McLean Hospital Corp.

National Labor Relations Board - Board Decisions

Jun 30, 1993

311 N.L.R.B. 1100 (N.L.R.B. 1993)

1100
311 NLRB No. 127
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
1 Review was requested of the Regional Director’s findings that:
(1) the petitioned-for unit, limited to the Employer’s registered
nurses, is an appropriate unit for bargaining, and (2) the Petitioner
is not disqualified from representing the Employer’s employees due
to an asserted disqualifying conflict of interest. Only the portion of
the Regional Director’s decision addressing the first issue is at-
tached.
12 McLean has been ranked by U.S. News and World Report as the
best psychiatric hospital in the country.
13 The average length of stay in McLean’s community residential
treatment program, however, is well over 6 months.
McLean Hospital Corporation and Massachusetts
Nurses Association, Petitioner. Case 1–RC–
19750
June 30, 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 well as the Peti-
tioner’s opposition brief. The request for review is de-
nied as it raises no substantial issues warranting re-
view.1
APPENDIX
REGIONAL DIRECTOR’S DECISION AND
DIRECTION OF ELECTION
The Petitioner seeks to represent a unit limited to the Em-
ployer’s nonsupervisory registered nurses. The Employer
contends that the only appropriate unit is a unit containing
approximately 160 classifications, consisting of all profes-
sional employees, including those professional employees
employed by the Employer at the Adolescent Day Service
and Adolescent Day Hospital. The Employer would also in-
clude in its proposed unit all psychiatrists-in-charge, medical
interns, residents, and fellows, the facilities design coordi-
nator, the research project operations supervisor, and three
program coordinators at the Adolescent Day Service and Ad-
olescent Day Hospital, but exclude all human resource de-
partment employees, information systems employees, security
guards, confidential and managerial, and supervisors as de-
fined in the Act. The Employer would further include in its
proposed unit two attending physicians, Dr. Sinor and Dr.
Livingstone.
. . . .
McLean Hospital is a nationally recognized psychiatric
hospital12 and a major teaching hospital of the Harvard Uni-
versity Medical School. It is a subsidiary of Massachusetts
General Hospital, a well-known general acute care hospital
in Boston, Massachusetts. In addition to having clinical and
teaching missions, McLean also serves as a research facility
in the area of mental illness.
McLean is licensed by the Commonwealth of Massachu-
setts Departments of Mental Health and Public Health and
accredited by the Joint Commission for Accreditation of
Health Care Organizations as a psychiatric facility. On its
240-acre campus in Belmont, Massachusetts, McLean pro-
vides inpatient, outpatient, partial hospitalization, and com-
munity residential services to severely mentally ill patients.
It has 14 inpatient units with 273 inpatient beds and 13 com-
munity residences with 134 beds. Eight of the community
residence programs are located on the Belmont campus; five
are located in nearby communities. Also located on the Bel-
mont campus are various research laboratories and the Ar-
lington School, a high school for severely disturbed adoles-
cents. Due in part to pressure from payors to contain health
care costs, the average length of stay in McLean’s inpatient
units has dropped dramatically in the last few years from
over 70 days to between 24 and 21 days at the end of
1991.13 Compared to 2 years ago, McLean is now admitting
twice as many patients who stay for one-third the time they
used to stay. As a result, the patients who are cared for on
McLean’s inpatient units are much more acutely ill than they
were 3 to 5 years ago, and they require more intensive care.
McLean expects this trend toward shorter lengths of stay and
higher acuity to continue.
McLean employs approximately 2000 professional and
nonprofessional employees. A bargaining unit of approxi-
mately 67 skilled maintenance employees is represented by
the International Union of Operating Engineers, while the re-
maining employees are currently unrepresented.
McLean is headed by Dr. Steven Mirin, general director
and psychiatrist in chief, and is organized in what McLean
describes as a matrix fashion. Five associate general directors
as well as the heads of the departments of nursing, psy-
chology, rehabilitation services, and social work report di-
rectly to Dr. Mirin and oversee some 51 departments. In ad-
dition to the main clinical departments of nursing, social
work, rehabilitation services, and psychology, there are nu-
merous other departments which provide clinical support,
such as the departments of internal medicine, admissions,
quality assurance/utilization review, pharmacy, clinical lab,
and chaplaincy. The vast majority of the registered nurses at
issue in this case work for and report to the nursing depart-
ment.
In addition to being organized along departmental lines,
McLean’s clinical employees are also organized into ‘‘pro-
grams,’’ essentially, programs designate a continuum of serv-
ices for patients with a certain type of diagnosis or for pa-
tients in a certain age grouping. For example, there are sepa-
rate ‘‘programs’’ for patients with affective disorders, psy-
chosocial disorders, psychotic disorders, and alcohol and
drug abuse problems, as well as programs for geriatric pa-
tients and children, each headed by a program director who
has clinical oversight across disciplines. Each program pro-
vides a continuum of services—inpatient, partial hospitaliza-
tion, community residential, and outpatient—for the type of
patients it serves, who may need varying levels of care de-
pending on the acuity of their illness. Programs are staffed
by various types of professionals, including nurses, physi-
cians, psychologists, social workers, and rehabilitation work-
ers. Nurses, social workers, rehabilitation workers, and some
psychologists are simultaneously members of their respective
departments and their respective programs. Each program
carries out a clinical, research, and training mission.
1101MCLEAN HOSPITAL CORP.
14 The parties stipulated at the hearing that the mental health spe-
cialists and administrative unit assistants are not professional em-
ployees.
15 In some instances a psychologist rather than a psychiatrist serves
as the PIC of an inpatient unit.
16 Neither party contends that charge nurses are supervisory em-
ployees.
17 Neither party contends that the licensed practical nurses are pro-
fessional employees or should be included in the unit.
The nursing department is headed by Nancy Valentine, ad-
ministrator for nursing, who is assisted by Dorothy Tuttle,
associate administrator for nursing, and three assistant admin-
istrators for nursing, Linda Ciulla, Linda Flaherty, and Karen
Mainville. Below them in the nursing department hierarchy
are 10 administrative nursing supervisors (ANS) who work
out of the central nursing office deploying nurses and man-
aging the department on all three shifts. In addition, there are
14 clinical nursing supervisors (CNS), each assigned to 1 of
McLean’s 14 inpatient units. Each CNS is the administrative
and clinical supervisor for her particular unit and is respon-
sible for hiring, evaluating, disciplining, terminating, and
counseling the staff she supervises: RNs, mental health spe-
cialists, and administrative unit assistants.14 CNSs have no
supervisory authority over the other professionals who work
on their inpatients units. A CNS from one unit may cover
for a CNS on another unit who is absent due to a holiday,
vacation, or sickness. The above-described members of the
nursing department have been stipulated by the parties to
hold supervisory positions.
The vast majority of McLean’s nonsupervisory registered
nurses, approximately 250 employees, work as full-time or
part-time staff nurses on 1 of McLean’s 14 inpatient units.
With the exception of eight nurses who ‘‘float’’ from unit to
unit as needed, staff nurses are permanently assigned to a
particular unit. Each unit has a psychiatrist-in-charge (PIC)15
and typically psychologists, social workers, and rehabilitation
staff who are also permanently assigned to the unit. These
professionals, along with the nurses, work together in multi-
disciplinary teams to provide patient care. The 14 units are
located in several separate buildings on the McLean campus,
with each building generally housing two patient units as
well as other floors containing office space. Unit capacity
ranges from 12 to 25 patients, all of whom are hospitalized
for severe psychiatric illness. Because many of the patients
may be in danger of hurting themselves or others, most of
the units are locked and have security screens on the win-
dows. Each inpatient unit has patient rooms, a common liv-
ing room, dining room, and kitchen, a central nurses station
which is enclosed and may be locked, and quiet rooms used
to isolate patients when necessary.
Staff nurses, along with mental health specialists, provide
coverage for McLean’s inpatient units 24 hours a day, 365
days a year. Although there is some variation, nurses gen-
erally staff three core shifts: 7 a.m. to 3:30 p.m., 3 to 11:30
p.m., and 11:15 p.m. to 7:15 a.m. Each unit does its own
scheduling. By and large, those nurses that work the night
shift are permanently assigned to that shift; the remaining
nurses rotate through the day and evening shifts, working
about 50 percent of the time on each shift. Some nurses’
schedules are changed from week to week. Once or twice a
week nurses may be required to work a ‘‘turnaround,’’ a
schedule which requires them to work the 3 to 11:30 p.m.
evening shift and then return to the hospital at 7 a.m. the
next day for the day shift. Nurses are required to work every
other weekend and holidays. As an incentive for staff nurses
to work weekends, McLean offers a ‘‘weekend package’’
under which staff nurses can work two 12-hour shifts on the
weekend for 40 hours pay. Staff nurses who work as charge
nurses, described below, may opt to work five 8-hour shifts
or four 10-hour shifts, Monday through Friday.
Depending on the unit, two to five nurses are typically as-
signed to each day shift, two to three nurses work each
evening shift, and one nurse generally covers each unit on
the night shift. The staff nurses on the units are assisted by
mental health specialists, the only other McLean employees
who provide direct patient care 24 hours a day.
On most units, one nurse is assigned on a rotating basis
to be charge nurse for the day and evening shifts.16 (Night
nurses, who are usually the only nurse on their shift, also act
in a charge capacity.) The assignment lasts for a month, and
a nurse may be designated to be the charge nurse every 8
or 9 months. The charge nurse is generally responsible for
seeing that the unit runs smoothly and is the primary conduit
of information about the unit and its patients. She begins her
shift by taking ‘‘report’’ from the outgoing charge nurse re-
garding the status of the unit. She then tours the unit with
the previous charge nurse, observing the whereabouts of each
patient. The two charge nurses also check and sign off that
the ‘‘code cart’’ contains all equipment and supplies nec-
essary in the event of a medical emergency. The charge
nurse’s duties include transcribing physicians’ orders for
periodic ‘‘safety checks,’’ medications, lab tests, and privi-
leges, obtaining physician’s orders as needed, assigning the
duties of the other staff nurses on her shift, reporting the sta-
tus of the unit to the central nursing office and to the incom-
ing shift, and relaying information about patients to the other
professionals, e.g., abnormal lab reports or unusual behavior.
