Addison-Gilbert Hospital

National Labor Relations Board - Board Decisions

Jan 6, 1981

253 N.L.R.B. 1010 (N.L.R.B. 1981)

DECISIONS OF NATIONAL LABOR RELATIONS BOARD
Addison-Gilbert Hospital and Massachusetts Nurses
Association, Petitioner. Case 1-RC-16777
Janauary 6, 1981
DECISION ON REVIEW AND
DIRECTION OF ELECTION
BY CHAIRMAN FANNING AND MEMBERS
JENKINS AND TRUESDALE
Upon a petition duly filed under Section 9(c) of
the National Labor Relations Act, as amended, a
hearing was held before a hearing officer of the
National Labor Relations Board. On March 28,
1980, the Acting Regional Director for Region I
issued a Decision and Direction of Election in
which he found appropriate a bargaining unit con-
sisting of all full-time and regular part-time regis-
tered nurses employed by the Employer at its
Gloucester, Massachusetts, location including
charge nurses, the patient care coordinator, and
certified registered nurse anesthetists, but excluding
utilization review coordinators, the environmental
control officer, all other employees, office clerical
employees, confidential employees, managerial em-
ployees, guards, and supervisors as defined in the
Act. Thereafter, the Employer timely filed a re-
quest for review in which it requested the Board to
order testimony in regard to other professional em-
ployees whom it had claimed should be included in
the unit with the registered nurses; that charge
nurses be excluded from the unit; and that utiliza-
tion review coordinators be included in the unit.
On April 28, 1980, the National Labor Relations
Board by telegraphic order granted review to the
extent it remanded the proceeding to the Regional
Director to reopen the hearing to permit the Em-
ployer to present its evidence with respect to the
appropriateness of the registered nurse unit. The
Board denied the request for review as to the status
of charge nurses and did not pass upon the issue
concerning the utilization review coordinators.
Pursuant to the Board's direction the hearing
was reopened and, thereafter, the proceeding was
transferred back to the Board for decision.
Pursuant to the provisions of Section 3(b) of the
National Labor Relations Act, as amended, the Na-
tional Labor Relations Board has delegated its au-
thority in this proceeding to a three-member panel.
The Board has considered the entire record in
this case, including the briefs of the Employer and
the Petitioner, and makes the following findings:
The Employer operates a hospital in Gloucester,
Massachusetts, where it offers acute patient care.
The hospital is administratively organized into five
major divisions: nursing service, professional serv-
ices and planning, administrative services, fiscal
253 NLRB No. 141
services, and development and public relations.
Each division is headed by its own director and the
directors are administratively responsible to the ad-
ministrator. Below the level of administrator there
is no supervision common to the different divisions.
At the original hearing in this proceeding, the
Employer contended that other positions which it
considered professional should be in cluded with
the petitioned-for registered nurses in an appropri-
ate unit. These positions included staff social
worker, staff pharmacist, physical therapist, medi-
cal technologist, laboratory section head, therapeu-
tic dietitian, bio-medical engineer, staff accountant,
and programmer analyst. The Board granted the
Employer's request for review and remanded the
case for further hearing to allow the Employer to
present its evidence concerning the appropriateness
of the unit. At the resumed hearing, the Employer
presented evidence concerning those other alleged
professionals in its employ. However, it declined at
that time to take any position as to the inclusion or
exclusion of the other alleged professionals in the
petitioned-for unit of registered nurses. The Board
has considered all of the evidence presented by the
parties and concludes that the unit found appropri-
ate by the Regional Director is an appropriate unit
in this case.
With the exception of the two certified regis-
tered nurse anesthetists, who work in the anesthesi-
ology department in the Division of Administrative
Services, all of the employees in the unit found ap-
propriate by the Regional Director work in the Di-
vision of Nursing Services. They are all registered
nurses working in several patient care areas of the
hospital, and are engaged in around-the-clock
direct patient care, including the dispensing of
medicines, changing dressings, providing for the
hygiene and comfort of the patients, and other
duties commonly associated with a staff nurse.
The nurses, approximately 125 in number, work
in 3 shifts, 24 hours a day, 7 days a week. On the
Employer's pay scale the nurses are paid at a grade
10 level. They receive overtime pay and a shift dif-
ferential when working the eveninig or night shifts.
Some of the nurses act as charge nurses on the eve-
ning and night shifts, overseeing the work of other
employees on those shifts in the absence of the
head nurses, who are supervisors. Nurses acting as
charge nurses receive 25 cents more per hour than
the other staff nurses. They also give "reports" to
the charge nurse or head nurse on the next shift.
The nurses and other employees in each individ-
ual patient care area are supervised by a head nurse
who in turn answers to a clinical supervisor in each
of five major clinical divisions. The clinical super-
visors and administrative supervisors in turn are re-
(10
ADDISON-GILBERT HOSPITAL
sponsible to the assistant director of nursing serv-
ices and the director of nursing services.
The record reveals that the registered nurse in
Massachusetts is required by law to have graduated
from an accredited school of nursing and must
have passed a uniform examination and been li-
censed by the Massachusetts Board of Registration
in Nursing in order to perform as a registered
nurse. In addition, the registered nurse is required
to receive continuing education in the profession
and to be relicensed biannually.
The record also reveals that a hospital such as
the Employer is required by law to maintain a dis-
tinct nursing service under the direction of a direc-
tor of nursing. The hospital is also required to pro-
vide inservice education to its nurses, to provide
for the appropriate supervision of the nurses by
registered nurses, and, inter alia, to staff its patient
