Holliswood Hospital

National Labor Relations Board - Board Decisions

Nov 22, 1993

312 N.L.R.B. 1185 (N.L.R.B. 1993)

1185
312 NLRB No. 196
HOLLISWOOD HOSPITAL
1 Review was requested of the Regional Director’s findings that
the petitioned-for units of registered nurses and of all nonprofes-
sionals were appropriate for bargaining.
4 The units appear as amended at the hearing.
5 Pursuant to Sec. 9(b)(1) of the Act, the Employer acknowledges
the need for a ‘‘self-determination’’ election for the professional em-
ployees. See Sonotone Corp., 90 NLRB 1236 (1950).
7 Some psychiatric patients are admitted with physical problems,
such as diabetes and hypertension, which require medical attention
during their stay.
8 This is based on the testimony of Randy Hampton, the Employ-
er’s executive director and chief executive officer. Her individual
unit figures result in an average stay of about 28 days.
9 This is set forth on Emp. Exh. 73, ‘‘Nonsupervisory Staff as of
March 1993,’’ a summary prepared by Executive Director Hampton
showing all nonsupervisory employees by job classification, based
on payroll records for March 1993. This summary also shows the
Employer employed 61 professional per diem employees (47 as reg-
istered nurses), and 31 nonprofessional per diem employees. Hamp-
ton testified that she included all per diem employees employed at
that time, regardless of the number of hours worked for any period
of time. Hampton also testified that three professional positions (a
psychologist, a creative therapeutic activities therapist, and an addic-
tion counselor) and one nonprofessional position (medical
transcriptionist) were vacant at that time. Hampton testified that
there were ‘‘probably’’ vacant positions for registered nurses and
mental health workers as well.
The Holliswood Hospital and Local 1199, Drug,
Hospital and Health Care Employees Union,
Petitioner. Case 29–RC–8085
November 22, 1993
ORDER DENYING REVIEW
BY CHAIRMAN STEPHENS AND MEMBERS
DEVANEY AND RAUDABAUGH
The National Labor Relations Board has considered
the Employer’s request for review of the Regional Di-
rector’s Decision and Direction of Election (pertinent
portions of which are attached as an appendix),
as well as the Petitioner’s opposition brief. The request
for review is denied as it raises no substantial issues
warranting review.1
APPENDIX
DECISION AND DIRECTION OF ELECTION
The Petitioner seeks an election in two separate units: (a)
all registered nurses, excluding all other employees, manage-
rial employees, guards, and supervisors as defined by the
Act; and (b) all nonprofessional employees, excluding all
other employees, professional employees, managerial em-
ployees, guards, and supervisors as defined by the Act.4 The
Employer takes the position that the only appropriate unit
herein is a single, wall-to-wall unit of all professional and
nonprofessional employees.5
. . . .
There is no history of collective bargaining for any of the
Employer’s employees.
. . . .
The Bargaining Units
The record evidence shows that the Employer operates a
100 bed private, for profit, psychiatric hospital that provides
acute psychiatric care for adults and adolescents with psy-
chiatric disorders.7 The Employer provides 24-hour nursing
care for its patients. The Employer is licensed by the State
of New York as a psychiatric hospital and is accredited by
the Joint Commission for Accreditation of Health Care Orga-
nizations (the Joint Commission). The Employer has four, 25
bed units (or programs) designated as follows: the adolescent
unit, the behavioral disorders unit, the intensive treatment
unit and the dual diagnosis unit. The average length of stay
for patients in all units is ‘‘approximately one month.’’8 The
averages for individual units range from 24 to 25 days (dual
diagnosis unit), to 28 days (intensive treatment unit), to 29
days behavioral disorders unit), to 32 to 33 days (adolescent
unit). The Employer employs about 54 ‘‘regular’’ profes-
sional employees and 89 ‘‘regular’’ nonprofessional employ-
ees.9
The Employer occupies two interconnected buildings (re-
ferred to as the clinical building and the administrative build-
ing) on a 6 acre site. In the ‘‘cellar’’ of the clinical building,
there is a patient and staff dining room, kitchen, and power
plant. On the first floor, there is the lobby, the atrium (large
meeting room), a conference room, various admissions of-
fices, classrooms (for the adolescent patients), and creative
therapeutic activities rooms/studios (for all patient). Also,
various departmental offices (nursing, psychology, social
work, creative therapeutic activities) are located on the first
floor, as well as the pharmacy, staff lockers, and storage
areas. On the second floor, there is a gymnasium with a
weight room and recreation room. On the third floor, located
above the weight and recreation rooms, there is an area
called the ‘‘mezzanine’’ with offices for the education coor-
dinator and teachers (for the adolescents), registered dieti-
cian, dietary technician, and discharge planner.
The clinical building also houses the four, 25 bed units:
the behavioral disorders unit (2 North) and the adolescent
unit (2 South) are located on the second floor; the dual diag-
nosis unit (3 North) and the intensive treatment unit (3
South) are located on the third floor. Each unit has patient
rooms, a dining room/meeting room, a patient lounge, a staff
lounge, a nursing station and medication room, a physical ex-
amination room, housekeeping and laundry rooms. In central
areas on the second and third floors, there are offices for the
program directors, unit secretaries, psychologists and social
workers, a large meeting room, and a patient ‘‘seclusion’’
room for use by both units.
In the ‘‘basement’’ of the administrative building, there is
a mailroom, central supply area, maintenance shop, house-
keeping offices, and creative therapeutic activities staff of-
fices. On the first floor, there are offices for payroll, ac-
counts payable, data processing, accounts receivable and the
human resources department. On the second floor, there are
offices for the executive director, administrator, and the com-
munity relations department.
As noted, Randy Hampton serves as the Employer’s exec-
utive director and chief executive officer. Hampton testified
1186 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
10 The CTA staff consists of art therapists, dance/movement thera-
pists, a recreation therapist, and an occupational therapist.
11 There is an exception in the case of the adolescent unit where
there is one RN and one LPN on the day shift. If absent the LPN
is replaced with an RN.
12 These are ‘‘base’’ staffing patterns and staff may be increased
due to patient acuity.
13 The psychosocial assessment is done by a social worker, and the
creative therapeutic activities assessment is done by a member of the
CTA staff.
14 See P. Exhs. 1 and 2.
15 See P. Exh. 1, NSG-I-3.0.1.
16 The Employer’s director of nursing, Majorie Witt, testified that
such reassignments occur about once a week and are necessitated by
patient emergencies, staff absences, and patient acuity levels.
that the Employer’s organizational structure is a ‘‘matrix’’
with reporting relationships delineated by department and by
unit/program. Hampton has overall responsibility for the Em-
ployer’s administrative, financial, and clinical operations. Jim
Aranda serves as the Employer’s administrator and chief fi-
nancial officer. Administrator Aranda, the medical director,
and the directors for clinical services, nursing, human re-
sources, community relations, and dietary services report to
Executive Director Hampton. The directors for pharmacy,
housekeeping, and environmental services, and the business
office manager, as well as various other business areas, re-
port to Administrator Aranda. The four unit chiefs and their
team leaders report to the medical director, all of whom are
physicians. The directors for social services, psychology, cre-
ative therapeutic activities, and the four program directors re-
port to the director of clinical services. Four nursing care co-
ordinators, three clinical nursing supervisors, and the staff
development coordinator report to the director of nursing, all
of whom are registered nurses (RNs).
The Employer provides a multidisciplinary treatment ap-
proach in its four units and offers several treatment modali-
ties including individual and group therapy, family therapy,
psychopharmacology (medication), milieu therapy (safe, sup-
portive patient environment) and self-help/support groups
(e.g., Alcoholics Anonymous). With respect to clinical staff-
ing patterns, the units are quite similar. Each unit has a unit
chief, team leader, program director, a nursing care coordina-
tor, one psychologist, three social workers, and three creative
therapeutic activities staff members (CTA staff).10 In addi-
tion, on the day shift and evening shift, there are two RNs11
and two or three mental health workers; on the night shift,
there is one RN and one or two mental health workers.12 In
addition to the foregoing members of the multidisciplinary
treatment team, there is an education coordinator who works
on the adolescent unit, an eating disorder coordinator who
works on the behavioral disorders unit, and an addiction
counselor who splits his time between the adolescent unit
and the behavioral disorders unit. The Employer also em-
ploys a pharmacist, a biofeedback therapist, a registered di-
etician, and a discharge planner who provides services for all
the units. The parties stipulated that the unit chiefs and team
leaders (physicians), program directors (one psychologist and
three social workers), and nursing care coordinators (RNs)
are excluded from any unit based on supervisory status. The
parties stipulated that all members of the multidisciplinary
treatment team are professional employees, with the excep-
tion of the mental health workers and the licensed practical
nurse; the parties agreed that they are nonprofessional em-
ployees. The parties stipulated to the professional status of
the pharmacist, the biofeedback therapist, and the registered
dietician, but they could not agree as to the professional sta-
tus of the discharge planner.
Within 8 hours of admission, a patient receives a nursing
assessment conducted by an RN, which includes an initial
nursing care plan for the patient. Within 24 hours, a physical
examination is conducted by a physician. Within 7 days, the
patient also receives separate psychiatric, psychosocial, and
creative therapeutic activities assessments.13 All patients re-
ceive psychological and nutritional screenings and, if nec-
essary, complete assessments. The various assessments are
placed in the patient’s medical record (chart) which is main-
tained at the nursing station on the patient’s unit. Within 7
days of admission, the multidisciplinary treatment team
meets in clinical ‘‘rounds’’ to formulate a treatment plan
based on the various assesments. The treatment plan contains
specific treatment interventions, with goals and objectives
tailored to the patient. Each discipline represents a compo-
nent of the treatment plan which, through interdisciplinary
collaboration and coordination, maximizes the benefits of the
patient’s hospitalization. The treatment plan is written on a
special form and placed in the patient’s chart. The various
disciplines complete progress notes related thereto, which are
kept in the patient’s chart. The multidisciplinary team re-
views the treatment plan every 7 days. In addition to the var-
ious assessments, treatment plan and progress notes, the pa-
tient’s chart also contains admitting forms, patient care mon-
itoring forms, medication and special precaution orders, vital
signs forms, observation flow sheets, laboratory reports and
a discharge/aftercare plan.
