Striking NJ Nurses to Governor: RWJ Bosses are Trying to Break the Union
Striking NJ nurses at Robert Wood Johnson University Hospital met with Governor Phil Murphy just prior to Thanksgiving. Photos by Bob Hennelly.
By Robert Hennelly
Just before the Thanksgiving holiday, New Jersey Gov. Phil Murphy and his chief of staff Diane Gutierrez-Scaccetti held a zoom session with the leadership of the United Steelworkers Nurses Local 4-200 that’s been on strike for safer staffing at Robert Wood Johnson University Hospital. It was the first such meeting with the union that represents 1,700 nurses that have been out since Aug. 4.
Local 4-200 President Judy Danella, RN, welcomed the opportunity to make her case directly to Gov. Murphy. The meeting lasted a half hour.
“He didn’t say much — his chief of staff asked about the sticking points in the negotiations and we told them about management’s attempt to try and break the union in such a labor state,” Danella later said. “We shall see.”
The prolonged and increasingly bitter labor dispute pits a healthcare local affiliated with one of America’s legacy unions against RWJ Barnabas, a not-for-profit healthcare giant with a dozen acute care hospitals, and a partnership with Rutgers University. It has 38,000 employees and generates $6.6 billion in annual revenue. The system’s recently-retired CEO and President Barry Ostrowsky earned $16 million in the second year of the pandemic, making him the highest paid hospital executive in the New York area, according to Crain’s New York .
The New Jersey standoff comes at a time when the American labor movement is in ascendancy with the United Autoworkers winning their much shorter national strike with a 25 percent wage hike and the restoration of the concessions the union made back during the Great Recession to help save the American auto industry. In an unprecedented move, President Joe Biden joined the UAW on the picket line.
PATIENT SAFETY IN FREE FALL?
It also comes at a time when New Jersey’s losing ground in the quality of the healthcare delivered by its hospitals, which as an industry, enjoy tremendous political clout in Trenton.
According to the Leapfrog National Hospital Guide, put out by a national nonprofit committed to patient safety, New Jersey dropped from its Number 1 ranking with 51.5 percent of its hospitals earning an ‘A’ grade last spring, down to ranking 13, with just 35.8 percent of the Garden State’s hospitals earning the ‘A’ grade this fall. New Jersey went from leading the nation, to falling behind Utah, Virginia, North Carolina, Pennsylvania, South Carolina, Connecticut, Montana, Tennessee, Florida, Texas, Kansas, and Colorado.
Gov. Murphy’s meeting with Local 4-200 came a few days after the launch of Tammy Murphy’s campaign for the U.S. Senate seat now held by the embattled Sen. Robert Menendez, who has now been twice indicted on multiple federal corruption charges. Tammy Murphy hopes to build on her substantial track record as an advocate for women’s health issues, specifically addressing the pronounced race disparities experienced by women of color during and after childbirth.
Last week, the Asbury Park Press reported Tammy Murphy used the setting of Newark’s University Hospital to discuss her proposal to support maternal healthcare. "This legislation will help ensure every mother can have the support of a doula during their greatest moment of need," Murphy said, according to the newspaper. "There is nothing like having a dedicated advocate in the delivery room who is solely focused on you and your baby."
New Jersey’s mixed COVID pandemic performance put a spotlight on the consequences of inadequate staffing in healthcare settings, whether it be hospitals or congregant care facilities like the New Jersey Veterans Memorial Homes at Menlo Park and Paramus. Both facilities are the ultimate responsibility of Gov. Murphy and the state legislature. The U.S. Department of Justice earlier this year, released the results of a an investigation into whether New Jersey subjected residents at these two veterans’ homes "to conditions that violate the 14th Amendment of the United States Constitution.”
“The department found reasonable cause to believe the residents of the New Jersey Veterans Memorial Homes at Menlo Park and Paramus face unreasonable harm and risk due to inadequate infection control practices and inadequate medical care, in violation of the U.S. Constitution,” according to a press release issued by U.S. Attorney Phillip Sellinger. “ “The Paramus and Menlo Park veterans’ homes fail to provide the care required by the U.S. Constitution and subject their residents to unacceptable conditions, including inadequate infection control and deficient medical care.”
Sellinger’s release continued, “The inadequate infection control practices and inadequate medical care at the homes are compounded by a lack of effective management and oversight. Such deficiencies expose residents to uncontrolled, serious, and deadly infections, and have resulted in the veterans’ homes suffering among the highest number of resident deaths of all similarly sized facilities in the region.”
PROMOTING A ‘SPEAK-UP’ CULTURE
According to the 43 page report, “the leadership in the Veterans Homes continues to create an environment that is needlessly adversarial toward their employees, the individuals directly responsible for resident care. Staff believe that their concerns are ignored and fear reprisal.”
