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[F]or three months, nurses at the UVM Medical Center have been negotiating with hospital administrators for higher wages and better staffing ratios. When the two parties couldn’t reach an agreement this week, the nurses took to the picket lines.
“The energy has been really high, but also emotional,” said Molly Wallner, a registered nurse at UVM who walked out Thursday morning. “It does feel sad to feel like we can’t be there for our patients today.”
Hospital administrators maintain that their vacancy rate is in line with other health care institutions, and the salaries they pay all employees reflect fair rates for their industry.
Wallner, who serves on the union’s bargaining committee, said those points don’t change the effects of nurses feeling chronically understaffed. “When you continue to be that stretched,” she said, “it really is at the expense of the patients.”
The union is holding a 48-hour strike: Wallner and her colleagues return to work on Saturday morning. But the tension between workers and management at Vermont’s largest hospital may be far from a resolution.
On this week’s podcast, Wallner and other union allies make their case for salary and staffing increases. Hospital administrators hold the line on contract terms. And VTDigger health care reporter Mike Faher discusses the ramifications for the UVM Health Network and its leaders.
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For three months, nurses at the UVM Medical Center have been negotiating with hospital administrators for higher wages and better staffing ratios. When the two parties couldn’t reach an agreement this week, the nurses took to the picket lines.
Molly Wallner: I got up to the hospital at 5:45 this morning. We were meeting the staff members that were still on the unit to make sure that the handoff went okay. And then we headed out here to the picket line.
This is Molly Wallner, a registered nurse at UVM who walked out on Thursday morning.
Wallner: Last night, we were hoping that we could come to an agreement with the hospital. I think that because we didn’t, obviously that brought on a lot of the emotions of disappointment, some sadness, and then this morning, the emotion of — we understand that there are nurses working in our place today, and we are appreciative of that for sure. At the same time, it does feel a little sad to feel like we can’t be there for our patients today. With that said, though, we also feel like being out here today is standing up for our patients as well.
Molly’s on the bargaining committee. She said their conversations with administration have gotten pretty intense.
Wallner: As you can imagine, people are very passionate because we’re talking about our jobs, we’re talking about a livelihood, we’re talking about caring for patients that we truly value and that we want to be there for. So you can imagine that it can create kind of a tense environment. And I think right now, unfortunately, most of the nurses working at UVM Medical Center don’t feel truly supported by upper management and they don’t feel valued.
The nurses union is holding a 48-hour strike. Molly and her colleagues are back to work on Saturday morning. But no matter how this conflict gets resolved, there will be other ramifications for the Burlington hospital — and its employees and its patients.
Mike Faher: I mean, it’s by far the biggest Hospital in Vermont, as indicated by the 1800 nurses that work there. I think their average daily patient census is somewhere in the high three hundreds. There’s thousands of health patient visits every single day. It is a place that serves I think something like a million people.
Mike Faher is VTDigger’s health care reporter.
Faher: It can’t be underestimated that even a two day strike has a major impact on really important services. And that’s not a judgment on my part: I think it’s a statement of fact. Certainly the union knows that. Nurses know that and they have said repeatedly that they didn’t take this decision lightly, that they felt that this was their only option.
You’ve been reporting on this since March. When did we first start getting hints about how these contract negotiations might go?
Faher: It was very early on. I have not covered the UVM nurses and their contract negotiations in the past. But I was surprised at the outset about how public the whole process was, especially from the union side. You know, the union was putting out press releases before negotiations even began, they were enlisting political support. The lieutenant governor signed on to some of their requests, things like that.
Is that unusual?
Faher: So the perspective I have is from covering 20 years’ worth of other types of labor disputes — you know, private businesses, schools — and I had just not seen that before. Normally, when, as a reporter, when you start hearing about labor disputes is when there’s an impasse or when they’re at the end of a contract, and there’s no new deal. And this was right at the outset, the nurses were making things very public. And for me, that felt like an indicator that they were sort of girding for a big battle.
Julie MacMillan [UVM Medical Center nurse; lead negotiator, Vermont Federation of Nurses and Health Professionals]: We need more nurses, registered nurses, licensed practical nurses and nurse practitioners, we need more support staff. When we don’t have enough support staff, patient care suffers.
