At the University of Vermont Medical Center, we’re struggling with the same critical issue that hospitals and healthcare unions across the country are: we don’t have enough staff.
Three years ago, in July 2018, our nurses went on strike for two days over persistent inadequate staffing and our hospital’s unwillingness to implement changes that would result in better recruitment and retention of nurses. We have been partnering with management through our staffing committee since our first contract in 2003, but we weren’t making enough headway on this critically important issue. By 2018, we knew we needed to take a stronger position. For the sake of patient and staff safety, we had to strike. Out of the resulting contract came the Unit Staffing Collaboratives Project, a systemwide initiative to address staffing issues. Each unit’s collaborative included four or six nurses and two administrators who met regularly to develop proposals for new staffing grids that better reflected unit needs.
The first step in the project was to evaluate our current situation. We and the hospital jointly hired a consulting team that specializes in staffing issues. They looked at the whole organization: at each department, at the patient population, at all of our staffing grids, and more. They also benchmarked us against like-size academic medical centers to provide a clear picture of where our staffing levels should be. Collaborative members took the information back to their units, where they spent time looking closely at their staffing—not only nurses but also the licensed nursing assistants, the unit secretaries, and everyone who contributed to patient care. They then used the consultants’ report and their own internal analyses to propose new staffing grids for their units. Both the chief nursing officer (CNO) and I had to sign off on their proposals.
This process was significantly delayed because of COVID-19, but ultimately we achieved a total of 77 new positions, spread across all but two units in the hospital. The majority of those jobs are nurses, and the rest are licensed nursing assistants or medical assistants. Unfortunately, we haven’t been able to fill many of these openings yet because of the larger nursing shortage and COVID-19. But most areas were able to add staff and a circulating nurse to help out on the floor. We know that will make a big difference in the short term to relieve the stress our care providers are feeling and to ensure patients get excellent care. In the long term, our Unit Staffing Collaboratives will continue meeting throughout and beyond implementation of these staff additions so that we can monitor our progress and reassess as new needs emerge.
What Good Relationships Can—and Can’t—Do
Staffing is always our top issue, but our labor-management partnership tackles a range of issues. One recent situation involved a hospital vice president who was discussing COVID-related furloughs and instructed managers to talk to staff quickly, before union stewards could get involved. We filed an unfair labor practice, and we got the hospital to agree to regular joint training sessions with union leadership and all hospital managers who oversee bargaining unit members. These sessions will give us the opportunity to identify the most common types of grievances and educate managers on the contents of our contract (including members’ right to have a steward present in meetings with management). We will begin with two sessions in 2022, and if we find the meetings productive, we will continue to hold them every year, with mandatory attendance by managers and supervisors. Both sides have long agreed that it’s best to try to settle things without needing to file grievances. But this is the first time the hospital has agreed to a training process like this, and it would not have been possible without our labor-management committee.
Many positive results have come out of the labor-management committee—but there is a lot of friction, too. In many circumstances, the hospital has not been honest with us, and issues we have brought to them have not been addressed. The CNO and I have worked together very closely, especially throughout the Unit Staffing Collaboratives Project. We keep a set appointment to meet every two weeks. We also meet with the president of the hospital every month. But sometimes the president tells people what they want to hear at that moment and then changes his mind when he is in front of another group. We have had to confront our CNO on some points as well. In December 2021, at the beginning of the omicron surge, I asked if the rumor that the National Guard and the Federal Emergency Management Agency were sending staff to our hospital was true. She said no—then a week and a half later they were at the hospital.
We are dancing and boxing at the same time. We want to try to have a good working relationship with hospital administrators and be able to discuss the issues that affect our ability to provide care, but it can be hard to trust them.
The biggest source of lack of trust is that even after the strike and all the work of the Unit Staffing Collaboratives, our staffing situation remains dire. Filling all 77 new positions will only be the first step; administrators have yet to truly reckon with our staff retention problem. They hired a company to survey all the staff across the hospital, and they were shocked when most workers said they didn’t feel appreciated. Upper management did what I call the Great Apology Tour, where they shared the data from the survey about how employees felt and promised to take the problems seriously. But even so, very little has changed.
Despite their acknowledgement of flaws in the organization, it is difficult for us to trust that the hospital will act decisively to repair those flaws because management continues to rely on the union to tell them how to improve the situation. Still, having a voice is a benefit of the partnership, even though we know that winning implementation of our ideas almost always requires tough tactics.
For example, we are currently (February 2022, as this issue goes to press) in another long phase of more boxing than dancing. In July 2021, the hospital asked us to offer a proposal that would help with staff retention, so we brought in a group of members to explain to management how unsustainable the situation is. Not only are wages low and the demands of the work extraordinary, but our members also struggle with obtaining housing in a very tight market, finding childcare, and paying their student loans. We asked the hospital to take the initial step of raising base wages 10 percent across the board for all of our members and for nonmembers, too—including our housekeeping staff, our maintenance staff—all the employees who work so hard every day. Management refused. In December, the hospital came to us again asking to bargain for two days about base wages, but at the bargaining sessions they offered nothing for nonmembers. Thinking they could sow division in the staff, they offered a wage increase for nurses only and a bonus for our technical professionals, with several conditions attached. In our bargaining survey, 98 percent of members voted to use our power at the bargaining table to win wage increases for our nonunion colleagues and make it easier for them to organize. Refusing the hospital’s offer was a relatively easy choice for us.
Finally, in February the hospital offered an immediate 10 percent raise. In addition, this October and next we will receive a 3 percent raise and 2 percent step increase, all with no strings attached. At long last, they are taking our financial struggles seriously. But other aspects of the contract remain to be resolved this spring, and we agreed that this would only be a two-year contract.
While we are pleased with the new wages, these negotiations have been frustrating because the hospital has learned little from our two-day strike in 2018 or from the last several years. The strike was not just about wages; it was about strategies to recruit and retain staff—but the hospital still has not made critical investments that show they care about staffing. When there are so many other job opportunities out there, we need incentives to bring nurses to our hospital and keep them here. That’s what these conversations have been about all along, and that’s what they will continue to be about in our ongoing bargaining.
Adding to Our Toolbox
The most important thing to remember with a labor-management partnership is that it does not replace the other tools we have to work with as a union—it gives us more tools to try. And the partnership can change over time. If one plan does not work, we can try a different way. With a labor-management partnership, we have more flexibility to work on solutions between bargaining contracts—and members have more opportunities to be involved in coming up with those solutions.
The members guide me in all of these decisions. I listen to them, get them involved in the process, and communicate regularly, especially during bargaining. After every session, we’re handing out leaflets, sending emails, posting to Facebook—doing whatever we can to make sure members see that we’re doing our best, and that they have opportunities to offer feedback. We tell them what we’re fighting for, based on what they told us they wanted. We also share the hospital’s counteroffer to ensure members are involved in sorting through our options. Members may choose to accept the hospital’s offer, or they may choose to continue negotiating. If all else fails, they may choose to strike. The power of the labor-management partnership is in that in-between space. Striking is always the last resort, and if we do exercise that option, we know that we tried all our other options first. The partnership makes that possible.
Deb Snell, RN, has served as president of AFT Vermont and the Vermont Federation of Nurses and Health Professionals since 2019 and has been a critical care nurse at the University of Vermont Medical Center for 21 years.
[Illustration by Pep Montserrat]