. But, Helias points out, "there wasn't much to the clinical ladder for nurses: there are only three levels, Staff Nurse 1, 2, and 3." Having already worked at FAHC for almost 15 years, Helias had "maxed out" on that scale. The union's pay scale, however - which, she says, is posted on the bulletin boards in every unit - is based on total years of service as a nurse. At the time of unionization, she was being paid below union levels and has since seen her pay rise in dramatic increments. "I'm overjoyed at the money," Helias says. "It's a good raise, and it's guaranteed every year."

This is not a small point for Vermont's working women, a significant slice of whom are RNs and licensed practical nurses (LPNs). The hospital is the largest private employer in the state, and of its approximately 1,500 nurses, 93 percent are women.

Helias' assessment of the downsides of unionization echoes objections usually raised against unions in general. "It puts a wedge between nurses and management. We used to be friends and peers with our management. Now, if there's even a small disagreement, you bring in a union rep." Overtime is also a problem, she says. "Union rules specify who gets offered overtime, and it's based on seniority. So I get called first in my unit all the time when there's a gap to fill. But there are some people who need that overtime [more than I do]."

Can she just say no? Yes, she admits. The offer then gets passed down the line. Similarly, if there are too many nurses on a unit, and management wants to give someone a day off, they have to offer it to the nurses with the most seniority first, even if a new person needs it more. "We're supposed to be professionals; the union kind of makes us drones," Helias concludes. "But if I had to say, let's get rid of the union, I don't know that I'd want to, because the money's been so good!"

The time off rule was negotiated by the union in their latest three-year contract, says Marianne Campbell of Shelburne, Helias' colleague in the MICU. Time off used to be granted according to both seniority and by turns; it is now granted strictly by seniority. "So the same people get time off all the time," she says, because older nurses rarely turn down a day off in order to benefit their less experienced colleagues. Helias worked in nursing administration in California for 25 years before coming to FAHC nine years ago to practice as an RN. As a former administrator, she says, she was originally "so against the union. But I'm extremely pleased about the salary raises for nurses who have been here a long time. I think this is fair, because in other industries, your experience is recognized, and in nursing it really wasn't." But, she adds, "speaking from my experience as an administrator, I don't like the fact that people have guaranteed jobs; it seems that the hospital's hands are tied."

What about patient care? The MICU, Helias points out, already had a strict nurse-to-patient ratio of two patients per nurse, rarely going up to three, as did all hospital ICUs. "Where they really needed that lower nurse-patient ratio was out on the floor, where you're in danger of having nine or ten patients a night," she says. But while the number of nurses in her unit has not significantly changed, Helias says that the number of those who are traveling nurses - nurses temporarily assigned to the unit - has shrunk from 13 to four. This, presumably, does result in better patient care.

Callie Fortin of Burlington, a traveling nurse for four years before she joined the MICU as an RN eight months ago, finds it disturbing that she did not have a choice of belonging or not belonging to the union. "We were told in orientation by the union rep that if we didn't want to belong, we could find work elsewhere." Like Campbell, too, she objects to union-backed job security. When nurses aren't working out, she says - for example, when they can't keep up with the workload - the union merely moves the problematic nurse to another floor. "Management, not unions, should deal with problems; that's their job," she says. When pressed, however, Fortin admitted that she had not witnessed a specific case of this herself; she had only heard of one, she said.

Fortin also questions basing the pay scale not on performance criteria but career longevity. "Raises are given when the union says so, not when you do a superb job. In my first job in California, there was a performance incentive, so I worked hard." However, Fortin admits that she does not work any less hard now that she's unionized. And she appreciates that the union "does fight for better wages and a better nurse-to-patient ratio."

Like Fortin, Helias questions discarding the merit system completely. "We still have yearly evaluations," she says, "but they're meaningless - there's no monetary reward" for being an excellent nurse. "That bums me out because we're supposed to be a profession that strives for excellence. I'm just that kind of person - I like to work hard." Does she feel that she or any of her colleagues works less hard, now that there is no monetary incentive to do so? "I can't really say that I've seen a negative effect," she admits after consideration. "The ones who are slackers are going to be slackers no matter what. So maybe my perception is wrong - maybe the union doesn't influence people to be mediocre."

