Brookwood Hospital

National Labor Relations Board - Board Decisions

Sep 30, 1980

252 N.L.R.B. 748 (N.L.R.B. 1980)

DECISIONS OF NATIONAL LABOR RELATIONS BOARD
Brookwood Hospital Management Corporation d/b/
a Brookwood Hospital and General Truck Driv-
ers, Warehousemen and Helpers Union, Local
980, Petitioner. Cases 20-RC-14863 and 20-
RC- 14864
September 30, 1980
DECISION ON REVIEW
BY CHAIRMAN FANNING AND MEMBERS
JENKINS AND PENE.ILO
On September 11, 1979, the Regional Director
for Region 20 issued a Decision and Direction of
Elections in the above-entitled proceeding, finding,
inter alia, that a separate unit of all registered
nurses employed by the Employer is appropriate.
The Employer, thereafter, in accordance with Sec-
tion 102.67 of the National Labor Relations Board
Rules and Regulations, Series 8, as amended, filed a
request for review of the Regional Director's deci-
sion as to Case 20-RC-14863, contending that the
unit must also include all of the Employer's other
professional employees.
On October 24, 1979, the National Labor Rela-
tions Board by telegraphic order granted the re-
quest for review as to the appropriateness of the
unit.
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 with respect to the issue under review and
makes the following findings:
The Employer operates an acute care/skilled
nursing facility in Santa Rosa, California, offering
rehabilitation and cancer therapy services as well
as treatment for voluntary psychiatric patients.
Nursing services are separated into two depart-
ments headed by the director of nursing and the di-
rector of psychiatric nursing, respectively. The di-
rector of nursing is responsible for nursing services
in the acute care unit, skilled nursing facility unit,
and plastic surgery unit. The acute care and skilled
nursing facility units are each staffed by four regis-
tered nurses and a number of nonprofessional nurs-
ing employees; the plastic surgery unit is staffed by
one registered nurse and a technician. The director
of psychiatric nursing is responsible for nursing
services in the psychiatric unit which is staffed by
seven registered nurses and a number of nonprofes-
sional nursing employees.
There are also two single-position sections orga-
nized under the director of psychiatric nursing-
social services and psychological testing. The
social service position, which was vacant at the
252 NLRB No. 107
time of the hearing, was formerly held by a psychi-
atric social nurse. However, the only requirement
for this position is that the incumbent must be a li-
censed clinical social worker. Psychological testing
is staffed by an associate psychologist. The parties
stipulated that the social worker and the associate
psychologist are professional employees.
In separate departments not under the adminis-
tration of any registered nurse the Employer em-
ploys approximately 12 other stipulated health care
professionals. This group includes a dietician, a
pharmacist, a psychophysiologist, three occupation-
al therapists, and six physical therapists. The Em-
ployer contends that the only appropriate unit is
one which includes both the approximately 17 reg-
istered nurses and the approximately 14 nonnurse
professional employees.
The Employer argues in support of an overall
professional unit that its registered nurses and non-
nurse professionals share similar wages and work-
ing conditions and have an unusually close work-
ing relationship because of their assignments to var-
ious teams. The Employer operates a chronic pain
and an acute rehabilitation team, both of which in-
clude registered nurses and various other health
care professionals in their membership. The chron-
ic pain team is headed by a medical doctor and
typically includes day-shift registered nurses from
the acute care unit, a physical therapist, an occupa-
tional therapist, the social worker, the psychophy-
siologist, and the associate psychologist. From time
to time, other professional employees such as the
dietician or the pharmacist may join the group
when their skills are required to meet the needs of
a particular patient. The acute rehabilitation team is
also headed by a physician and its membership in-
cludes one or more physical therapists, an occupa-
tional therapist, registered nurses from both the
acute care and skilled nursing facility units, the
psychophysiologist, the social worker, the dietician,
and a pharmacist. The chronic pain and acute reha-
bilitation teams operate in substantially the same
manner. The teams meet about once a week to dis-
cuss the patient's progress and to make recommen-
dations with respect to goals, problem areas, dis-
charge planning, etc., in order to insure a consist-
ent, integrated treatment program for each patient.
Between weekly meetings, the team members may
have further discussions or personal contact with
one another during the course of implementing the
treatment program. For example, a registered nurse
may work with a therapist by monitoring a pa-
tient's blood pressure during the therapy session,
and the dietician or a pharmacist may discuss the
patient's reaction to some food or medication with
a nurse.
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BROOKWOOD HOSPITAL
In addition to the chronic pain and acute reha-
bilitation groups, there are smaller teams that meet
