BRATTLEBORO — Members of the United Nurses and Allied Professionals union lined the sidewalk in front of the Brattleboro Retreat last week as a volley of car horns sounded in support of the union members.
The picketers held their informational picket during a week-long heat wave, waving to the passing traffic and carrying signs that portrayed a strained relationship between staff and management at the psychiatric hospital.
A change in how the Retreat configures schedules - which affects inpatient nurses, licensed practical nurses (LPNs), and mental-health workers - drove union members to picket.
Conversations with union members, however, raised the question: Is the hospital staff's frustration about the schedule change alone? Or has its working environment been strained for so long that the schedule change was simply the final straw?
'A fragile game of Jenga'
According to union spokespeople, the action was a response to a litany of its members' frustrations. Workers, they said, feel disrespected and believe that management has shown disregard for the union contract. Some have even made allegations of bullying.
The administration, however, has another take on scheduling.
According to a letter to the editor from the Retreat's Chief Nursing Officer Meghan Baston [“Retreat management: new realities in nursing require new approaches,” Letters, July 4], the staffing changes are in accordance with best practices used elsewhere in the country.
In both her letter and in an interview with The Commons, Baston said the hospital wants to create a schedule for direct-care nursing staff that is predictable and provides the best cross-section of skills.
“To meet the demands of today's health-care environment we must first create sensible, predictable base schedules that reflect best practices for patient care and safety,” wrote Baston. “Once those are in place, we accommodate worker needs wherever possible.”
She continued, “To rely on a scheduling approach that attempts to prioritize the personal preferences and life circumstances of each employee over safe patient care and good management practices creates results that end up looking - and behaving - like a fragile game of Jenga.”
Staff member Daniel Watson took over as president of the union's Bargaining Unit Two two weeks ago. (Union employees are represented at the bargaining table in contract negotiations by two units, each representing a range of jobs, but only one contract applies to the unionized workforce at the hospital.)
In the view of Watson, a mental-health worker who has been at the hospital for five years, the “standard [scheduling] practice” instituted by the current administration goes against the intentions of founder Anna Marsh.
“She was not happy with the standard practice going on at the time. So she wanted something different. She wanted a place that provided good food, fresh air, exercise, and a calm environment. None of which we provide now,” Watson said.
Keeping up with changes in health care
In a phone interview, Baston said, “We really care about our employees. We recognize how valuable they are.”
Despite the informational picket, she said she felt confident that staff and management would find a way forward.
But Baston explained that the administration finds it necessary to reorganize the direct-care nursing staff's schedules.
Over many years, staff members had crafted their schedules individually, she said. As a result, staffing on the units had grown “uneven.” Under the current system, one day, a unit that requires five staff members for coverage might have six; the next day, four.
According to Baston, the new base schedules will provide “fair and equitable” situations for staff. For patients, the new schedules are designed to provide the right mix of staff and skills to meet patients' needs, she said.
Baston added that the shift and number of hours a staff member was hired for will remain the same. The days of the week might change.
This base schedule is what most hospitals “just-call scheduling,” Baston said.
“Our nursing leadership team has personally met with every willing employee to attempt to resolve questions and concerns about their new schedules,” she said. “We have had much success.”
Baston does acknowledge that the new scheduling model represents “a paradigm shift,” noting that some employees have had the same schedule for decades.
“That shift is based on the universally accepted premise that as with any organization you can name, staff schedules must give first priority to those we serve (in our case, patients) and to the overall good of the organization,” she said.
“Everything changes, and it's hard,” Baston said.
A long list of frustrations
Key to Daniel Watson's frustrations is what he sees as a “clear violation of contract language.” According to Watson, a paragraph in the contract outlines how management can change a staff member's schedule.
The contractual process includes meeting with the union membership, designing the schedules, distributing the new schedules in descending order of seniority and, finally, giving staff members their new work schedules 30 days ahead of implementation, he said.
Instead, Watson said, “They're going to plug you in where they want you, with no consideration to what you have going on in your personal life, and that is a lack of respect.”