Evening and weekend charge nurses also have their own pa-
tients for whom they are responsible during their shift; the
day-shift charge nurses generally do not have their own pa-
tients but are responsible for attending rounds and team
meetings, which take place two to five times a week. Rounds
and team meetings, discussed further below, are meetings of
the multidisciplinary staff of the unit during which the
progress of each patient is discussed.
Nurses may be assigned other functional roles during their
shift, such as medication nurse, vital signs nurse, admissions
nurse, or nurse assigned to handle patients in seclusion or re-
straint. Nurses also rotate through these roles; i.e., a nurse
may be assigned to be the medication nurse on one shift and
the admissions nurse on her next shift. The medication nurse
counts the narcotics on the unit with the prior shift’s medica-
tion nurse. She pours and administers medications to all the
patients on the unit who need them, first checking the doc-
tors’ order books to verify that medication orders are cor-
rectly transcribed on a medication chart sheet and making
sure that no medications are given to those patients who are
to have blood tests or vital signs checked first. Medications
may be administered orally or by intramuscular or intra-
venous injection, and may only be administered by a physi-
cian, registered nurse, or licensed practical nurse.17
1102 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
The admissions nurse greets patients being admitted to the
unit, checks their vital signs, does a body and belongings
search, and interviews the patients to obtain their history and
do a nursing assessment. Each admission takes about 2 hours
to complete and is done together with a physician, who may
be present all or part of the time, and who is the only profes-
sional authorized to sign a patient into the hospital. On some
units one nurse is assigned to check all the patients’ vital
signs.
On some shifts one nurse may be assigned the task of
monitoring patients who, because of their dangerous behav-
ior, must be secluded in a quiet room and/or restrained, ei-
ther physically or chemically. By law, only a physician may
order chemical restraint, and only a physician or a licensed
registered nurse may order physical restraints. Nurses are au-
thorized to order physical restraint of assaultive patients for
up to 1 hour, although a physician is supposed to arrive
within 15 minutes to countersign the order. No other profes-
sionals at McLean authorize restraints. On some units there
are typically two or three restraints per shift; on others, se-
clusion and restraint is rarely used, perhaps a few times a
year. Patients in restraints must have periodic breaks to avoid
circulation problems, and nurses must check patients in re-
straints every hour to monitor their vital signs and ensure
sufficient fluid intake.
In addition to the functional roles described above, each
nurse on a shift is typically assigned to care for three or four
of her own patients. Nurses are responsible for preparing, im-
plementing, and periodically updating a written ‘‘nursing
care plan’’ for each patient, which is directed toward their
nursing needs. Each patient also has a written ‘‘treatment
plan’’ which is developed in collaboration with the other pro-
fessionals on the unit. While nurses are not trained in formal
psychotherapy, they do individual counseling with patients in
the form of daily ‘‘staff talks’’ in which they assess the pa-
tient’s clinical condition, and focus on the patient’s day-to-
day life and problems. Nurses report each patient’s progress
daily on ‘‘assessment flow sheets’’ and in ‘‘nursing notes.’’
They also may lead or co-lead group therapy sessions, fur-
ther discussed below. They are responsible for performing
periodic ‘‘safety checks’’ in which they must observe pa-
tients at a specified interval ordered by a physician. While
the minimum interval for checks is every 30 minutes, some
patients must be checked as often as every 15 or 5 minutes,
and some are ordered to be under constant observation.
Nurses are also responsible for educating their patients about
the medications they are taking. Nurses are responsible for
preparing patients for lab tests or treatments they may under-
go while hospitalized, such as electroconvulsive therapy.
They may also assist patients with activities of daily living
on the unit such as dressing, bathing, cooking, or doing laun-
dry.
A few inpatient units at McLean use the so-called primary
nursing model, under which a single nurse is assigned to per-
form all the nursing functions related to a single patient, and
a nurse and doctor team are the patient’s primary caregivers.
On primary nursing units, nurses are not assigned the func-
tional roles described above, and each shift has a ‘‘shift co-
ordinator’’ rather than a charge nurse, who handles only ad-
ministrative details. On those units, someone wishing to
speak to a nurse regarding a particular patient would be di-
rected to that patient’s primary nurse rather than to the
charge nurse. While the nursing functions are divided up dif-
ferently on primary nursing units, the functions are essen-
tially the same as on those units that employ a more tradi-
tional model of nursing care.
Staff nurses interact primarily with the nurses, mental
health specialists, and other professionals on their own unit.
Most units have a staff meeting for nurses and the CNS once
a week; on some units there is an additional weekly meeting
for the CNS, staff nurses, and mental health specialists. Con-
tact with staff nurses on other units is much less frequent.
Nurses are occasionally assigned to work a shift on another
unit. Nurses also have occasional contact with nurses from
other units when patients are transferred from one unit to an-
other or when a patient who needs to be secluded in a ‘‘quiet
room’’ is temporarily ‘‘boarded’’ off the unit to another unit
due to the lack of an available quiet room in his or her own
unit. When a patient is boarded, the charge nurse from the
sending unit generally calls the charge nurse from the receiv-
ing unit to discuss the need for boarding, as well as the pa-
tient’s diagnosis and medications. Boarding occurs as often
as every week in some units or as little as one to three times
a month or rarely in others. Nurses from one unit may also
be called to help another unit in emergency situations, such
as a seclusion or restraint. This happens as often as three or
four times a day in some units and once a shift on average.
Less frequently, about every 2 months, a nurse may be called
to another unit to assist with a medical emergency.
Patients are admitted to McLean for psychiatric rather than
medical care, and the vast majority of a staff nurse’s time
is spent focusing on her patients’ psychiatric illness. While
the nursing care plan developed for each patient addresses
both the patient’s medical and psychiatric condition, the
focus is on the psychiatric issues. Because McLean is not
equipped to deal with medical conditions of a serious or
emergency nature, patients who develop such conditions are
transferred to a medical/surgical hospital for treatment. How-
ever, depending on the unit, anywhere from 20 to 75 percent
of the patients may have concurrent medical problems which
are also managed by the nursing staff. Medical conditions
seen on the units include diabetes, seizures, pneumonia, hy-
pertension, infections of various kinds, and adverse reactions
to medications. McLean has nurse practitioners and internists
whose function it is to diagnose and order treatment for pa-
tients’ physical illnesses; staff nurses on the units are respon-
sible for following through with the prescribed treatment.
Annual training in CPR is mandatory for all nurses. All pa-
tients have lab work done on admission and about one-half
continue to have lab work done throughout their stay. About
half or more of the patients must have their vital signs
checked one or more times a day, a function that can also
be performed by mental health specialists. Some of the more
traditional task-oriented nursing duties, such as transcribing
doctors’ orders, counting narcotics, checking the code cart, or
touring the unit at the change of shift, take only a few min-
utes. Receiving report at the change of shifts can take any-
where from 15 to 30 minutes. Somewhat infrequently, nurses
perform such medical tasks as changing dressings, catheter-
izing a patient, or monitoring fluid intake and output.
Many of the patients at McLean are treated with medica-
tions. While the vast majority of the medications adminis-
tered are psychotropic drugs for treatment of mental illness,
these drugs may have physical side effects. Although other
1103MCLEAN HOSPITAL CORP.
18 There was testimony that the chief of the internal medicine de-
partment, which runs the medical clinic, occupational health, and in-
fection control services, has oversight over all the nurses and doctors
in that department. However, the nursing department’s assistant ad-
ministrator for nursing and coordinator of medical nursing, Linda
Ciulla, testified that she supervises the nurse practitioners and staff
nurses in the medical clinic. Similarly, there appears to be dual su-
pervision of the clinical nurse specialists who work in the outpatient
clinic and Arlington Day Service described below; the nursing de-
partment’s associate administrator for nursing, Dorothy Tuttle, is re-
sponsible for hiring, evaluating, and firing those nurses, but they re-
ceive supervision from their colleagues in those departments with re-
spect to clinical issues.
19 The parties have stipulated that nursing students are not employ-
ees of McLean and should not be included in any unit found appro-
priate.
professionals may report their observations as to the effect of
a medication on a patient, only doctors or nurses may admin-
ister them, and nurses are uniquely responsible for ensuring
that the correct dosage is administered, assessing drugs for
effectiveness and side effects, and teaching patients about
their medications. Nurses spend about one-half hour daily
teaching patients about medication. Dispensing medications
on the alcohol and substance abuse unit, one of the units
with the most medications, takes about 40 minutes each time.
In addition to staff nurses, the nursing department18 em-
ploys several other categories of nurses whom the parties
concur should be included in any unit found appropiate.19
McLean has a medical clinic which provides physical care on
a walk-in basis for patients on the inpatient units and in com-
munity residences, and also has a staff of internists and nurse
practitioners who are assigned to provide medical care on the
inpatient units. The medical clinic has two staff nurses. One
is a half-time nurse who assists in the walk-in clinic giving
injections, hearing, vision, and tuberculosis tests, enemas,
and the like, and also assists the doctors with electro-
convulsive therapy. The other is a full-time charge nurse who
oversees the daily flow of activities in the clinic, commu-
nicates with the nurses and doctors on the units, does triage
of emergencies by telephone, schedules appointments, and
arranges for followup care. Both work daytime, weekday
hours.
McLean also has six full-time and part-time nurse practi-
tioners, some of whom split their time between various roles.
Four of them work full- or part-time in the medical clinic
and are assigned to various inpatient units where they go to
see patients and consult with the staff nurses concerning care
for patients’ medical conditions. Two of them work as part-
time occupational health nurses, providing routine medical
care and physicals for employees. Two share the role of in-
fection control nurse, consulting with nursing staff on how
to manage patients with infectious diseases and developing
policies and procedures relative to infection control.
Also employed by the nursing department are one full-
time and two part-time clinical educators in nursing who are
responsible for a 3-week orientation program for new staff
nurses, mental health specialists, and administrative unit as-
sistants. They also act as instructors for certain mandatory
continuing education classes for nurses, present seminars to
staff on topics as needed, and provide an orientation session
on mental illness for new nonprofessional employees. They
work weekdays, 8:30 a.m. to 5 p.m. Three nurses work as
clinical specialists, two in the outpatient clinic and one in the
Arlington Day Service. These nurses do individual and group
therapy and evaluate the need for medication in their respec-
tive settings and, like the nurse practitioners and clinical
nurse educators, are more expert than staff nurses. Finally,
one nurse works half-time as a staff nurse and half-time as
a research coordinator reviewing research proposals by staff
nurses.
