Ascension via Christi’s St. Joseph and St. Francis hospitals join a growing number around the country facing union demands related to staffing shortages and working conditions.
by Suzanne King
It’s been a year since the nurses at Ascension via Christi St. Joseph Hospital in Wichita voted to unionize. Even longer since St. Francis nurses made the same play.
About nine months have passed since they walked off the job the first time to protest what they contend are the hospitals’ spare staffing levels and problematic scheduling policies.
And three months have gone by since they walked off a second time.
Now, the nurses threaten to strike again if management doesn’t start moving on union demands.
“We’re here. We’re unionized. You can’t ignore it,” said Marvin Ruckle, an RN who has worked at St. Joseph for 34 years and is part of the union’s negotiating team. “You need to just face it and deal with it.”
No workers figured more essential during the pandemic than those in health care. Now nurses, doctors in training and other hospital workers are unionizing — demanding better pay and beefier staffing. They’re fed up with getting spread so thin.
Hospital systems, like Wichita’s Ascension via Christi, go to great lengths to line up replacement workers to weather any strikes. Rather than promising higher pay to more workers, they’re focused on consolidation, trimming costs and ways technology can save money in a sector that already eats up 17% of the economy.
The 950 Wichita nurses represented by National Nurses United (NNU) have said Ascension, the nonprofit hospital chain that owns both facilities, is not hiring enough nurses for safe patient care.
The St. Louis-based hospital chain has been in the national spotlight in recent years amid criticism that it’s trimmed staffing levels too much. It reported $182 million in revenue in 2022 and net income of $18.6 million, up from $8.7 million in 2021.
Ascension would only respond to questions about the Wichita labor dispute with a written statement. But hospitals tend to answer criticism about staffing levels by arguing they’re restricted by a chronic nursing shortage.
The union counters that nurses are available if hospitals would only hire them. An NNU spokesperson pointed to 2022 data from the Bureau of Labor Statistics that counted 34,000 registered nurses employed in Kansas and a report from the National Council of State Boards of Nursing, which says 53,000 RNs are licensed in the state, although they may not all be available or interested in working there.
According to BLS data, 6,220 RNs worked in Wichita in 2022, compared with 6,010 in 2019.
Nurses contend that the Ascension hospitals have cut back staffing so much that they are expected to care for more patients every shift and do jobs like cleaning or delivering meals that leave even less time for patient care.
“If I am taking care of six patients, that means each patient only gets 10 minutes an hour,” said Katie Best, a nurse in St. Francis’ pediatric sedation department who is often asked to fill in in other departments. “That doesn’t include the amount of time for me to walk from room to room. … And if I have a patient who needs 12 minutes of my time in an hour, that means another patient doesn’t get their full 10 minutes.”
The nurses also want Ascension to stop asking nurses to “float” to areas of the hospital they’re not trained for.
Best dreads a strike. The last one, just before Christmas, left many of her colleagues scrambling to cover expenses and buy presents for their kids, she said.
But “our goal is to get a good strong contract so we as nurses have what is necessary for us to provide awesome care for our patients,” Best said.
In its written statement, Ascension Via Christi said negotiations were “productive and moving forward.”
“We believe differences are best resolved respectfully at the bargaining table, and remain focused on working together to reach agreement on a fair and reasonable contract for our registered nurses,” the statement said.
The company declined to answer questions about a potential strike.
With a general worker shortage, organized labor finds itself in resurgence. The U.S. Bureau of Labor Statistics reported 33 major work stoppages last year — strikes or lockouts that involved at least 1,000 workers and lasted at least one shift during the work week. That’s up from 23 in 2022. An Economic Policy Institute report found that 14 of the 2023 work stoppages took place in health care.
Last year, 188,900 health care workers were involved in strikes or lockouts. That included what was the largest health care strike in U.S. history, when 75,000 nurses, technicians and support staff walked away from jobs at Kaiser Permanente in October.
Staffing shortages became glaring in many hospitals during the pandemic. Now they pose the central backdrop to nursing strikes — and the reason more nurses are forming unions.