According to Watson, the schedule change is the final issue in “a big list of problems” in the way the administration treats its employees.
Other staff members have expressed concerns about safety on the units, he said.
“Safety on the unit is always a concern and, when it's raised, it's not dealt with; it's just swept aside,” he said.
Watson felt the staffing changes won't correct any such concerns. For example, he said, patients who should have two staff members assigned to them because of safety issues often only have one.
Why? According to Watson, it's because the Retreat is still short-staffed. He cited low pay and poor treatment of workers as some reasons behind the low staffing, and he asserted that until those core issues improve, the problems at the Retreat will only get worse.
As an example, Watson shared his experience with being disciplined for a “no call, no show,” the only such blemish on his record in five years. Meanwhile, he claimed, four other staff members who are not members of the professional union racked up “no call, no shows” in the same month and under the same manager - yet they were not disciplined.
Watson noted that his ding for the “no call” came two days after he had an argument with a supervisor, who, he said, asked him to do something during safety checks that violated hospital policy.
Coincidence? “I'm just connecting the dots,” he said.
Watson said he has brought the issue up for arbitration through the union process.
“That's the kind of bullying it is,” he said. “If you are pro-union, if you stand up for yourself, if you speak out against them, they will come after you,” he said.
What can the Retreat do to satisfy Watson and his fellow union members at this point?
“As the president of the union, the only thing they can do to satisfy me is if they freeze the change,” Watson said.
“Keep everyone where they are at. Meet with us, union leadership. Redesign the schedules, if that is what truly needs to happen; we will notify the employees at the start of discussions and then give the shifts out by seniority on the units,” Watson said.
Responding to concerns
During her interview with The Commons, Baston responded to some of the union members' concerns.
She disagreed with allegations that the administration was “redefining” union contract language.
In her view, the administration uses the language in the contract as an “anchor that we use in conversation with each other and in the way we manage employees.”
If union members worry that the contract is being misinterpreted, they can access the grievance process, Baston said.
Baston noted that on June 26, the administration called in an arbitrator. The union was offered “unconditional” arbitration, she said.
“When the Retreat offered to fast-track arbitration about the scheduling issue, the union unfortunately declined in favor of informational picketing,” she said. “I feel confident that with face-to-face dialogue that puts patients at the center of our decision-making, our shared goal of providing safe, quality care will carry the day.”
When asked about retaliation by the administration toward staff, Baston said, “It feels like a broad claim.”
Baston said she is interested in hearing about specific examples of retaliation or bullying.
“Because if that's happening, it's not OK,” she said.
Baston agreed that Retreat staff are paid less than others with comparable jobs in neighboring communities in New Hampshire and Massachusetts.
The administration would like to pay staff more, she said, but the hospital works with limited resources in its pursuit of sustainability, said Baston, who pointed out that Medicare and Medicaid reimburse behavioral-health services at a lower rate than medical services. The reimbursement in general has remained flat for eight years, she said.
In the meantime, the hospital tries to compensate staff through other means such as tuition reimbursement, free continuing education, and time off.
A hospital's motto
Staff member Winston Sailsman Jr. characterizes the current situation as “a power play by the new management,” namely, Baston, who joined the Retreat last year, and Chief Executive Officer Louis Josephson, hired in 2016.
“It's a terrible power play to go against the force that drives this organization,” said Sailsman, a mental-health worker who is certified to instruct staff in nonviolent workplace violence prevention measures.
He characterized the Retreat staff as “great.” The fact that those employees out carrying signs in the hot weather felt “pushed to the limit and disrespected to this magnitude is just uncalled for,” he added.
Sailsman, the local chapter's former president, serves as vice president of bargaining. He has worked at the Retreat since 2010.
Some staff have been at the hospital 40 years without a schedule change, he said.
In Sailsman's experience, the only time his schedule changed came after he earned a better position that brought with it a different schedule.
He noted that staff have “lives outside of here.” Those lives include caring for sick parents, caring for children, or, most notably, working a second job. Staff have been accustomed to building their schedules around those other lives, he said.