Noreen Wolfstitch, an RN for 13 years who helped organize the first (failed) vote for unionization and the second, successful vote, as well as negotiate the first contract between the union and management, dismisses the idea that replacing merit-based pay with a standardized union pay scale has had an effect on nurses' sense of their profession. Speaking by phone from a busy hospital floor, she says adamantly, "We're professionals; we're expected to be professionals. We keep each other up to standard; we're constantly learning on the job and from each other." Increased pay brought about by the union, in her opinion, simply gives recognition where it's due. "We work incredibly hard," she says, suggesting that everyone try putting herself in a nurse's shoes for a day to find out just how hard. Wolfstitch is a resource pool nurse who covers all floors except the ICUs and the emergency room on an as-needed basis, and she remains active in the union without holding an elected position.

From Wolfstitch's perspective, two benefits of unionization stand out: pay increases, and the better nurse-to-patient ratio. Five patients to one nurse is probably the limit for good patient care, she says; an ideal ratio is 1:3. Before the union, she claims, nurses feared for their job security if they considered refusing to take on, say, six patients. "They thought, 'They'll fire me if I don't.' Now, I feel empowered with my contract to say no to six patients."

Helias feels that, in theory, the union-mandated nurse-to-patient ratios are good but speculates that, in reality, when a nurse is told s/he has "another patient or two, you're not going to just say, 'No,' because your main concern is the health of those patients."

Like Wolfstitch, Jennifer Henry, the elected president of the union since 2003 and an RN for 20 years, including 16 in the Post-Anesthesia Care unit, also claims that, with the union, "the sense of fear is gone. There is now the opportunity for nurses to speak out without fear when something goes wrong that impacts patient care and that they think they can fix."

In order to institute such grassroots changes, she says, the union has created the Model Unit Process, in which a minimum of eight nurses in a unit come up with a proposal for how to improve their unit, which is then negotiated with the hospital. For example, nurses in the Oncology unit assessed "physical layout of the unit, staffing issues like the number of LNAs and secretaries, equipment gaps, and standardized level of care" in their Model Unit document. One result of negotiations is that the nurse-to-patient ratio in the Oncology unit is now 1:3, whereas it was often 1:6 and even 1:7 only a year ago, says Henry.

"Nurses are much more invested in making sure their unit is running well" as a result of the Model Unit Process, says Henry. And, she adds, "people are calling from all over the country looking for our contract language." The process has been completed in six of the hospital's 40 units so far, with four more scheduled for the fall.

Regarding the claim that discipline problems are shifted around rather than directly addressed, Henry points out that the union has now put into clear language how to address discipline problems. "The little red book," as she calls the published agreement between FAHC and the union, states that management's feedback to nurses should be clear and should give them a chance to improve. "Some nurses are terminated," she emphasizes, "when there is just cause. The union can't protect an employee [no matter what]. That's a false perception."

For Henry, the loss of a merit system is actually a benefit for nurses. "The merit system was based on how much money was in the unit's budget, and it was possibly subjective," she points out. For example, she says, in pre-union days, nurses might merit a higher clinical ladder level after being evaluated but be told that they would have to wait until next year for their raise because of budget restrictions. And personal relationships might interfere with management's evaluation of a nurse's performance. Further, Henry asserts, "merit shouldn't be tied to money. Getting a 'treat' didn't seem very professional. I don't know of any nurse who does it for the money."

With an open, regulated system of advancement, observes Henry, nurses tend to point things out to each other on the floor, offering more peer-based learning experiences. "If we're going to have young nurses stay, you have to create a supportive teaching environment." Not only has this had an effect on retention rates, Henry asserts; it has affected the number of nurses in the hospital: "We're already seeing less of a shortage of nurses." She cites a few numbers: the number of nurses has gone from 1,120 in 2002 to almost 1,600 today; since May 1, 2007, 125 nurses have been hired.