The Employer has a department of nursing headed by a di-
rector of nursing. The Nursing Department Policy Manual
contains numerous, detailed policies and procedures which
apply to the nursing staffs.14 The department of nursing uti-
lizes the American Nursing Association Standards of Psy-
chiatric and Mental Health Nursing Practice.15 Four nursing
care coordinators, three clinical nursing supervisors, a staff
development coordinator, and an administrative assistant re-
port directly to the director of nursing. With the exception
of the administrative assistant, all are RNs and Section 2(11)
supervisors. The nursing staff provides nursing care 24 hours
a day, 7 days a week, 365 days a year, on all four units. The
State of New York and the Joint Commission require that
every nursing unit has at least one RN in charge at all times.
There are three shifts for nursing staffs: 8 a.m. to 4:30 p.m.
(day); 4 p.m. to 12:30 a.m. (evening); and 12 a.m. to 8:30
a.m. (night). Nursing staffs work every other weekend, and
four of eight holidays a year. Nursing staffs are subject to
a mandatory overtime policy; RNs are the only professional
employees so affected. Nursing staffs are assigned to specific
units, but they may be reassigned to another unit for an en-
tire shift or part of a shift due to staffing needs.16
Each unit has a nursing care coordinator who has 24-hour
accountability for the standard of nursing care provided by
the nursing staff on her unit. The RNs, the LPN, and the
mental health workers report directly to her. The nursing care
coordinator works Monday through Friday, 8 a.m. to 4:30
p.m., and, at her discretion, she may ‘‘flex’’ her hours into
the evening shift. There is a clinical nursing supervisor as-
signed to the evening shift and to the night shift; she is
1187HOLLISWOOD HOSPITAL
17 Director of Nursing Witt testified regarding the duties of the
clinical nursing supervisor using vague descriptions and offering few
specifics. In the absence of a clinical nursing supervisor, an RN is
designated the ‘‘Senior Nurse’’ on the evening and night shifts.
18 For other professional job classifications, the Employer requires
a minimum of a Bachelor’s degree, except for the recreation thera-
pist.
19 See Emp. Exh. 62, ‘‘Position Description’’ for RNs.
20 It should be noted that under the ‘‘Standards of Practice’’ con-
tained in the Department of Nursing Policy Manual, the section enti-
tled ‘‘Psychotherapy’’ has been deleted by hand; the Employer’s
nursing staffs do not function as psychotherapist.
21 This requires all nursing staffs to remain one-half hour into the
next shift.
22 ‘‘Nursng staffs’’ refers to the RNs, the LPN, and the mental
health workers who report to the nursing care coordinator on their
unit.
23 The patient’s chart has a section marked ‘‘Progress Notes’’
where all disciplines make entries related to their component of the
multidisciplinary treatment plan.
24 An RN must cosign any entry made by a mental health worker,
and an RN or LPN must make an entry regarding medication or
medical status.
25 The sole LPN, assigned to the adolescent unit, can administer
medication. No member of any other unit job classification is al-
lowed to administer medication.
26 One mental health worker may attend rounds depending on pa-
tient acuity on the unit.
27 On at least one unit (dual diagnosis unit), the nursing care coor-
dinator writes the nursing care plan component of the treatment plan.
deemed to be responsible for the ‘‘overall direction and lead-
ership’’ of the nursing staff on her shift and is the ‘‘des-
ignee’’ of management on her shift.17 The staff development
coordinator has overall responsibility for the education and
training of the nursing staffs, and she participates in training
other disciplines and in quality assurance activities.
The Employer’s requirements for an RN are graduation
from an accredited school of professional nursing and a cur-
rent license from the State of New York. The Employer pre-
fers a Bachelor’s degree, experience in a psychiatric nursing
unit, and 1 year’s experience as an RN.18 The RN provides
professional nursing care utilizing nursing methods and tech-
niques on his or her assigned unit.19 These include the
‘‘nursing process’’ (assessment, planning, implementation,
and evaluation) related to the individual patient’s nursing
care plan, patient/family teaching, and the maintenance of a
therapeutic milieu for the patient.20
At the start of every shift, the nursing staffs receive the
‘‘inter-shift report’’ from the previous shift.21 The intershift
report is a status report on the unit which includes admis-
sions, discharges, patient incidents and special orders. On
every shift, an RN and a mental health worker are assigned
to respond to a ‘‘code white’’ (patient psychiatric emer-
gency) on other units. On every shift, each patient is as-
signed either an RN or a mental health worker as his or her
‘‘primary contact’’ for the shift. The primary contact must
meet with the patient and assess the patient’s condition and
behavior. For every admission, an RN must complete a nurs-
ing assessment record which includes the initial nursing care
plan for the patient. The nursing assessment provides a de-
tailed medical history, past and present, of the patient’s phys-
ical and mental health, and substance abuse, if any. The RN
conducts the patient’s initial orientation to the unit. For every
discharge, the RN must meet with the patient to ensure his
or her understanding of the discharge/aftercare plan and
make a record of their meeting.
On every shift, an RN must complete a patient acuity as-
sessment form which reports the patient census and individ-
ual patient acuity ratings (reflects the severity of the patient’s
symptoms and special orders related thereto); the nursing
care coordinator can recommend that additional staff be as-
signed to the unit based thereon. The patient care monitoring
form must be completed by the nursing staffs for each pa-
tient for each shift.22 If a member of the nursing staffs other
than an RN completes the form, an RN must cosign it. This
form reflects the patient’s status (e.g., special orders) and the
patient’s responses to interventions. These form are used for
the intershift report and clinical rounds. In addition to the pa-
tient care monitoring form, an RN must make an entry on
the patient’s progress notes a minimum of once in 24
hours.23 In the following circumstances, the nursing staffs
also must make an entry on the patient’s progress notes: pa-
tient’s response to medication dispensed ‘‘prn’’ (as needed),
off ground passes, therapeutic passes, patient incident, or
change in behavior or medical status.24 The vital signs form
records the patient’s pulse, blood pressure, temperature, and
weight. The observation flow sheets refer to specific ‘‘pre-
cautions’’ or restrictions for the patient, e.g., constant super-
vision related to suicide risk, public area restriction, or
guarterly checks (every 15 minutes). There is a separate ob-
servation flow sheet for each shift (day, evening, and night)
with sections marked by the quarter hour for observation
notes. The vital signs form and the observation flow sheets
are completed by nursing staffs and are maintained in the
‘‘Nursing Observations’’ section of the patient’s chart.
On the day and evening shifts, one RN is assigned as the
‘‘charge nurse’’ and the other RN is assigned as the ‘‘medi-
cation nurse’’ on the unit.25 On the night shift, the RN must
function in both roles. The medication nurse’s principal func-
tion is the administration of medication on his or her unit.
Virtually all the patients on the intensive treatment unit, and
most of the patients on the dual diagnosis unit, take pre-
scribed medication; and medication is administered on the
other units as well. The Department of Nursing Policy Man-
ual delineates the extensive procedures and documentation
related to the administration of medication. The medication
nurse interacts mostly with physicians. The medication nurse
on the day and evening shifts also serves as a ‘‘primary con-
tact’’ for patients on his or her unit.
On Monday through Friday, from 9 to 9:45 a.m. or 10
a.m., clinical rounds are held on each unit. The nursing care
coordinator and the charge nurse attend as the representatives
of the nursing staffs.26 At rounds, the charge nurse usually
reads the nursing intershift report from the evening and night
shift. Each patient’s status is discussed briefly, and specific
patient problems can be raised by any team member. As
noted, the team formulates the individual treatment plans at
rounds; each discipline proposes its component of the plan
in response to the specific problems identified in the patient’s
psychiatric assessment. The treatment plan is written on a
special form and placed in the patient’s chart. Either one
team member is assigned to write the complete treatment
plan, or a member of each discipline writes his or her com-
ponent of the treatment plan.27 The treatment team also re-
views the treatment plan at set intervals during the patient’s
1188 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
28 Quality assurance/improvement activities are conducted on the
basis of a unit/program or a department.
29 Several witnesses had difficulty attempting to estimate the fre-
quency of teaming or contracts on the various units. It appears that
teaming and contracts occur mostly on the adolescent unit, and to
a lesser extent on the behavioral disorder units.
30 The Employer offered a list of groups coled or alternately led
by ‘‘nursing staffs’’ and other disciplines through Edward Spauster,
its director of clinical services. (See Emp. Exh. 71.) However,
Spauster’s cross-examination related thereto shows that nonunit staff
(e.g., a program director) colead or alternately lead groups with unit
RNs (not a nursing care coordinator or the director of nursing), ex-
cept as mentioned above. (See Spauster, Tr. 1851–1872.) Even if
there was more evidence to show that unit RNs colead or alternately
lead patient groups with other nonsupervisory members of the treat-
ment team, it would not affect my conclusions regarding the appro-
priate bargaining units herein.
31 Director of Nursing Witt estimated that a ‘‘code white’’ occurs
several times a week.
32 See testimony of RNs Daphne James, Doris Brown, Fred
Pelczynski, and Joanne Haws.
hospitalization. Depending on the unit, this review is done
during rounds or in a separate meeting. Immediately after
rounds, the nursing care coordinator or the charge nurse
gives a ‘‘post-rounds report’’ to the other members of the
nursing staffs.