In addition to registered nurses employed by the nursing
department, McLean employs registered nurses in some other
departments whom the parties agree should be included in
any unit found appropriate. Five registered nurses work as
utilization review coordinators and report to the director of
the quality assurance department. Utilization review coordi-
nators must be registered nurses, and all the incumbents are
former staff nurses at McLean. Their function is to prove to
insurers that the care provided by McLean in each case is
necessary, and they regularly consult with staff on the unit,
attend rounds, and review patient charts. Two clinical nurse
specialists and two triage nurses report to the director of the
admissions department and perform psychiatric assessment of
patients presenting themselves for admission to McLean. The
clinical nurse specialists, some of whom are former staff
nurses, are master-level nurses who do a more in-depth as-
sessment than that performed by nurses on the units. They
work during the day. Triage nurses cover the admissions de-
partment during the night shift, floating out to units that re-
ceive a new admission and helping to stabilize patients. The
community residential treatment program employs three
nurses whose function is primarily to administer medications,
as well as four master-level clinical nurse specialists who
oversee medical treatment and work with community resi-
dential counselors to implement treatment plans. Most of
these nurses work 8:30 a.m. to 5 p.m., weekdays; two clin-
ical nurse specialists cover the night shift. Two staff nurses
work for the research department providing patient care to
patients who volunteer to be research subjects in the alcohol
and drug abuse program. Their job duties and responsiblities
are the same as those of a staff nurse on an inpatient unit.
All staff nurses at McLean must be licensed registered
nurses, a state license which is obtained by passing an exam-
ination, and graduates of an accredited school of nursing. No
experience is required. A degree in nursing may be obtained
by completing a 2-year associate degree program, a 3-year
diploma school program, or a 4-year bachelor’s program.
Nurse practitioners, clinical educators in nursing, and clinical
nurse specialists are required to have a master’s degree in
nursing in addition. While nursing school may include a psy-
chiatric rotation lasting several weeks, nursing students do
not receive training in psychotherapy. On hire by McLean,
nurses are required to go through a 3-week orientation pro-
gram which is attended by new nurses from all units. Some
of the classes during the orientation are attended only by reg-
istered nurses; some are also attended by mental health spe-
cialists. Nurses also annually attend mandatory training in
CPR, CPI (intervention with dangerous or assaultive pa-
tients), patients’ rights, and infection control.
McLean also employs numerous other categories of pro-
fessionals throughout the hospital whom the Employer con-
tends should be included in an all-professional bargaining
unit with the registered nurses. Those who work most closely
with the nurses in the petitioned-for unit are the psychiatrists,
psychologists, social workers, and rehabilitation specialists
1104 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
who work on the inpatient units. Psychiatrists, psychologists,
social workers, and rehabilitation specialists are also em-
ployed by McLean’s outpatient service, by its community
residential treatment program, by the adolescent day service
(ADS) program, and by the North Cottage Adolescent Day
Hospital.
While there are about 450 physicians who are employed
by or have some other kind of affiliation with McLean, there
are only about 40 to 45 physicians whom McLean contends
are nonsupervisory and properly belong in a professional bar-
gaining unit, as well as about 40 to 50 interns, residents, and
fellows, who are psychiatrists in various stages of their train-
ing. Most of the physicians at McLean are psychiatrists, i.e.,
medical doctors who have obtained their license to practice
medicine after completing a 4-year bachelor’s program, 4
years of medical school, and 1 year of internship, and who
also have completed a 4-year residency in psychiatry.
McLean also employs a few physicians who are not psychia-
trists, including about five internists and a neurologist. All
physicians must meet continuing education requirements im-
posed as a condition of renewing their license.
Psychiatrists at McLean evaluate and admit new patients,
prescribe medications, order the frequency of checks, author-
ize patient privileges and, when necessary, seclusion and/or
restraint, and engage in individual and group therapy. Of the
40 to 45 psychiatrists whom McLean would include in the
bargaining unit, about 25 to 30 of them are psychiatrists-in-
charge (PICs) of an inpatient unit. Each inpatient unit has
two full-time equivalent PICs, in some cases two full-time
individuals, and in some cases one full-time and two half-
time doctors. PICs are responsible for clinical oversight of
their unit and lead the clinical teams which provide patient
care. They report to the clinical director of the program with
which their inpatient unit is affiliated, generally another psy-
chiatrist. PICs generally keep daytime hours, although their
hours vary. They may leave work at 4 p.m. one day and 10
p.m. the next. They do weekend rounds and may be called
to the hospital at night in the event of an emergency. The
other doctors whom the Employer would include are staff
psychiatrists who work on the units, most of them on a part-
time basis. They report to the PICs, at least for clinical pur-
poses.
Patients at McLean are also treated by some 40 to 50 resi-
dents and fellows, doctors being trained in the specialty of
psychiatry. As licensed physicians, they admit and treat pa-
tients, prescribe medication, attend rounds, write orders, and
give clinical direction to nurses. When assigned to an inpa-
tient unit they report to the PIC of that unit. Residents spend
the first year of their residence in a general hospital, getting
experience in internal medicine, pediatrics, neurology, or
emergency room medicine. Second, third, and fourth year
residents rotate through McLean’s various inpatient units, the
outpatient service, and the admissions office. Residents’
schedules vary considerably depending on the year of resi-
dency. Second year residents are required to act as ‘‘night
float’’ 3 weeks of the year, during which they must be phys-
ically at the hospital from 10 p.m. to 8 a.m. Ten second year
residents rotate acting as the weekend resident on call, each
shift lasting from 8 a.m. to 8 a.m. Third and fourth year resi-
dents rotate being on call evenings from 5 to 10 p.m. Some
residents volunteer to ‘‘moonlight’’ doing admissions eve-
nings and weekends for extra pay. Residents spend about
half a day per week in classroom training. About half of the
residents and more than half of the clinical fellows stay on
after the completion of their residency or fellowship, but
there is no guarantee that they will be able to stay.
The Employer employs about 40 to 45 nonsupervisory so-
cial workers throughout the hospital. Two are assigned to
most inpatient units, while three or four are assigned to the
Hall Mercer Center, McLean’s inpatient unit for children.
Social workers are also assigned to the admissions office,
outpatient clinic, the ADS program, and to various commu-
nity residences. With the exception of the social workers in
the community residence treatment program, social workers
are hired, evaluated, and promoted by the social work depart-
ment and attend weekly social work staff meetings. However
they are also considered to be affiliated with the program
within which they work. Clinical social workers I, the entry
level position, must have a master’s degree in social work
with one internship in a psychiatric setting. The master’s
takes 2 years to complete and provides graduate level train-
ing in psychotherapy. Entry level social workers must be li-
censed by the State as LCSWs or take the first licensing
exam they are eligible to take after hire. Clinical social
workers II are more experienced. Some social workers at
McLean have an LICSW, a license which allows social
workers to practice autonomously. An LICSW must have a
master’s plus 3 years of postmaster’s experience, pass an
exam, and meet certain other requirements. Both licenses re-
quire a certain number of hours of continuing education for
relicensure.
Social workers do individual, couple, family, and group
therapy. They focus in therapy on family issues and are the
primary contact with patients’ families. Their standard hours
are 8:30 a.m. to 5 p.m. weekdays, although many stay
longer. Social workers are on call for emergencies on a rotat-
ing basis, about one evening a month and three weekends a
year. When on call they assist with admissions when there
is a family member present and may be paged regarding
problems on the units. Social workers have their own offices,
usually, but not always, in the building that houses the unit
to which they are assigned.
McLean employs roughly 40 to 50 full-time and part-time
nonsupervisory psychologists in various titles throughout the
hospital, including assistants in psychology, assistant psy-
chologists, assistant child psychologists, associate psycholo-
gists, and associate child psychologists. Assistants in psy-
chology are master-level clinicians and are not required to be
licensed. The remaining psychologists are licensed by the
state Board of Registration in Psychology. In order to be li-
censed, a psychologist must have a PhD in psychology, have
3200 hours of clinical experience in a health provider setting,
and pass a national and state exam. It takes approximately
8 to 11 years of post-high school education to obtain a doc-
torate in psychology. McLean also has approximately 30 to
35 predoctorate-level interns and postdoctorate fellows who
are in various stages of their training.
Psychologists engage primarily in individual and group
psychotherapy in inpatient and outpatient services at
McLean. There are six psychologists who do psychological
testing throughout the hospital and are primarily affiliated
with the psychology department. The balance of the psy-
chologists are primarily affiliated with the unit and program
in which they work rather than the psychology department.
1105MCLEAN HOSPITAL CORP.
20 It appears from the record and the posthearing briefs submitted
by the parties, that neither party seeks to include the marketing rep-
resentatives in an RN unit. Since, as discussed below, I find a unit
limited to RNs to be appropriate, I shall exclude the marketing rep-
resentatives from the unit.
21 The parties dispute the professional status of five categories of
research employees: senior clinical research technician, senior animal
research technician, research project administrative coordinator, re-
search computer specialist, and senior laboratory research technician.
Psychologists have their own offices and spend some time in
their offices and some time on the patient units. They work
day and evening hours and their schedules vary.
The Employer’s rehabilitation services department employs
about 40 nonsupervisory professionals in various titles who
provide therapy that is focused on improving patients’ daily
living, vocational, and social skills. Each inpatient unit has
an occupational therapist or rehabilitation coordinator. The
department also has occupational therapists and clinical ad-
ministrators who work in the outpatient clinic and commu-
nity residential treatment program. These employees are gen-
erally master-level occupational therapists or rehabilitation
counselors and are licensed by the State. Those who work
on inpatient units meet with patients individually to assess
them, attend rounds and team meetings to form a treatment
plan, lead therapy groups, and plan after-care, which may in-
clude talking to a patient’s employer to help with their
posthospitalization adjustment. Rehabilitation program coor-
dinators are certified recreation, art, or music therapists who
are assigned to an inpatient or outpatient setting and spend
about 75 percent of their time running group activities for
patients.
