Karen Rockefeller was a nurse at Rochester General Hospital for 41 years, beginning in 1976. In her time she saw nursing union talks come and go, often meeting strong resistance from administrators.
She was always supportive, but the campaigns never made it far. Recently, that luck changed for union hopefuls at the hospital. After Rockefeller’s 2017 retirement and decades of false starts, RGH nurses filed to unionize last month in yet another push.
Karen’s daughter Lindsay Rockefeller, a current RGH nurse herself, was highly involved in this latest organizing drive. And in the late evening of July 13, Lindsay received news she has been waiting to hear for months: The nurses supporting the drive won the vote, 431-295.
Once the results are certified, the nurses will be represented by the Rochester Union of Nurses and Allied Professionals, the union they are forming with help from the Northeast Nurses Association, an alliance of unionized nurses built to help nurses gain representation at their facilities.
“I’m just hoping that we can better our working conditions, that we can better our wages, our benefits, and therefore it’ll trickle into being able to take the best care of patients that we can,” Lindsay Rockefeller says.
The vote to unionize was the culmination of an arduous organizing period met with an expensive response from management, who brought in consultants with records of conducting anti-union campaigns across the health care sector and beyond.
The nurses and organizers countered that campaign by emphasizing how a union could improve staffing ratios, help retain senior nurses, and remedy a host of other common complaints by giving the RNs a seat at the table with management and a way to enforce demands. That messaging’s resonance was heightened by nurses’ experiences during the last two years of the COVID-19 pandemic, which widened the fault lines created by unremedied staffing problems.
‘I don’t even think you can call it nursing’
On the list of complaints held largely in common among the nurses, low staff-to-patient ratios are front and center.
Carmen Camelio, a 20-year nurse currently working in the medical ICU at RGH, previously was a float nurse before the float team was disbanded prior to the COVID–19 outbreak. Floats are highly-skilled nurses ready to aid any unit in the hospital facing a heavy workload. This experience gave Camelio a lot of perspective on the hospital’s staffing issues.
“In the last year to two before the float pool went away, there (were) times when we would go to general medicine floors with 40 beds and long hallways staffed by four nurses,” Camelio says. “That’s a 10-1 ratio.
“The only way to visualize your patient is to look in the room,” he adds. “When you have 10 patients, if you have one or two of them that demand a lot of your time because of the acuity of their care, you’ve got eight patients who are being neglected. And when you’ve only got four nurses on a unit with 40 beds, each of those nurses is busy at all times, so there’s nobody you can count on to catch something if you’re stuck in a room because they’re all stuck in rooms.”
Nurse Jordan Brouk, who currently works in RGH’s catheterization lab, recalled stories from when he worked at Unity Hospital, another site in the Rochester Regional Health network, as a contract nurse five years ago. He says that on his second or third shift at the hospital, he was asked to serve as charge nurse due to understaffing. Charge nurses serve as a resource for other nurses and are meant to have enough experience to aid in troubleshooting. Brouk says he didn’t even know where the bathroom was.
He adds that Unity would regularly float him to different units of the hospital every four hours during his 12-hour shifts to patch staffing shortages.
“I think in one night, in each four hours, I would pick up eight to 10 patients,” he says. “I remember one shift where I cared for 30 patients in a 12-hour shift. Regardless of what role you are in health care, you’re probably not going to be seeing 30 hospital-acuity patients in 12 hours. So, just for reference, if you work as a nurse practitioner in a hospital, you’re kind of expected to see about one patient an hour in an eight-hour shift.”
The pandemic prompted an exodus of nurses from Rochester General, heightening the existing ratio issue, the nurses say. Medical floors became so overwhelmed that they would float operating room nurses to lend a hand despite the fact that many OR nurses have spent a lot of time away from bedside care, Lindsay Rockefeller says.
Working in the OR, Rockefeller’s unit handles only one patient at a time, but she has still noticed problems she attributes to staffing ratios.