Faher: The sticking points have been remarkably consistent, really from March onward. They’ve been salary and staffing, and those those two issues are very much related. The nurses say that they’re not being paid enough, especially in regards to some of their counterparts in other parts of the UVM Health Network. And because they’re not being paid enough, the hospital can’t recruit and retain enough nurses to keep the place fully staffed.
MacMillan: When Vermont nursing students are saddled with tens of thousands of dollars in debt, and nurses in Plattsburgh are making significantly more than those in our state, management simply needs to do better if we have any chance at filling the 152 nursing positions that remain unfilled.
Faher: The vacancy numbers have varied a little bit, but there’s general agreement that there’s over 100 nursing vacancies at UVM Medical Center, and the union says that at any given time it’s 130 to 150. I should say to sort of balance that, that the hospital says given their workforce, their vacancy rates are on par with healthcare institutions in Vermont and nationwide. As a health care reporter, I can confirm that hospitals everywhere are having trouble attracting nurses and doctors.
So, they’re saying, this is not just UVM Medical Center. This is not just the UVM Health Network. This is happening everywhere.
Faher: That’s the hospital’s line. And of course, the unions — I mean for them, this is where they work. This is where they live.
And they say, look, we don’t have enough nurses and if we want more nurses, we have to be paid more.
Deb Snell [Vice President, Vermont Federation of Nurses and Health Professionals]: We’ve asked for wages that would make us competitive on a national level and attract retain nurses. We are looking at a significant nursing shortage in the next few years, and we need to make the investment now.
Faher: The wage issue has been hard for them to come to an agreement on. They’ve been very far apart. Even in recent weeks, hospitals offered 13% raise over the three year contract nurses have countered with 25%, or it might be 23% now. So it’s a pretty big gap.
When does the notion of a possible strike get put on the table?
Faher: I believe it was early June, mid-June, the union took a vote and said, would you authorize our bargaining committee to call a two day strike? And 94% of those who voted said yes. It’s pretty overwhelming.
Snell: At two this morning ballots were counted and 94% voted to authorize the nurses bargaining committee to call for a two day strike on behalf of our patients, should it be necessary.
Faher: And at that time they said well, it’ll be a two day strike if necessary. You know, there were a lot of talks scheduled throughout the rest of June. There was hope that they could get a deal. But last week they had a press conference and said well, we just don’t see it happening. Our contract expires July 9th, and we’re issuing a strike notice.
Snell: We just left the nursing CNO. We delivered our 10 day notice.
Faher: And so they decided to go out 7 a.m., Thursday, July 12.
Snell: Every nurse on the picket line July 12 should hold their head up high and be proud of the stance we are taking for our patients, our community, our colleagues, and ourselves. We are your strongest advocates.
Normally, when we think of a strike, we think of workers walking off the job until they choose to come back because they’ve arrived at some kind of agreement. How does a two day strike give nurses leverage in these negotiations?
Faher: Certainly, it puts the onus on the hospital to keep the ship running. This is a big hospital. They’ve got a lot of people in in that place. And unlike a school or a coal mine, right, you can’t just shut the place down until we get things resolved.
Eileen Whalen [President and Chief Operating Officer, UVM Medical Center]: We have a comprehensive plan in place to accomplish a goal of providing care with as little disruption as possible. While there will be some rescheduling of elective surgeries, we believe the vast majority of patients will not see an impact over these next couple of days.
Faher: The hospital contracted with a Colorado company that specializes in staffing for healthcare work stoppages, and there are now roughly 600 replacement nurses in town being trained. Now, that comes at a big cost for the hospital. We don’t know the exact number, but the union has estimated that the hospital is going to pay $1.2 million dollars a day during a strike just for salary because obviously these nurses come at a higher cost than regular nurses. So I would guess there that part of the leverage for the union is that it’s hurting the hospital’s bottom line even to have just a two day strike.
I asked the union, why not an open ended strike as we’ve seen, say, with teacher strikes? And their only answer was simply that this is just what’s generally done in health care is a one or two day strike.
So they announced that July 12 is going to be the date of this potential strike, if they don’t reach an agreement. What kind of a reaction do they start getting? Like, what do members of the public and patients think about that possibility?
Faher: Well, what we tend to hear in the press is the most vocal folks. So we’ve heard a lot from other unions. We’ve heard a lot from the general public, and they support the union. They support the nurses. And that’s not a surprise to me.
Some people that I’ve heard from have personal experiences with with the nurses at UVM. A lot of people do. They feel a sort of kinship with them.