According to Sailsman, Retreat staff - at least those directly serving patients - aren't receiving industry-standard pay.
He said starting pay for nurses in Rutland - two hours away - is $8 more per hour than what Retreat nurses earn in Brattleboro, which starts at $24.22 per hour.
For mental-health workers, who provide “nursing care responsibilities with supervision,” according to a recent job posting, it's a $6-an-hour starting-pay increase in Rutland. Mental-health workers start at $12.64 per hour in Brattleboro. If they go south to Massachusetts, they can get $5 to $7 more per hour.
“So this scheduling change was the last straw,” he said.
Scheduling might have been the last straw, but it wasn't the first. Another such straw? Mandation, answered Sailsman.
Mandation is labor jargon for what happens when a manager requires a staff member to work a specific shift. For example, an employee might have just finished an eight-hour shift, but the person scheduled to relieve that person has the flu and can't come to work. So, the first staffer (now said to be “mandated”) keeps working.
“We wanted mandation to stop,” he said.
What's more, “The previous management wanted mandation to stop,” he said, noting that efforts were underway to address the issue.
According to the June 2016 issue of The Flame, the union's newsletter, the current contract “commits the hospital to end mandatory overtime.”
But “the collaboration went out the window,” Sailsman said. “They stopped collaborating with us on the whole mandation; they've hired more travel nurses.”
Travel nurses roam the country and take temporary, non-union assignments from hospitals.
Joëlle Montagnino, who represents the Retreat's LGBT unit employees on the UNAP local's executive board and serves on the union's grievance committee, said the problems with reliance on the travel nurses are twofold.
For the staffing shortages, “certainly, yes, travelers offer some relief,” said Montagnino.
For one thing, having so many short-term non-union employees affects continuity, she noted. And for permanent union workers, “it means that travelers can end up with stable schedules (because they negotiate their own contracts) while core staff get shunted wherever.”
But for Montagnino, a mental-health worker in the LGBT unit, it's been “especially frustrating” there “because it is so, so awful when someone just has no experience with queer or trans people” and is assigned to that program, where, according to the hospital's website, “lesbian, gay, bisexual and transgender individuals find a safe, supportive community of professionals and peers in an LGBT-affirming setting. Free from judgment. Free from prejudice.”
“One of the most distressing things about being queer is having to explain yourself to people all the time,” Montagnino said. “It is alienating enough in everyday life. For patients in crisis, it is the worst time to have this burden revisited.”
The Retreat struggles to “retain good staff, so we find ourselves short-staffed, so then we're getting mandated. We're tired,” Sailsman said.
And then, there was the matter of respect.
Sailsman said that when he was president, he asked why management didn't consult the union before working to implement the scheduling changes, contrary to what he characterized as clear language in the contract.
Sailsman claims that Baston responded, “But we don't have to.”
“At that point, I knew that the disrespect from before just carried on,” he said.
Baston disputes this characterization. “Other people's perceptions are their perceptions, and that's okay.”
Another area of disrespect that Sailsman noted was the administration's “redefining” and “misinterpreting” the contract - an agreement that the previous administration and union worked hard to create.
The contract expires on Oct. 31, 2018.
In Sailsman's view, the relationship between the current administration and staff stopped working approximately two years ago.
It started with a memo Josephson sent announcing budget cuts, Sailsman said. The cuts extended to cutting patients' usage of spoons, forks, and Styrofoam. The hospital now gives patients reusable plastic cups but, said Sailsman, not all patients have access to sinks to wash them.
From that point, things took a turn for the worse, he said.
“More than anything, I came into this eight years ago, and I love this organization,” said Sailsman. “I love what it stand for and, on our Retreat badges, the mission statement is so powerful.”
According to the Retreat's website, the organization's mission is, in part, to “holistic services delivered by expert caregivers in a uniquely restorative Vermont setting.”
“And the fact that they don't treat us like expert caregivers or even pay us like expert caregivers, or respect us like expert caregivers - that's the most disheartening for me,” Sailsman said.