Two units hold multidisciplinary staff meetings on such
topics as policy and procedures issues, administrative mat-
ters, and quality assurance/improvement activities on a week-
ly basis; the other units hold them biweekly or monthly.28
The nursing care coordinator attends, as well as one RN. The
nursing care coordinators conduct meetings for the nursing
staffs only on their units on a biweekly or monthly basis.
During clinical rounds, the treatment team can decide to
‘‘team’’ a patient. ‘‘Teaming’’ is a treatment intervention
whereby two or more members of the patient’s treatment
team confront the patient with certain problematic behavior
in order to reinforce treatment plan goals. Members of the
nursing staffs are often involved in teaming a patient with
other members of the treatment team. A teaming can last
from 5 minutes to 30 minutes with an average about 15 min-
utes. The treatment team also can decide to enter into a
‘‘contract’’ with a patient whereby the patient is expected to
self-monitor certain problematic behavior and record data re-
lated thereto; contracts run for 1 to 3 days. The patient’s
contract is kept at the nursing station on the patient’s unit.
The nursing staffs monitor the patient’s compliance with the
contract and keeps other members of the treatment team in-
formed as to the patient’s compliance or noncompliance.29
Although the frequency of contact between RNs and other
members of the treatment team varies by individual and by
unit, it consists mostly of brief conversations regarding pa-
tient behavior on the unit or in a group.
The nursing staffs lead didactic groups for patients, e.g.,
RNs conduct medication education groups. Some mental
health workers colead or alternately lead groups with other
disciplines such as a drama workshop or ‘‘stretch’’ with
CTA staff, or a meal preparation group with the registered
dietician. Although there is some general testimony that
‘‘nurses’’ colead patient groups with other disciplines, the
record evidence does not establish that unit RNs colead or
alternately lead patient groups with other nonsupervisory
members of the treatment team, except on the dual diagnosis
unit where a per diem RN coleads a ‘‘women’s group’’ with
a social worker.30
Other than physicians, RNs are the only members of the
treatment team who can initiate seclusion or restraint for a
patient. The Department of Nursing Policy Manual delineates
the specific procedures and special documentation related
thereto. RNs also can initiate a ‘‘code white’’ (patient psy-
chiatric emergency). All members of the treatment team re-
ceive ‘‘management of the aggressive patient’’ (MAP) train-
ing and are expected to respond to a ‘‘code white’’ on their
unit. However, only nursing staffs are assigned by shift to re-
spond to a ‘‘code white’’ on other units. Either the charge
nurse or the nursing care coordinator functions as the leader
of a ‘‘code white’’ and assigns roles to the other participants
(e.g., to act as the ‘‘communicator’’ or to hold the patient’s
limbs).31 RNs can initiate body searches and room searches.
Nursing staffs must be trained in cardiopulmonary resuscita-
tion, and only physicians and nursing staffs respond to a
‘‘code blue’’ (patient medical emergency). Nursing staffs
monitor patients in the process of drug detoxification, which
requires specific documentation. Only RNs can initiate intra-
venous therapy and prepare and monitor a patient receiving
electroconvulsive therapy. RNs must report and document
medication errors and any adverse drug reactions, which are
reviewed by the pharmacy and therapeutics committee.
There is considerable record evidence regarding the con-
tact between RNs and other professional employees who pro-
vide patient services on a unit. The record evidence shows
that the multidisciplinary treatment approach encourages col-
laboration and cooperation among members of the treatment
team. However, the record evidence also shows that the col-
laboration and cooperation associated with a multidisci-
plinary treatment approach primarily affects the RNs as-
signed to the day shift, as there is minimal contact between
RNs and other professionals on the evening shift and vir-
tually none on the night shift.32
Director of Nursing Witt testified regarding the differences
in the role of an RN in an acute care hospital and an RN
at the Employer’s facility, based on her experience. Witt tes-
tified that at the Employer’s facility, although the RN exer-
cises independent judgment in designing and implementing
the nursing plan of care, it is consistent with and supports
the multidisciplinary treatment philosophy. At an acute care
hospital, the RN designs and implements the nursing plan of
care independently of the individual treatment plans devel-
oped by each distinct discipline. Witt also testified that at the
Employer’s facility, there is much more ‘‘collaboration and
sharing’’ between RNs and other disciplines related to the
multidisciplinary treatment plan. At an acute care hospital,
although working in the same environment, RNs and other
disciplines do not necessarily share the outcome of their
therapeutic interventions. Witt also testified that patients are
admitted to acute care hospitals because they require nursing
care, whereas patients are admitted to psychiatric facilities
because they require treatment by several disciplines. In a
psychiatric facility, the maintenance of a ‘‘therapeutic mi-
lieu’’ (safe, supportive patient environment) is a key treat-
ment approach facilitated by nursing staffs, which is not pro-
vided in an acute care hospital.
The Employer employs 22 ‘‘regular’’ RNs and 47 per
diem RNs. No other professional job classification relies so
1189HOLLISWOOD HOSPITAL
33 See Emp. Exh. 13, ‘‘Nonsupervisory Staff as of March 1993.’’
34 Although the highest requirement for the position is a Bach-
elor’s degree, there are several mental health workers who have ad-
vanced degrees. Director of Nursing Witt testified that a mental
health worker’s responsibilities can vary according to the individ-
ual’s abilities.
35 The gymnasium used by the patients consists of a weight room
and a recreation room; a CTA staff member accompanies patients to
the weight room while the mental health worker accompanies them
to the recreation room.
36 See Emp. Exh. 73, ‘‘Nonsupervisory Staff as of March 1993.’’
37 The director also serves as a unit psychologist.
38 The Employer subcontracts the psychological testing to persons
known as ‘‘psychology technicians.’’ As noted, the parties stipulated
that they are not employees of the Employer and should be excluded
from any unit found appropriate herein.
39 The psychologists do not offer individual psychotherapy to pa-
tients; rather, they act as an adjunct to the individual psychotherapy
provided by the unit psychiatrists.
heavily on per diem employees. The Employer employs 33
non-RN professional employees, 14 non-RN professional per
diem employees, 51 ‘‘regular’’ nonprofessional employees,
and 22 nonprofessional per diem employees.33
The other members of the nursing staffs are the LPN and
the mental health workers. There is one LPN who is assigned
to the adolescent unit. The Employer’s requirements for the
LPN position is a New York State license as a practical
nurse, with related experience preferred. The LPN performs
virtually all the functions of an RN, under the supervision of
an RN, including the administration of medication; however,
the LPN cannot serve as a charge nurse or perform the nurs-
ing assessment. When the LPN is absent, he is replaced by
an RN. The incumbent LPN, who is also a certified addiction
counselor, coleads a substance abuse group with his unit’s
program director.
As noted, there are mental health workers assigned to
every unit, on every shift. The Employer has a single job de-
scription listing three titles: mental health worker, senior
mental health worker, and mental health counselor. The Em-
ployer’s requirements vary with the title: an Associate’s de-
gree in mental health and related experience for the mental
health worker; Bachelor’s degree in mental health for the
senior mental health worker; a Bachelor’s degree and 3 to 5
years’ experience for mental health counselor. Although it
would appear that these titles, and respective requirements,
are utilized to set initial salaries, the Employer does not use
these titles to differentiate among ‘‘mental health workers’’
regarding their duties and responsibilities.
The mental health workers provide direct patient care
under the supervision of the nursing care coordinator or the
charge nurse. In addition to the duties and responsibilities
discussed above, the mental health workers assist in the ad-
mission of patients by orienting patients to the unit, perform-
ing body/belongings searches, obtaining routine laboratory
specimens, and taking vital signs. They also monitor patient
safety factors on the unit and assist in special observation
procedures for patients at risk. Some mental health workers
conduct community meetings and goals groups (referred to
as ‘‘milieu’’ groups) on the units.34 Mental health workers
accompany patients to the dining room and gymnasium,35 as
well as to appointments inside and outside the Employer’s
facility. The parties agreed that the mental health workers are
nonprofessional employees. There are 37 mental health work-
ers and 9 per diem mental health workers.36
The Employer’s requirements for a unit psychologist are a
Doctorate in applied psychology, a New York State license
as a psychologist, and 1 year’s experience in an in-patient
psychiatric setting. There are three psychologists, all of
whom work 4 days a week, Monday through Friday. The
psychologists report to the director of the psychology depart-
ment.37 The psychologists refer patients for psychological
testing and analyze and report the findings to the treatment
team.38 The psychologists lead ‘‘skill training’’ groups for
patients, such as anger management groups. They lead about
two patient groups a day for their unit, and they record
progress notes in the patients’ charts once a week as related
thereto. They also meet individually with patients on a con-
sultation basis,39 they develop behavioral management plans
(‘‘contracts’’) for individual patients, and they serve as the
‘‘cognitive behavioral treatment’’ expert for the treatment
team. In addition, they participate in formal marketing efforts
as organized by the community relations department.
The Employer’s requirements for a social worker are a
Master’s degree in social work and experience working with
family and group modalities. There are 11 social workers
who report to the director of the social work department. The
eating disorder coordinator also reports to the director of so-
cial work and functions much like a social worker on her
unit. There are three social workers assigned to each unit.
They work 5 days a week, Monday through Friday; 1 day
a week they ‘‘flex’’ their hours so as to work one evening
(e.g., 12 noon to 9 p.m. rather than 9 a.m. to 5 p.m.). The
social workers do the required psychosocial (comprehensive
social work) assessment on every patient. The social workers
lead various patient groups including women’s group, sur-
vivors’ group, and family roles group; and they meet with
patient families. They make weekly progress notes and
record all family contacts. They develop individual
discharge/-aftercare plans in consultation with the treatment
team. They also participate in formal marketing efforts.
