A July 20 vote to authorize a strike of Rochester General Hospital nurses brings a long-simmering conflict between the hospital’s fledgling union and Rochester Regional Health’s management to a full boil.
Barring a sudden reversal in RGH’s negotiating strategies, says Gillian Kingsley, secretary of Rochester Union of Nurses and Allied Professionals, the union is planning the walkout to begin Aug. 3 and end two days later. The short duration is meant to minimize disruption to patient care, Kingsley says.
However, she adds, the union fears the hospital could lock them out for an additional three days. While RUNAP has no indication that RGH plans such an action, other hospitals have cited the difficulty of hiring replacement nurses for less than five days as justification for locking striking nurses out.
Hospital officials could not immediately be reached for comment.
According to an internal communication obtained by the Rochester Beacon, a memo apparently signed by RGH chief operating officer Tammy Snyder, the hospital planned to convene “an ad hoc meeting” of its medical and dental staff today to inform them of plans for dealing with the strike.
RUNAP first voted to organize some 12 months ago. The union and hospital management did not begin first-contract talks for some three months, kicking off negotiations in last October.
The union represents roughly 900 nurses at the hospital. At 528 beds, RGH is Monroe County’s second-largest acute-care hospital and the flagship of RRH’s system.
RUNAP is the first nurses labor organization to successfully organize in Rochester. If it is able to negotiate a first contract with RGH, it hopes to extend its reach to other area hospitals, including its home systems and other acute care facilities.
RRH’s other hospitals are Unity Hospital in Monroe County, Clifton Springs Hospital and Clinic in Ontario County, Newark-Wayne Community Hospital in Wayne County, and United Memorial Medical Center in Genesee County.
In addition to staff shortages and poor employee retention, concerns the union points to as not adequately addressed by management include patient safety, high incidence of hospital-acquired infections, and vehicle break-ins at RGH’s parking facilities.
The RGH nurses union formed in COVID-19’s wake.
In the pandemic, Rochester hospitals—like hospitals nationwide—faced resignations of nursing staff and deep financial strains. Hospitals, including RGH, have been forced to shore up flagging nursing numbers with temps known as travel nurses whose hourly rates are as high as three times as much as what regular staff makes.
In an interview last year, RRH chief medical officer Robert Mayo M.D. said RGH’s nurse turnover was running at 25 percent and travel-nurse expenses were driving up labor costs unsustainably.
In a town hall meeting with RRH staff in the first quarter of this year, CEO Chip Davis called rises in the health system’s labor costs “extreme” and its expense-to-revenue ratio as unsustainable.
Davis said the system’s travel-nurse costs had soared from $9 million in 2019 to $200 million in 2020. Along with rises in costs for prescription drugs, supplies and other expenses, the health system had gone from realizing operating income that topped operating expenses by more than 1 percent in 2018 to an operating deficit of 1.5 percent in 2022, Davis said in March.
The system’s financial challenges are growing now that federal pandemic-era subsidies have dried up, he noted. While the system’s financial performance was improving, Davis said, RRH was still losing $400,000 a day.
In the first-quarter presentation, Davis suggested that in light of the mounting challenges facing RRH hospitals and facilities, the system’s salvation could lie at least partly in tightening operations. He cited so-called lean manufacturing principles also known as Lean Six Sigma. Touted by proponents of the 1980s-era total quality management movement, Lean Six Sigma stresses improvement of processes as a means of cutting costs without degrading working conditions.
Backing Davis’ push for lean processes at the town hall event, RRH chief operating officer Jennifer Enslinger asked, “Why does the nurse have to take a 100 steps to go find something a 100 times a day? That’s incredibly wasteful, and it pulls our staff, our important vital team members away from the patient and the bedside.”
To cure RGH’s ills, hospital staff would have to work not harder but smarter, Davis said.
While some have suggested that application of lean principles could greatly improve U.S. health care, “there are significant gaps in the (Six Sigma and Lean) health care quality improvement literature and very weak evidence that Six Sigma/Lean improve(s) health care quality,” a National Institutes of Health analysis concludes.
“Six Sigma application will work to improve a hospital’s financial performance,” a similar analysis of a dozen studies on the method’s health care applications published in the Journal of Nursing found. However, the article adds that “what these articles do not address, at least not in a specific way, is how to manage the inevitable backlash that can occur when a person’s or a department’s standard way of operating is interrupted.”
How eager or willing RUNAP nurses might be to buy into lean processes as an answer to their concerns is not clear. The union’s dissatisfaction with management’s responses to their proposals so far has included salary. RGH’s wage offers have remained below what nurses in comparable area hospitals are making, the union notes.
The hospital’s July 21 memo, meanwhile, states that “RGH does not want a strike and we believe nothing we have proposed or haven’t proposed in our contract negotiations warrants a strike.”
The union paints a far different picture.
“Throughout the bargaining process, our committee has come together committed to making positive changes to our Hospital. RGH administration, on the other hand, has delayed responses on our most pressing matters or rejected them outright,” a pre-strike-vote post on RUNAP’s website states.
In the hospital’s July 21 memo, RGH cites its call in June to bring a federal mediator into talks with RUNAP as evidence of its good intentions.
RGH hoped the federal mediator would “focus everyone’s energies on trying to reach an agreement rather than talking about a strike or other activities that could harm these stakeholders and negatively impact patient care,” RRH COO Enslinger said last month, announcing the hospital’s intention to call in a federal mediator.
The union was not impressed by negotiations that followed, however.
RGH negotiators have “spent months telling us staffing is fine. They ignore our experiences and continue to commit unfair labor practices. Meanwhile, experienced nurses continue to leave RGH while patient care continues to deteriorate,” RUNAP’s pre-strike-vote post contends.
