As many as 18,000 nurses in Northern California are preparing for a two-day strike that will start Tuesday. Nurses plan to leave their posts at 7 a.m. and picket outside 21 Kaiser Permanente medical centers and clinics.
The placards nurses carry and the chants they repeat will say little about salaries or pensions. No economic proposals have even been put on the bargaining table yet.
"This seems awfully quick to go to a strike," says Joanne Spetz, an economics professor at the University of California, San Francisco School of Nursing. "I can't recall a situation where a strike has come up where there has not been some kind of disagreement about wages and benefits as part of the package."
Instead, nurses are focusing on more than 35 operational proposals that remain unresolved after three months of bargaining. These demands include a call to fill more than 2,000 nursing positions that have been vacated in the last three years, better protections for use of sick leave or more flexibility over breaks, and more training and education.
Both sides have leaned on the recent Ebola scare to try to win PR points with the public. Nurses have demanded better protective gear and more training for caring with potential Ebola patients — calls that the Centers for Disease Control and Prevention heeded by updating its federal guidelines last month. Kaiser nurses say they still want more, and have timed the second day of their strike to coincide with nurse demonstrations across the country in a "National Day of Action" over Ebola preparedness.
The hospital system has tried to turn that argument around in light of the work stoppage.
"We are baffled by the union's tactics at this critical time," read an ad that Kaiser ran in Northern California newspapers Monday. Calling a strike now, "just as we are entering flu season, and when the nation and our members are concerned about the risk of Ebola, seems particularly irresponsible."
The hospital system has hired and trained more than 2,800 temporary nurses to staff its medical centers while its regular nurses are on strike, a stopgap that costs as much as $20 million per day, Kaiser says. Some elective surgeries and non-urgent appointments will be rescheduled to ease pressure on the system.
"Our main concern is patient care issues and safe staffing," says Zenei Cortez, co-president of the California Nurses Association and chair of the bargaining team for the Kaiser nurses.
She says Kaiser will only agree to changes that are "cost neutral," which is one reason the proposals are stuck in limbo.
The main tension in the negotiations is over what's not being said. Nurses say they are eager to incorporate the subject of wages and benefits into the negotiation. While they have made no formal economic proposals, they have stated that they are seeking the status quo: no cuts.
Kaiser is quiet on this. It has not put forward any of its own proposals yet. The hospital system said in a statement that it prefers to resolve a majority of the "other issues the union has already put on the table and then add our wage and benefit proposals to the mix."
Experts say this is all unusual. But the move to isolate patient care demands from economics could be a strategy on either side, says Spetz.
Because the nurses' patient-care proposals would both cost money and create a benefit to nurses in their working conditions — by reducing workload, for example — it makes sense that they would want to balance these requests against any proposed changes to salary and benefits.
"Usually these all get negotiated as a group," says Spetz.
Kaiser may prefer to separate the issues as a way to strengthen its position when negotiating over wages and pensions. Nurses in California are among the few private professions to still have pensions.
But nurses may benefit from the separation, too, now that they've called a strike.
"To the extent the union can clearly state what exactly their concerns are and argue that Kaiser is not listening, that can bring a lot of public sympathy," Spetz says. "It does not benefit Kaiser to be perceived as (being) against patient safety."