Saturday, November 29, 2014

A Skeptic Dissects z Nursing Strike

This blog is an attempt to distill the communications and issues that lead to the two-day work stoppage across Northern California’s Kaiser Permanente (KP) facilities. In my mind, California Nurse’s Association (CNA) had not built a strong case for strike. Nonetheless, they received a clear mandate from my colleagues. Ever the skeptic, I saved every 2014 communication from both organizations, just knowing I would want to follow the breadcrumbs. 

“The union is a double-edged sword.” If I’ve said that once, I’ve said it a thousand times. I appreciate that my wages and benefits are the spoils of hard fought battles. That nurses can work twenty-plus years for a healthcare system and retire without medical benefits remains the norm. Excepting the state and feds, Kaiser was early to grant healthcare benefits to retirees. The union did that. We affectionately call our pay and pension package the golden handcuffs and I believe nurse retention spares Kaiser the largest expense in any healthcare budget - the hiring and training of nurses. The union did that - that however, is no mandate to heed every word like chiseled tablets from the mountain.

Context is decisive. My context for CNA is not a powerful one. Our last contract was ratified September 1, 2011. Contract negotiations were secreted between CNA and Kaiser arbiters. The rank and file were notified post-hoc and encouraged to ratify. It was a different time, profit margins were thin and Kaiser was anxious to settle the behemoth budgetary item. The contract was bounteous, included raises during a time of high, national unemployment and economic downturn. Generous beyond expectation, we were universally thankful and thrilled.
CNA’s chief arbiter visited each campus to explain the new contract and encourage ratification. I found one phrase unsettling. “They are… scared of us,” he said smugly to the rank and file, “Yeah, scared is a good word.” And not for the first time, I wondered about supporting such an organization. 
That same organization called for a one-day work stoppage twenty-two days into that brand-spanking-new contract to support other, non-KP RNs and KP optical techs in union contract negotiations. A union representative visited each site to encourage nurse participation. I entered the fray brandishing my newly-minted-copy of the Agreement between Kaiser Permanente, Kaiser Foundation Hospitals, the Permanente Medical Group, and CNA dated 9/1/2011 - 8/31/2014.
Page 116 Section I - No Strikes or Lockouts 4023 addressed the issue: There shall be no strikes, lockouts or other stoppages or interruption of work during the life of this Agreement. 
“How do you reconcile a call for a work stoppage with this new contract?” I asked pointedly, after reading the passage aloud.
“We have a past practice,” the union representative said.
“This contract says no strikes, lockouts or other stoppages or interruption of work during the life of this Agreement,” I reiterated. “It does not say except for past practice.” We were diametrically and equally opposed, entrenched and immovable. Some nurses, elated with the new contract, saw heeding CNA’s call-to-action as homage due. Honoring the contract and one’s word seemingly fell upon deaf ears. All told, 23,000 nurses from numerous healthcare systems heard and heeded the call - a CNA flex-of-muscle, described as “the largest-ever strike by nurses.”
That nurses would stage a work stoppage, in direct conflict with our new and very generous contract, and for issues unrelated to Kaiser RNs was unfathomable to me. That CNA would call for such an action was unconscionable. CNA became suspect and the minions who, without question, would do their bidding? I viewed as uninformed and ignorant. I penned a letter of dissent to Sac Bee’s Letters to the Editor that went unpublished. But context is decisive and subsequent calls-to-action by CNA are met with fervent skepticism and scrutiny.

Fast forward to 2014. The Kaiser-CNA contract was set to expire 8/31/2014. 
In April, Dr. Robbie Pearl, Kaiser’s CEO, was filmed at The Permanente Medical Groups shareholder meeting. “A big threat is that our nurses union has a contract coming up this year that will not get settled. There is no way it gets settled. And so we are looking at strikes inevitably coming up sometime in the latter part of 2014, heading into 2015.”
As early as May 2014, CNA emails to membership pointed to the 2014, 21.7 billion dollar profit while care units were short-staffed or shut down. 
With contract negotiations scheduled to begin 7/24, CNA encouraged RNs, on July 20th, to set aside 2% of each paycheck as a Patient Protection Fund and sought a written commitment to do so. A Patient Protection Fund  “for our patients and ourselves if Kaiser fails to work with us…” A strike fund, by any other name, is still a strike fund. Sadly, seemingly both sides were entrenched before negotiations had even begun. Score: 15-love, point-CNA for the pre-emptive strike.

