The Health Care Revolution Has Only Just Begun

Sandy Eaton is a staff nurse at the Quincy MA Medical Center. He is also a member of the Board of Directors of the Massachusetts Nurses Association, which he represents on the steering committees of the Coalition for Health Care and MASS-CARE, two Massachusetts coalitions working for fundamental reform of the current market-driven health care system.

By the time the 49-day strike against Tenet Healthcare Corporation by 615 Worcester, Massachusetts, nurses ended, not only were the lives of the participants changed forever, but also the consciousness of nurses throughout Massachusetts, across the United States and in other countries as well. At 4:50 PM on May 19th, Anne Spellane, co-chair of the Saint Vincent Hospital/Worcester Medical Center bargaining unit of the Massachusetts Nurses Association (MNA) announced the result of the balloting by the rank-and-file on their first contract. Predictably, ratification was achieved by the lopsided vote of 358 to 5. The picketers marched one last time around the sprawling new WMC campus, laid down their picket signs and started to celebrate.

The story begins in 1997 when the Catholic Saint Vincent Hospital was sold to OrNda, a for-profit hospital chain, which was then bought up to help create the Santa Barbara-based Tenet Healthcare Corporation, the second largest for-profit acute-care hospital chain in the United States (and in the world, since no other nation does health care like we do). In the '90s, changes in the way health care was financed were passed as the state government strove to become "entrepreneurial." For the first time, for-profit hospital chains found Massachusetts a fertile field. New battle lines were drawn.

"Flexibility" Means Mandatory Overtime

Sensing danger to her patients and to her license to practice nursing safely, Anne Spellane gathered a handful of colleagues together and approached MNA for help in organizing. In 1998, the nurses of Saint Vincent voted in their new union and bargaining began for a first contract. After two slow years of negotiating, almost all issues had been settled, except Tenet's insistence on the right to impose mandatory overtime, a practice that had not been part of the work life of these nurses up to that point.

Construction of the new $215 million edifice in downtown Worcester called the Worcester Medical Center neared completion, thanks to significant tax breaks and other incentives from the City, with April 1st as the target date for a grand opening. The nurses realized that Tenet's plan was to staff the newly configured units at a minimal level, with mandatory overtime, including a second eight-hour shift for those already on duty if the patient census jumped up on a given day, and with staff sent home without pay if the census fell. Managed care has heavily penetrated Massachusetts, and wide swings in patient census are now typical. The hospital insisted on the "flexibility" to be able to mandate 16-hour shifts, and nurses around the country have been battling the scourge of mandatory overtime with increasing passion, as they realized that this practice spawned a far higher rate of possibly fatal medication and other errors and a far higher rate of staff illness and accidents, as well as disrupting nurses' family lives.

Sandy Ellis, speaking on behalf of the striking nurses and the Massachusetts Nurses Association, observed "For [the Tenet Corporation] it is much more cost effective to pay nurses overtime pay, mandate tired and fatigued nurses to care for very ill patients, rather than to keep the appropriate number of nurses on the payroll--even if it places patients' safety at risk."

Getting the Word Out

Throughout the two years of protracted negotiations, the nurses worked to build bridges and organize the community around the issues of patient safety and workers' rights. At the pre-strike rally on March 30th, almost the entire political leadership of the Worcester area came to speak on behalf of the nurses, pledging their unwavering support. For years nurse leader Sandy Ellis had effectively focused on relations with this group. None of them would attend the gala celebrations marking the opening of the new hospital, so these celebrations had to be canceled. Many of these political leaders returned time and again to the picket line. The entire Massachusetts congressional delegation signed a letter to Tenet in support of the nurses' position.

In mid-March, the nurses voted three-to-one to strike over patient safety and gave Tenet the required ten-day notice of intent to strike. The strike began the day before the grand opening. The night shift turned the narcotic keys for each unit over to their supervisors and gathered in the main lobby of the old Saint Vincent Hospital at 6:30. They marched out the front door and set up picket lines at both campuses. Replacement workers arrived at 7:00--the hundred or so nurses who had voted against the strike and about 125 professional replacement workers flown in by Denver-based US Nursing Corporation. The situation was chaotic, and the move into the new hospital was delayed until April 3rd.

Due in part to tireless efforts by MNA's public communications department, the local media articulated the issues and gave thorough coverage to the strike. Letters to the editor reflected overwhelming support from the community and its grasp of the overriding issue of patient safety. Although there tended to be spotty coverage of the strike beyond Massachusetts in the established media, news spread rapidly by "word of mouse." Daily strike bulletins spread from email list to email list, crossing both the Atlantic and Pacific Oceans. Nurse-oriented and -run chat rooms buzzed with the news from Worcester. The MNA web page received over a half million hits in the month of April. Global awareness grew, with messages to Tenet and to the Worcester nurses coming in from as far as Abu Dhabi and Australia.

Strength in Solidarity

MNA Co-chair Debbie Rigiero had become an integral part of the central labor council, even though the Massachusetts Nurses Association is not part of the AFL-CIO. Organized labor in the Worcester area, and then throughout the state, understood the issue and what was at stake. Teachers and teamsters, carpenters and counselors, massed on the picket line, contributed to the strike fund, and contacted Tenet with the demand to listen to the nurses and settle immediately. The Worcester firefighters, who had lost six of their number in a tragic warehouse fire a few months before, were especially fervent in their support, not only marching on the line but opening their adjacent fire station for the nurses' respite. This labor solidarity peaked when the three largest unions in Worcester approached Fallon HMO, the largest managed care company in that part of the state, to pressure Tenet to negotiate with the nurses. Fallon has an exclusive contract with Tenet and the unions threatened to take their members elsewhere if Fallon declined. Fallon publicly called for the Tenet CEO to fly out from California to enter negotiations directly. When no response came, Fallon began referring its surgical day patients to an off-campus surgicenter independent of Tenet.