The CTA staff consists of one recreation therapist, one oc-
cupational therapist, four art therapists, and three dance
therapists. The CTA staff report to the director of CTA, who
also serves as a dance therapist. The CTA staff works 5 days
a week, including 1 weekend day. Two CTA staff members
work until 8 p.m., 4 days a week.
The Employer’s requirements for a recreation therapist are
a minimum of an Associate’s degree in recreation therapy,
2 years’ experience in recreation therapy, and registration
with the National Therapeutic Recreation Society. The Em-
ployer’s requirements for an occupational therapist are a
Bachelor’s degree in occupational therapy and current certifi-
cation and registration by the ‘‘A.O.T.A.’’ The Employer’s
requirements for an arts therapist are a Master’s degree in art
therapy and registration as an art therapist. The Employer’s
requirements for a dance/movement therapist are a Master’s
degree in movement therapy and registration as a movement
therapist. All CTA staff do the required creative therapeutic
activities assessment on assigned patients. They plan, orga-
nize, and conduct therapeutic programs in their specialties for
the patients. They also formulate individual treatment plans
and record patient responses thereto in patient charts. In ad-
dition, the CTA staff have marketing duties and provide clin-
ical in-service training. The recreation therapist is assigned to
1190 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
40 As noted, the director of CTA is assigned to a unit as a
dance/movement therapist.
41 At the time of the hearing, the addiction counselor had tendered
his resignation, and no replacement had been found for him.
42 There are per diem pharmacists who work ‘‘occasionally’’ in the
evening and on weekends.
the dual diagnosis unit but runs groups for all units. The oc-
cupational therapist is assigned to the intensive treatment
unit. There is an arts therapist and a dance/movement thera-
pist assigned to each unit.40
The Employer’s requirements for the education coordinator
are a Master’s degree in special education and New York
State certification in special education, and a minimum of 3
years’ experience in special education. The education coordi-
nator is assigned to the adolescent unit and report to the pro-
gram director. She serves as the liaison between the Em-
ployer and the adolescent patient’s home school system and
his aftercare/discharge school system, if different. The edu-
cation coordinator oversees the special education program
provided by the New York City Board of Education at the
Employer’s facility for the adolescent patients during their
in-patient stay to ensure that the clinical philosophy and
goals are supported in the special education program. She
also serves as the expert in psychosocial education for the
treatment team.
The Employer’s requirements for the eating disorder coor-
dinator are a Master’s degree, or ‘‘Ph.D. prepared,’’ and 5
years’ experience. The eating disorder coordinator is assigned
to the behavioral disorders unit; she works part time. Al-
though the Employer’s position description states that the
eating disorder coordinator reports to the program director,
the incumbent reports to the director of social work as she
has her Master’s degree in social work and is assigned a
small social work caseload in addition to her other duties. In
conjunction with the program director, she coordinates the
clinical management and marketing efforts of the eating dis-
order program. She serves as the eating disorder specialist
for the treatment team, leads eating disorder groups, and
oversees such groups led by other disciplines. In conjunction
with the community relations department, she engages in var-
ious marketing efforts for the eating disorder program.
The Employer’s requirements for the addiction counselor
are a Bachelor’s degree (Master’s preferred), New York State
certification, and 2 years’ experience. The addiction coun-
selor splits his time between the behavioral disorders unit
and the adolescent unit and reports to their program direc-
tors.41 The incumbent addiction counselor works 32 hours a
week. He serves as the liaison with the self-help community
and is an expert on ‘‘12-step’’ programs. He facilitates pa-
tient groups on topics relevant to addiction and coordinates
12-step meetings at the Employer’s facility. In conjunction
with social workers, he facilitates family education programs
related to addiction.
In addition to the foregoing members of the multidisci-
plinary treatment team who are assigned to specific units,
there are other professionals who provide services related to
patient care for all the units: the pharmacist, the biofeedback
therapist and the registered dietician. As noted, the parties
did not agree as to the professional status of the discharge
planner.
The Employer’s requirements for the pharmacist are a
Bachelor’s degree in pharmacy and New York State license
and registration. The pharmacist works Monday through Fri-
day, from 8 a.m. to 4 p.m., and she reports to the director
of pharmacy.42 The pharmacist compounds and dispenses
medications and pharmaceutical supplies for all units. She
performs monthly inspections of the nursing stations and
medication rooms. The pharmacist maintains records known
as ‘‘patient profiles’’ which are kept in the pharmacy. She
distributes medication literature to the nursing staffs. Along
with the director of pharmacy, she collects data on medica-
tion administration errors which pertains to nursing staffs
only. She serves as a member of the pharmacy and thera-
peutics committee, along with the executive director, the lab-
oratory manager, a physician, the registered dietician, and a
nursing care coordinator. This committee is mandated by the
Joint Commission and its members review and analyze all
incidents of medication administration errors and adverse
drug reactions and make recommendations for action related
thereto.
The Employer’s requirements for the biofeedback therapist
are a Bachelor’s degree, 2 years’ experience, and member-
ship in the Biofeedback Certification Institute of America.
The biofeedback therapist reports to the director of psychol-
ogy. She conducts biofeedback assessments and training ses-
sions for patients from all units who are referred by the treat-
ment team. She attends rounds to report on a patient’s
progress and records such progress in the patient’s chart.
The Employer’s requirements for the registered dietician
are a Bachelor’s degree in nutrition and food service, reg-
istration with the American Dietetic Association, and 1
year’s clinical experience. She works from 9 a.m. to 5 p.m.
and reports to the director of the food services department.
The registered dietician conducts a nutritional screening on
all patients, with a full assessment if necessary. She develops
a nutrition care plan for patients with special needs, and she
attends clinical rounds on all units on a regular basis to mon-
itor and evaluate the patient’s progress related thereto. The
registered dietician conducts patient education groups and in-
service training related to nutritional issues. She works most
closely with the eating disorder program on the behavioral
disorders unit. The registered dietician also spends about 20
percent of her time working with the staff of the food serv-
ices department to develop and evaluate menus for all pa-
tients, as well as those with special dietary needs.
. . . The Employer’s requirement for the discharge plan-
ner is a minimum of a Bachelor’s degree in the social
sciences (e.g., psychology or social work). The discharge
planner reports to the director of social work. The incumbent
discharge planner has a Master’s degree in social work. Ex-
ecutive Director Hamptor testified regarding the duties and
responsibilities of the discharge planner. In collaboration
with the social work staff and the multidisciplinary treatment
team, the discharge planner identifies community resources
for utilization in the discharge/aftercare plans developed for
all patients. She also clarifies insurance coverage for
aftercare programs. She attends the weekly discharge plan-
ning rounds held on all units, along with the director of so-
cial work, program director, unit chief, and team leader. At
times, the director of community relations and/or community
relations representatives also attend the discharge planning
rounds as the Employer seeks to use community resources
1191HOLLISWOOD HOSPITAL
43 There are 12 social workers on staff, all of whom are profes-
sional employees. Hampton first testified that the discharge planner
is ‘‘sporadically’’ assigned to substitute for a social worker; Hamp-
ton later testified that she does so ‘‘infrequently’’ or ‘‘a couple of
times this year.’’ However, Hampton did not elaborate as to the du-
ration of such assignments.
44 RNs and mental health workers do not require secretarial serv-
ices.
45 As there is no longer a dispute regarding the professional status
of the community relations representatives and the referral coordina-
tors, there is no need for a lengthy analysis regarding such status.
I find that the record evidence supports the finding of the profes-
sional status of the community relations representatives and referral
coordinators.
who make referrals to the Employer’s facility as part of the
Employer’s discharge/aftercare plans. The referral coordina-
tors serve as a primary resource for the discharge planner to
identify appropriate aftercare referrals, but she also identifies
new community resources through her own community con-
tacts and visits to community programs.
Hampton also testified that the discharge planner exercises
independent judgment and discretion in the selection of ap-
propriate aftercare referrals for individual patients; for exam-
ple, the treatment team member will provide a ‘‘picture’’ of
the patient and goals for the patient, and the discharge plan-
ner will decide the community resources appropriate for the
patient. Hampton testified that the duties of the discharge
planner are intellectual in character, such as the development
of new community resources which requires creativity, the
clarification of insurance coverage for aftercare programs
which requires negotiation skills, and the visits to special
programs in the community which reguires independent judg-
ment in their evaluation for use in discharge/aftercare plans.
The discharge planner receives MAP (management of the ag-
gressive patient) training and is expected to respond to a
‘‘code white.’’
In addition to the aforementioned duties and responsibil-
ities, the discharge planner also can substitute for an absent
member of the social work staff.43 When substituting for a
social worker, the discharge planner can be assigned a pa-
tient caseload, conduct the required social work (psycho-
social) assessment, and lead and colead patient groups. Prior
to the conferment of her Master’s degree, the discharge plan-
ner’s work as a substitute social worker had to be supervised
by, and her work product (e.g., a psychosocial assessment)
had to be cosigned by, a Master’s level social worker.
. . . .
. . . I find that the discharge planner is a professional em-
ployee within the meaning of the Act.
The Employer also employs unit secretaries and unit re-
ceptionists assigned to specific units. The Employer has no
educational requirements for these two positions, and the par-
ties agree that they are nonprofessional employees. There is
a unit secretary assigned to each unit. They provide secretar-
ial assistance for unit staff members, other than nursing
staffs;44 assemble materials for reports and questionnaires;
maintain certain patient records; and order supplies. They
take minutes at unit staff meetings. There are two unit recep-
tionists who cover two units each (one per floor). They pro-
vide ‘‘coverage’’ at the nursing stations. They also maintain
certain patient records, schedule patient appointments inside
and outside the Employer’s facility, and screen unit tele-
phone calls. Both the unit secretaries and the unit reception-
ists provide ‘‘back-up’’ coverage for the nursing stations.