“I would have patients come down just completely filthy, like they hadn’t been washed in days, their beds hadn’t been changed in days,” she says. “And I can’t even fault the floor nurses for this because they have to prioritize their care. They’re spending all day passing meds. By the time you’re done with one med pass, it’s on to the next med pass, and then you’re charting a million things on every patient. So there was no time for personal patient care, which then leads to increased infection rates, increased bed ulcers, there’s been an increase in falls because there’s no supervision.”
Similarly, Brouk says the cath lab gets a lot of needs addressed because cardiology-related units generate a lot of revenue, so he does not experience the brunt of the problem. He says that he is speaking up on behalf of nurses who are passionate about working bedside and who have to deal with conditions akin to what he experienced at Unity Hospital.
“You’re throwing medications at patients,” he says. “I don’t even think you can call it nursing. They’re better off not being in the hospital at that point because they’re not getting the care that they need.”
‘What can we do?’
Camelio was the one who placed the initial call to NENA. He says that call was preceded by months of discussions during early 2021, the height of the second wave of COVID.
The medical ICU, where he works, was hit particularly hard by the pandemic, so they were getting a lot of outside help, giving him the chance to broach discussions about problems with nurses from a diverse array of units.
He was careful about how he spoke, framing the conversations neutrally by asking open-ended questions.
“What can we do? What are we going to do to make our lot better?” he would ask.
Some people brought up union representation, and he quickly looped them in. Camelio, whose parents were both union workers, always had the idea in the back of his head.
He reached out to NENA in June 2021, and he and some other nurses met with a few organizers on July 13, exactly one year before they won the election.
“It was a great meeting,” he recalls. “For the first time, we kind of felt empowered, and we really felt like we could make a difference. From there, we just started picking up more people. … I had people reaching out to me that I didn’t even know because they had heard from other folks that I had been talking about it.”
As the ball got rolling, around August, Camelio started partnering with some of the new joinees to strategically approach others during their breaks. They would pick a unit and start talking to people until they had to go back to work. By November or December, he started noticing nurses involved that he had not approached.
“It turns out there were other people that had the same idea and were starting to organize themselves in their own areas, some of whom had reached out to other unions, but we just happened to be farther along than everybody else,” he says. “So, they just kind of came into what we were doing.”
The movement was organic and widespread. Some people in units like the OR, cath lab, and post-anesthesia care unit—mainly surgical and procedural areas—simultaneously felt inclined toward unionizing, the nurses say.
In the OR, Rockefeller was first approached with the idea of unionizing by a coworker who had been tipped off by past conversations that Rockefeller was unhappy with conditions at work. Rockefeller was singled out because she had been in the department for a long time, and her coworker figured she knew enough about other staff members’ personalities to discern who else could be approached. She did some research and touched base with her mother before diving into organizing.
“My mother worked there for 40-plus years in the operating room, and I know they had tried unionizing multiple times in the past,” she says. “I talked to her about it and I got some advice from her on who to speak to, who she (thought) would be good, the few left that she knew. And she was very supportive, she was like, ‘Go get it. We’ve been wanting this.’”
Indeed, the hospital has seen a number of organizing efforts over the years. Karen Rockefeller saw multiple failed efforts during her tenure. Records of unionization pushes at RGH go back as far as 1974. The nurses say the current movement was preceded by an attempt in 2020.
After talking to her mother, Rockefeller reached out to NENA, who also helped educate her a bit, and from there her involvement kept growing. She first approached a coworker who had been at the hospital for over 20 years, and in a short period of time the three worked together to start conversations with most of the remaining staff. The majority were very interested, Rockefeller says.
Brouk tagged onto the organizing a bit later. He didn’t hear about the movement until November because he dropped to part time during the fall to focus on school. Once the semester died down, he tried to get more involved.