at least once a week to discuss practical day-to-day
treatment problems. These smaller team meetings
are regularly attended by registered nurses, li-
censed vocational nurses, aides, and therapists.
Other professionals, such as a pharmacist or the
social worker, may also occasionally attend these
meetings if they have worked on any of the cases
to be discussed. Based on the foregoing, and the
record as a whole, we find that the Employer's
team approach to health care does not result in
such a community of interest between the regis-
tered nurses and other professional employees that
only an all professional unit is appropriate. Aside
from weekly meetings at which some nonnurse
professionals and some registered nurses discuss pa-
tients' treatment plans, the Employer's hospital op-
erates in a familiar pattern. The registered nurses
may have some contact with other professionals in
carrying out their primary function of monitoring
patient care, but these contacts are no more than
can be expected in any modern hospital using an
interdisciplinary approach to patient care. The
daily interaction between the Employer's registered
nurses and other professionals is, for example, simi-
lar to that described in Newton-Wellesley Hospital,
250 NLRB 409, 410 (1980). Moreover, there are no
psychiatric nurses on the acute rehabilitation or
chronic pain teams and only one classification of
nonnurse professional regularly attends the smaller
team meetings. The attendance of some registered
nurses and other professionals at interdisciplinary
team meetings does not, in itself, establish any sig-
nificant community of interest that would require
the inclusion of all these professional employees in
a single unit for purposes of collective bargaining.
There are, on the other hand, important differ-
ences in training, supervision, and responsibility be-
tween registered nurses and other professionals.
With respect to training, all of the Employer's reg-
istered nurses must have been graduated from an
accredited nursing school and be licensed by the
State of California. All of the other professionals
sought to be included in the unit have college de-
grees and a few have graduate degrees. Some other
professionals, such as the psychophysiologist, must
be certified by their own professional society and
others must be licensed by the State. With respect
to supervision, all of the registered nurses work
under supervision of one of the nursing directors.
With the exception of the associate psychologist,
the other professionals are supervised by various
nonnurse department heads. Finally, with respect
to responsibility, and with the possible exception of
the plastic surgery nurse, all of the Employer's reg-
istered nurses act as charge nurses for their units.
Unlike any of the more specialized health care pro-
fessionals, charge nurses are responsible for overall
patient care. The charge nurse is required to moni-
tor each patient's condition and to direct non-
professional nursing employees in their patient care
tasks. Since only registered nurses may perform the
charge nurse function, there is clearly no functional
interchange between them and the nonnurse profes-
sionals.
In all the circumstances, we conclude that the
appropriateness of a separate unit for the registered
nurses has been adequately established. Unlike St.
Francis Hospital of Lynwood, a Corporation,' the
parties here were afforded a full opportunity to
present evidence with respect to the unit issue.
Evidence that the Employer's registered nurses
work together in teams including other professional
employees with whom they share similar wages
and working conditions does not, in our view, dis-
qualify them from representation.
The only remaining question is whether the asso-
ciate psychologist and the social worker should be
included in the unit with the registered nurses in
view of their administrative placement under the
director of psychiatric nursing. Since there was no
incumbent in the social service position at the time
of the hearing, no ruling shall be made as to the
proper unit placement of this position.2 The asso-
ciate psychologist might appropriately be included
in the registered nurse unit except for the fact that
he works only 16 to 20 hours per week, he is re-
quired to be in the hospital no more than 4 to 8
hours per week, and he arranges his own schedule
based on orders he receives from various physi-
cians. There is no indication in the record that the
director of psychiatric nursing exercises any day-
to-day supervisory authority over the associate
psychologist. Thus, the fact that he may be admin-
istratively responsible to the director of psychiatric
nursing does not compel his inclusion in the nurses'
unit. We conclude that his representation, if any,
should be as part of a unit of nonnursing profes-
sionals.
Having concluded that the requested unit of reg-
istered nurses at the Employer's facility is an ap-
propriate one for collective bargaining, we hereby
direct the Regional Director to open and count the
impounded ballots, and to take further appropriate
action as may be required.
232 NRB 32 (1977), enforcement denied 601 F2d 404 (9th Cir
1979)
2 eneral Dtnamiom Corporarion Convair .4erospace Division. San Diego
Operations, 213 NIRB 851, 868. fn 35 (1974).
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