The nonsupervisory rehabilitation employees all report to
a clinical supervisor for each program who reports in turn to
the director of the rehabilitation services department. The
vast majority of them have offices in the rehabilitation build-
ing, but about one-third of those who are assigned to an in-
patient unit have an office in the building in which the inpa-
tient unit is located. Those who work on inpatient units
spend about 75 percent of their time on the units. Rehabilita-
tion employees who work in the outpatient clinic work a day
shift, Monday through Friday. Program coordinators on the
inpatient units work 10 a.m. to 8 p.m. Monday through Fri-
day, although six of them work on Saturday as part of their
schedule. Rehabilitation coordinators and occupational thera-
pists on the inpatient units work days, Monday through Fri-
day, and also work one evening a week at their discretion.
Some rehabilitation coordinators who work on a per diem
basis occasionally provide weekend coverage for the inpa-
tient units when called in because of an unusually large num-
ber of admissions over the weekend.
The Employer employs other professionals who are also
involved in patient care. The pharmacy department has eight
registered pharmacists who work in the pharmacy filling pre-
scriptions for inpatients and community residents. Medica-
tions are delivered to the units by messengers in locked cas-
settes. However, pharmacists do visit the inpatient units once
a month to check for expired medications on the code carts
and they may occasionally give inservice training to inpatient
staff. Pharmacists must have a bachelor’s degree and are li-
censed by the State. Continuing education courses are re-
quired to maintain their license. The pharmacy is open Mon-
day through Friday, 8 a.m. to 10 p.m., Saturday 8 a.m. to
5 p.m., and Sunday 10 a.m. to 2 p.m. One pharmacist covers
only Saturdays. The others rotate covering the day, evening,
and Sunday hours. There is also one clinical pharmacist who
has a PhD in pharmacy. The clinical pharmacist reviews
medical records, sees patients on the units, and consults with
physicians concerning such matters as drug interactions. She
works weekdays, 8 a.m. to 4:30 p.m..
Other professional employees who provide patient care are
a part-time physical therapist in the internal medicine depart-
ment and three clinical dieticians in the dietary department.
The pharmacists and clinical dieticians occasionally consult
with the treatment teams with respect to medication or nutri-
tional issues.
Numerous other professionals are employed in other de-
partments throughout the hospital. The admissions depart-
ment has approximately seven admissions coordinators
whose function is to receive the telephone calls from patients
or their families requesting admission, take certain essential
information, call the appropriate clinical staff to clear the ad-
mission, call the patient back to make admission arrange-
ments, notify insurers, and arrange for patient records to be
sent to McLean. They are required to have a bachelors de-
gree plus 2 years of experience in a psychiatric setting and
provide coverage 24 hours a day, 7 days a week. Two mar-
keting representatives, both of whom are registered nurses,
work out of the admissions suite expediting admissions in
order to ensure that the institutions and professionals who
regularly refer patients to McLean are satisfied.20 Two dis-
charge coordinators work in the discharge planning depart-
ment making arrangements for patients’ posthospitalization
care.
In addition to doctors and nurses who do research,
McLean employs in its research department approximately
50 nonsupervisory professionals in numerous categories with
titles such as clinical research technologist, animal research
technologist, laboratory research technologist, clinical assist-
ant investigator, laboratory assistant investigator, etc.21
McLean engages in both basic research, which is primarily
conducted in laboratories in its Mailman Research Center
and its Alcohol and Drug Abuse Research Center, and in
clinical research, which involves interviewing and working
with actual patients, and is conducted in the buildings which
house the inpatient units and outpatient clinics. Those em-
ployees who engage in clinical research are considered to be
affiliated both with the research department and with the pro-
gram in which they work, although their salaries are paid
from grants rather than from clinical revenues. Research em-
ployees who work in the laboratories have bachelors or mas-
ter’s degrees in fields such as biology, pharmacology, or bio-
chemistry, while those who do clinical research may be psy-
chology majors. McLean also employs two research associ-
ates in its evaluative services unit who conduct patient sur-
veys designed to evaluate patient satisfaction with the quality
of care provided.
McLean’s Hall Mercer Center, an inpatient unit for chil-
dren, has five or six clinical educators who function as teach-
ers for the younger children and also administer educational
and psychological tests to the children. They have a bach-
elors or master’s degree in special education and work week-
days. McLean also employs 10 teachers and a dean at the
Arlington School, a private, independent secondary school
for emotionally disturbed children ages 13 to 22, which
1106 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
serves children who are inpatients and outpatients as well as
children who live in McLean’s community residences. Most
of the Arlington School faculty work only during the school
year, September through June, and take the traditional school
vacations. The dean works year round, and a few faculty
may work during the summer, depending on the patient cen-
sus. The faculty spend 90 percent of their time at the school,
but they may occasionally visit students on the inpatient
units in connection with their schoolwork. The dean occa-
sionally goes to the inpatient units for meetings regarding pa-
tients.
McLean employs several psychologists, a social worker,
and a registered nurse in its ADS I program, ADS II pro-
gram, and the North Cottage Adolescent Day Hospital, day
treatment programs for adolescents who are being released
from an inpatient unit or who are attending the Arlington
School. Each of the three programs has a program coordi-
nator who, in addition to carrying a caseload of patients like
the other professional staff, also serves as contact person
with outside agencies, inpatient staff, and community resi-
dential staff concerning referrals into or out of their respec-
tive programs. One of the program coordinators is a master-
level registered nurse who works .25 fte (full-time equiva-
lent) as the program coordinator for ADS I and .25 fte as
a nurse for the North Cottage Adolescent Day Hospital,
where she handles cases and runs a medication group. The
other two program coordinators are doctorate-level psycholo-
gists. The four professionals who staff ADS I rotate being
‘‘on call’’ for a week, every fourth week, 24 hours a day.
ADS II, a less intensive program, does not provide 24-hour
on-call coverage.
The remaining professionals whom the Employer seeks to
include in the bargaining unit are scattered throughout the
hospital. Two accountants and two financial analysts work in
the fiscal services department. A facilities design coordinator
in the plant and operations department performs architectural
and interior design services for hospital construction and ren-
ovation projects. The environmental health and safety depart-
ment employs an industrial hygienist who implements pro-
grams designed to protect the hospital’s environment from
materials such as asbestos, radon, and hazardous materials
used in the labs. The development office employs develop-
ment officers and development associates who handle
McLean’s fund-raising activities. Professionals within the
public affairs department include a public affairs writer who
prepares copy for McLean’s various newsletters, a publica-
tions editor who prepares McLean’s annual report and other
literature, and a special projects coordinator who coordinates
special events and handles media relations for special events.
Finally, McLean employs chaplains who meet the spiritual
needs of its patients, librarians who staff the library used by
researchers and clinicians, and an assistant archivist in the
office of the registrar who is responsible for maintaining
McLean’s historical records.
While the staff nurses on the inpatient units have little or
no contact with many of the professionals described above,
they do have frequent interaction with the psychiatrists, psy-
chologists, social workers, and rehabilitation professionals on
the inpatient units who, together with the nurses, constitute
the members of the multidisciplinary teams. Each patient is
required to have a multidisciplinary treatment plan. Each unit
holds team meetings about two to three times per week for
about 2 hours which are attended by all members of the mul-
tidisciplinary teams—the PIC, psychiatric resident, CNS,
charge nurse, other nursing staff if they are available, social
worker, rehabilitation personnel, and, occasionally, staff from
utilization review or other consultants. At these meetings the
team members share information, discuss the progress of
each patient, and collaborate to develop an appropriate treat-
ment plan. In addition, most units have multidisciplinary
‘‘rounds,’’ brief meetings to discuss what happened on the
unit the night before, three to five times per week. While the
day shift charge nurse or shift coordinator always attends
these meetings, other staff nurses on the day shift attend
somewhat less frequently, about half of the time on some
units, because of their patient care responsbilities. Rounds
and team meetings are never held during the evening, night,
or weekend shifts.
Staff nurses also work with other professionals in group
therapy and other meetings with patients. Each unit has a
weekly community or ‘‘hall’’ meeting which is attended by
patients and staff of all disciplines for the purpose of dis-
cussing issues and events of common interest. Many units
also have a weekly ‘‘contract’’ meeting attended by patients
and multidisciplinary staff in which patients make a contract
to achieve certain goals by the next meeting. Most units have
numerous therapy groups which meet once or twice a week
for about 45 minutes; many are led by one discipline alone,
but in some cases nurses co-lead groups with psychiatrists,
psychologists, social workers, or rehabilitation staff. In addi-
tion to weekly staff meetings for nurses, some units have a
multidisciplinary staff meeting once a week.
Outside of meetings, the other professionals with whom
staff nurses have the most contact are physicians, with whom
they collaborate in determining the appropriateness of medi-
cations, the frequency of checks, and the need for continued
seclusion or restraint. Because nurses are in a position to ob-
serve patients minute to minute, they frequently contact phy-
sicians to report changes in patients’ conditions and rec-
ommend changes in their orders. Individual contact with the
other professionals during the day varies in frequency, but
typically consists of brief conversations to inform the nurses
that a patient is being taken off the unit for some purpose,
e.g., a group activity or therapy session, and to report after-
ward how the patient did. Such contacts occur several times
a day in some instances, but some nurses interact with a so-
cial worker, for example, about twice a week for a couple
of minutes. Nurses have daily contact by phone with the
pharmacists, concerning patients’ medication. Staff nurses’
contact with other professionals is much less frequent on the
evening and night shifts, as most of the other professionals
leave for the day by 5 or 6 p.m., and few professionals other
than nurses and physicians work weekends.
Twenty-one registered nurses currently employed by
McLean have transferred from one nursing position to an-
other. For example, four utilization review coordinators, two
triage nurses and two clinical specialists in the admissions
department, two nurses in the medical clinic, and five nurses
in the community residential treatment program are former
staff nurses. No registered nurses have ever been employed
in any other professional positions at McLean, nor have any
other professionals ever transferred into registered nurse po-
sitions.
1107MCLEAN HOSPITAL CORP.