April Howard [Champlain College faculty member]: I’m proud to be here on behalf of the adjuncts newly unionized at Champlain College. Nurses at the UVM Medical Center have saved my life, have saved my family members’ lives, and probably those of everyone here and everyone in this town.
Faher: We live in a democratic state; it’s a state that’s pretty labor friendly. So again, it’s not a surprise to me that folks would tend to come out in support of the union. I’ve heard people talk about, “our nurses need to make a fair wage, a livable wage.” Obviously some folks are worried that if the nurses are as overworked as they say, then has there been deterioration in the quality of care at the hospital? So that’s another concern.
And I get it: as a citizen, it’s pretty hard to identify with a hospital administration. It’s a lot easier to say, look, I get it. I understand what the nurses are fighting for.
Andrew Styles [teacher, Edmunds Elementary School]: The bosses are scared of unions. They know that when workers organize they can’t be taken advantage of. That’s why there are so many attacks on our unions today.
You mentioned other unions, how have other labor unions been showing their solidarity here?
Faher: Yeah, there was a big rally just the other day. A really remarkable diversity of organizations came out: the Burlington firefighters, faculty unions, other nurses, the Teamsters. One of the folks I talked to was a unionized shop steward at the City Market in Burlington. I mean, it was a wide array.
Jill Charbonneau [President, Vermont AFL-CIO]: The Vermont AFL-CIO stand firmly in support of the UVM Medical Center’s AFP nurses. In this economy, it should not be that they have to struggle to make a fair wage.
Faher: And it really it was just about solidarity. Some of those union members said that they would join the nurses on the picket line. Others just pledged their support. The Burlington Education Association was there, and those teachers went out on strike just last fall. So they know they know what this is like.
The question, of course, is, what impact does that have on the talks? If you’re the UVM administration, does it matter what the Teamsters think? Does that impact this at all? I’m not sure, but I know that there’s been a lot of solidarity among the unions in the area.
Another pretty high profile supporter of the nurses was Sen. Bernie Sanders. He came out and spoke last Friday in favor of the nurses. What kind of messaging did we hear from him?
I mean, he has talked about the high cost of health care, and he has talked about health care executive compensation. That’s a really sensitive topic in these negotiations.
Sen. Bernie Sanders: I find it hard to believe — I find it really hard to believe — that the hospital has enough money to pay nearly $11 million to 15 administrators — $11 million to 15 administrators — including more than $2 million to the CEO, but apparently doesn’t have enough money to pay their nurses the same wages as nurses earn just across the lake in Plattsburgh, where the cost of living is in fact lower.
Faher: We have reported that John Brumsted, who is the CEO of both UVM Medical Center and UVM Health Network. made over $2 million in salary and benefits in 2015. That’s a really big number any way you slice it. And both the Senator and and members of the union and union supporters have all said, so wait a minute, you’re telling me you can’t pay us more, but the CEO can make $2 million?
The hospital has said consistently that they’ve done their homework and they pay their executives what they need to pay them to attract talent. And in fact, just the other day, they put out a statement, a pretty vague statement about CEO compensation. It said that, “UVM Medical Center compensates all of its employees based on market analysis. We think that is a fair approach, and it allows us to meet the goal of attracting and retaining talented employees at all levels.”
Sanders: I find it even harder to believe the medical center when it says it has to pay these inflated administrative salaries to attract the best and the brightest people to run the hospital. Well, how about paying competitive wages to attract the best and the brightest nurses who actually care for the patients?
Faher: They’ve also pointed to a lot of the expansion projects and capital projects that UVM Medical Center and the Health Network have undertaken. They’ve pointed to the fact that UVM is over budget, generally, in their revenues: they were back in fiscal 2017. All of which sort of points to: why isn’t there more money to pay us?
And what about from the hospital administration? What was their response to the plans for a potential strike starting to firm up here?
Faher: They have been working pretty hard to prepare.
Whalen: We’re here to discuss the preparations for an event that we’re still actively working to avoid.
Faher: As I said, they have something like 600 nurses, temporary staff in town from this Colorado firm, Autumn Consulting, that specializes in this sort of thing.
Laurie Gunn [Vice Presdient of Human Resources, UVM Medical Center]: The nurses who are hired by firms like Autumn do this for a living. There are very experienced nursing professionals who are used to coming into unfamiliar surroundings and performing at a very high level. Training is being provided by our subject matter experts and covers such things as our electronic health records and policies and practices that are unique to our organization.