The Employer also employs professional employees in the
department of community relations. Its director, also known
as the director of marketing, reports to Executive Director
Hampton. The community relations representatives (also
known as ‘‘marketing associates’’) report to the director of
marketing. The director of intake/referral and the admitting
supervisor also report to the director of marketing. The refer-
ral coordinators report to the director of intake/referral. The
parties stipulated to the supervisory status of the director of
intake/referral and the admitting supervisor. At the hearing,
the Employer took no position as to the professional status
of the community relations representatives and the referral
coordinators, and the Petitioner took the position that they
are professional employees. However, in its brief, the Em-
ployer agreed that they are professional employees.45
The function of the community relations department is to
‘‘maintain a census,’’ that is, to ensure maximum patient ad-
missions. The Employer’s requirements for a community re-
lations representative are a Bachelor’s degree (Master’s level
preferred), experience, and affiliation/certification related to
the field (e.g., a certified addiction counselor). They function
like ‘‘account executives’’ in developing new referral ac-
counts and maintaining existing accounts, and they handle
the Employer’s public relations through the media, advertis-
ing, community education events, and participation in com-
munity organizations. They have no contact with patients,
but they have contact with the treatment teams through mar-
keting meetings held weekly on each unit. However, the
nursing staffs do not attend these marketing meetings. They
have designed and implemented professional education series
for the public utilizing members of the treatment teams. Two
of the three incumbent community relations representatives
have Master’s level degrees; the other has a Bachelor’s de-
gree and is a certified addiction counselor and a certified em-
ployee assistance professional.
The Employer’s requirements for a referral coordinator is
a Master of Social Work, or a Bachelor of Science in Nurs-
ing, degree with psychiatric experience. The referral coordi-
nators receive calls from various referral sources and screen
individuals for admission. They complete the initial intake
information, make a clinical assessment regarding admission,
consult with a staff physician, and arrange the initial psy-
chiatric interview. They also coordinate admissions with the
staff of the benefits office and the admitting office. The two
referral coordinators cover their office from 8 a.m. to 8 p.m.,
Monday through Friday. Both referral coordinators have a
Master of Social Work degree.
As noted, the admitting supervisor also reports to the di-
rector of marketing. The admitting clerks, receptionists, and
switchboard operators, all nonprofessional employees, report
to the admitting supervisor. The Employer requires a high
school diploma and experience for the admitting clerks; there
are no educational requirements for the receptionist and
switchboard operator positions. The admitting clerks prepare
all necessary paperwork related to a patient admission, secure
necessary signatures from patient or family, enter admission
data into a computer, and notify the unit of an admission and
patient arrival. They staff the admitting office from 9 a.m.
to midnight, 7 days a week. From 8 p.m. to midnight, and
1192 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
46 The referral coordinator completes the first page, which contains
patient and family identification data, and the patient finance coun-
selor completes the second page, which contains insurance coverage
and verification information. Contrary to the assertion in the Em-
ployer’s brief that the patient finance counselor has ‘‘significant
work-related contact with referral coordinators,’’ although these em-
ployees do complete portions of the same log/form, the record evi-
dence does not reflect the degree or frequency of personal contact
between these employees.
47 In response to her counsel’s questions regarding ‘‘work-related
contact’’ among the various staff members employed in the business
office, data processing, and medical records, Executive Director
Hampton used such vague terms as ‘‘interface’’ and ‘‘interact’’ in
her testimony which do not reflect the degree or frequency of such
contact among unit employees.
on weekends, the admitting clerks receive referral calls, do
initial screening (nonclinical), and forward calls to referral
coordinators if necessary. The receptionist sits in the lobby
and receives all patients and visitors, directs them to the
proper destination, and notifies the staff of the arrival of ap-
pointments and visitors. There is a receptionist on duty from
8 a.m. to midnight. The admitting clerks serve as the recep-
tionist on weekends. The switchboard operator answers the
telephone for the entire facility.
The business office manager reports to Administrator
Aranda. The benefits office supervisor and the accounts re-
ceivable supervisor (also known as the patient accounts su-
pervisor) report to the business office manager, all stipulated
supervisors. There is one patient finance counselor, who re-
ports to the benefits office supervisor. There is one patient
accounts representative and one senior patient accounts rep-
resentative who report to the accounts receivable supervisor.
The Employer requires a high school diploma, a college de-
gree preferred, and experience for the patient finance coun-
selor; and a high school diploma, college preferred, for the
patient accounts representatives. These employees work
Monday through Friday, from 8 a.m. to 4 p.m. The parties
agreed that they are nonprofessional employees.
The patient finance counselor calls health insurance com-
panies to verify and precertify coverage for patient admis-
sions. They complete part of a two-page form, the ‘‘Insur-
ance Communication Log,’’ which is forwarded to them by
a referral coordinator.46 They meet with the patient and/or
family regarding insurance coverage and arrange individual
payment plans if necessary. They also maintain a weekly dis-
charge list for all units and distribute it to management staff.
The patient accounts representative processes all accounts re-
ceivable and collects moneys from insurance companies and
patients and/or families. The senior patient accounts rep-
resentative performs these same duties but also serves as the
accounts receivable supervisor in her absence due to illness
or vacation.47
The data processing supervisor, the accounts payable coor-
dinator, and the payroll representative report to Administrator
Aranda. There is one data processing clerk who reports to
the data processing supervisor, who is a stipulated super-
visor. The parties agreed that the data processing clerk, the
accounts payable coordinator, and the payroll representative
are nonprofessional employees. These three employees work
from 8 a.m. to 4 p.m., Monday through Friday, and share an
office with the data processing supervisor. The data process-
ing clerk compiles and processes data from various depart-
ments using software known as the Meditech Information
System. He also serves as the data processing supervisor in
her absence due to illness or vacation. The Employer re-
quires a college degree and computer knowledge and experi-
ence, for the data processing clerk position. The accounts
payable coordinator receives and processes purchase req-
uisitions, processes invoices and voucher packages, and se-
cures timely payments for vendors. The Employer requires a
high school diploma, college preferred, and related experi-
ence for the accounts payable coordinator position. The pay-
roll representative processes all paperwork necessary to the
generation of biweekly payroll and performs certain purchas-
ing functions. The Employer requires a high school diploma,
and related experience for the payroll representative position.
The director of the housekeeping department reports to
Administrator Aranda. Housekeepers and floormen-
/projectmen report to the director of housekeeping. They
maintain assigned areas in a clean, sanitary, and orderly con-
dition. In addition, the floormen/projectmen periodically strip
and buff floors and shampoo rugs throughout the facility.
The housekeeping staff are given instructions on how to
interact appropriately with psychiatric patients and are ex-
pected to report ‘‘problems’’ to the nursing station, for ex-
ample, the discovery of contraband in a patient’s room, or
the refusal of a patient to leave a room for cleaning pur-
poses. The housekeeping staff works 7 days a week, from 8
a.m. to 4 p.m. on weekdays, and from 11 a.m. to 7 p.m. on
weekends. Some housekeeping staff work from 4 p.m. to 8
p.m. on weekdays in the administrative office areas. There
are no educational requirements for the housekeepers and
floormen/projectmen positions.
In addition, the central supply clerk reports to the director
of housekeeping. The central supply clerk distributes office
and medical supplies and the mail, transports patients and
staff to and from airports, appointments, community meet-
ings, and court appearances, and cleans and maintains hos-
pital vehicles. By virtue of his duties, he can come in contact
with employees in numerous other job classifications. The
Employer’s requirements for the central supply clerk position
are a high school diploma, a driver’s license, and transpor-
tation experience. The parties agree that the central supply
clerk is a nonprofessional employee.
The director of the environmental services (maintenance)
department, who is also the Employer’s safety officer, re-
ports to Administrator Aranda. Four maintenance mechanics
report to the director of environmental services. The mainte-
nance mechanics maintain and repair the Employer’s phys-
ical plant and grounds including electrical, heating, ventila-
tion, and air-conditioning systems, plumbing fixtures and
sanitary systems, and fire detection and firefighting equip-
ment, and dietary kitchen equipment. They perform these
maintenance and repair tasks throughout the Employer’s fa-
cility. They work from 7 a.m. to 3 p.m., and they rotate ‘‘on
call’’ for evenings and weekends. The Employer requires a
high school diploma, or equivalent, and related building
maintenance experience. The parties agreed that the mainte-
nance mechanics are nonprofessional employees.
The manager of medical records-managed care, a stipu-
lated supervisor, reports to Executive Director Hampton.
Two medical transcriptionists, a medical records technician,
a medical records clerk, and a word processor report to the
manager of medical records-managed care. They work Mon-
day through Friday, 8 a.m. to 4 p.m., or 9 a.m. to 5 p.m.
1193HOLLISWOOD HOSPITAL
48 The Employer’s job description does not list this responsibility.
In any event, no party asserts that the medical records technician is
a professional employee and the record evidence provides no basis
for such finding.
49 Hampton was unable to testify as to how such accreditation is
secured.
50 Most patients eat their meals in the patient/staff cafeteria.
51 As noted, the parties stipulated that the administrative assistants
to Executive Director Hampton and to the director of human re-
sources are confidential employees and excluded from any unit.
The parties agreed that they are nonprofessional employees.
The medical transcriptionists primarily transcribe three docu-
ments, the psychiatric admission and discharge summaries
(dictate by a physician), and the psychosocial history (dic-
tated by a social worker). In the course of their duties, they
may need to contact a physician or social worker. The Em-
ployer has no educational requirements for the medical
transcriptionist position, although a secretarial school grad-
uate is preferred.