“It feels like every month or so the numbers got bigger and bigger and bigger to the point where the last meeting that I went to, I couldn’t even find a chair to sit down,” says Brouk.
“Within a couple months (the union) group chat went from 30 people to about 150 people, and I was just mind-blown,” says Rockefeller. “Like, ‘Oh, wow, this is really spreading, and there is a lot of support. We’re all commiserating with each other and we’re all on this page.’”
The nurses officially filed for their election with the National Labor Relations Board on June 1.
‘We know the hospital is capable of giving us more’
But how exactly does a union translate to better staffing ratios and safer working conditions? Penn State University labor and employment relations professor Paul Clark, whose research has focused on employment relations in the health care industry, says the academic evidence is on the organizers’ side.
“The rate of nurses organizing has increased steadily during the last 10, 15, 20 years, and it’s one of the few areas until just recently where we saw a lot of growth in organizing,” Clark says. “My interpretation of this is that nurses see unions as a way to have a greater voice in patient care.
Adds Clark: “Hospitals over the last couple of decades have tried to reduce staffing, to do a lot of things to cut costs and save money, and this has led to nurses not being able to provide the kind of care that they think their patients deserve. One way to change that, one way at least to have a voice in that area, is to organize a union.”
The nurses I spoke with cite a cocktail of changes for which the union could bargain.
All three say a big factor in the staffing issue is pay, especially for senior nurses. Camelio says the starting salary at RGH is relatively competitive, even compared to bigger areas like Buffalo, but that their raises are not sufficiently keeping up with inflation. The hospital’s Know the Facts website says the average base hourly pay for acute-care nurses at RGH is just over $37 an hour.
“Our biggest issue with that is, how are you going to retain nurses over the long haul if they’re falling behind financially as we progress?” he says. “I’ve been there almost 20 years. I’m in probably a little bit better position than some, just by virtue of the fact that I had been a corporate float. We were paid extra for the job we did, and when they got rid of the float pool they did give us an opportunity on a lateral move. But I know nurses that have been working there for 20+ years who are making only a couple of dollars an hour more than our new grads, and I’m only making a couple dollars more than they are.”
Rockefeller echoes many of Camelio’s concerns about pay.
“I’ve gotten a three dollar an hour raise over eight years. We don’t get cost-of-living raises. Vacation time was taken away from senior nurses. It almost feels like (the) administration was punishing seniority. … When several nurses had two weeks vacation taken away with 25-plus years of experience, that really threw people for a loop.
“Back in the fall, there was a mass exodus, so there was an email sent out promising this huge raise coming in October. That raise was 1-2 percent. I got about 36 cents. They sent that email hoping it would stop that exodus, but when people got their raises, people were not happy. I just took mine from my manager and I said thanks and I threw it in the garbage.”
Camelio says the hospital is bringing in licensed practical nurses to help. He used to be an LPN and loves them—they are some of the smartest, most skilled nurses he ever worked with—but the LPNs today don’t have the same experience, he says. In his time, LPNs with 20, 30, or even 40 years of experience were not uncommon.
“I’m glad to have them in place, but there’s only so much they can do,” he says. “And the LPNs that we’re getting, most of them don’t have the experience that our LPNs used to have. A lot of that is, when I started and I was an LPN, the state regulations on LPN practice was a little murky. Around the time I became an RN the state started to clarify what an LPN was allowed to do, and it made it a little bit more difficult for LPNs in the hospital.”
Camelio hopes the union will be able to partner with the administration to figure out better ways of using LPNs and helping them become RNs.
Rockefeller says the key to retaining senior nurses will be creating a robust and public wage scale at the hospital and enhancing benefits.
“We can get a wage scale based on years (of) experience, based on performance, whatever it may be,” she says. “It would be something that people can look at and be like, ‘Oh, if I stick it out here until five years, look at how much more I’ll be making. If I go to 10 years, look at that.’ We have some of the worst benefits of anybody, and in health care you would think you would have amazing benefits. They’re horrible. They’re through-the-roof expensive, and we know the hospital is capable of giving us more and they just aren’t.”