22 As medical school appointees, physicians are given an academic
as well as a functional title, but the medical school appointment car-
ries with it no added duties or compensation.
23 Under the salary schedule for nurses, staff nurses, community
residence nurses, and utilization review coordinators are classified as
weekly paid employees. Medical clinic nurse practitioners, research
nurses, triage nurses, and the quality assurance manager are listed in
a pay category which appears on both the weekly and monthly paid
nursing schedules, and it is unclear in which category they fall. The
remaining positions are monthly paid. Weekly paid employees are
eligible for overtime.
24 For purposes of comparison I have relied on Emp. Ex. 35 in
Case 1–RC–19750, which conveniently sets forth the annualized
minimum and maximum salaries for positions in the Employer’s pro-
posed professional unit by title. A 3-percent salary increase, which
went into effect March 1992, is not reflected in Emp. Exh. 35. How-
ever, that increase would not have altered the relative standing of
the various positions. I note that Exh. 35 also does not reflect a 5-
percent market adjustment for staff nurses, a 5-percent increase in
the minimum for all nursing positions, a 5-percent increase in the
maximum for some nursing positions, and a 4-percent increase for
the clinical social worker I position which was implemented in Octo-
ber 1992.
McLean has a human resources department which recruits
for all positions except doctors. A human resources employee
sometimes referred to as a ‘‘nurse recruiter’’ and sometimes
referred to as an ‘‘employment specialist,’’ recruits and
screens nurses as well as some other nonprofessional em-
ployees such as administrative unit assistants and mental
health specialists, but no other professional employees. A
clinical nursing supervisor in the nursing department inter-
views and makes the final hiring decision for nursing posi-
tions, and the nursing department evaluates and disciplines
nurses, as do the supervisors in other departments for their
employees.
Physicians at McLean are recruited by the hiring depart-
ment rather than human resources and are hired as ‘‘joint ap-
pointees’’ of McLean and Harvard Medical School.22 As a
condition of appointment to the ‘‘professional’’ staff at
McLean, physicians, psychologists, and fellows go through a
credentialing process under which they submit their cur-
riculum vitae, licensure, and malpractice information to the
program or training director who has recommended them.
Their applications are then reviewed in turn by the creden-
tials committee, the joint executive committee of professional
staff, and, finally, McLean’s board of trustees, which has the
final vote. The appointment carries with it certain clinical
privileges, which usually include authorization to practice
independently. Residents are selected through a national pro-
gram which matches graduating medical students with insti-
tutions all over the country. As members of the professional
staff, physicians and psychologists must be recredentialed
every 2 years and are bound by bylaws applicable only to
professional staff.
Social workers who have an LICSW may, but are not re-
quired to, go through a similar credentialing process pursuant
to McLean’s bylaws applicable to allied health professionals.
On being credentialed, social workers are entitled to engage
in psychotherapy without supervision, both in the course of
their employment and in private practice. Not all social
workers at McLean have an LICSW, but, as a rule, those
who do have an LICSW go through the credentialing proc-
ess. Registered nurses who are licensed to practice in the ex-
panded role, e.g., master-level nurses, are also eligible to be
credentialed as allied health professionals, and practice psy-
chotherapy independently. Nine nurses at McLean have done
so; only two of them, however, one nurse educator and one
clinical specialist, are nonsupervisory nurses who would be
bargaining unit employees. None of McLean’s staff nurses
are authorized to practice independently and most would
have to undertake years of additional schooling to do so.
Nurses at McLean are paid according to a separate salary
schedule for nurses,23 under which annual salaries for nurses
fall generally within the same range as that of other profes-
sionals, with the exception of physicians, whose base salary
is substantially higher. Examples of annual minimum and
maximum salaries for various registered nurse and other pro-
fessional positions are set forth below.24
Nursing Positions Minimum Maximum
Staff nurse, community resi-
dential nurse, utilization re-
view coordinator $30,208 $48,695
Medical clinic nurse practi-
tioner, research nurse,
triage nurse, quality assur-
ance manager 32,406 52,241
Clinical nurse specialist I, in-
fection control nurse, nurse
clinician, nurse practitioner,
occupational health coordi-
nator 34,674 55,892
Clinical nurse specialist II, in-
structor nursing education 37,049 59,721
Other Professionals Minimum Maximum
Rehabilitation coordinator,
clinical social worker I,
clincial dietician 26,890 40,552
Teacher secondary school 25,388 54,683
Occupational therapist 28,172 42,482
Resident 29,500 40,400
Clinical social worker II 29,521 44,518
Assistant psychologist 30,000 45,635
Associate child psychologist 35,252 57,007
Psychiatrist in charge 44,000 68,270
Assistant biochemist, assistant
in chemistry, associate
neurobiologist, assistant re-
search child psychologist,
research associate, research
fellow, and numerous other
research titles 26,891 83,477
Associate child psychiatrist 54,348 79,585
Child psychiatrist, psychiatrist 80,000 101,311
Physician 85,000 104,002
In addition to the above-described base salaries, psychia-
trists and psychologists are eligible, in their capacity as
credentialed psychotherapists, to supplement their income by
performing work as a therapist beyond their regular work re-
1108 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
25 About 10 to 12 psychiatrists and psychologists, described as
‘‘status seven’’ employees, work only under the unit system and are
not paid a salary. These doctors agree with McLean on a target num-
ber of units they will bill annually, and are paid 12 regular monthly
paychecks based on that target. Their productivity is reviewed every
3 months, and their target or compensation is adjusted accordingly.
If they work at least .40 fte, they are eligible for benefits such as
pension and health insurance, but are not eligible for vacation or hol-
iday pay. The parties have stipulated that they are employees within
the meaning of the Act.
26 The October 1992 salary adjustment for nurses and social work-
ers was announced in September 1992 after the hearing in this mat-
ter had been closed. The Petitioner moved to reopen the record for
the limited purpose of introducing evidence relative to that issue.
The motion was granted, and the hearing was reopened for one day
on December 1, 1992, for that purpose.
27 The Employer notes in its posthearing brief that community res-
idence counselors also receive charge pay; as stipulated nonprofes-
sionals, however, their working conditions are not relevant to the de-
termination of unit scope among professional employees.
28 Although Director of Human Resources Gary Kalajian testified
that rehab counselors who work off-shift receive a shift differential,
Director of Rehabilitation Services Frances Palmer testified that they
are monthly paid employees and do not receive either an evening or
weekend differential for working at those times.
29 McLean points out that a degree differential has also been re-
cently awarded to a pharmacy supervisor and a community residence
counselor; neither of those categories, however, would belong in any
unit found appropriate here, as pharmacy supervisors are stipulated
supervisors, and community residence counselors are stipulated non-
professionals.
30 Although Kalajian testified that ‘‘recreation counselors’’ are eli-
gible for overtime pay, Palmer testified that the title ‘‘recreation
therapist’’ is obsolete, that the correct title is now rehabilitation pro-
gram coordinator, which is a monthly paid position and not eligible
for overtime pay.
quirements. For example, about one-third to one-half of the
PICs perform about 9 to 20 units (hours) of clinical service
per week, for which they are compensated at the rate of $50
per hour, thus supplementing their base salary by $450 to
$1000 per week. Many further supplement their income by
doing weekend rounds over and above the 9 to 20 units,
which is billed at anywhere between 4 to 15 clinical units
of service.25 About 1 in 10 nonsupervisory psychologists also
supplement their base salary by doing 3 to 5 hours per week
of therapy under the unit system, at the rate of $35 to $40
per hour. Credentialed social workers are eligible to partici-
pate in the unit system of compensation at the rate of $30
per hour. Most social workers do not perform work under the
unit system, but those who do pick up about 1 to 6 hours
of extra work per week.
In addition to being compensated by McLean through sal-
ary or billable units, most psychiatrists, psychologists, and
credentialed social workers engage in private practice at
McLean, for which they get paid directly by their patients
and/or their insurers, generally at the rate of $90 to $100 per
hour. They may see private patients in their McLean offices
during the regular workweek so long as it does not interfere
with their duties as employees. These professionals are al-
lowed to use their McLean secretaries to perform billing and
receptionist services in connection with their private prac-
tices, so long as they pay them extra for such services, gen-
erally about $100 per month. Psychologists generally spend
about 10 to 15 hours per week in private practice; social
workers who are eligible to engage in independent psycho-
therapy generally devote about 2 to 16 hours to their private
practices. There is no record evidence as to the average num-
ber of hours psychiatrists engage in private practice, but joint
appointees are subject to a Harvard Medical School guideline
under which they may not earn in private practice more than
twice the maximum salary for their academic rank. Some
nurses supplement their income by doing part-time work
elsewhere, on their own time, such as temporary work for
agencies that provide home care, at the rate of $22 to $23
per hour.
McLean periodically surveys compensation rates for com-
parable positions at other hospitals in the area and, from time
to time, has increased salaries for particular positions based
on market conditions. In October 1992, McLean imple-
mented a 5-percent market-based increase to all staff nurses,
and also increased the minimum salary for all nurses, as well
as the maximum for all staff nurses. Nurses have been sin-
gled out for one or two other such increases in recent years.
However, in the past few years McLean has also awarded
salary increases based on market forces to other profes-
sionals: psychiatrists in 1985, clinical educators in 1989, ac-
countants in 1990, occupational therapists in 1989 and 1991,
pharmacists in 1990 and 1992, and research employees. The
entry level salary for clinical social workers I was increased
in October 1992, at the same time the adjustment for nurses
was implemented.26
While the minimum salary for any given position reflects
the lowest salary that any employee in that grade receives,
some employees may, depending on their experience, be
hired at a salary up to 25-percent higher than the minimum.
Nurses are the only category of employees at McLean for
whom the hiring ceiling has been set at 35-percent higher
than minimum. Entry-level salaries for all employees, except
doctors (psychiatrists and PhD psychologists), are established
by the human resources department. The entry-level salary
for doctors is established by their hiring department.