In the two bargaining sessions this month that were joined by a federal mediator, RGH management’s proposals scarcely deviated from earlier ones that the union sees as inadequately addressing its concerns, the union’s post maintains.
“The last session on Thurs 7/13 was the first time we were joined by a federal mediator,” the post states. “Unfortunately, instead of coming with anything on staffing, admin came with yet another dress code policy and only a couple other minor proposals.”
Counting from the October beginning of talks with RUNAP, the hospital suggests that the union’s call for a strike is premature after only nine months of talks. Citing a Bloomberg Law study, RGH notes in the memo that first-contract talks typically take 15 months to conclude.
Despite the strike authorization vote, RGH “remains committed to bargaining in good faith,” the hospital’s memo asserts. “We continue to believe that contract issues are best settled at the bargaining table and urge the union to return to negotiations so we can work together to reach a contract that’s good for nurses, patients, the community and RGH.”
The hospital planned to convene “an ad hoc meeting” of its medical and dental staff today to lay out its plans for dealing with a nurses strike, the July 21 memo states. In the meantime, RGH says it is “committed to scheduling additional bargaining dates with the union.”
Will Astor is Rochester Beacon senior writer. The Beacon welcomes comments and letters from readers who adhere to our comment policy including use of their full, real name. Submissions to the Letters page should be sent to [email protected].
I worked at RGH for 8 years. Worked in various types of hospitals in different states, the south, Chicago, Rochester. I found RGH to be the most abusive system to their nurses. This was well before the pandemic. I was a nurse educator and at one of our nurse leader meetings, a nurse leader said “We don’t hire nurses based on their skill or their knowledge, but on what they can look up.” I was livid. I wrote a scolding letter that day. When the upper nurse management has the attitude that “a nurse is a nurse” it pervades throughout the system. The lack of respect is obvious.
RRHS would have an annual mandatory town hall meeting. The theme was growth, higher capital gains, becoming the biggest and driving the “system across town” out of business. RRHS did grow. It stopped collaborating with the well regarded and well-known university system. And it lost itself.
I laughed when I read about the Lean Six Sigma solution. I was there when the supplies were moved off the units to locations down the hall so that extra patient beds could be placed in the hallways of the nursing units. I even raised the point of the inefficiency of this to the director of nursing at the time. I was told that the nurses would have to live with it. I was told that the patients would get used to being in the hallway.
I’m a conservative and generally do not favor unions. When I heard of the nurse’s decision to unionize I celebrated. I knew the desperation they felt. Nurses at RRHS have been abused and ignored for far too long. The fact that the hospital is willing to spend unprecedented amounts of money on anti-union consultants and hire nearly 500 international nurses instead of working with LOCAL nurses to reach a compromise is telling.
RRHS nurses are dedicated and some of the hardest working nurses I’ve ever worked with. The only way they have survived is because they truly are a family and they love and support one another. It’s like being in a fox-hole. I wish them the best and I hope they continue to stay strong for their principles. Strike on brothers and sisters!
Sorry, not drinking the RRHS tea anymore.
After viewing the clip embedded in this article I was disappointed to hear the cheer for “the strike is on!!!”. This is serious business, period. It’s not party time. The situation is pretty sad. That two parties have to place the patient in peril is tragic! I don’t believe the nurse profession did itself any favors with the joyous cheer. Just saying.
I agree 100% with Josh Porte’s comment. I too have worked in different systems in the northeast and I NEVER saw anything like what I endured at RGH. I worked in the ED when more than 100,000 patients per year were treated and it was a top 100 heart hospital. I would routinely have 8-12 patients. Our top “leader” was the worst manager I ever worked for. One morning she walked us managers through the department pointing at wastebaskets and not in a kind way, spat out “this needs to be emptied.” This woman had never worked in any of the departments she oversaw, and to the best of any of our knowledge, her clinical experience was as a night nurse in a nursing home before attaining all her degrees. She always had her business suit on while we were dealing with bedlam. So, how does that kind of leadership support the staff? IT DOESN’T! Yet it seems like the more incompetent you are, and the more willing you are to stay in your business suit and “ivory tower” the more likely you’ll be given a top leadership role. This pervades every area I am familiar with (through many friends). If any leadership in this hospital, from the top down, suited up and helped in the trenches they would gain respect and perspective on what the front facing staff are dealing with. Instead they never lend an open ear or dig in and provide actual help. Instead they breeze through the units and offer “at a boy!” This mentality pervades other facilities in the RRH system as well. So now the nurses have said enough. Ultimately the patients are the losers. After years of trying to use the provided avenues to improve patient care and having the door left unopened, locked, and slammed in your face, it has come to a strike. I’d walk the picket line with them if I could. I offer this to RGH nurses: it isn’t this bad in other places and I support your vote!
There is not enough space to respond to this issue, that said I’ll give it a go. Having been in department head positions with IDE and Park Ridge Hospital way back in 1975 as well as several other hospitals in NYS and out of state, I have witnessed this tug and pull between upper management and staffing in every case. In most cases senior management was the primary problem. Rarely did a senior member walk the institution. Rarely did they familiarize themselves with middle management. Theylived in this “ivory tower” and expected that all would be well. Some of this is the fact that senior management has no idea what the professions do nor do they realize their role in quality patient care. The boots on the ground realize that all too well. When you work facing life and death daily, it takes its toll. I’m actually at a loss why hospitals don’t include their department heads on a daily basis. This negotiating would vanish if one and all were familiar with the financial status. There doesn’t need to be a moat between senior management and staffing. Inclusivity could prevent the need for a union in the first place. That ship has sailed. There still is an opportunity to reorganize the operational mission. At this point trust has eroded and ego is obstructing progress.