The medical records technician audits closed medical
records (patient charts) for accuracy, completeness, and time-
liness and notifies professional staff of deficiencies to be cor-
rected, codes diagnoses for statistical purposes, and compiles
data from medical records for reports. According to Execu-
tive Director Hampton, the medical records technician also
selects documents from medical records for release pursuant
to subpoenas issued to the Employer, and she must exercise
independent judgment in this process.48 In the course of her
auditing duties, the medical records technician has contact
with professional staff, primarily clinicians other than nursing
staffs. The Employer requires a high school diploma and
computer experience for the medical records technician. In
addition, the Employer requires an ‘‘accredited records tech-
nician’’ (A.R.T ) for the position.49
The medical records clerk processes legal admission pa-
pers, assembles discharge records, files and retrieves medical
records, and performs other clerical tasks. The word proc-
essor extracts data from medical records for a variety of re-
ports including daily census reports, monthly statistical re-
ports, and quality assurance reports. The Employer requires
a high school diploma and related experience for the medical
records clerk and the word processor positions. The duties
and responsibilities of these two positions do not require
contact with any employees outside of the medical records
department.
The director of the dietary department, also known as food
services, reports to Executive Director Hampton. The parties
stipulated that the director of dietary, and the supervisor of
dietary who reports to him, are supervisors. The registered
dietician and the dietary technician report to the director of
dietary. The cooks and dietary assistants report to the super-
visor and the director. The dietary department prepares and
serves food for patients and staff, 7 days a week. The duties,
responsibilities, and educational background of the registered
dietician have been discussed above. The dietary technician
spends about 35 to 45 percent of her time in the Employer’s
main kitchen overseeing the preparation and delivery of
therapeutic diets and food preferences for patients. She also
acts as a liaison between the dietary department and patients
and staff regarding nonnutritional food service issues such as
quality, service, and food preferences, and she visits the
treatment units in that role. The Employer’s requirements for
the dietary technician are a Bachelor’s degree in nutrition
and food service, with experience preferred. The parties
agreed that the dietary technician is a nonprofessional em-
ployee.
The dietary assistants assemble and distribute food in the
patient/staff cafeteria and deliver trays to the treatment units
for patients who are unable to leave the unit for meals.50
They also wash dishes, clean, and maintain sanitary condi-
tions in the kitchen and cafeteria, and process and store food
and supplies. The cooks prepare and cook food in accordance
with the therapeutic diets and ‘‘house’’ menus, maintain the
cooking equipment, and proper inventory levels of food and
supplies. The Employer’s requirement for the dietary assist-
ant and cook positions is a high school diploma or ‘‘GED,’’
with experience required for cooks. The parties agreed that
the dietary assistants and cooks are nonprofessional employ-
ees. There are a total of 17 dietary assistants and cooks, who
work full time or part-time schedules during the hours of 6
a.m. to 8 p.m., and there is one full-time dietary technician.
Several department heads have administrative assistants in-
cluding the medical director and the director of clinical serv-
ices, nursing, and community relations.51 The Employer has
no educational requirements for these positions but prefers
graduates of accredited secretarial schools; the parties agreed
that these administrative assistants are noprofessional em-
ployees. The administrative assistants perform a variety of
administrative support services for their department heads,
and they have contact with staff members of their depart-
ment. The administrative assistant to the director of clinical
services also performs administrative support services for the
directors of psychology, social work, and creative therapeutic
activities. As the administrative assistant to the director of
community relations coordinates community relations con-
ferences, meetings, and tours, she also has contact with clini-
cians other than nursing staffs.
In summary, the record evidence shows that some non-
professionals have little, if any, work-related contact with
other nonprofessionals and professionals, such as certain
business office clericals. Some nonprofessionals have contact
with both nonprofessionals and professionals in their imme-
diate work areas, such as the unit receptionist and unit sec-
retary. A clinical staff member has contact with the other cli-
nicians assigned to his or her unit but has little contact with
clinicians assigned to other units. Among professional em-
ployees, only RNs are assigned on a temporary basis to other
units to ensure adequate staffing levels.
The director of human resources is responsible for staff re-
cruitment. All staff vacancies are posted on the employee
bulletin board. The director of human resources places adver-
tisements in newspapers, checks references, and screens
some applicants. Applicants are interviewed by department
heads and may be interviewed by other supervisory staff.
The director of human resources interviews all applicants
who have accepted offers of employment prior to their hire
date. She also checks New York State license requirements
for all employees, other than nursing staffs and physicians.
The human resources department conducts a general ori-
entation program for new hires. All staff must attend in-serv-
ice training regarding fire safety/disaster and infection con-
trol, and professional and nonprofessional employees can at-
tend these sessions together. In addition, each department
1194 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
52 See Emp. Exh. 70, ‘‘Hourly Wage Rate Range Comparison of
Non-Per Diem Incumbent Employees.’’
53 Executive Director Hampton testified that she was ‘‘not posi-
tive’’ whether CTA staff members were paid for overtime work and
she would have to check on it; however, she did not supplement her
testimony later thereon.
54 On Thanksgiving and Christmas, there is only one clinical staff
member on duty.
provides its own orientation for new hires. The nursing staffs
development coordinator conducts a separate orientation pro-
gram for new nursing staffs and provides in-service training
for nursing staffs. Cardiopulmonary resuscitation (CPR)
training is mandatory for nursing staffs only, and CPR re-
views are offered annually. Management of the aggressive
patient (MAP) training is offered periodically for all clinical
staff members. The dual diagnosis unit offers in-service
training once a month for its clinical staff members, which
is held in lieu of a unit staff meeting.
Wages and benefits packages are administered by the
human resources department. Through Executive Director
Hampton, the Employer offered an exhibit regarding hourly
wage rate ranges between RNs, or mental health workers,
and other employees.52 This exhibit contains nine statements
regarding wage rate ranges, such as: ‘‘Lowest hourly wage
rate paid to RNs is lower than the lowest hourly wage rate
paid to psychologists’’ and ‘‘The hourly wage rates of em-
ployees in the following classifications are within the range
of hourly wages paid to RNs: dietician, referral coordinators,
community relations representatives, eating disorder coordi-
nator, educational coordinator, pharmacist.’’ Hampton testi-
fied that she had directed the human resources department to
provide the Employer’s attorney with actual wage rates, the
Employer’s attorney prepared the exhibit based thereon, and
Hampton reviewed the exhibit for accuracy. The hearing offi-
cer noted on the record that he had requested the Employer
to provide the actual wage rates paid to employees. In the
alternative, the hearing officer requested the Employer to
provide percentage differences in the actual wage rates paid
to employees. The Employer failed to provide any additional
information and took the position that the record evidence re-
garding wages was ‘‘adequate for the Region to make a de-
termination in this proceeding.’’
The Petitioner’s attorney cross-examined Hampton on the
contents of the Employer’s wage rate range exhibit. The ex-
hibit contains the following statement: ‘‘Lowest hourly wage
rate paid to an RN is higher than the lowest hourly wage rate
paid to social workers, addictions counselor, and CTA thera-
pists. Hampton testified that all RNs do not start at the same
hourly wage rate, and that the statement may mean that there
is only one RN who is paid this lowest hourly wage rate and
there is only one social worker who is paid less than this one
RN. The other statements regarding the RNs contain similar
generalized comparisons without regard to the number of
employees so affected. Although these statements show some
overlap in wages between RNs and other professional em-
ployees, they provide insufficient information for a meaning-
ful comparison of wage rates.
The Employer’s wage rate range exhibit also contains the
following statement: ‘‘The hourly wage rate paid to some
employees in the following classifications are lower than the
hourIy wage rate paid to some mental health workers: CTA
therapists, social workers, addiction counselor.’’ This gener-
alized statement made about a single nonprofessional job
classification, and without reference to the number of af-
fected employees, does not provide support for a conclusion
that professional and nonprofessional employees share a
community of interest regarding wages. Moreover, although
Director of Nursing Witt was unable to testify regarding the
wage rates paid to mental health workers, she testified that
3 of the 37 mental health workers have completed medical
school and are waiting to complete medical boards. If they
are compensated for their additional education, their wage
rates would skew any comparison. Of course, the Employer
has sole possession of, and control over, wage rate informa-
tion and could have avoided the need for conjecture elicited
by its faulty exhibit.
Members of the nursing staffs are paid a shift differential
for evening and night work. Executive Director Hampton tes-
tified that she did not know the dollar amounts for the dif-
ferentials although she knew the night differential was higher
than the evening differential. No other professional employ-
ees are paid a differential for evening and night work. RNs
and the sole discharge planner are the only professional em-
ployees paid for overtime work.53 The two admitting clerks
who work from 4 p.m. to 12 midnight are paid the evening
differential. For special projects, housekeepers and mainte-
nance mechanics are paid a differential for evening and night
work. The record evidence does not reflect the frequency of
such special projects.
With regard to other benefits, all employees who work 20
hours or more a week accrue the same ‘‘paid time off’’
(p.t.o.) for holidays, sick leave, and personal leave. Nursing
staffs are required to work four of the eight holidays. The
CTA staff work two of the eight holidays. With regard to
other clinical staff members, there are two clinical staff
members on duty on holidays for each unit.54
Vacation leave is added to an employee’s ‘‘paid time off’’
and the amount depends on job classification and years of
service. ‘‘Non-exempt’’ employees, who are paid time-and-
a-half for overtime work, receive 2 weeks’ vacation at hire,
3 weeks after 5 years, and 5 weeks after 10 years. All non-
professional employees are deemed ‘‘non-exempt’’ except
for the dietary technician and some administrative assistants.