Staff nurses who serve as charge nurse or shift coordinator
are paid a 50-cent-per-hour charge differential and are the
only professionals who receive such a benefit.27 Staff nurses
are paid a shift differential of $1 per hour for evening shifts,
$2 per hour for night shifts, and an additional $1 per hour
for weekend shifts. The only other professionals who work
off-shifts and are entitled to a shift differential are phar-
macists, admissions coordinators, and discharge coordina-
tors,28 who are paid at the rate of 60 cents per hour for
evening and weekend shifts and $1.20 per hour for night
shifts. McLean offers a degree differential of 3 percent for
obtaining a bachelors degree and 3 percent for obtaining a
master’s degree which historically has been applied only to
registered nurses.29 As weekly paid employees, staff nurses
receive overtime pay and holiday premium pay at the rate of
time and a half. Other professionals who are weekly paid,
such as pharmacists, admissions coordinators, and some re-
search employees, are also eligible for overtime pay. Month-
ly paid employees—including psychiatrists, psychologists,
social workers, rehabilitation staff,30 and nurses in such posi-
tions as nurse clinician, clinical educator in nursing, nurse
practitioner, clinical nurse specialist—are not eligible for
overtime pay.
Staff nurses, who are entitled to 3 weeks of vacation to
start, are the only employees at McLean who are entitled to
1109MCLEAN HOSPITAL CORP.
31 The tuition reimbursement program and employee assistance
plan are not available to joint appointees, and the life insurance and
long-term disability plan for joint appointees is different.
4 weeks’ vacation after 1 year of employment. Other profes-
sionals, with the exception of joint appointees, start out with
2 or 3 weeks of vacation, depending on their grade, and are
not entitled to 4 weeks of vacation until their fourth or fifth
year of employment, depending on the position. Joint ap-
pointees are entitled to 1 month’s vacation to start.
In the event of discharge or other disciplinary action, pro-
fessional employees who are credentialed—physicians, psy-
chologists, and some social workers—have access to a spe-
cial appeals procedure pursuant to the bylaws for profes-
sional staff or allied health professionals. This process in-
cludes procedural protections such as the right to a fair hear-
ing with sworn testimony, the right to counsel, the right to
a transcript, the right to submit a report, and ultimate review
by McLean’s executive commitee and, for doctors and psy-
chologists, McLean’s trustees. Nurses who are disciplined are
entitled to appeal pursuant to the standard grievance proce-
dure available to all other McLean employees, which does
not include the due-process protections afforded to
credentialed professionals and which ends at a lower level of
review.
With the above-described exceptions, the personnel poli-
cies and remaining fringe benefits offerred by McLean are
applied uniformly to all professional employees. All profes-
sionals receive the same holidays, time off with pay, be-
reavement leave, jury duty leave, leaves of absence, medical
insurance, dental insurance, life insurance, business travel in-
surance, long-term disability coverage, pension plan, tax sav-
ing plans, health clinic, tuition reimbursement, and employee
assistance plan.31 All employees use a common entrance and
have equal access to parking areas. A child care center, cred-
it union, cafeteria, and recreation building are open to all
McLean employees.
The record reflects certain distinctions between the oper-
ation of a psychiatric hospital versus a general acute care
hospital that the Employer alleges have an impact on the role
of the registered nurses and other professional employees in
a psychiatric setting. First, in addition to the use of psycho-
tropic medications and intensive psychotherapy to treat pa-
tients, an important component of the treatment of patients
in a psychiatric hospital is the ‘‘therapeutic milieu.’’ A thera-
peutic milieu essentially connotes an environment in which
patients feel safe and understood. This includes ensuring the
physical safety of patients who may be suicidal or violent.
It also connotes a setting in which patients are surrounded
by staff who relate to them in a supportive, therapeutic man-
ner and in which patients feel that they are part of a commu-
nity.
An important aspect of treatment at McLean is its use of
multidisciplinary teams composed of psychiatrists, nurses, so-
cial workers, psychologists, and rehabilitation professionals.
Given the complexity of the psychiatric disorders treated at
McLean, treatment is not a job for one person, but requires
a team of professionals, all of whom play a role in devel-
oping a relationship with patients and in providing the inter-
ventions necessary to recovery. Effective patient care re-
quires flexibility on the part of professionals on the team, so
that if a patient finds a relationship with a team member of
a particular discipline to be the most therapeutic, the treat-
ment team can ‘‘flex’’ in that direction.
According to Dr. Lloyd Sederer, McLean’s associate direc-
tor for clinical services, there needs to be a sense of true
partnership in the clinical enterprise among the different dis-
ciplines in order for the therapeutic milieu to work, and
nurses must be identified as wholly a part of the treatment
team and not segregated. He testified that a significant con-
flict among the staff on a team can have an adverse effect
on the therapeutic milieu and that, in his clinical judgment,
a separate bargaining unit for nurses would be inconsistent
with the therapeutic milieu.
Dr. Mirin, general director and psychiatrist in chief, testi-
fied that professionals in a mental health setting need to
work together in a tight-knit fashion, that a different set of
employment terms for one professional group versus another
could have a profoundly negative effect on McLean’s ability
to deliver patient care, and that separate bargaining units for
one group of employees would strain the relationship be-
tween those employees who are in and out of the unit. He
expressed his opinion that if nurses had different vacation or
holiday benefits from other members of the team, it might
be difficult to schedule meetings for the treatment teams. Fi-
nally, he testified that having to transfer employees from one
part of the hospital to another in accordance with a seniority
clause in a union contract, as opposed to in accordance with
what makes common sense, would be disruptive, and that a
third party intervening in the relationship between the hos-
pital and its professional staff would undermine the sense of
community and family that McLean tries to foster among its
employees.
McLean also attempted to demonstrate that multiple bar-
gaining units would have a harmful effect on the therapeutic
milieu through the testimony of Roy Ettlinger, who has
served as an administrator in several public and private psy-
chiatric institutions. Because Ettlinger has managed psy-
chiatric facilities with multiple unions, one union, and no
unions, McLean contends that he is in the unique position of
being able to compare the effect on patient care of these var-
ious bargaining unit configurations. Ettlinger worked for sev-
eral years in a managerial capacity at Marlboro Psychiatric
Hospital in New Jersey, a public psychiatric hospital which
had four bargaining units: a technical and maintenance unit,
a unit of other nonprofessionals, a professional unit, and a
unit of police. He testified that psychiatric patients are very
sensitive to conflicts between staff and may wonder if they
are the cause. As an example of the potential danger posed
by multiple bargaining units, Ettlinger cited an instance at
Marlboro Psychiatric Hospital in which the union rep-
resenting mental health workers and dietary employees struck
as a result of an impasse in contract negotiations, and the
other unions crossed the picket lines to work. This, according
to Ettlinger, caused angry feelings between employees in the
different bargaining units which spilled over into the thera-
peutic milieu, disrupting patient treatment and leading to an
increase in acting-out behavior and assaults by patients on
other patients and staff. Ettlinger also testified, however, that
some members of the very same bargaining unit who struck
also chose to work during the strike.
Ettlinger has also worked at the Human Resources Insti-
tute Hospital (HRI) in Brookline, Massachusetts, a private
psychiatric hospital in which registered nurses are rep-
1110 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
32 The Petitioner represents all-professional units at two area hos-
pitals, Malden Hospital and Morton Hospital and Medical Center.
The Petitioner also represents a bargaining unit of state hospital em-
ployees which includes nurses, psychologists, physicians, and phar-
macists.
33 In the cases of Waltham-Weston Hospital and Carney Hospital,
the testimony of the MNA reps as to how the psychiatric units at
these hospitals operate was supplemented by policy and procedure
documents published by those hospitals and stipulated by the parties
to be authentic and currently in use. Pet. Exhs. 37 and 38, published
by those hospitals and stipulated by the parties to be authentic and
currently in use.
34 The Employer contends in a motion to dismiss (Emp. Exhs. 1a
and 1b), which has not been expressly withdrawn, although it was
not renewed in its brief, that because the Board’s rules governing
bargaining units in health care facilities specifically exempted psy-
chiatric facilities from coverage, unit determinations in psychiatric
facilities continue to be governed by the disparity of interest test set
forth in St. Francis Hospital, 271 NLRB 948 (1984) (St. Francis II),
under which separate RN units were routinely rejected by the Board.
Alternatively, the Employer moves to dismiss on the ground that
even under the old community of interests test, the Board found in
Mount Airy Psychiatric Center, 253 NLRB 1003 (1981), that profes-
sionals in psychiatric hospitals should not be divided into separate
units. Since Mount Airy ‘‘commands’’ dismissal of the petition under
any possible standard, the Employer argues, a hearing is unneces-
sary. The motion is denied. The proper standard for determining ap-
propriate bargaining units in nonacute care health facilities was an-
nounced by the Board in the Park Manor Care Center decision, de-
scribed below. Because Park Manor was issued by the Board the
day after the Employer submitted its motion to dismiss, the Em-
ployer did not have the benefit of that decision at the time the mo-
tion was submitted. That Park Manor governs the principles applica-
ble to unit determinations for all health care facilities exempt from
rulemaking, including psychiatric hospitals, was recently confirmed
by the Board in its order denying review of the companion case in
this matter, McLean Hospital Corp., 309 NLRB 564 (1992). As for
the contention that the holding in Mount Airy ‘‘commands’’ dis-
missal of the petition without a hearing, the Board never suggested
in Mount Airy that its finding in that case would apply uniformly
to all psychiatric hospitals; in fact, the Board specifically stated in
Mount Airy that it reached its decision with Newton Wellesly Hos-
pital in mind, under which the Board has a responsiblity to decide
‘‘in each case,’’ after a thorough examination of the particular facts,
whether the requested unit is appropriate.
I also reject the Employer’s contention at 93 of its posthearing
brief that
[By] exempting psychiatric hospitals from the regulations calling
for a separate nurses unit, the Board already has determined that
a separate nurses unit is not appropriate for a psychiatric hos-
pital such as McLean. [Emphasis in original.]