As I walked toward my office on July 23rd, I was asked to sign a petition urging Kaiser to bargain in good faith.
“Isn’t that a given?” I asked. 
“No,” the nurse said, shaking her head.
“I don’t think the best strategy for negotiations is to go in with guns blazing,” I said moving on, “Sorry, I won’t sign that.” Score: love-all, penalty point-CNA for un-sportsman-like conduct.

The first day of bargaining was re-scheduled for July 31st, 2014. CNA reported that Kaiser failed to show, so they marched to Kaiser’s corporate offices in Oakland and read their opening statements in the lobby - which was covered by the national news. Kaiser had been working for weeks to obtain an agreement to meet at a neutral location, at which they waited on the appointed day. Apparently, CNA never agreed to that venue. To their detriment, Kaiser failed to widely broadcast their version. Score: 15-love, point-CNA, everyone loves a David beats Goliath tale.

CNA, framing their demands around patient care and safety, delivered 38 proposals to the bargaining table. As early as August 14th, CNA represented their proposals focused on “working conditions and changes for improved patient care and services” while Kaiser’s rebuttals allegedly cite “cost containment”. (Cost containment will seem ludicrous later with reports of Kaiser’s, record, $12,000,000 daily profit in 2014.) CNA showcased the death of a bay area toddler as proof that services were lacking.  Score: 30-love, point-CNA for strumming the heartstrings. It’s difficult for many to see issues beyond the death of a child.

On August 21st, CNA employed a time-tested-tactic, the old bait and switch. “No takeaways in light of record profits.” With that declaration, a two-pronged attack was launched and the battle subtilely shifted from patient care and safety only, to sharing in the loot. Leaflets addressed corporate profits and CEO salaries. ACE! Score: 40-love, point-CNA, for stirring stinky bait into the pot, muddying the waters and altering the debate.

PAUSE IN THIMK (this was a phrase my university math prof used to indicate a sidebar)
No margin; no mission. Where do new, digital mammogram machines come from? From the margin. Where do new hospitals come from? The margin. Where do newer, designer drugs like expensive insulin pens subsidized by pharmacy programs come from? Yep, you guessed it; from the margin. Where does my very substantial paycheck and pension come from? Righto - the margin. 
As one who has owned a small business, I understand the cost of business, a P&L statement and the margin. While current and historic evidence of income inequality and its deleterious effects on society is well documented, that discussion is for a future blog. Nonetheless, I view CEO pay and corporate profits as a separate issue, unrelated to my own W-2. During my 35 years of nursing, my wages have increased 7-8 fold. Kaiser nurses are well paid, possibly some of the highest paid nurses in the country (uh... = world). When one points to CEO and corporate greed, must one address the three fingers pointing back at self?
End Pause in Thimk

9/11 - CNA reported, “Kaiser informs us that they have no interest in the majority of our proposals.” Did Kaiser actually say this? Unlikely. Counter-proposals are part of the game and do not infer no interest - that's what a rejection is for. There is no record of Kaiser rejecting any of the proposals. Kaiser’s accounting of negotiations on 9/11 are collegial and collaborative. They propose extending the contract 60-days and adding numerous bargaining days. Score: 40-15, point-KP for bargaining in good faith.
As negotiations proceeded, nurses were encouraged to attend the bargaining sessions, to witness the process first hand. Carpools were organized across northern California and CNA filled the bargaining venue with chanting RNs. At one point, Kaiser’s negotiating team refused to continue and called for an arbiter to arbitrate the arbitrations on the grounds that they did not feel safe. Excuse me - is this a professional nurse's association or the Teamsters? Score: 30-all, point-KP for professional conduct, penalty point-CNA (and attendant nurses) for behaving like thugs.