Faher: Early on, they said we don’t expect there to be really any impact or very little impact, but one of the things that hospital has now done is they’ve rescheduled some elective procedures. About 68 of those — things like eye surgeries, ear, nose, and throat — that they felt could be rescheduled that were scheduled for the time during the strike have been postponed.
Isabelle Desjardins [Chief Medical Officer, UVM Medical Center] We contacted the patients scheduled to have elective surgeries on Thursday and Friday of this week to provide them with the option of rescheduling, and some chose to do so. In total 68 procedures have been postponed. Most will be rescheduled within the next month. Outpatient appointments are largely unaffected.
Faher: I think that’s a nod toward the fact that there has to be some concession to the fact that your nurses are out on strike. But overall, they have made a really strong push to not only keep the hospital running, but also almost try to make it business as usual, especially when it comes to critical and key care, urgent care.
In the meantime, administrators and the nurses union have been negotiating. What do we know about how those negotiations have gone so far?
Faher: You know, it’s hard to say. I mean, you hear folks say there’s been some progress, but then there doesn’t seem to be any change in the public statements.
One thing I know is that there have been some concessions on both wages and staffing. The hospital has increased its raise offer from 7% over the course of the contract to 13%. The union has come down a little. On staffing, the hospital has said charge nurses, which are sort of unit supervisors, won’t have to take direct patient care anymore. They’ll be sort of available to monitor things and intervene as needed. And the union has said, we think that’s a really positive step: it’s a safety issue, and it will help our nurses.
But none of these things have been nearly enough, apparently, to even get close to an agreement. At least that’s what we’re hearing publicly.
What are the possible outcomes here?
Faher: They’ll be out on strike until 7 a.m. Saturday. That’s the 48 hours. They’ll come back to work. And really, the hard part of this is that nothing has changed.
Certainly, you know, the hospital has incurred certain expenses. The union has gotten its message out more through picket lines. But that’s it, and we’re right back where we are: the nurses are back to work and there’s no contract.
It could be that then if they don’t feel like there’s any indication that there’ll be any concessions that they could call another strike. That’s certainly a possibility. But they haven’t said whether or not that they will call for that. One could surmise that going through this 48-hour strike could solidify the positions of both sides and make it less likely that there’ll be a compromise.
But the strike itself doesn’t actually resolve anything.
Wallner: Just because we’re having the strike, that doesn’t mean that things are over. If anything, you know, it’s proving that we have probably an even longer road ahead of us to work with the hospital and hopefully come to agreement.
I think that the union’s hoping that it’s a message to be sent to management that we’re serious. And what we’re asking for isn’t just because we feel like it, but it’s because it truly feels like it’s what we need to accommodate the more acute, the more complex patients that we’re seeing, and to get those nurses here to recruit and retain. So I hope that they take it as a takeaway message from us as nurses that we we need more. And it’s not just for us, it’s for the patients, it’s for the community, it’s for the greater good. It’s not just so, you know, we can live more lavish lifestyles. It’s so we can be the best nurses that we want to be for our patients.
I’m curious, what’s our takeaway from all this? I mean, this being such a major hospital, and with this even threat of a strike having become such a high-profile conflict: how does that organization, in general, move on from this?
Faher: You know, it’s interesting. When the hospital announced its plans for the strike, they were already talking about “healing.” Healing being, how do we, as you say, move on?
I think that overall, because of the size of Vermont, the politics of Vermont, and the sheer size of UVM Medical Center and UVM Health Network, we are going to see continued conflicts about their spending, about their employees, about their executive compensation, about their growth. That can happen through what we’re seeing now — contract strife. It will happen at the Green Mountain Care Board when it comes time to review their budget. And it’ll probably happen in other ways.
There are a lot of people in Vermont who can’t wrap their heads around the sheer size of that hospital, and how much it spends, and how much it takes and how big it’s gotten. There are a lot of people who are concerned that it’s gotten too big, and it’s making it hard to be an independent doctor and independent hospital in Vermont. So I think this is something we’re going to just we’re going to hear about for years to come. It will just be a matter of what the forum is for those debates.
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Subscribe to The Deeper Dig on Apple Podcasts, Google Play, Spotify or anywhere you listen to podcasts. Additional audio by Kelsey Neubauer. Music by Lee Rosevere.
