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Health Care Understaffing Is Deadly — That’s Why Kaiser Workers May Strike

Saddling an overworked staff with inadequate pay and resources ​​threatens employees and patients alike.

Workers protest Kaiser Permanente's attempt to replace workers who have good environmental services housekeeping jobs with robots, at Baldwin Park Medical Center outside the facility on November 10, 2020, in Baldwin Park, California.

A major labor action is poised to commence in the medical sector: A vast strike that could have significant implications for U.S. health care, staff and patients alike. For weeks, workers and management at Kaiser Permanente, one of the largest care providers in the country, have been locked in an impasse on contract negotiations. The company has insisted on a minuscule wage increase and a “two-tier” system of reduced benefits for new employees — despite the fact that Kaiser has amassed billions in profits during the pandemic.

Were these plans to be implemented, labor organizers claim, already-dire working conditions would further deteriorate: namely, the spiraling understaffing crises that have made for untenable pressures on hospital employees, and corresponding risks to patients. Kaiser workers believe that the new contract’s pay reductions, far from mitigating the crisis, would make staff retention and hiring all the more difficult. In October, this clash of interests came to a head, and tens of thousands of unionized Kaiser employees voted to authorize a strike. If it’s declared, the company will be given 10 days’ notice, and workers will embark on a collective action that could have transformational repercussions.

Management’s Dubious Offers

Kaiser Permanente is notable for its operational strategy of labor-management partnership, which has long allowed for coordination between the two opposing interests. Its fully unionized workforce is represented by the Alliance of Health Care Unions (AHU) and the Coalition of Kaiser Permanente Unions, in addition to independent locals. The Alliance comprises 21 unions, representing 52,000 workers. In three of the AHU’s largest unions, over 95 percent of members voted this October to authorize the strike, while similarly decisive majorities were tallied among other Kaiser unions. A number of non-Alliance unions have also voted in favor of striking. Labor has made a definitive statement that management’s propositions are a nonstarter.

In addition to a paltry wage increase of 1 percent (union bargainers had asked for 4 percent, which in itself would be a pay cut, accounting for inflation and rising costs of living), Kaiser is proposing the adoption of a two-tier pay and benefits structure. Current employees would be offered a compensation package with this small raise, while future hires would receive a far less advantageous contract: Their pay would be lowered by as much as 26 to 39 percent. As labor journalist Alex Press explained in The Washington Post, two-tier plans are a reliable (and transparent, to labor organizers) management tactic — often deployed by capital to hamstring unions by introducing division and conflicting interests.

Truthout spoke with Shane Burley, communications organizer at the Oregon Federation of Nurses and Health Professionals (OFNHP) — an American Federation of Teachers (AFT) affiliate that represents over 4,000 Kaiser workers — who commented, “These are the worst proposals we have seen in decades.” The contract as designed was unacceptable to Alliance unions, but management could not be swayed. They determined that their only recourse was to vote on authorizing collective action, which, unless management capitulates soon, is now on the verge of launching. In the event of a strike, management would likely bring in replacement workers and “contingency staff” to continue care, and patients would still be treated. Kaiser staff, though they would prefer to settle a fair contract before striking, feel their hand has been forced by unacceptable conditions.

It’s important to reiterate that it is not the issue of pay that is most salient — the key motive behind the potential strike is to avoid the acceleration of a severe understaffing crisis. “Even if there wasn’t a staffing problem already, their two-tier proposal would create one,” said Burley. “It’d be harder to attract new members with worse pay and benefits, and these contract provisions would create extra workloads and more difficulty in patient care, which would make it hard to maintain workers.” This cycle of multiplying pressures is approaching a breaking point. A dwindling, overstressed health care workforce threatens employees and patients alike.