On September 30th, CNA proffered its last proposal - one for Ebola preparedness including supplemental insurance in the event that Ebola is contracted at work.
October 8th - Kaiser’s response to the Ebola Proposal included creating a CNA/KP task force to incorporate best practice and ensure all voices/concerns are addressed. CNA scoffed and spun this into: “Kaiser is responding with a proposal with the lowest common denominator. Kaiser is using our patient’s lives as bargaining chips. Kaiser’s lack of preparedness matches how they treat us every day when they fail to prepare for admissions, discharges and sick calls. It is clear they are unwilling to embark on a sufficient Ebola preparedness plan in an effort to limit costs.” 
Here, CNA effectively taps into national nursing outrage that frontline nurses were inadequately protected at Texas Presbyterian, while proper personal protective equipment was available onsite. Undoubtedly, mistakes were made; mistakes for which Texas Pres has apologized and paid. But methinks Texas Pres was a long time ago and far, far away from where we are now. That was then; this is now. Score: 40-30, point-CNA for effectively personalizing the debate and tapping into the outrage required to mobilize the minions.
10/15 - Kaiser is “unwilling to spend any of the $12 Million in daily profits on ensuring adequate relief for nurses.” Score: point and Game-CNA for guerrilla warfare that effectively demonizes Kaiser at every opportunity, tossing in every bone and stirring the pot. Game Score: CNA-1, KP-0.

Burnout: the condition of someone who has become physically and emotionally tired/spent after doing a difficult job for a long time. One symptom of burnout is anger. 
I left the Emergency Department because I was becoming a person I didn’t like. I was angry: angry at patients, angry at home, angry at work, angry at friends, angry with my parents and family. I’ve spent years working on self, finding that which nurtures my soul - returning to myself. “You are more you,” a friend said. Exaaactly. I know many angry nurses; the workplace can be a cauldron, little kindling required to light the fire.
To combat burnout and boost mental health, Kaiser has an Employee Assistance (counseling) Program and an employee wellness program called LiveWellBeWell that is unmatched in the industry. There are processes to escalate concerns of workplace violence, sexual harassment, and unsafe practice, to name just a few. Programs are free too all but employees must actually participate (engage, document, submit) to receive the benefits.
This is not to say that cases of harassment and unsafe practice do not exist; only to say that there are options to anger and strikes.
End Pause in Thimk

Game 2
10/16 - “CNA told Kaiser that we are willing to settle our contract today providing there were NO TAKEAWAYS.”
Regarding the Ebola Proposal: “Kaiser’s refusal to agree to this proposal further solidifies that Kaiser is putting profits before the safety of nurses and our patients.” Note: Kaiser did not refuse but countered. I'm sure CNA knows the difference.
I view this communique as critical. First, while CNA claimed 39 proposals addressed patient care and safety - they are clearly willing to chuck the entire body of work for no takeaways in pay and pension. Really? Didn’t they just commit the exact offense they accused Kaiser of in the next line? Of putting profiteering before the safety of nurses and our patients?
Score: love-15, point-CNA for cleverly/effectively couching double-speak for political gain whipping the nurses into a frenzy.

10/20 - Petition to Authorize Bargaining Team to Call Strike if Necessary 
“We have been bargaining for several months and it is clear that Kaiser is not interested in putting its $12 million per day in profit towards the provision of safe patient care. …Kaiser has the resources to settle our contract …but obviously they have no intention of settling our contract without coming after our benefits.” 
Note: Not agreeing to no takeaways is not the same as proposing takeaways. At this point in the game, Kaiser has deferred financial discussions. Rather, they propose settling most of the 39, non-financial proposals before discussing pay and pension. But notice how CNA framed this as “they are coming after our benefits.”
They may come after our benefits but that has not been proposed. I will hardly strike over something I fear Kaiser might do. But fear is a powerful motivator. When my physician friends express confusion with the issues” its because issues are difficult to discern in the stewing cauldron stirred by CNA. This strike, best I can tell, was not about issues but emotions. Bubble, bubble, toil and trouble. Score: love-30, point-CNA for obvious reasons.

