More than three months after the nurses voted not to form a union, Duke Hospital officials have started to address the numerous issues that sprang into the limelight during the unionization campaign.
While some nurses think these actions are too little, too late, others believe the moves signify the start of an improved relationship between the registered nurses and management.
Chief Nursing Officer Mary Anne Crouch said she believes hospital administrators learned that they must tackle three key issues-communication, the competitiveness of nurses' benefits and staffing levels.
To address the specifics of these three issues, Crouch will help form a council of registered nurses.
"We believed we had good communication channels," Hospital CEO Mike Israel said. "[But] you shouldn't make assumptions that the mechanisms you set up to communicate with employees are adequate."
Israel also said it may have been intimidating for employees to speak up at the regular forums administrators used to host. He said he will concentrate on making sure employees can air their concerns in more familiar and comfortable environments-the forums used to draw as many as 200 people.
While most nurses seem to be taking a wait-and-see approach, many are disappointed with the relative lack of speed with which Duke is implementing its changes.
"I'm not discouraged [by what I have seen so far], but I also have not seen anything concrete done," said Connie Donahue, a trauma unit nurse and a past union organizer. "They've done nothing bold and concrete."
For example, Donahue said she is wary of the nursing council idea, which she thinks has failed in the past. "We've tried it before and the minute [an idea] comes up against someone who doesn't agree, it's shut down or altered to fit the management's needs," she said.
But some nurses also see these latest developments as positive first steps; they say they believe that Duke is making an honest effort to appease them.
Clinical nurse Susan Simpson said that on her floor the nurse-to-patient ratio has dropped from six-to-one to five-to-one since the union vote, which she says is a "huge difference."
"But it took the threat of a union to start it," added Connie Pierpoint, a medical inpatient nurse.
Still, even those who are optimistic about future changes within Duke Hospital agree that there is a lot of work to be done.
"Councils and [increased] communication are a good start but the [issue of] pay still has not been addressed," Simpson said. "If we become complacent again, will things go back to the way they were?"
But Duke has already taken some steps toward addressing nurses' concerns about pay. Human Resources fixed a system glitch that caused recently hired nurses to accrue benefits at a rate greater than that of veteran employees. The Hospital recently paid out the accumulated difference to some 1,900 affected nurses.
"It was the right thing for us to do," Israel said.
Hospital officials were informed of the discrepancy early last year, but fears of unfair labor practice charges prevented them from taking action, Israel said. Under federal labor rules, employers are forbidden from adjusting their workers' benefits during an ongoing unionization drive.
Additionally, Crouch stressed the importance of making each solution to staffing problems department-specific. She said several departments, like urology and neurology, are currently testing alternate scheduling structures that will cut down or completely eliminate the need for mandatory overtime-one of the nurses' major concerns during the unionization campaign.
To aid them in this re-evaluation, Hospital leaders are currently employing the services of Mercer Management Consulting.
Dot Taylor, nurse manager in the neurology division, said that although her department has always been conscious of staff input in overtime requirements, its new plan will emphasize voluntarism rather than requirements.
"We [will] go to people and ask them to pick up an extra shift if there was a hole in the schedule that needed to be filled," she said.
While the Hospital has not assessed the effect of the union campaign on nurse recruiting, Crouch said, the current number of vacancies is unchanged since last summer. To overcome this shortage-of approximately 190 nurses-the Hospital has been forced to hire temporary nurses, a very expensive remedy. Crouch said the Hospital hopes to hire more permanent RNs when nursing schools begin graduating their classes in upcoming months.
Even Donahue acknowledged Duke's concerted effort to hire more traveler nurses and to adjust the error in pay.
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