Camelio says that a union is the only way to get management to take nurses’ demands seriously. The hospital currently has unit councils and a nurses’ council, but effecting change through those routes requires administrators to voluntarily adjust policies. Camelio says a union will force management to take concerns seriously.
“Right now they hold all the power and we can talk to them until we’re blue in the face and they can just ignore what we have to say, and they just have,” he says.
Clark says that health care administrators should not be quick to try to bust unions because they can be a source of helpful input for management.
“We’re starting to see, just in the last year or two, that some employers aren’t buying this idea that the only way to deal with a union is to go nuclear on them. In fact, it may be counterproductive. ‘We’ve got unhappy employees, they try to organize a union, we come down on them like a ton of bricks. Maybe we fire some of the organizers, we put the fear of God in them.’ That’s going to lead to happy, well-adjusted employees? No, it’s not.
Adds Clark: “People in my field are starting to be a little more optimistic that some progressive employers will see unions not as enemies but as partners, because it’s just your employees saying, ‘We want a greater voice. We want to be sure that you’re going to listen to us.’”
The anti-union campaign
The response by management at RGH was more traditional than progressive. Rockefeller says they were initially tipped off when a surgeon overheard a discussion in the operating room and reported it to the administration.
From there, the hospital mounted a comprehensive “Vote No” campaign. It brought in union avoidance consultants from the firm Healthcare Labor Solutions, assembled a website featuring interviews with anti-union doctors and management, and administrators at all levels pushed out anti-union messaging, particularly nursing managers, the nurses say.
Banners were erected in the hospital instructing nurses to vote against the union, the desktop backgrounds on hospital computers were changed to display a “Vote No” message systemwide, and some managers were seen wearing anti-union apparel leading up to the vote, the nurses contend. NENA organizer Nate Miller says that nurses were made to attend mandatory meetings where anti-union perspectives were presented by consultants and administrators.
RUNAP estimates the cost of the anti-union campaign to be just under $1.3 million based on average pay for union avoidance consultants, which is a very rough estimate. The official figure will not be known until the end of the filing year when the hospital will be required to report the values of the contracts to the NLRB.
In 2021, the average value of Healthcare Labor Solutions’ hospital contracts was about $533,000 in 2022 dollars, according to U.S. Department of Labor filings, but that does not take into account hospital size or a host of other relevant factors. The costs of their hospital campaigns ranged from around $148,000 to $1.2 million, also in inflation-adjusted figures.
One of the five consultants brought into RGH was Ricardo Pasalagua, the former owner of the California-based union avoidance consulting firms RP & Associates and Labor Relations Specialist, LLC. He has a history of violating the terms of the National Labor Relations Act.
In 2013, while contracting with Green Fleet Systems to counteract a Teamsters campaign to unionize their truck drivers, Pasalagua repeatedly told drivers to provoke their union-supporting coworkers into fights to give the company grounds for firings, National Labor Relations Board judges ruled based on the testimonies of four drivers.
Pasalagua also requested in an email that nurses and organizers refer to the meetings he was conducting as “the National Labor Relations Act Training,” which Miller says was an attempt to disguise anti-union messaging as neutral NLRB training.
“The only way to fight a movement of people trying to come together is to create division, and that’s really what the hospital administration has been trying to do,” says Camelio. “Instead of having an open and honest discussion of how things could be and how it can be a partnership or a detriment, we’re instead just getting a lot of propaganda.”
Documentation on Pasalagua’s consulting history is provided in LM-20 and LM-21 reports filed with the Labor Department under his and his companies’ names. Based on their respective academic and organizing experience, Clark and Miller both say that the department’s record may be incomplete due to lack of enforcement of the filing requirement.
