On Monday, upwards of 3,200 nurses at Johns Hopkins Hospital (JHH) announced their plan to unionize. The mammoth healthcare institution, located in the heart of Baltimore City and ranked top hospital for 21 consecutive years by U.S. News & World Report through 2012, is Maryland’s largest private-sector employer and has enjoyed decades of nearly unchallenged market dominance in the region. However, today Hopkins is facing an upswell of nurses organizing with the National Nurses United (NNU) who want more for themselves and their patients. They are demanding collective bargaining rights to improve unsafe and unsustainable working conditions as well as substandard pay.
Left Voice interviews Jennifer Davis, a nurse who has been organizing with her coworkers over the last year.*
Why are Hopkins nurses fighting for a union?
JD: Every unit has its own issues, but there are some salient things across units. A big one is that Hopkins nurses tend to work more hours and still get paid less than other nurses in the area. Comparing salaries alone, it’s not that big of a difference, but for example at other hospitals, a nurse might work 36-hour weeks only day shifts, while I’m working 40 hours a week, with a mix of day and night shifts. We may have similar salaries overall, but if you break it down by hour, we’re paid less. Also, on some units, nurses do mandatory overtime, mandated to work 16+ hours and still come in to work the next day.
Staff retention is a big problem. We have a 30 percent turnover rate. We can’t attract experienced nurses; there’s a dilution of experience as we’re losing the experienced and replacing them with the inexperienced. For example, 60 percent of the nurses on my unit have less than 2 years of experience. On shift the other day, I looked around and noticed that with just eight months of experience, I’m a middle-seniority nurse!
Breaks are an anomaly. In rare cases, we cover each other during breaks, but then we end up with double the patient load. This happens even in ICUs where you end up with four, instead of two critically ill patients. In most units, we take a break when we can, which means almost never. When we don’t take a break, we don’t get compensated.
Workload and expectations keep growing, but there aren’t more hours in the day, and they’re not hiring new staff. Every time there’s a new bit of research to back up additional assessment tools or practices, more work and charting gets added on top of what we already have to do. The management just shows up and says, “Here’s this new complex mobility assessment,” or, “Now we want you to chart this really long educational assessment.”
Required documentation is constantly growing and we don’t get paid overtime if we stay later to chart. If we have a crazy, busy shift and have to catch up later to document (making sure our t’s are crossed and i’s are dotted), we don’t get paid that time.
Workload and expectations keep growing, but there aren’t more hours in the day, and they’re not hiring new staff.
According to management, we’re allowed four reasons to stay overtime and get paid. One reason is if you’re stuck in a code and can’t leave. Another reason is if you’re stuck in a procedural area and have to transport patient back, etc. Everything else they call poor time-management skills.
Beginning last year, hospital management said they’d address the nurse retention issue and nurse dissatisfaction. They held “town hall meetings” once a month where we went and spoke to administrators and they asked us questions. Nurses brought up problems with pay, benefits, and hours. In response, management said, “Okay we’ll bring down your hours to the 36-hour norm, but to do that, we’re going to cut your benefits, like dependent tuition reimbursement.”
Toward the end, they came up with a complete restructuring of pay, called the PACE model. No one’s happy with it. In fact, most people are getting paid less now. These weren’t improvements. They were just rearranging furniture in the same house.
We’re organizing to stop feeling powerless. There’s a lot of disillusion among younger people who get trained in nursing schools, are told, “your opinion is important,” and then go to the hospital and find it’s bullshit. I really appreciate the older generation because they’ve shaped nursing to what it is today. But I see a lot of people thinking nursing can be even more still. We constantly want to push it further.
Since the unionizing became public, how has administration responded?
JD: Once they caught on that we were organizing for a union, Senior Vice President for Nursing Deborah Baker wrote a letter to nurses stating that Hopkins nursing does not want a union to speak for them. She warns nurses: “There is some important information about unionization that I want to share with you in the event you are approached by a colleague to sign a union authorization card…I believe in our ability to create solutions together, without the involvement of a third party, and in a way that supports the culture and work environment that we strive to sustain and improve upon every day.”
With the union drive gone public, management’s now saying, “If you have a union, we won’t have the close relationships we’ve always had.” But I never felt like we were close.
Since the hospital found out we were unionizing, they’ve held warning huddles, captive audience sessions where they tell us they’re “really disappointed.” Those of us most involved were already inoculated against the retaliation. So, the administration is now saying what we expected them to say. They’ve held one-on-one meetings, spouting classic anti-union lies: “Unions are outsiders, they’re paying nurses…If you sign anything, including a voting card, its irrevocable and you’ll forever be part of the union,” when, in fact, signing a card doesn’t mean anything besides showing you want an election.
Since the hospital found out we were unionizing, they’ve held warning huddles, captive audience sessions where they tell us they’re really disappointed.
There’s the stick…and the carrot. On Sunday, one of the directors walked around the unit and was acting buddy-buddy with people. They’re actually throwing pizza parties (laughs). They’ve had a few nurses walk throughout the hospital, handing out candy and inviting them to this “Hopkins Nursing” Facebook page. Apparently, you get a pizza party if you post the most pictures. It all eggs me on even more. You throw pizza parties for third graders. This doesn’t make nursing more sustainable. This is why I want a union, so this career is treated with respect.
How are nurses’ working conditions linked to patient care and the broader community in Baltimore, Maryland?
JD: Johns Hopkins has a troubled history in the community. If you read Johns Hopkins’ original mission statement when he founded the hospital over 100 years ago, you’ll see it wasn’t solely to be a preeminent research institution. He founded it to help the local community.
That’s the front that Hopkins has failed the most. The patients I treat have so much distrust toward me, as an agent of the Hopkins Health System and the healthcare system in general. It gets in the way. I’ve had patients who, in their bouts of delirium, think I’m experimenting on them. Historically, they are not wrong. That has happened. What I want to do as a union is hold Hopkins accountable to its original mission.
That said, I’m proud to work at Hopkins. I’m proud of the nurses on my unit. i think we work with a very difficult population – people who have chronic diseases, who have been failed by the healthcare system over and over, who’ve had bad experiences. When we have difficult patients, it can be draining. It’s hard to deliver good outcomes, but I see nurses who really care about the patients and are non-judgmental. Patients get high quality care because nurses work so hard, because of the people who work there – in spite of the policies.
Administrators are a cog in the machine. Hospitals are run by businesses. Instead of figuring out how to efficiently run hospitals, it’s, how much can we take from our patients before they’re broken. Let’s ride it until that breaking point. And: how much can we take from our nurses. Let’s ride it there.
Why did you get involved in organizing at Hopkins hospital? How do you overcome fears of losing your job?
JD: I’m in this for the political picture. Nurses need more say because we’re a voice from the frontlines. We see how broken the system is and we don’t have the same profit motives that pharmaceuticals and insurance companies have.
I see how patients are put at risk every day because nurses are overworked. For example, we have frequent re-admit patients. After every major holiday, I have a patient who comes in crashing, volume overload. So we end up treating the patient, and discharging. I didn’t have time to educate him.
If I had a little bit of an easier time at work, it’s not like I wouldn’t be doing stuff. Instead, my day would open up to be filled with the stuff that isn’t easy to measure – what nursing is actually about: education and human connection. They now fill our day to the brim with the max amount of charting, because charting is what we use to measure what we do, but doing that doesn’t necessarily help our patients. Of course, charting is important for some reasons, but it’s not therapeutic. If we had time to do what we need to do during the day, more one-on-one time with patients, getting their fears and questions addressed, that’s where change can start.
*Details and name have been changed to protect the identity of the nurse.