The Board stated clearly in rulemaking that it had decided to pro-
ceed as to psychiatric hospitals ‘‘on a case-by-case basis’’ and gave
no indication whatsoever that any particular unit configuration would
resented in a bargaining unit along with LPNs, milieu thera-
pists, mental health workers, clericals, dietary workers, and
occupational therapy aides. The remaining professional em-
ployees at HRI—social workers, occupational therapists, rec-
reational therapists, psychologists, pharmacist, and clinical
coordinators—are unrepresented. There have been no juris-
dictional strikes. While there have been some jurisdictional
disputes between nurses and nonrepresented professional
staff, they have been disputes over professional roles unre-
lated to to any right asserted pursuant to the nurses’ collec-
tive-bargaining agreement. There has been no adverse impact
on the therapeutic milieu at HRI due to differences in terms
of employment between represented and unrepresented em-
ployees. Similar disagreements over professional roles have
also arisen between social workers and registered nurses at
the Arbour Hospital, a nonunionized private psychiatric hos-
pital in Jamaica Plain, Massachusetts, where Ettlinger has
also worked.
Ettlinger also testified that at Marlboro Psychiatric Hos-
pital, scheduling problems arose due to the fact that the pro-
fessional and paraprofessional members of the treatment
teams had different processes for requesting vacation and had
contractual seniority rights affecting scheduling of vacation.
However, the hospital also had difficulty scheduling vacation
for social workers, psychologists, nurses, and rehab per-
sonnel, notwithstanding the fact that they were all in the
same bargaining unit. At HRI, the fact that represented and
unrepresented employees had disparate holidays off also cre-
ated operational problems; at Marlboro Psychiatric Hospital,
all employees in the four bargaining units there had the same
holiday schedules.
In rebuttal to Ettlinger’s testimony concerning the adverse
impact of separate representation for nurses, the Petitioner
offerred the testimony of Elaine Mauger, Julie Pinkham, and
Shelley Reever. The Petitioner represents various all-RN bar-
gaining units at several area hospitals.32 Reever, Mauger, and
Pinkham are the MNA staff representatives assigned to rep-
resent bargaining units of registered nurses at Saint Eliza-
beth’s Hospital, Cambridge Hospital, Carney Hospital, Faulk-
ner Hospital, Newton-Wellesley Hospital, Waltham-Weston
Hospital, New England Medical Center, Marlboro Hospital,
and Quincy Hospital. As MNA representatives, they are re-
sponsible for negotiating collective-bargaining agreements
and processing grievances on behalf of bargaining unit mem-
bers. Each of these hospitals is an acute care general hospital
that also has one or more psychiatric units. Registered nurses
employed on the psychiatric units are included in the all-RN
bargaining units.
The psychiatric units in the hospitals represented by the
Petitioner also use multidisciplinary teams composed of
nurses, physicians, social workers, psychologists, and reha-
bilitation workers who collaborate in the assessment and
treatment of patients. They also treat patients using a com-
bination of individual, family, group, and milieu therapy.33
As at McLean, registered nurses are the only professionals
who work three 8-hour shifts around the clock. None of the
three representatives has ever received any complaints from
management at any of these hospitals that representation of
psychiatric nurses separate from the other professionals on
the psychiatric units has had any adverse impact on the de-
livery of patient care. There have been no work jurisdiction
disputes at any of these hospitals, nor have any grievances
been filed which have involved the other professionals.
In 1989, after extensive hearings, the Board promulgated
at 29 CFR Section 103 its rule for determining appropriate
bargaining units in the health care industry. Under that rule,
there are eight presumptively appropriate bargaining units in
health care facilities, including a separate unit of all reg-
istered nurses. While the rule was originally intended to
cover psychiatric facilities, the Board eventually determined
that the rule would apply only to acute care hospitals and
that bargaining unit determinations for psychiatric hospitals
and other non-acute care facilities should continue to be
made on a case-by-case basis.34 The standard by which the
1111MCLEAN HOSPITAL CORP.
be automatically precluded. 53 Fed.Reg. 33930, 284 NLRB at 1570
(1988). I also note that this argument, also made and rejected in the
companion case to this proceeding, has already been implicitly re-
jected by the Board in its denial of the Employer’s request for re-
view of my decision in that case.
Board will determine appropriate bargaining units in non-
acute care facilities was established in Park Manor Care
Center, 305 NLRB 872 (1991). Under the ‘‘pragmatic or em-
pirical community of interests approach,’’ set forth in Park
Manor, the Board will consider background information
gathered during rulemaking and prior precedent involving ei-
ther the type of unit sought or the particular type of health
facility in dispute, as well as traditional community of inter-
est factors. The Board suggested that it would be helpful to
compare and contrast the work force in the unit sought with
the work force in acute care hospitals. Finally, the Board
noted in Park Manor that certain general principles set forth
in the rulemaking procedure are equally applicable to unit
determinations in non-acute care facilities:
[I]n exercising its discretion to determine appropriate
units, the Board must steer a careful course between
two undesirable extremes; If the unit is too large, it
may be difficult to organize, and, when organized, will
contain too diversified a constituency which may gen-
erate conflicts of interest and dissatisfaction among
constituent groups, making it difficult for the union to
represent; on the other hand, if the unit is too small, it
may be costly for the employer to deal with because of
repetitious bargaining, and/or frequent strikes, jurisdic-
tional disputes and wage whipsawing, and may even be
deleterious for the union by too severely limiting its
constituency and hence its bargaining strength. [Foot-
note omitted.] The Board’s goal is to find a middle-
ground position, to allocate power between labor and
management by ‘‘striking the balance’’ in the appro-
priate place, with units that are neither too large nor too
small. [Footnote omitted; 53 Fed.Reg. 33904, 284
NLRB at 1534.]
Id. at 5.
The Petitioner contends that the petitioned-for bargaining
unit of all registered nurses is appropriate. The Employer
maintains that, due to its status as a psychiatric hospital, an
all-professional unit is the smallest appropriate unit at
McLean. Applying the principles of Park Manor to the facts
of this case, I find, for the reasons set forth below, that a
unit of registered nurses is appropriate.
Looking first to the Board’s experience during rulemaking,
the Board’s examination of registered nurses at acute care
hospitals resulted in a finding that these employees constitute
a discrete group whose distinctive interests warrant separate
representation. The evidence showed that RNs are the only
professionals who are required, as a group, to be on duty 24
hours a day, 7 days a week and are the only professionals
regularly required to work overtime. While there are isolated
examples of other professionals working evenings or week-
ends, most work primarily day shifts during the weekdays.
Thus nurses have a unique collective-bargaining interest in
such matters as scheduling, shift differentials, and floating.
Nurses are also unique in that they use the nursing process
to assess patients and in that their profession demands con-
tinuous contact with patients, while the patient contact by
other professionals is more intermittent. RNs alone contin-
ually monitor patients to make sure that physicians’ orders
are carried out and that treatment procedures are not proving
harmful. All acute care facilities have a department of nurs-
ing managed by RNs, and nurses overwhelmingly report to
nurses. While some nurses work in other departments, the
vast majority are ultimately responsible to the director of
nursing. Some hospitals use ‘‘product line management,’’ a
system of organization by type of service under which nurses
may be responsible in some way to the manager of a project,
but they still report to nursing supervisors. 53 Fed.Reg.
33911–33912, 284 NLRB at 1544.
The Board also noted that nurses are in a distinct labor
market, which hospitals sometimes recognize by having
nurse recruiters, a position which does not exist for other
professionals. Because nurses are overwhelmingly female,
and because RN wage scales are tied to RN wages at other
hospitals, there is no pressure to increase wages from outside
the industry, resulting in low nursing salaries relative to
those of other professionals. While all professions require
specialized education and training, nurses must pass licensing
exams which are uniform throughout the country, and must
follow state nurse practice acts under which no other health
care workers may function as a nurse. RNs must report er-
rors made by other professionals, e.g., errors in medication
dosages by pharmacists, which may result in antagonism be-
tween RNs and other professionals. Cross-training and inter-
change is limited because of licensing requirements for RNs
and the other professionals; RNs cannot be replaced by other
professionals. While other professionals may occasionally
perform RN functions, e.g., watching a heart monitor while
nurses are on break, such examples are minimal. 53 Fed.Reg.
33912–33913, 284 NLRB at 1544–1547.
RNs in acute care hospitals do not have regular or recur-
ring contact with nonnurse professionals, in part because li-
censing regulations preclude health care professionals from
doing each others’ work, because RNs have different work-
ing hours, and because many nonnurse professionals are lo-
cated away from the patient units where RNs work. While
some hospitals use multidisciplinary teams which interact
daily and have weekly formal meetings, the Board was not
persuaded that the team concept detracted from the appro-
priateness of an all-RN unit. The Board noted that team
members interact only with the few other members of their
team, that other duties may prevent RNs from participating
fully in teams, and that participation in teams does not alter
each professional’s scope of practice or separate identity. The
Board also found that the hospital industry had offered only
unsubstantiated speculation that separate RN unit would ad-
versely affect team care. 53 Fed.Reg. 33912–33913, 284
NLRB at 1545–1547.
The Board found that nurses have historically sought sepa-
rate representation and that other professionals often do not
react favorably to their inclusion with RNs. This is due in
part to the fact that RNs in acute care hospitals may out-
number other professionals by a ratio of 4 to 1 or more, and
the nonnurse professionals are concerned that their interests
will not be given priority in an all-professional unit due to
their smaller numbers. The Board found no evidence of wage
whipsawing or jurisdictional disputes between unions of pro-
fessional employees in the hospital industry. With regard to
1112 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
strikes, the Board found that the strike percentage (number
of strikes per contract negotiations) was relatively low in the
health care industry and that hospitals continued operations
during them. It further found that even in an all-professional
unit, RNs, because of their numbers, could obtain a strike
vote over the objections of the other professionals, and that
a strike by an all-professional unit would be even more dis-
ruptive to a hospital than a strike by an all-RN unit. Finally,
the Board found that due to a nursing shortage and a trend
toward higher patient acuity, fewer nurses are required to
care for more seriously ill patients, leading to more stress
among the remaining RNs. It noted that nurses view separate
collective bargaining as a vehicle for improving their work-
ing conditions and that hospitals are trying innovative pro-
posals targeted at RNs in an effort to attract and keep them.
53 Fed.Reg. 33912–33916, 284 NLRB at 1545–1551.
With regard to psychiatric facilities, the Board found that,
unlike acute care hospitals, psychiatric hospitals do not treat
physical illness, that RNs are not the primary facilitators of
care, and that RNs’ work is closely integrated with that of
psychologists, social workers, doctors, and other counselors.