That excerpt from the DOJ report really resonates with Danella who said in a phone interview that all too often that’s how her rank and file members feel at RWJUH. “This is the reason why some of our nurses don’t speak up when you want to question them — some of them are very vocal, but some of them are afraid when they go into work that there will be retaliation.”
“We know that smaller nurse to patient assignments equate to better care, safer workplaces, and better outcomes for patients.” — HPAE President Debbie White, RN.
That reticence to ‘speak-up’, as Sellinger’s report documents, can have deadly consequences for patients in all healthcare settings. In essence, Local 4-200 sees their strike as using their collective power to ensure individual nurses feel empowered to speak up on behalf of their patients, even if it might impact the RWJUH bottom line.
The strike is being closely watched by the rest of the state’s hospitals and the other nurses’ unions that are pressing Trenton to adopt the nurse to patient staffing ratios enacted by California in 2004.
Debbie White, RN, is president of HPAE, New Jersey’s largest nurses’ union.
“HPAE continues to stand in solidarity with our brothers and sisters of the USW nurses at RWJB who have had the courage to strike for safe staffing,” White wrote in a statement. “We are thankful for these brave nurses, and we applaud their resolve as they highlight an issue that will affect every patient in every hospital. We know that smaller nurse to patient assignments equate to better care, safer workplaces, and better outcomes for patients.”
But while Local 4-200 has garnered support from a long list of political figures including Sen. Cory Booker and Rep. Frank Pallone (D-NJ), as well as Assembly Speaker Craig Coughlin, the hospital chain has executed an insider’s game of locking down power brokers like Gov. Murphy’s former chief of staff George Helmy.
BACK CHANNEL POWER
Back on Sept. 29, RWJBarnabas announced that George Helmy, Gov. Murphy’s former chief of staff, was joining the hospital chain as its new executive vice president, chief external affairs, and policy officer to “serve as a key senior strategic advisor on policy matters, as well as the health system’s relationships with key external stakeholders.”
At the time, Murphy’s press office did not respond to queries about the timing of Helmy’s departure despite the fact that he had been playing an active behind-the-scenes role as a public employee in the labor dispute.
Over the arc of the labor standoff, management and the union have only had sporadic negotiations under the auspices of a federal mediator. As of Sept. 29, RWJUH President Alan Lee confirmed management had spent $76.2 million on replacement nurses. According to a Nov. 16 update, the hospital has now spent more than $120 million to backfill their staff.
Management has consistently maintained they had signed off on a “new contract that would have ensured RWJUH would remain among the highest nurse staffing levels in the state and also would have further ensured that RWJUH nurses would remain the highest paid in New Jersey, more than 14 percent on average above their peers at similar hospitals, according to publicly available data.”
RWJUH’s statement continued, “Despite this agreement, the union membership rejected the contract, leading us to further negotiate in good faith. However, it became evident that the union was intent on striking.”
Local 4-200 disputes the hospital’s narrative.
Nurses’ hourly rates range between $44 to $65 an hour. The union said management offered a four percent increase; but over the next few years, also wanted to raise healthcare premiums by seven percent — which, along with inflation, would significantly shrink the real value of their raise.
As for the hospital’s staffing provisions, the union is pressing for nurse patient ratios language that would be enforceable with consequences if staffing standards are not complied with.
In a phone interview, just before the strike, Danella explained that after three years of COVID, she and her colleagues were feeling quite directly the exit of bedside nurses who left the profession due to the pandemic, a trend that’s been well documented around the country.
Following her union’s recent meeting with Gov. Phil Murphy, Local 4-200 President Judy Danella said, “He didn’t say much — his chief of staff asked about the sticking points in the negotiations and we told them about management’s attempt to try and break the union in such a labor state.
In the aftermath of the COVID pandemic that killed more than 1.1 million Americans, as well as thousands of healthcare workers, who died as a consequence of their workplace exposure to the virus, health care unions have flagged the lack of sufficient PPE and staffing as helping to undermine infection control during the once in a century mass death event.
Last month, Sen. Bernie Sanders (I-VT), chair of the Senate’s Health, Education, Labor, and Pension Committee (HELP) convened a field hearing in New Brunswick captioned, “Overworked and Undervalued: Is the Severe Hospital Staffing Crisis Endangering the Well-Being of Patients and Nurses?”
While the media reported that RWJBarnabas would be testifying at the high profile hearings — they opted not to show up.