care areas with a set minimum of registered nurses.
In contrast to what has been revealed concerning
the common interests of the registered nurses, the
record shows that the other categories of employ-
ees about whom the Employer has submitted evi-
dence do not share the same community of interest
as do the nurses. With the possible exception of the
medical technologists (the record is unclear as to
their hours), the other alleged professionals work
normal daytime hours, 5 days a week. They do not
receive pay for overtime; do not wear the same
uniform as a nurse, if they wear any type of uni-
form; they are not under the supervisory structure
of the nursing department, but rather work in the
various other divisions of the hospital; and with the
exception of the physical therapist, who spends ap-
proximately 50 percent of working time on patient
care, and the social worker, who spends an unde-
termined amount of time with patients, these em-
ployees are not involved with patient care or in
regular contact with patients. Any day-to-day con-
tact between these employees and the nurses ap-
pears to be minimal and a result of the nurses'
broad responsibility pertaining to the care of pa-
tients. Also, the evidence show that the nurses and
other professionals do not as a rule attend the same
meetings at the hospital.
Although the Employer emphasizes the fact that
all of the alleged professionals, including the
nurses, are under the same wage structure and per-
sonnel policies and enjoy the same fringe benefits,
the same appears to be true of all of the hospital's
employees. There are 21 pay grades in the Em-
ployer's pay structure, with an 8 percent difference
between grades. As noted, the nurses are paid at
grade 10. The other employees in question receive
pay in the range of grades 9 through 12. The
record is silent as to the pay grades of other em-
ployees not in issue here. Also, although employees
are free to transfer from one position to another if
they meet the qualifications for the sought-after po-
sition, there is no evidence of transfer between the
position of registered nurse and the other positions
dealt with here.
The educational requirements for the employees
other than registered nurses vary. With the excep-
tion of the programmer analyst, all must have a
college degree, and the staff pharmacist and physi-
cal therapist must be registered by the State.
A review of all of the evidence in this proceed-
ing clearly shows that the registered nurses em-
ployed in the Division of Nursing Services and the
two certified registered nurse anesthetists share a
common community of interest separate and dis-
tinct from the other alleged professionals about
whom the Employer has presented evidence. This
is true not only in the type of work performed con-
cerning direct patient care, but in educational and
licensing requirements imposed by the State, the
hours of work and the pay received, the separate
supervision, and the obligations imposed by the
State on the Employer concerning this category of
employees.
Moreover, we note that the Petitioner represents
exclusively units of registered nurses in scores of
other health care institutions and desires to repre-
sent only the nurses here. Also, no other labor or-
ganization seeks to represent a unit different from
that found appropriate by the Regional Director
here, and, as the Employer declines to take a posi-
tion in this case as to the exclusion or inclusion in
the unit of other professionals, there is no opposi-
tion to the appropriateness of this unit.
The Employer wishes to include two utilization
review coordinators in any unit found appropriate.
The Regional Director excluded these employees
from the unit he found appropriate, and we agree.
Utilization review coordinators are employed in
the medical records department and report to its
director, who in turn reports to the director of pro-
fessional services and planning. It is not necessary
to be a registered nurse to hold this position, al-
though one of the two persons currently holding
the position, who works part time, is a nurse. Their
responsibilities include, inter alia, reviewing admis-
sions and charts on patients in for an extended stay
and, using approved criteria and standards, deter-
mining the need for such admissions and extended
stays. They are in contact with physicians and fam-
ilies of patients concerning such items as Medicare
t Sec NJeIwhto'n- el/leU., Ilorpial. 2) NIRB 4.09 t 091)), herein "c , ct
forth the crileria hby hich \e Aisl determine he appripril.cncs , ol reg-
istered nurse unllt It appears that ill Mostl respectls the facts here are
quite similar toi the facts of that case
1 1
DECISIONS OF NATIONAL LABOR RELATIONS BOARD
coverage and maintain a liaison with other divi-
sions of the hospital to facilitate the continuity of
patient care. Generally, it appears that their func-
tion is to attempt to provide for the most effective
and efficient utilization of the hospital's facilities.
The utilization review coordinators do not pro-
vide any patient care and their contact with nurses
appears limited and of an administrative nature. Al-
though this position requires knowledge of medical
terminology and the health care field in general,
the employees do not have to be nurses, or possess
the education or license of a nurse. The full-time
utilization review coordinator works 8 to 4:30, 5
days a week, and spends much of her worktime in
an office. We agree with the Regional Director
that this position is administrative in nature and
that these employees do not share a community of
interest with the registered nurses. We will exclude
them from the unit.
Accordingly, for the foregoing reasons, we find
that the following employees of the Employer con-
stitute a unit appropriate for the purposes of collec-
tive bargaining within the meaning of Section 9(b)
of the Act:
All full-time and regular part-time registered
nurses employed by the Employer at its Glou-
cester, Massachusetts location including charge
nurses, the patient care coordinator, and certi-
fied registered nurse anesthetists, but excluding
utilization review coordinators, the environ-
mental control officer, all other employees,
office clerical employees, confidential employ-
ees, managerial employees, guards and supervi-
sors as defined in the Act.
[Direction of Election and Excelsior footnote
omitted from publication.]
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