County Chief Executive Officer Greg Devereaux has forged a modus vivendi with the  influential and hard-nosed union representing nurses working at the county hospital.
Within the last fortnight, Devereaux drafted a side letter agreement with the California Nurses Association to establish that eligible employees in the per diem nurses unit may receive the additional compensation consistent with their performance of higher level duties than normally associated with regular nursing assignments.
The county employs 1,247 nurses. Of those, 901 are in the nurses’ bargaining unit and 346 are in the per diem nurses bargaining unit.
Devereaux has been both lionized and demonized for his handling of county employee compensation issues since he was brought in to serve as the top manager of the county’s governmental structure in 2010. He arrived at the nadir of the economic downturn that gripped the nation, state and region toward the end of 2007 and persisted for more than a half dozen years. The financial malaise resulted in diminishing revenues to state and local governments, triggering a round of belt tightening that was not gladly received by public employee unions. Devereaux consistently held the line in refusing to grant employee raises over several budgetary cycles and went further, seeking concessions from county employee bargaining units that reduced benefits, in particular the county’s pick-up of employee contributions to their retirement funds, a perquisite that had been granted to many employees during previous economic boom years.
Devereaux had early success wringing concessions from the county’s firefighters’ union and bootstrapped that into similar concessions from the sheriff’s deputies’ union, largely because previously more generous salary and benefit terms had been confirmed upon the county’s public safety employees than others. Some other employee bargaining units followed suit but others were more recalcitrant.
Sore points with county-employed nurses are what they maintain are comparatively low wages and a high turnover rate among them as many go elsewhere for higher pay. Nurses claim they are paid roughly $17 an hour less than nurses in many of the region’s competing hospitals. This is exacerbated by the county’s employment of registry nurses.
Assembly Bill 394 mandates that hospitals maintain minimum nurse-to-patient ratios. The use of registry nurses at the county hospital has long been practiced.
Somewhere in the neighborhood of 900 nurses who are permanent county employees work at Arrowhead Regional Medical Center in Colton, the county’s main hospital campus, and more than 320 other nurses employed by the county work in public health capacities such as within the jails, juvenile halls and various clinics. When the need for nurses increases, the county turns to registry nurses, that is, those employed by private sector employers who provide nurses for a set fee on an as-needed basis.
In March 2008, the board of supervisor approved agreements for temporary help services, some of which included nurses, for a total not-to-exceed amount of $9 million from March 1, 2008 through February 28, 2011. In January 2009, the board approved ten nurse registry contracts at a cost of $1,500,000 per year, from January 27, 2009 through June 30, 2012. In March 2009, the board approved eleven additional nurse registry contracts with a $1.5 million expenditure limit, through June 30, 2012. In June 2009, the board approved ten additional nurse registry contracts, again with a $1.5 million expenditure limit through June 30, 2012. In March 2012, the board approved amendments with 8 of the 31 contracts, increasing the not-to-exceed amount by $6,882,041, from $1,500,000 to $8,382,041 through June 30, 2012. In August 2012, the board approved amendments with 14 of the 31 contracts, increasing the not-to-exceed amount by $3,000,000, from $8,382,041 to $11,382,041, and extending the termination date from June 30, 2012 to December 31, 2012.
In June 2014, the county’s contract with its nurses expired. Beginning in 2013 the county and the nurses association sought to negotiate terms of a new contract, but failed to reach a resolution.
In the five months after the expiration of the contract, the nurses staged three demonstrations. In November 2014, the leaders of the California Nurses Association, asserting the county was functioning with a budget surplus and should be able to provide pay increases and hire more qualified nurses, gave San Bernardino County notice that roughly 1,200 nurses employed by the county would initiate a two-day work stoppage on December 9, concluding on December 10.
While public statements emanating from Devereaux’s office held that the situation was under control, the Arrowhead Regional Medical Center’s newly-hired director, William T. Foley, moved to declare a “state of emergency” at the county hospital ahead of the planned strike. Simultaneously, the county hospital reduced its patient count by 86, with 66 from discharges and 20 from transfers to other hospitals and the board of supervisors called an emergency meeting at which it authorized the expenditure of up to $4 million for nursing strike replacement personnel and the reimbursement of local hospitals and transportation providers for costs incurred for preparing to or accepting Arrowhead Regional Medical Center patients because of the strike.
The county then made three attempts to have San Bernardino County Superior Court issue an injunction prohibiting the strike, claiming it would put patients in jeopardy and that the hospital was in “dire straits” because registry nurses were reluctant to cross the picket line, and a major strike replacement firm would not be able to muster enough personnel to cover all nursing assignments at Arrowhead Regional Medical Center. The first two comprehensive tries for an injunction failed but San Bernardino Superior Court Judge Pamela King issued a temporary restraining order, prohibiting about 60 essential nurses from participating in the strike.
An uneasy stand-off has ensued between the county/Devereaux and the California Nurses Association/National Nurses United in the intervening months.
Last week, Devereaux reported to the board of supervisors that “Recently, Arrowhead Regional Medical Center has experienced increases in the number of patients, while staffing has not kept pace in certain specialty units within the hospital. This has resulted in the need to fill vacant or additional shifts to meet state mandated nurse-to-patient staffing ratios. In order to address the need to fill these shifts, the county and the California Nurses Association met and conferred regarding the terms and conditions of employment for employees in the nurses unit and per diem nurses unit. The meet and confer process resulted in a proposed side letter agreement to establish, consistent with the nurses unit employees, that employees in the per diem nurses unit filling those vacant or additional shifts in the specialty units shall be eligible for the additional compensation pursuant to the temporary performance of higher level duties article of the memorandum of understanding. The proposed side letter will maintain consistency between nurses unit and per diem nurses unit employees and assist Arrowhead Regional Medical Center in filling the vacant and added specialty unit shifts in order to maintain the required staffing levels.”