The union representing nurses in Wichita, for example, has seen membership jump to almost 225,000 nurses nationally from around 150,000 before the pandemic.
A 2022 study in the Journal of the American Medical Association found that health care workers represented by unions between 2009 and 2021 made better wages and got better benefits, like full premium-covered health insurance and retirement benefits, than those without unions. The study also found that unions helped erase the pay disparity between white workers and racial and ethnic minority groups.
The Bureau of Labor Statistics reported that registered nurses working in Wichita in 2022 had a mean annual salary of $68,800, compared with $57,470 in 2019, the year before the pandemic. Nationally, the mean salary for nurses was $89,010 in 2022, compared with $77,460 in 2019.
Authors of the JAMA study estimated that union membership during the period they looked at remained steady at around 13%. Many industry observers expect that number to climb.
Nurses and health care workers first gained the right to strike in 1974. They still must give employers at least 10 days’ notice before walking off the job. Health care strikes can also be subject to mandatory mediation.
In Wichita, the union represents relief charge nurses, but not supervisors. When the nurses have gone on strike, the hospital has hired temporary nurses to fill the gaps. Both times, the union nurses walked off the job for one day, but Ascension locked them out for three more, saying they had negotiated four-day contracts with the temporary workers.
The nurses have called the tactic an attempt at union busting because nurses are effectively forced to miss four days’ pay rather than the one day they voted to strike. But the hospital company says its hands are tied by the contracts it has with temporary nurses.
In a statement released at the time of the December strike, Ascension said it was negotiating in good faith and said the strike created “unnecessary uncertainty for our (employees) and their families, and concern for our patients and their loved ones.”
On the ground, especially on the hospitals’ medical and surgical floors, nurses say the conditions that led them to unionize haven’t improved, and they vow to continue fighting for a signed contract.
But the reality, said labor experts, is that employees voting to form a union doesn’t always lead to a signed contract. Even when it does, it can take months or years. In that sense, the failure to reach a deal in Wichita in the first year is fairly ordinary.
Sometimes contracts never get signed because U.S. labor law does little to require labor and management to come to terms.
The Economic Policy Institute reports that 18% of union certification elections involve a charge of employers failing to bargain in good faith. But bargaining in good faith is the only obligation employers and employees have under the National Labor Relations Act, the federal law that oversees union organizing.
“There’s nothing to deter employers from violating the law,” said Margaret Poydock, a senior policy analyst with the Economic Policy Institute. “There are no financial penalties.”
And employers may gain an advantage by dragging out negotiations or simply avoiding the bargaining table. The longer a union lingers without a contract, the more likely workers will drop out of the union. And if membership falls off enough, an employer could request a new certification vote, which might cause the union’s demise.
In Wichita, nurses have been meeting with a lawyer representing the hospital just once a month. Ruckle said the hospital has declined the union’s request for more frequent meetings.
“We will sit there until 1 in the morning if that’s what it takes to get this done,” he said.
While labor advocates want to see changes to federal labor law, which they say puts employees at a disadvantage, legislative changes look unlikely.
“Labor reform has been attempted many times,” said Betsy Lawrence, an adjunct professor at the University of Kansas Law School. “It’s not a new thing. It’s been passed in the (U.S.) House a number of times, but it never gets a whole lot farther than that.”
Court cases, she said, are more likely to shape labor law in the next few years.
For example, SpaceX, Trader Joe’s and Amazon.com are among companies that have filed suit this year calling the National Labor Relations Board and its enforcement practices unconstitutional. And in January, the U.S. Supreme Court heard arguments in cases that could overturn a 40-year-old legal precedent, known as the Chevron doctrine, which says agencies — like the NLRB — have the right to interpret federal law.
“Given the current interest of the U.S. Supreme Court in taking cases that will likely weaken the administrative enforcements of agencies,” Lawrence said, “if anything, the NLRB is most under assault in the courts.”
This article was republished here with the permission of: The Wichita Beacon