The nurses have filed a number of complaints of their own alleging seven categories of NLRA violations committed by management or the consultants. The investigation is pending and those filings are the subject of an outstanding Freedom of Information Act request.
Rockefeller gave insight into some of the complaints. She says that some units were explicitly asked by nursing managers to reveal whether they support or oppose the union, and that there was a case of a nursing manager changing the entry code to a shared break room to prevent her staff from interacting with a more pro-union unit, both alleged violations of NLRA section 8(a)(1) that were reported to the NLRB.
The nurses say that this is not the first unionization attempt that management has worked to quash. In 2020, Brouk says, several nurses began organizing in response to working conditions during the pandemic.
“What I gathered when I spoke to a few nurses that were in that first wave, they were dragged into administrators’ offices, their nurse managers’ offices, and pretty much told, ‘Shut this down or you’ll never work in Rochester again,’” he says.
Camelio says he was involved in this push, and says that management threatened to use a “loophole” to justify firing another nurse involved.
“That was right at the beginning before anything really happened, and it did really kind of crush the movement,” Camelio says. “I was in some meetings with that group. I was personally not very good at it at that point, and COVID killed it.”
Rochester Regional Health and Healthcare Labor Solutions did not respond to requests for comment.
Aside from the legal complaints, the nurses also disagree with management’s speculations about the potential detrimental effects of their union.
In the video interviews posted to the hospital’s “Know the Facts” website, a range of doctors and medical staff managers voiced some common concerns. They are chiefly worried that a union will disrupt the “family feel” of the hospital by introducing a “third party,” and that a union will lead to less flexible interaction between nurses and management and diminish the quality of care. They are also asking the nurses to give the new CEO, Chip Davis, a chance to address their concerns.
The nurses, in turn, held their responses in common. They say that RUNAP will not be a third party because they are not partnering with an outside union, the union will not have an impact on dialogue within units unless administrators decide to treat the relationship differently, and that the union will aid in increasing the quality of care by bargaining for enhanced bedside resources and measures to retain more experienced nurses.
“Bringing in a union is going to bring back a lot of that family feeling,” Camelio says. “For the first time in ages, we’ve got nurses from all over the hospital working together to do something, to make a change in the hospital. We used to know each other. … That’s not the situation anymore, but it’s becoming the situation again because we’re going out and meeting each other and we’re working together to make a change that’s positive.
“If management thinks we have a family feeling right now, it’s a dysfunctional family. It’s the abusive parent not happy that their child is standing up for themselves and not taking it anymore.”
Clark says the academic evidence also suggests that nursing unions increase quality of care. He cites research by University of Pennsylvania professor of nursing Linda Aiken concluding that nursing union-advocated policy changes in California that placed caps on patient-to-nurse ratios led to improvements in quality of care and nurse outcomes predictive of improved retention..
“When nurses unions do organize, one of the big focuses of their bargaining has been on issues that affect patient care,” Clark says. “Safe staffing is number one, but things like mandatory overtime and floating policies, those are things that are high on the list of priorities of nurses that organize unions and they want to negotiate these things because it will improve patient care.”
The hospital issued this statement in response to the election results:
“We are disappointed in this outcome, as we continue to believe a direct working relationship with our employees is best for our hospital, our team members, and our patients. However, we accept the election results, and remain fully committed to healing and coming together as ONE TEAM to continue to make RGH a great place to work and receive care.”
Despite the reaction, all three nurses say they found a lot of meaning in the organizing process.
“It’s been really cool to see how this has come together and to see how every unit has been brought together and now it’s opened up the doors to so many conversations with other nurses,” Rockefeller says. “It’s been a wonderful experience. I’m so happy I’ve done it. I found my voice in it. I before was kind of just a sit back, come to work, do my thing, and go home type, but this has given me a reason to keep going.”
Justin O’Connor is a Rochester Beacon intern and a student at the University of Rochester. The Beacon welcomes comments from readers who adhere to our comment policy including use of their full, real name.