Although deemed nonexempt employees, mental health
workers and the accounts payable coordinator receive 3
weeks’ vacation at hire, 4 weeks after 5 years, and 5 weeks
after 10 years. ‘‘Exempt’’ employees, who are not paid for
overtime work, receive 4 weeks’ vacation at hire and 5
weeks after 5 years. Despite their nonexempt status, RNs and
the discharge planner receive the additional vacation leave
provided to exempt employees. All other professional em-
ployees are deemed ‘‘exempt.’’
Employees who work 32 hours or more a week receive
health insurance benefits. There is a uniform policy for leave
for bereavement, disability, jury duty, military service, and
personal reasons. The Employer has a 401(k) plan and an
educational reimbursement program for all employees.
All employees are subject to a 3-month probationary pe-
riod and a progressive disciplinary system. All disciplinary
actions are taken in consultation with the human resources
department. All employees receive annual evaluations pre-
pared by their department heads and are eligible for merit in-
creases based thereon.
1195HOLLISWOOD HOSPITAL
55 305 NLRB 872 (1991).
56 Id. at 873.
57 See McLean Hospital Corp., 311 NLRB 1100 (1993), here the
Regional Director applied the Park Manor method of analysis and
found a separate RN unit appropriate at a psychiatric facility, and
the Board refused to grant the employer’s request for review thereon.
As noted, the parties stipulated that the Employer is a psy-
chiatric hospital as defined in the Board’s Final Rule on Col-
lective-Bargaining Units in the Health Care Industry. The
Board’s rule provides for eight presumptively appropriate
bargaining units in health care facilities, including a separate
unit of all registered nurses. The Board determined that the
rule would apply only to acute care hospitals and that bar-
gaining unit determinations for psychiatric hospitals and
other nonacute care facilities would continue to be made on
a case-by-case basis. In Park Manor Care Center,55 the
Board provided the method of analysis for bargaining unit
determinations in nonacute care facilities. Characterized as a
‘‘pragmatic or empirical community of interests approach,’’
the Board considers background information gathered during
its rulemaking process, prior precedent involving the type of
unit sought or the particular type of health care facility and
traditional community-of-interest factors.56 The Board also
will consider a comparison of the work force at the nonacute
care facility with those at acute care hospitals. In exercising
its discretion to determine an appropriate unit, the Board will
be guided by the principle that it should avoid finding a unit
that is either too large or too small due to the undesirable
consequences to the parties.
The Petitioner asserts that separate units of all registered
nurses, and all nonprofessional employees, constitute appro-
priate units at the Employer’s psychiatric facility. The Em-
ployer contends that the only appropriate unit at its facility
is a single, wall-to-wall unit of all professional and non-
professional employees. Applying the Park Manor method of
analyis for the bargaining unit determination herein, I find
that separate units of all registered nurses, and all nonprofes-
sional employees, constitute appropriate units herein.57
The rulemaking process produced evidence that the dis-
tinct functions and collective-bargaining interests of RNs at
acute care hospitals compelled the conclusion that a separate
unit of RNs was warranted there. Unlike other professionals,
the Board found that RNs have a professional responsibility
which requires them as a group to work 24 hours a day, 7
days a week, and subjects them to mandatory overtime.
Whereas other professionals specialize and have intermittent
contact with patients, RNs have continuous interaction with
patients. The nursing process involves the continuous assess-
ment and monitoring of the patient’s status. RNs have special
responsibilities related to the administration of medication to
patients. RNs have an organized department of nursing and
are supervised by RNs. There is a distinct labor market for
RNs which affects their wages, and a severe nursing shortage
which affects their working conditions.
In addition to their specialized education and training, RNs
must pass state licensing examinations. Such licensing re-
quirements and other regulations preclude the cross-training
or interchange among RNs and other professionals; RNs can-
not be replaced by other professionals. The lack of cross-
training and interchange, in combination with different work-
ing hours, minimizes the contact between RNs and other pro-
fessionals. Although some acute care hospitals use multi-
disciplinary treatment teams, the team members interact only
with the few other members of their team; the RNs’ other
duties may limit or prevent their participation with the team’s
activities; and the team approach does not alter each profes-
sional’s scope of practice.
The Board also found that RNs have sought separate rep-
resentation for many years, and other professionals have not
reacted favorably to their inclusion with RNs for collective-
bargaining purposes. In acute care hospitals, the other profes-
sionals fear not having their interests given priority as they
are far outnumbered by RNs. RNs have several issues of
unique concern to them such as staffing, scheduling, shift
differentials, mandatory overtime, and floating. The Board
concluded that separate RN units have not led to wage whip-
sawing, jurisdictional disputes, or more strikes, and they have
had no adverse effects on multidisciplinary team care.
With regard to psychiatric hospitals, the rulemaking proc-
ess produced evidence that as they do not provide patient
care for the physically ill, RNs are not the primary
facilitators of health care there. The RNs’ work is closely in-
tegrated with the work of other professionals in the treatment
plan designed for the patient. Unlike acute care hospitals,
RNs do not outnumber other professionals and there are
more ‘‘paraprofessionals’’ (e.g., mental health workers) and
other employees who are trained to relate to patients.
A review of the factors which supported the Board’s deci-
sion to permit separate RN units at acute care hospitals, with
an analysis of the work of RNs at the Employer’s facility,
compels the conclusion that the Employer’s RNs have dis-
tinct functions and collective-bargaining interests. The Em-
ployer’s RNs are the sole professional employees who are re-
sponsible for providing patient care 24 hours a day, 7 days
a week, 365 days a year, on all four units. The State of New
York and the Joint Commission require that every nursing
unit has at least one RN in charge at all times. Although
some other professionals work into the evening shift (social
workers who work one evening a week until 9 p.m.), and
some other professionals work 1 day on the weekends (CTA
staff members), no other professionals cover the patient units
24 hours a day and 7 days a week. No other professional
employees are subject to a mandatory overtime policy or re-
ceive overtime pay. No other professional group relies so
heavily on per diem employees. Thus, the RNs’ unique staff-
ing responsibilities lead to special bargaining interests such
as staffing, scheduling, shift differentials, mandatory over-
time, and floating.
Although the focus of the patient care delivered at the Em-
ployer’s facility is on mental illness and not physical illness,
the RNs provide professional nursing care utilizing nursing
methods and techniques which include the nursing process.
Within 8 hours of admission, the RN must complete a nurs-
ing assessment record which is a detailed medical history of
the patient’s physical and mental health and includes the ini-
tial nursing care plan for the patient. On the day and evening
shifts, one RN is assigned as the charge nurse and one RN
is assigned as the medication nurse. The night-shift RN must
function in both roles. On every shift, each patient is as-
signed an RN or mental health worker as his or her ‘‘primary
contact’’ for the shift. On every shift, an RN must complete
a patient acuity assessment form and RNs complete patient
care monitoring forms. RNs must make entries on the pa-
tient’s progress notes a minimum of once every 24 hours.
1196 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
58 See McLean, where the Regional Director found that the staff
RNs assigned to the the multidisciplinary treatment teams had fre-
quent contact with the other professional members of the teams
through various clinical meetings and through coleading therapy
groups, yet she found a separate RN unit appropriate therein. The
Regional Director also found that a separate RN unit would not im-
pact adversely on the multidisciplinary treatment team approach or
on the maintenance of therapeutic milieu there. Although McLean is
a much larger psychiatric facility, the Employer’s RNs function simi-
larly to the McLean staff RNs assigned to multidisciplinary treat-
ment teams.
59 See Mercy Hospitals of Sacramento, 217 NLRB 765 (1975), for
the Board’s reasoning related thereto.
60 See Keokuk Area Hospital, 278 NLRB 242 (1986); North Arun-
del Hospital Assn., 279 NLRB 311 (1986); St. Vincent Hospital, 285
NLRB 365 (1987).
61 284 NLRB 1580, 1515 (1989).
62 253 NLRB 1003 (1981). Prior to the Board’s rulemaking, Mount
Airy is the only Board decision involving RNs in a psychiatric hos-
pital.
63 The Board noted that an RN’s license to make medical assess-
ment and to administer medication might be a crucial factor in find-
RNs complete vital signs forms and observation flow sheets.
No other professional group has responsibility for such ex-
tensive patient status documentation.
At the Employer’s facility, the medication nurse’s prin-
cipal function is the administration of medication on his or
her unit. No member of any other professional job classifica-
tion in the bargaining unit is allowed to administer medica-
tion. The RN must comply with the extensive procedures and
documentation contained in the Nursing Policy Manual re-
garding the administration of medication. Virtually all pa-
tients on the intensive treatment unit take medication, as do
most patients on the dual diagnosis unit; and medication is
dispensed on the other units as well. RNs must teach patients
about their medication. RNs must report and document medi-
cation errors and any adverse drug reactions. Other than phy-
sicians, RNs are the only professionals who must be trained
in cardiopulmonary resuscitation, respond to a ‘‘code blue,’’
initiate intravenous therapy, prepare and monitor a patient for
electroconvulsive thereapy, initiate seclusion or restraint, ini-
tiate a ‘‘code white,’’ and must respond to a ‘‘code white’’
on other units. Because of the RNs many distinct functions
and responsibilities, no other professionals can replace an ab-
sent RN on any unit. The RNs are segregated in the depart-
ment of nursing and are separately supervised by RNs, who
report to the director of nursing. No other professionals re-
port to the director of nursing. The other clinical profes-
sionals report to their respective department heads, who
along with program directors, report to the director of clini-
cal services.