Overworked and Understaffed

The tremendous strain that the pandemic has placed upon those in an already-taxing profession has led to soaring dropout rates. Health care workforces nationwide have been forced to weather COVID surges, fractious, denialist patients and great personal risk. The resulting staff shortages have made workloads “unsustainable.” Kaiser is no exception; when surveyed, 60 percent of Kaiser workers in Oregon indicated that they were considering leaving their jobs, with 42 percent weighing an exit from health care entirely. “When it comes to recruiting and retaining people,” says Nicholas Eng, a registered nurse (RN) first assistant and a shop steward at OFNHP AFT Local 5017, “I see talented colleagues leave, and we struggle to find a new person to fill that role. Paying people less is not going to achieve that. It’s not about the money. It’s about having enough people to do the work well.”

Michelle Back, a 30-year veteran of Kaiser, is an inventory control assistant in the pharmacy department and a longtime union shop steward in United Food and Commercial Workers Local 770, which also represents Kaiser health care workers. She described the staggering toll that this work exacts: “It’s been really exhausting…. We’ve worked really hard to meet the needs of our members and our communities, at great risk. We’ve had union members pass away, or get COVID at work and come home and spread it to their families. It’s been a really gruesome fight.” These traumas are underscored by the perception of callous disregard on the part of management: Back cites a sense of abandonment, saying that workers feel undervalued and endangered by the company’s unwillingness to address the staffing crisis, as well as failures like the inadequate provision of personal protective equipment.

In fact, even before the pandemic catalyzed exit rates, a staffing crisis had loomed in Kaiser workplaces, a consequence of bureaucratic cost-cutting and profit-focused restructuring. Katie Johnson, a Kaiser oncology nurse, is the RN bargaining unit vice chair of the OFNHP AFT Local 5017 and an inpatient contract specialist. Speaking with Truthout, she described growing burdens: “For years, Kaiser has thrived on what they call a lean staffing model. Other hospitals call it a skeleton crew. They’re having us do more with less. In my own role, at times, I was asked to do the job of three other people…. You get tired, you get burned out.”

Kaiser has responded to these concerns with a statement that claims that the central issue is in fact pay rates, downplaying union concerns about understaffing. The statement also urged employees not to strike. (Kaiser further insists that its employees are actually overpaid, and that the wage cuts are designed to improve prices for customers.) Staff who have experienced the enormous strains caused by the staffing crisis disagree vehemently with this portrayal.

“Over the last three years, the lean model has only gotten worse, on top of a pandemic,” said Johnson. “Health workers don’t want to put up with what we’ve been accepting. [At my hospital] we have about 60 percent turnover, when the average rate of turnover is about 12 percent. We have 30 nurses when we should have 72…. Kaiser executives are trying to cut costs, and they’re doing it on the backs of frontline workers.”

Placing Lives at Risk

These constraints could have — without exaggeration — fatal results. Home health physical therapist and Local 5017 shop steward Hannah Winchester cited a number of egregious delays that Kaiser patients have faced lately: the difficulty of scheduling mental health appointments, delays of between six and eight weeks for essential physical therapy, and unacceptable wait times for a dermatologist to look at potentially cancerous lesions, for only a few examples. She herself was told that she would need to wait two months for an appointment to treat a broken bone. The consequences of delayed or denied care can be deadly serious. “We’ve seen this grow exponentially over a long period of time, and it’s coming to a head now,” Winchester told Truthout. “Health care can’t wait. This isn’t something we can put on the back burner.”

Back describes how the shortage has had similarly drastic impacts on the pharmacy department. “Now I have only two pharmacists, and we’re doing [around] 800 prescriptions a day. I don’t have people taking calls from patients. I don’t have people taking members’ phone calls.” She expressed a concern that patients, including the elderly and vulnerable, have been forced into extended wait times for prescriptions, sometimes in waiting rooms that could expose them to the virus.

Multiple Kaiser staff members also pointed to potential problems that can result from the use of temporary workers known as travel nurses. Kaiser has regularly brought in “travelers,” also called rapid response nurses, to augment threadbare workforces. In some cases, say staff, this reliance has led to a “skills gap”; travelers may also be unfamiliar with the nuances of procedures in particular hospitals. These stopgap measures can contribute to rising error rates and substandard care.