Agencies of the state government which held the mandate for public safety came under scrutiny. The Department of Public Health routinely reported that no serious violations of standards of care were to be found within the struck facility, until its written report was made public revealing that three replacement nurses had been fired for serious lapses in nursing judgment which threatened patient safety. The Board of Registration in Nursing was publicly excoriated by a legislative oversight committee, both for its tendency to scapegoat staff nurses for systemic health facility problems and for its apparent double standard in swiftly granting licenses to practice nursing to imported workers while other candidates had to wait weeks before being able to secure employment in Massachusetts.

Groups of organized nurses from across Massachusetts regularly came to Worcester to picket. The United Nurses and Allied Professionals sent large contingents from Rhode Island, seeing this struggle as part of their own campaign for safe patient care. Both the California Nurses Association, which has had extensive dealings with Tenet, and the American Nurses Association took out ads in the local press critical of Tenet and supportive of the nurses' issue of safe care. They also lent immense logistical support and suggestions for effective action. The American Nurses Association organized a picket at the Denver headquarters of US Nursing Corporation. Magazines such as Nursing Spectrum which carry ads for agencies that recruit replacement workers were targeted and their job fairs picketed.

On May 5th, 1500 delegates to the annual convention of the Massachusetts Teachers Association left the nearby convention center and rallied with the nurses. Senator Ted Kennedy, who had been to Worcester to address the teachers, came out to stand with the nurses and proclaim the justice of their cause.

National Nurses Day was celebrated on the sidewalk outside the Worcester Medical Center on May 7th, as elected officials, community activists, labor leaders, representatives of organized nursing from one end of Massachusetts to the other, from California, from Michigan, from Rhode Island and New Hampshire took the microphone to speak of their undying commitment to safe patient care.

Tenet Comes to the Table

On May 10th, intense telephone conversations heated the lines between Santa Barbara and Washington, and between Washington and Worcester. On the morning of May 11th, the 17 members of the nurses' negotiating committee, with their attorney and staff, flew to Washington to sit across the table from Tenet executives from California in the offices of Senator Ted Kennedy, assisted by Representative Jim McGovern. Tenet put out an offer almost identical to the last one the nurses themselves had put forth in negotiations: no full-shift mandated overtime and severe limits (no more that four hours) on required overtime, with nurses retaining the right to refuse if too tired or ill. The nurses also negotiated a provision governing the "delegation of nursing activities," which gives the nurse the power to decide if, when, and to whom they will delegate any nursing activity. This language, which has been included in a number of MNA contracts in recent years, guarantees patients that only nurses will decide how their nursing care is delivered, and provides a roadblock to administration attempts to implement staffing plans that replace registered nurses with less qualified caregivers.

"Taken together, our staffing, mandatory overtime, floating and delegation provisions provide the nurses of St. Vincent Hospital with a series of protections that allow them to protect the integrity of their practice and take steps to ensure our patients access to appropriate nursing care," said Rigiero.When the team arrived back at Logan International Airport in Boston that evening, throngs of nurses and other supporters were there, hailing them as conquering heroes, with as much joy and enthusiasm as has ever been received by any winning sports team.

Worcester Tenet CEO Bob Maher, despite repeated accusations that he lied to the press during the period of protracted negotiations, probably hit the nail on the head when he told the press, after the tentative agreement had been reached, that "we are right at the beginning of a revolution in nursing, and we're at the front end of it...We believe nurses throughout the United States are willing to work long and hard to fight mandatory overtime. We could have fought back and let this drag out, but that's not good for anybody...We needed to recognize that this is a national trend, and move on."

While it's probably too soon for an exhaustive analysis of this strike, I think a few lessons jump out. First of all, the Worcester nurses themselves and their elected leadership are committed, principled, and organized. The central issue, the nurses' mandate to provide safe patient care, was clear and widely supported. Organized efforts to reach out to the whole community and to its organized components were systematically undertaken. Effective relations with the media and political leaders were crucial, and the groundwork had been laid in the months leading up to the strike. Having access to an organization able to focus its resources and priorities, such as the Massachusetts Nurses Association, is invaluable. Local, regional, national, and international connectedness multiplies one's strength immensely. And being at the right moment in history, with growing revulsion of corporate health care and corporate priorities in general, maximizes the potential of the action.

These nurses became the vanguard of the revolution taking place right now in health care in Massachusetts and across the country. Wherever you live, there are groups organized to put patients before profits. This is the moment to add your voice!

Some organizations working for universal health care:

• Universal Health Care Action Network (national clearinghouse for movements working for single-payer universal health care), 2800 Euclid Avenue, Suite 520, Cleveland, OH 44115-2418; 216/241-8422; www.uhcan.org
• MASS-CARE (coalition of local and statewide Massachusetts organizations united around single-payer health care), The Massachusetts Campaign for Single Payer Health Care, 25 West Street, 2nd Floor, Boston MA 02111; 800/383-1973;masscare@aol.com; www.masscare.org
• Coalition for Health Care (coalition of groups working to pass a binding state-wide ballot initiative in Massachusetts in November 2000, that would enact a strong patients' bill of rights, mandate a universal health care system by July 2000, and impose a moratorium on any further conversions ofnot-for-profit health care facilities to for-profit status until the universal system is in place), 11 Ward Street, Suite 200, Somerville, MA 02143; 617/623-5455; www.voteforhealth.org