10/30 - Notice Issued for 2 Day Strike
CNA got their mandate from Northern California Kaiser nurses to strike, and in an am-a-a-a-zing coincidence, coordinated Kaiser’s work stoppage to precede a (yet to be declared) National Day of Action by nurses for Ebola preparedness. Ask yourself; does my employer need to be penalized with a day of strikes because their Ebola Policy changes with the evidence? Aren't you glad it does? Score: love-40, point-CNA for coincidental planetary alignment with the moon in the 7th house and Jupiter aligned with Mars. Does anyone feel even remotely manipulated? Think nurses - THINK!

From California to Maine, registered nurses plan to make their voices heard louder on Nov. 12 with a National Day of Action for Ebola Safety Standards.
This comes after hospitals across the country refuse to set proper safety protocols and training with optimal personal protective equipment.

To their detriment, Kaiser all too sparsely leaflets its nurses with position statements and their disappointment in the rhetoric and tactics of CNA. Their information is tempered, a welcome sprinkle on the flames fanned by the frequent CNA communiques. A sprinkle nonetheless - inadequate and infrequent. Kaiser needs a counter-terror blogger, one to call a-spade-a-spade; an impartial voice with an eye for half-truths and spin.
On Novemember 7th, Kaiser's Leadership responded with an email to employees: “The union’s use of Ebola as a rationale for a strike is not justified. We are very disappointed about the nurses union's decision to call for a strike. The reasons it is giving for striking are simply not supported by the facts. To date, CNA leadership has… continued to label KP publicly as unprepared, which is not true and is stoking unnecessary fear.” Score: 15-30, point-KP for stating the obvious - albeit ineffectual.
Buried at the bottom of that 11/7 email, I found this: If you have questions: We understand that you may be hearing conflicting or confusing information from different sources. Please visit For the Record (, our website that provides updates, answers to frequent questions, and KP’s perspective on bargaining and other important topics. WHAT???
Dear Bleader (blog reader), you know me to be a voracious reader and consumer of information. Trust me when I say, November 7th was the first I’d learned about a Kaiser website for bargaining information. Truth is, it is not solely dedicated to bargaining though bargaining dominates the website at this time. Shame on me and shame on KP. Score: love-30, penalty point-KP for failing Employee Communications 1.0.
November 13th: the day following the strike, Kaiser’s Leadership sent a conciliatory email: “We especially want to express appreciation for the many hundreds of nurses who chose to put their patients first and came to work. On behalf of our patients, we thank you for your dedication and commitment.”  
“With this unfortunate work stoppage behind us, we welcome back those nurses, engineers, and other employees who were not here during the strike. We know you will resume providing excellent care in your departments, your care teams, and at your patients’ bedsides.” Score: 15-30, point-KP for diplomacy and inclusivity.
November 20th: CNA claims victory and responsibility for improvements to the Cal OSHA Ebola policy announced November 14th. Score: 15-40, point-CNA for effectively using circumstance to their advantage.

I spoke of the strike with a non-Kaiser, nursing friend. “Wait a minute,” she cut me off, “Isn’t Kaiser a great place to work?”
I wonder - are we better off after a two-day work stoppage? I fear not. I am cautious in speaking with those who supported the strike. I am curious about their view - so different from my own - and  wonder about the decision-points leading to their willingness to strike. 
As the game continues, Kaiser is seemingly outmatched in propaganda and spin. I have spent hours sifting through data for this distillation. Few have the time or want for such a summary; few will read this blog. No matter as my blogs are typically (no exception here) the place to address that which niggles and gnaws and to observe the distillate.

I recently listened to an interview with Arie Kruglanski, an Israeli researcher, psychologist and terrorist expert. He points to the black-and-white, right-and-wrong, rigid versus nuanced thinking of extremism as juvenile, underdeveloped but providing a place for one to become part of a larger whole. He cautions that victims often become as extreme as their oppressors and cites his mother country as an example. Finally, he discussed decreased cognitive complexity as exemplified in one’s inability to digest many points of view and extremism and entrenchment as causal for literally dumbing-down.
I continue to be unmoved by CNA and have been known to call them rabid. It is for me to move forward carefully, that I am not equally rabid from the opposite side of the net and court. Life is not back-and-white, mostly methinks, we inhabit the vast fields of gray.

Rumi said it most eloquently - Out beyond ideas of wrongdoing and rightdoing there is a field. I’ll meet you there.