The same issues arise from Kaiser’s habit of reassigning managers to patient care, some of whom “haven’t touched a patient in a decade or more,” says Winchester. “They’re brushing up on skills like how to place a catheter, how to place IVs, how to pass meds. I would personally see that as a big risk with someone so fresh on a job, when we’re talking about people’s health care.” Responsibility for any mistakes should not always fall on reassigned or insufficiently trained temporary workers. Management’s decisions set many up to fail — in a field where failure can threaten lives. A further consideration is that understaffing also contributes to increased rates of violence and sexual assault against staff, incidents of which are already rampant. (In fact, nurses are more likely to be assaulted than police officers.)

“I don’t want to think about moving forward, if it’s normal for there to be hours and hours of wait time to be seen at an urgent care clinic or an all-day wait to be seen in the emergency room,” RN Eng says. He and other Kaiser employees described a sense that management’s decisions are forcing them to do a disservice to the patients that they care for deeply. “We will do anything for our patients, which makes it difficult for some of us to face the reality, should we have to walk out. But this is all on Kaiser…. As health care workers and as working people, and as a society, I think we need to ask ourselves: Should we allow this? And should we allow this to get worse?”

Another facet of the rising antagonism is centered on inequities within Kaiser workforces. The Alliance alleges a “double standard” on behalf of Kaiser: a much-touted $100 million in grants was promised “to address systemic racism.” However, union advocates claim that Kaiser is neglecting the fact that they could make interventions in their own unequal workforces, which are rife with wage gaps (Black workers have been systematically underpaid, for instance.) The Department of Justice also alleges that the company has been overcharging elderly Medicare recipients, and other forms of discrimination persist. Winchester told Truthout that Kaiser has backed away from multiple proposals put forth by unions in attempts to address diversity and inclusion. She says that the opportunity to make progress was present — but “when it came time to put pen to paper, they balked. They walked away.”

A Crossroads for U.S. Health Care

The U.S. health care system — a usurious, expensive patchwork — lags far behind other high-income nations. The structure of privatized health care, by making coverage unaffordable and inaccessible for so many, already produces tens of thousands of unnecessary deaths a year. Substandard care is the standard in the richest nation on Earth, where rampant health inequality closely tracks lines of race and class. To further undermine the workforce at the country’s largest provider in the midst of the most catastrophic public health crisis in generations is reckless, to say the least. Workers and union members feel that Kaiser management, with its consuming focus on cost-cutting and profit, has spared little thought for patient and worker welfare.

“What does lifesaving care look like when there aren’t enough people to save lives?” wonders Burley. “I can’t think it does anything but put people at risk…. It’s black and white. People will die if there’s not enough staff.”

Yet, should Kaiser’s unions execute this strike and win a better contract, the victory could resound throughout the sector. Amid a broader strike wave, U.S. labor is asserting its power once more. If management concedes, such a highly visible win might have implications for workforces at other health care providers.

This conflict is not entirely without precedent: As reporter Noah Lanard noted in Mother Jones, threats of a strike neutralized a two-tier proposal at Kaiser in 2019 — but the inverse also occurred in 1986, when Kaiser pushed through a two-tier proposal by outlasting a six-week strike. A victory for labor is far from assured. A successful imposition of the two-tier contract will likely legitimize it as a mechanism of cost-cutting for other health care corporations equally eager to slash pay — in keeping with the neoliberal austerity policies that have inflicted enormous damage on public institutions, health care and otherwise.

The looming collective action comes at an inflection point. The pandemic continues to steal thousands of lives per day, and pressures on staff are only mounting as dropout rates spike. Kaiser’s workers are making their appeals with great urgency. “This is a plea for us to say: Not only do we deserve more, but our patients — our patients absolutely deserve more,” says Kaiser nurse Johnson.

“Every day when we go to work, we feel like we’re not giving them, one: the care that they deserve; and two: it’s not the care they paid for.”

If the staffing crisis is not alleviated, conditions seem certain to further devolve. Saddling an overworked staff, who have already made unimaginable sacrifices throughout a pandemic, with inadequate pay and resources is an issue of public health, of life and death. As RN first assistant Eng puts it, “The future without addressing these issues — it’s scary.”

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