Can the union claim credit for more nurses and higher retention rates? The hospital currently has about a five percent vacancy rate for nurses on the in-patient side, which is slightly better than the national average of 8.3 percent: this is where the hospital has made "real headway" since 2000, says Sandy Dalton, RN, FAHC's chief nursing officer. But nursing shortages are cyclical, she adds; FAHC's vacancy rate was highest at the peak of the last nursing shortage, in early 2000. And retention rates, she says, have remain unchanged at 8.5 percent - just about the national average.

The number of traveling nurses being hired is definitely shrinking; says Dalton, "We believe we can cut the number of our travelers in half by the end of October, from the beginning of this fiscal year." The hospital, however, has a financial, rather than a patient-care, incentive to hire fewer traveling nurses: even with the cost of benefits, paying regular RNs is "significantly less" than paying traveling nurses, says Paul Macuga, FAHC's chief human resources officer. The reason so many were being hired before the union, he says, is that the hospital simply couldn't fill vacancies.

The increase in nurses' pay since unionization, the most visible benefit members have seen (and only slightly impacted by union fees, which are one percent of salary), is a non-issue for Macuga, who insists that the hospital still adheres to "market-based rates of pay." The union may have brought a new pay scale to the bargaining floor, but those rates were "negotiated, not introduced," he emphasizes.

One thing Dalton and Macuga make clear is that management is happy to be working with the union. "From my perspective, it has opened the lines of communication, and built a more visible partnership with nurses," she says. "Today, the environment for nurses is a lot better." Further, patient care initiatives are now worked out in partnership with the union, and Dalton cites the Model Unit Process as an example.

Faye Straight of Grand Isle has been at FAHC for 20 years; she works both as a research nurse and as a per-diem RN in the Cardiology unit. Straight says that she first saw the union as a bad idea but has since seen it effect positive change. "Right now, on the whole, I definitely favor the union more than I did when it started. It has definitely helped the in-patient staff nurses tremendously - with staff ratios, better pay, better differentials - that is, when you work evening, night or weekend shifts or float to another floor, you make more money now." For herself, the pay raise has made little difference because all research nurses at FAHC are still paid on the lower out-patient nurse scale. "But the union is working on that," she adds.

Straight has seen other improvements first-hand while training to run for a chief stewardship position in the union in the fall. "I've been able to sit in on manager meetings, and you're an equal with the managers instead of being under them, which is kind of nice. I also helped two nurses get their jobs back, one in an out-patient and one in an in-patient setting." Straight can't reveal details but says that one nurse attempting to move from LPN to RN status via the Baylor Program, in which trainees work on weekends, was unfairly deprived of her rights to the program when she couldn't meet certain stipulations; Straight won back those rights for the nurse.

"Before, if a manager said, this is the way it's going to be, then that's the way it was," Straight says. "The union can change nurses' relationship with the managers," she points out, "but it doesn't have to."

She adds that the union has more clearly defined nurses' roles - "they really want nurses to be doing nurses' functions." Now, she says, there are more nurse's aides on the floor to make beds and perform other "hands-on" jobs, as well as additional people to help with paperwork, including data entry and budgeting for her research department.

Straight may be among the more dramatic converts to the union, going from complete opposition to actively pursuing a union leadership position. But there are still legitimate objections to unionization coming from nurses, as well as the possibility that voicing those objections may not be welcome in the current atmosphere. One nurse relayed the message through her colleague that she was refusing to share her strong anti-union positions, even anonymously, for fear of being identified.

When asked if she had received any negative feedback from nurses in her role as union president, Henry said yes, but that complaints often stem from a lack of knowledge about how the union works. "I still hear from nurses wondering about, for example, the $200 bonus we negotiated that the hospital now gives to nurses who complete a national certification in their specialty. They've heard of it, and they want to know why they didn't get it. But you don't get it if you don't ask for it!"

As she noted, "Cultural change takes a while."

Associate Editor Amy Lilly lives in Burlington.