The multidisciplinary treament team approach utilized at
the Employer’s facility encourages collaboration and co-
operation among all members of the treatment team. The
team members meet in clinical rounds, attend staff meetings,
colead groups, ‘‘team’’ patients, and monitor ‘‘contracts’’ to-
gether. However, the professional contact associated with the
multidisciplinary treatment team approach primarily affects
RNs assigned to the day shift, as there is minimal contact
between RNs and other professionals on the evening shift
and virtually one on the night shift. Although RNs probably
have more contact with the professionals assigned on their
units than they do with RNs assigned to other units, this is
true for the other professional job classifications as well.
However, RNs are the only professional employees who are,
assigned temporarily to other units for a shift or part of a
shift due to staffing needs. The Board does not require that
all members of a bargaining unit have contact with each
other. At the Employer’s facility, the application of such a
requirement could lead to a conclusion of four separate bar-
gaining units, one for each unit. Moreover, a review of the
record evidence comparing the duties and functions of the
Employer’s RNs with its other clinical professionals supports
the conclusion that the pivotal role of the RNs in the delivery
of patient care remains unique in this psychiatric facility.58
With respect to comparison of wages, the Employer pro-
vided insufficient information for a meaningful comparison
of wage rates between RNs and other professionals. Rather
than provide actual wage rates or percentage differences in
wage rates, the Employer provided nine statements of gener-
alized comparisons between job classifications without regard
to the number of employees so affected. These statements
show some overlap in wages between RNs and other profes-
sionals. RNs receive a shift differential for evening and night
work. No other professionals are paid a differential for
evening and night work. RNs, and the sole discharge planner,
are the only professional employees who receive overtime
pay. Various personnel policies are applied uniformly to all
employees, including the use of annual evaluations to deter-
mine eligibility for merit increases. Regarding benefits, all
employees accrue the same ‘‘paid time off’’ for holidays,
sick leave, and personal leave. However, the Employer does
make some distinctions between professional and nonprofes-
sional employees regarding vacation leave, as well as be-
tween certain job classifications among the nonprofessional
employees. The remaining fringe benefits are applied uni-
formly to all employees.
Based on the foregoing, and the record evidence as a
whole, I find that the Employer’s RNs have distinct functions
and collective-bargaining interests which establish that they
share a substantial community-of-interest which sets them
apart from the Employer’s other professional and nonprofes-
sional employees.
A review of Board precedent prior to rulemaking regard-
ing separate RN units also supports the conclusion of the ap-
propriateness of a separate RN unit herein. From 1974
through 1984, applying the traditional community of interests
analysis, the Board consistently approved separate RN
units.59 After the Board’s adoption of the disparity-of-inter-
ests test, the Board found separate RN units inappropriate in
several cases.60 However, during the rulemaking process
with its consideration of substantial empirical evidence re-
garding RNs’ functions, training, and interests, the Board ob-
served that it might well have reached a different result in
St. Vincent.61
In Mount Airy Psychiatric Center,62 the Board refused to
find a separate RN unit appropriate and directed an election
in an all professional unit. There, RNs and other profes-
sionals in the job categories of ‘‘team leader’’ and ‘‘charge
person’’ peformed virtually the same duties; and the team
leaders worked 24 hours a day, substituted for each other,
and had the same supervision and the same benefits. In addi-
tion, the RN team leaders did not have any separate respon-
sibility for administering medication.63 In these cir-
1197HOLLISWOOD HOSPITAL
ing a separate RN unit appropriate in other circumstances. 253
NLRB at 1006.
64 250 NLRB 409 (1980).
65 250 NLRB at 414.
76 Davison-Paxon, 185 NLRB 21; and Sisters of Mercy Health
Corp., 298 NLRB 483 (1990).
77 Employees who average 4 or more hours of work per week in
the calendar quarter (13 weeks) immediately preceding the date of
issuance of this Decision and Direction of Election shall be eligible
to vote.
78 Id.
cumstances, the Board concluded that the exclusion of non-
RN team leaders from the unit would be inappropriate. The
Board also included the nine remaining professionals in the
unit as otherwise they would constitute a small residual unit
without a strong community of interest. Unlike the RNs at
Mount Airy, the Employer’s RNs and other professionals do
not share job titles, do not perform virtually the same duties,
do not have the same supervision, and do not work side-by-
side 24 hours a day. No other professional can substitute for
an RN at the Employer’s facility, and the RNs do have re-
sponsibility for administering medication.
In Newton-Wellesley Hospital,64 the Board found a sepa-
rate RN unit to be appropriate in an acute care hospital with
psychiatric units. The Board cited in support of its conclu-
sion the following factors: the RNs’ possession of a license
and their similar education and training; their ability to inter-
change among the hospital’s units; their sole responsibility to
serve in a ‘‘charge’’ capacity and to give and receive
intershift reports; and their unique responsibility or patient
care 24 hours a day. With respect to the RNs on the psy-
chiatric units, the Board rejected the contentions that other
professionals should be included in their unit despite its find-
ing that the RNs had frequent and substantial contact with
other professionals. In excluding the professional job classi-
fication of ‘‘mental health counselor’’ from the RN unit, the
Board found that although mental health counselors per-
formed work similar to the RNs, worked 24 hours a day, and
shared clinical supervision, the two groups were ‘‘not equiv-
alent.’’65 The foregoing factors cited by the Board in support
of its conclusion of the appropriateness of a separate RN unit
at Newton-Wellesley all apply to the RNs employed in the
Employer’s facility as well.
Contrary to the Employer’s assertions in its brief, the find-
ing of a separate RN unit herein does not create a small re-
sidual unit of professional employees. Based on the Employ-
er’s staffing figures, the ‘‘regular’’ RNs are outnumbered by
the other professional employees.
With regard to the Employer’s assertions in its brief that
its nonprofessional employees share a strong community of
interest with its professional employees so as to warrant their
inclusion in a single, wall-to-wall unit, beyond the evidence
of some contact among certain nonprofessionals and profes-
sionals, and some overlap in wages between some mental
health workers and some professionals, the record evidence
falls short of providing support for the Employer’s argument.
A review of traditional community-of-interest factors such as
skills, training, education, job duties and functions, employee
interchange and functional integration, regarding job classi-
fications such as psychologist and unit receptionist, or reg-
istered dietician and admitting clerk, or social worker, and
housekeeper, clearly reveals the appropriateness of a separate
unit of nonprofessional employees.
Moreover, the finding of a wall-to-wall nonprofessional
unit, along with the separate RN unit, complies with the
Congressional policy against undue proliferation of bargain-
ing units in the health care industry as it appears that there
can be only one additional appropriate unit at the Employer’s
facility, that is, a unit of all professional employees exclud-
ing RNs.
. . . .
Based on the foregoing, and the record evidence as a
whole, I find that per diem employees share a sufficient
community of interest with unit employees. As the Employer
offered no evidence of special circumstances to warrant a de-
parture from the Board’s standard eligibility formula for
‘‘on-call’’ employees, I find that per diem employees are eli-
gible to vote if they average 4 or more hours of work per
week in the calendar quarter (13 weeks) immediately preced-
ing the eligibility date herein.76
Accordingly, I find that the following separate units of
employees constitute appropriate units for the purposes of
collective bargaining within the meaning of Section 9(b) of
the Act:
All full-time and regular part-time77 registered nurses,
including Senior Nurses, employed by the Employer at
its Holliswood, Queens, New York location, excluding
the Director of Human Resources, Director of Commu-
nity Relations, Director of Intake/Referral, Director of
Housekeeping, Director of Environmental Services, Di-
rector of Food Services, Director of Pharmacy, Director
of Clinical Services, Director of Psychology, Director
of Social Work, Director of Creative Therapeutic Ac-
tivities, Director of Nursing, Nursing Care Coordina-
tors, Clinical nursing Supervisors, Staff Development
Coordinator, Program Director, Business Office Man-
ager, Benefits Office Supervisor, Accounts Receivable
Supervisor, Manager of Medical Records/Managed
Care, Admitting Supervisor, Data Processing Super-
visor, Food Services Supervisor, all other professional
employees, nonprofessional employees, managerial em-
ployees, guards and supervisors as defined in the Act.
All full-time and regular part-time78 nonprofessional
employees, including mental health workers, licensed
practical nurse, unit secretaries, unit receptionists, ad-
mitting clerks, receptionists, switchboard operators, pa-
tient finance counselors, patient accounts representa-
tives, senior patient accounts representatives, accounts
payable coordinators, payroll representatives, data proc-
essing clerks, housekeepers, floormen/projectmen, cen-
tral supply clerks, maintenance mechanics, medical
transcriptionists, medical records technicians, medical
records clerks, word processors, dietary technicians,
cooks, dietary assistants, and the administrative assist-
ants to the Medical Director and the Directors of Clini-
cal Services, Nursing and Community Relations, em-
ployed by the Employer at its Holliswood, Queens,
New York location, excluding the administrative assist-
ants to the Executive Director and to the Director of
Human Resources, Director of Community Relations,
Director of Intake/Referral, Director of Housekeeping,
Director of Environmental Services, Director of Food
1198 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
Services, Director of Pharmacy, Director of Clinical
Services, Director of Psychology, Director of Social
Work, Director of Creative Therapeutic Activities, Di-
rector of Nursing, Nursing Care Coordinators, Clinical
Nursing Supervisors, Staff Development Coordinator,
Program Director, Business Office Manager, Benefits
Office Supervisor, Accounts Receivable Supervisor,
Manager of Medical Records/Managed Care, Admitting
Supervisor, Data Processing Supervisor, Food Services
Supervisor, pharmacist, biofeedback therapist, registered
dietician, discharge planner, physicians, social workers,
psychologists, referral coordinators, community rela-
tions representatives, education coordinator, eating dis-
order coordinator, addiction counselor, art therapists,
dance/movement therapists, occupational therapists,
recreation therapists, all other professional employees,
managerial employees, guards and supervisors as de-
fined in the Act.