At What Cost Care?

When the 330-member nurses union at Encino-Tarzana Regional Medical Center staged two one-day strikes Sept. 15 and Oct. 23, union President Anne Clarke became the strikers’ chief spokeswoman.

The Canoga Park resident, a nurse since 1953, took a firm stand against the hospital’s owner, Santa Barbara-based Tenet Healthcare Corp. Tenet recently agreed to renew negotiations if the union canceled its strike, which it did. The union, the American Federation of Nurses, Service Employees International, Local 535, and Tenet are scheduled to meet tomorrow in Glendale.

Clarke, 66, a neonatal nurse who has worked at the Tarzana hospital for 24 years, spoke recently with Scott Holleran. Holleran, 33, is editorial director of Americans for Free Choice in Medicine, a nonprofit patient advocacy group based in Newport Beach.

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Holleran: What was the core idea behind the nurses’ strike?

Clarke: To make us whole. We lost time-and-a-half, we gave money back graciously [agreed not to take raises], we did not strike and we never really recouped everything because we’ve been on a wage freeze for 5 1/2 years. The only people who received raises were fairly new to the hospital. Seventy-five percent of the nurses at Tarzana have been there for over 18 years. So the people who make the hospital work--and I’m not putting down people who have been there for less time--got nothing.

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Holleran: What are your demands?

Clarke: An across-the-board 6% raise the first year and a 4% raise the second year. [The current system] divides people. We see it as a union-breaking issue. You immediately create problems between people with the current two-tiered system. The staff gets upset--which is exactly what [Tenet] wants. An across-the-board raise is fair.

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Holleran: Whose decision was it to ask for an across-the-board raise?

Clarke: The entire bargaining team. The team represents the membership. We distribute surveys to union members and nonunion members a month ahead of negotiations. They’re supposed to return the survey and, therefore, the bargaining issues are their issues.

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Holleran: What percentage of surveys were returned?

Clarke: Probably 40%.

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Holleran: Do union members vote to approve the terms?

Clarke: No.

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Holleran: Doesn’t Tenet have the right to reject an across-the-board raise and reward nurses based on merit?

Clarke: I see nothing wrong with merit-based pay, but that’s not the way things work. I would rather see us all get the same raise and make less.

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Holleran: What are the union’s other demands?

Clarke: Staffing by a committee--on the table and tentatively agreed upon--which includes that the acuity system, which determines how many people staff a certain area, is determined by the level of a patient’s care, not by volume. A safer needle system is also a big discussion on the table. The union opt-out issue is also very important.

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Holleran: In other words, once a member of the union, a nurse can’t leave the union while employed at [Encino-Tarzana]?

Clarke: Right. Tenet wants a 90-day opt-out period. We told them that we would absolutely never agree to that. We want to keep it a closed shop.

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Holleran: Then newly hired employees will automatically become union members?

Clarke: No. New hires have the option to opt out of the union after 30 days. If the nurse doesn’t put it in writing, he or she automatically becomes a union member.

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Holleran: Are hospitals dominated by managed care, such as [Encino-Tarzana], better or worse than hospitals 45 years ago?

Clarke: That’s the $64,000 question. I really don’t have many good things to say about managed care. I don’t know what is better, but we have to find something that works better because the patient suffers, and unless the patient has an advocate with him for 24 hours a day, the patient will continue to suffer.

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Holleran: Doesn’t Tenet deserve credit for Tarzana’s top-rated NICU [neonatal intensive care unit]?

Clarke: I don’t think you can thank Tenet for that. The NICU’s always been one of the best because of the staff, the care and the management by physicians.

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Holleran: Regarding Tenet’s lockout of striking nurses: If nurses have the right to strike, why doesn’t Tenet have the right to take those nurses off schedule?

Clarke: They do have that right.

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Holleran: Then why did the union go to the National Labor Relations Board and file a complaint about the lockout?

Clarke: Because it may have been illegal. I totally understand why Tenet locked nurses out, because they had to allocate dollars to nurses. But if you really value the nurses that you have, why wouldn’t you let them come back?

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Holleran: Is the union membership prepared to go on strike indefinitely?

Clarke: Some of the membership is prepared, though I certainly don’t think we have enough for that. There are a lot of problems with a strike, like a loss of money. There’s no strike fund.

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Holleran: How much are dues?

Clarke: Dues are 1.4% of a member’s base salary. For example, I pay $56 per month. Dues pay for salaries, lobbying, the international union, clerical work and attorney fees. I’m not paid.

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Holleran: What about reports of sabotage by strikers?

Clarke: There was some sabotage. I know that three staff nurses--who were suspended--made it difficult for the registry nurses to find equipment. The union denounced their actions. The union would never condone doing that. On the other hand, there were 17 incident reports written [against replacement nurses] while we were on strike.

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Holleran: Were patients denied care during the strike?

Clarke: Well, a 38-week baby coded and the family told us alarms on the baby’s monitor went off for over 30 minutes before the baby received care. The infant’s heart rate went too low and he ended up on a ventilator. He’s fine now. There was another report that a baby had not been fed for six hours.

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Holleran: Wasn’t that the purpose of your strike--to show that union nurses are needed?

Clarke: I wouldn’t anticipate that an NICU nurse would not know to feed a baby on time.

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Holleran: On the one hand, nurses went on strike to demonstrate their value, but now you’re criticizing registry nurses for bearing out the truth of your claims. Aren’t you trying to have it both ways?

Clarke: That’s true. But they should know basic NICU care. There were some real horror stories. One woman had surgery and went three days without a bath. That’s basic cleanliness.

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Holleran: Tarzana nurses are paid an average of $27 an hour, receive 401(k) benefits, health insurance, stock options, holiday and vacation time; if they don’t like working for Tenet, why don’t the nurses quit?

Clarke: They can. But if they go to work for Valley Presbyterian or Northridge [hospitals], they’ll work the night shift, take a pay cut and make no decisions.

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Holleran: Doesn’t that support Tenet’s claims that Tarzana is a fine hospital to work for?

Clarke: No, because Tenet took over an already premier hospital with a premier staff.

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Holleran: Your statements--on radio ads and in press releases--imply that Tenet should transfer profits to employees. Do nurses have the right to dictate what percentage of profits go to wage increases?

Clarke: We have a right to ask for a raise. A raise is a percentage of company profits.

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Holleran: What are the essential principles of good nursing?

Clarke: The core of nursing is helping others. In addition to having the technical skills necessary, you have to love what you’re doing for its own sake. Even if you have an awful day. [When I started,] I saw nursing as one of the most secure jobs. I could go anywhere and still get a job. The security was important to me. Today, every day you walk in there’s a new regulation and you still have to care about your work.

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Holleran: What would you advise a nursing student about working in today’s medical profession?

Clarke: I don’t know that I would encourage anyone to go into nursing. If my kids came to me and said they wanted to become a nurse, I’d say, “You really need to think about that,” because nurses are expected to work twice as hard as we used to for less money. And I see it getting worse.

More than anything, patients--who are losing their choice of doctors and hospitals and treatments--have to get outraged by what’s happening in the medical profession enough to make it better.