“Our negotiating team at Robert Wood Johnson University Hospital has met with the union six times since Oct. 6, including this past Sunday, Oct. 22, with the goal of reaching a fair and equitable resolution that provides the highest‐quality patient care and creates a safe and supportive working environment for our nurses,” Mark Manigan, the chain’s CEO, said in a statement to News 12. “I believe and humbly ask that you understand that is where my focus should be at this time.”
NON-PROFITS PAYING WALL STREET WAGES?
The Sander’s HELP Committee released a report in preparation for the field hearing documenting that nonprofit hospital systems like RWJBarnabas failed “to provide low-income Americans with the affordable medical care required by their nonprofit status – despite receiving billions in tax benefits and providing exorbitant compensation packages to their senior executives.”
“In 2020, nonprofit hospitals received $28 billion in tax breaks for the purpose of providing affordable health care for low-income Americans,” Sanders observed in a press release issued with the report. “And yet, despite these massive tax breaks, most nonprofit hospitals are actually reducing the amount of charity care they provide to low-income families even as CEO pay is soaring. That is absolutely unacceptable.”
Sanders continued, “At a time when 85 million Americans are uninsured or underinsured, over 500,000 people go bankrupt because of medically related debt, and over 60,000 Americans die each year because they cannot afford to go to a doctor when they need to, nonprofit hospitals should be providing more charity care to those who desperately need it, not less. And if they refuse to do so, they should lose their tax-exempt status.”
At the New Brunswick hearing Sanders observed the U.S. was spending “almost as much per capita as any other major country. We are spending $13,000 for every man, woman, and child in this country. We should have the best healthcare system in the world. We are far behind many, many countries. Despite our large expenditure, 85 million Americans are uninsured or underinsured.”
Addressing his audience directly, the Vermont senator said, “You deal with these folks every day and it’s not talked about at all but some 60,000 Americans die every single year because they don’t get the medical help they need it — you’ve seen it. They are sick and the doctors and nurses ask: ‘Why didn’t you come in six months ago when you had your symptoms?’ And the answer was, ‘I wasn’t insured or couldn’t afford the deductible.”
The other issue that is not discussed is U.S. life expectancy, Sanders added. “How long we live is much lower than other countries, and is actually in decline,” he said. “And for working class people, lower income people, the gap in their life expectancy with the rich is about ten years in America — that is unacceptable.”
THE GREAT EXODUS
Nearly 1,000 nurses attended the hearing where expert testimony connected the underlying economics of the nation’s “non-profit” healthcare sector — and why so many of their colleagues have opted to leave the hospital bedside.
“The reasons for these departures are understaffing, poor working conditions and the corresponding fear of harming patients and witnessing this harm is resulting in moral injury, a form of trauma caused by not being able to provide the care they believe patients need and feeling they are powerless to make change,” Dr. Patricia Pittman said.
The Milken Institute of Public Health at George Washington University professor continued, “Among the outcomes of this distress is depression and suicide. Nurses commit suicide at twice the rate of the general population,” Pittman added. “Nurses concerns over staffing have been borne out by 20 years of research outcomes associated with low staffing levels including patient mortality, failure to rescue, hospital acquired pneumonia, respiratory failure, ulcers, falls, urinary infections and patient satisfaction.”
Local 4-200 has consistently maintained their strike was actually more about raising staffing standards. They point to peer reviewed studies in the years since California enacted mandatory nurse to patient ratios in 2004, that document improved patient outcomes, a reduction in the incidence of patient re-admittance to the hospital, a drop in workplace injuries, as well as a gain in nurse retention — a major national challenge.
“In April 2022, Dr. David Auerbach and colleagues published a nursing workforce analysis in Health Affairs, which found the total supply of RNs decreased by more than 100,000 from 2020 to 2021 – the largest drop than ever observed over the past four decades,” according to the American Association of Colleges of Nursing. “A significant number of nurses leaving the workforce were under the age of 35, and most were employed in hospitals.”
The renewed push for the staffing requirements comes as a national survey predicted New Jersey would be shy 11,400 nurses by 2030, ranking it in the top ten state with a severe shortfall. Also, included in that crisis mix is Connecticut (27,926), New York (18,784), and Pennsylvania (16,430).
“I am grateful that 1,700 people were willing to stand up for what’s right even though it was such a sacrifice because it was so scary but people were brave enough to realize how important this is,” Carol Tanzi, RN, a member of USW Local 4-200, said. “This is such a broken [healthcare] system and hopefully this is shining a light on that and we will have some impact on that too.”
Tanzi continued, “Now, we are going community to community and going to Town Hall meetings — getting the public more engaged. We have also started a coalition between the larger community and nurses from other hospitals to get involved. Little by little, we are growing this movement. The only way you can’t grasp just how sick the healthcare system is right now is if you don’t have any skin in the game — or are making money off keeping it the way it is.”