CINCINNATI--Although the 83-day strike by Appalachian Regional Healthcare nurses has ended with ratification of a new contract, some return-to-work issues are still being resolved, union negotiator Pat Tanner said Jan. 2.

“The story isn’t over yet,” Tanner told BNA, noting that the Lexington, Ky.-based hospital system has agreed to bring 350 striking nurses back by Jan. 31, but how this will happen is proving problematic.

Members of the Kentucky and the West Virginia Nurses Associations employed by ARH ratified a 40-month contract during voting Dec. 21-22, approving it by a vote of 239-193.

The agreement, which took effect with ratification and runs to April 2011, calls for all strikers to return to work by March 31. Under the pact, ARH pledges to make its “best effort” to return all of the striking nurses to their pre-strike units and shifts, and guarantees that at least 80 percent will go back to their pre-strike units.

Nurses at nine ARH hospitals in eastern Kentucky and southern West Virginia walked off their jobs Oct. 1 after rejecting the not-for-profit provider’s “final contract offer” because it failed to satisfactorily address their key concerns over inadequate staffing levels and excessive mandatory overtime (190 DLR A-2, 10/2/07).

The walkout began with about 800 nurses, but since then about 150 have taken jobs elsewhere, according to the union.

Tanner said the contract establishes specific criteria for overtime, limiting it to “unplanned events or emergencies,” thereby keeping ARH from building it into each nurse’s schedule.

The union wanted to curb ARH’s past practice of using mandatory overtime to offset inadequate staffing levels, a practice that can lead to chronically exhausted nurses and put patients at risk, Tanner said.

ARH has repeatedly denied the union’s claims regarding its mandatory overtime practice, saying federal and state regulators have never found that its staffing levels adversely affect patient outcomes.

During the walkout, the hospital chain released payroll documents showing that nurses, on average, worked 2.5 hours overtime a week.

About a month into the strike, ARH issued statements saying the union's strike was motivated more by economics than concerns over patient care.

Wage Hikes Negated by Health Care Premiums.

The final contract disproves that allegation, Tanner said, with nurses receiving annual raises averaging about 2 percent, an amount negated by higher premiums for health and disability insurance. Nurses were willing to accept this, she said, because “they realize this is happening across the country.”

During talks that led to tentative agreement, union negotiators objected to ARH’s back-to-work proposal that called for recognizing 150 strike replacements as permanent employees (245 DLR A-9, 12/21/07).

Although replacement workers will be kept on under the agreement, Tanner said, “No nurse is left behind and our issues have been addressed.”

Without a doubt the strike went on much longer than the union expected, Tanner said, “but we were able to endure because of the support we received from the outside.”

As the strike wore on, the nurses received financial support from other unions, including a $20,000 donation to their strike fund from the AFL-CIO (218 DLR A-7, 11/13/07).

West Virginia Gov. Joe Manchin (D) lent his support to the strikers, Tanner said, asking ARH to allow union nurses to return to work while negotiations continued; the hospital system refused (234 DLR A-6, 12/6/07).

For most of the strike all of the system’s hospitals have remained open, staffed by replacement nurses, but in late December ARH said it had to close the general medical unit at its hospital in Beckley, W.Va., and lay off 17 support workers because of a drop in patient volume.

Declining revenue caused by patients refusing to cross the picket line also prompted ARH to lay off 43 support staff at its South Williamson, Ky., hospital, according to company spokeswoman Candace Elkins.

Following ratification, ARH President and CEO Jerry W. Hayes said in a statement, “We are pleased that our nurses have accepted this contract that includes an excellent compensation and benefit package. This is not only a vote in favor of a very good contract, it is a vote for quality patient care and improving the health and well being of all the communities we serve.”

ARH, one of the region’s largest health care providers, owns seven hospitals in Kentucky and two in West Virginia. Established in the 1950s by the United Mine Workers to serve Appalachian communities that lacked adequate medical care, the hospital network became an independent not-for-profit provider in 1963.

By Bebe Raupe

Copyright 2008, The Bureau of National Affairs, Inc., Washington, D.C.