The Board further observed that there are more professionals
other than nurses and doctors in psychiatric facilities, with
the ratio of nurses to other professionals about 1:1; therefore
nonnurse professionals would not have the same concern
about being outnumbered as they would in an all-profes-
sional unit in an acute care hospital. For these reasons the
Board decided to exclude psychiatric hospitals from applica-
tion of its rule for acute care hospitals and to proceed as to
them on a case-by-case basis. 53 Fed.Reg. 33929–33930, 284
NLRB at 1568–1570.
While there are some important differences between the
roles of nurses in psychiatric and acute care hospitals, I find
that the factors which supported the Board’s decision to per-
mit separate nurses units in acute care hospitals are present
at McLean and justify a similar result. Although all profes-
sional employees have certain working conditions, personnel
policies, and benefits in common, the registered nurses share
other unique working conditions, interests, and benefits
which distinguish them sufficiently from the remaining pro-
fessionals to warrant separate collective bargaining. Like the
nurses is acute care hospitals, nurses at Mclean are the only
professionals who are responsible for providing patient care
24 hours a day, 365 days a year. While there is evidence that
some other professionals work occasional evenings and
weekends, and that doctors may be on call for emergencies
at night, no other professional group at McLean covers the
patient units three shifts a day. This work schedule gives the
nurses unique bargaining interests in shift and weekend dif-
ferentials, shift rotation schedules, overtime, charge pay, and
special incentives targeted exclusively at nurses, such as the
24-hour weekend package.
The evidence does show that there is somewhat more
overlap between the functions of nurses and other team
members at McLean than there is between the nurses and
other professionals at acute care hospitals. In this regard, be-
cause McLean’s patients are admitted due to mental rather
than physical illness, the primary focus of care is on psy-
chiatric rather than medical treatments, and all team members
engage in individual counseling, group therapy, and treat-
ment planning in rounds and team meetings. While nurses at
McLean may spend relatively less time engaged in medical
tasks as compared to their counterparts at acute care hos-
pitals, I find, however, that traditional nursing tasks still con-
stitute a significant aspect of their role which differentiates
them from the remaining professionals. In addition to treating
patients by means of individual, group, and milieu therapy,
McLean treats patients with medical treatments such as drug
and electroconvulsive therapy. Nurses at McLean are the
only professionals, aside from physicians, who may admin-
ister medications. While the vast majority of the medications
administered are psychotropic drugs, they have physical ef-
fects which must be monitored by medical professionals.
While other professionals observe patients and may report
whether or not they feel a drug has been effective for a given
patient, only doctors and nurses are trained and responsible
by law for the safe and effective administration of drugs, and
nurses are uniquely responsible for teaching patients about
their medications. Only nurses may act in a charge capacity
and give and receive report at the change of shifts. Only
nurses transcribe physicians’ orders, check vital signs, and
perform periodic safety checks. Nurses are the only profes-
sionals other than doctors who, by law, may authorize phys-
ical seclusion and restraint. While McLean is not designed
to treat patients with serious or life-threatening medical con-
ditions, some patients do require treatment for routine, con-
current medical conditions, a function performed only by
nurses. Because many of the foregoing functions may be per-
formed, by law, only by a licensed registered nurse, no other
professional may substitute for a nurse who is absent from
work. The uniqueness of their role is also underscored by the
fact that, while 21 nurses at McLean have transferred from
one nursing position to another, no other professional has
ever transferred into an RN position and no nurses have
transferred into non-RN positions. Because of their unique
role, nurses attend a 3-week orientation at the outset of em-
ployment and annual mandatory training which is attended
by no other professional groups at McLean.
In finding an all-RN unit appropriate I also rely on the fact
that the vast majority of the registered nurses, like the nurses
in acute care hospitals, are administratively segregated within
a department of nursing and are separately supervised by
other registered nurses. Although professionals at McLean
are affiliated with their ‘‘program’’ as well as their profes-
sional department, this is not unlike the ‘‘product line man-
agement’’ system of organization by type of service that
acute care hospitals also use. Notwithstanding that affiliation
with a program, for purposes of hiring, evaluation, termi-
nation, and other disciplinary matters, nurses report to a hier-
archy of other registered nurses to whom no other profes-
sionals report.
The appropriateness of a separate nurses unit is also sup-
ported by sharp differences in the level and methods of com-
pensation for nurses versus the other professionals. While the
base salary levels for nurses are generally within the same
range as those for most other professional groups, physicians
may earn twice as much as nurses, counting base salary
alone. Physicians’ higher base salaries, coupled with their
ability to earn even more based on the unit system of reim-
bursement and in private practice, their prestigious academic
appointment, and their separate system for hiring, setting sal-
aries, and grieving discipline combine to make the bargaining
interests of McLean’s physicians so divergent from those of
the nurses, that I find it would be inappropriate to include
1113MCLEAN HOSPITAL CORP.
35 As noted above, acute care hospitals also use multidisciplinary
teams to some degree, but the Board found that the team concept
did not detract from the appropriateness of RN units.
36 In Newton-Wellesley Hospital, 250 NLRB 409 (1980), the Board
declared that it disavowed any intention to create an irrebutable pre-
sumption in favor of an all-RN unit and that it would consider the
particular circumstances of each case. In that case and a series of
cases thereafter, however, it continued to approve all-RN units. In
St. Francis Hospital, 265 NLRB 1025 (1982) (St. Francis I) the
Board announced that it would consider a maximum of seven poten-
tially appropriate units in health care cases, including a registered
nurses unit, that they would be neither presumptively appropriate nor
invariably granted, and that it would continue to apply community-
of-interest criteria.
them in a unit with nurses. To the degree that psychologists
and social workers are credentialed pursuant to the profes-
sional or allied health professional bylaws, their ability to
supplement their income through the unit system and private
practice and their access to a separate grievance procedure
also gives them different bargaining interests from the
nurses, who with rare exceptions, have no such opportunity.
While the Employer argues that nurses may also supplement
their income with outside employment, nurses’ ability to earn
$23 per hour on their own time is simply not comparable to
the opportunity afforded other professionals to see private
patients in their McLean offices during the regular workweek
at the rate of $90 to $100 per hour.
In approving an all-RN unit, I am aware that because they
co-lead group therapy sessions with other professionals and
attend multidisciplinary team meetings and rounds, nurses at
McLean generally have more interaction with other profes-
sionals than do nurses in acute care hospitals.35 I also concur
with the Employer that most staff nurses probably have more
interaction with the professionals on their own units than
they do with nurses who work on other inpatient units. I find
nonetheless that nurses have sufficient contact with one an-
other and, more important, sufficient common interests, to
justify separate representation as a group. The Board has
never required that all members of a bargaining unit have
contact with one another. If that were the case, the unit of
professionals proposed by the Employer would be equally in-
appropriate, as psychiatrists, psychologists, social workers,
and rehabilitation personnel are also permanently assigned to
one unit at McLean and presumably have just as little contact
with the professionals on other inpatient units as nurses do.
Following that argument to its logical conclusion, the only
appropriate units would be separate bargaining units for each
inpatient unit, a solution which would surely violate the Con-
gressional mandate against undue proliferation of bargaining
units.
An examination of prior precedent involving the appro-
priateness of separate bargaining units for registered nurses
also supports this result. In the 10-year period following pas-
sage of the 1974 Health Care Amendments which extended
the protections of the Act to employees in nonprofit hos-
pitals, the Board, applying traditional community-of-interests
analysis, consistently approved all-RN units. The Board’s
reasoning, first set forth in Mercy Hospitals of Sacramento,
217 NLRB 765 (1975), was that nurses are the only profes-
sionals required to be on duty 24 hours a day, that their du-
ties, by law, may not be delegated to other professionals, and
that the vast majority of nurses are administratively separated
in a nursing department as required by state law, under
which they are subject to common supervision by head
nurses and higher level managers who have authority to hire,
fire, and regulate working conditions. Based on these factors,
the Board found that RNs possess ‘‘interests evidencing a
greater degree of separateness than those possessed by most
other professionals in the health care industry.’’ Id. at 767.
Responding to judicial criticism that it had not given due
deference to the Congressional admonition against prolifera-
tion of bargaining units in the health care industry, the Board
modified its approach during this period, but continued to ap-
prove separate units for nurses.36
In the face of continued criticism by the circuit courts, the
Board reversed gears in St. Francis Hospital, 271 NLRB 948
(1984) (St. Francis II), in which it held that the ‘‘disparity
of interests’’ test better met Congressional concern over
undue proliferation. Under that analysis, sharper than usual
differences between the requested group and an overall pro-
fessional or nonprofessional unit are required in a health care
facility to justify separate representation. Applying the dis-
parity of interests test, the Board found separate RN units in-
appropriate in Keokuk Area Hospital, 278 NLRB 242 (1986),
and North Arundel Hospital Assn., 279 NLRB 311 (1986).
Finally, after the St. Francis II approach was itself se-
verely criticized by several circuit courts, the Board decided
to engage in rulemaking to determine appropriate health care
bargaining units, but to process all petitions under the dis-
parity of interests test pending issuance of a final rule. St.
Vincent Hospital, 285 NLRB 365 (1987). During this interim
period, the Board found separate RN units appropriate in a
few further cases, including St. Vincent Hospital. During
rulemaking, however, the Board observed that, having had
the opportunity to consider the substantial empirical evidence
adduced in rulemaking, it had a far better understanding of
the role of nurses in hospital operations, and that, were it to
apply that empirical evidence, it might well reach a different
result in St. Vincent. 53 Fed.Reg. 33916, 284 NLRB 1551 fn.
22.
The only Board decision involving registered nurses in a
psychiatric hospital is Mount Airy Psychiatric Center, 253
NLRB 1003 (1981), in which the Board rejected the peti-
tioned-for unit of registered nurses in favor of an all-profes-
sional unit. Mount Airy was divided into four programs for
different types of patients. Two programs were staffed by
nurses who performed traditional nursing functions and em-
ployed the standard nursing hierarchy in which staff nurses,
charge nurses, and head nurses reported to higher level
nurses. Two were headed by nonnurse program coordinators
who served as administrators of their respective programs.
One of these, the adolescent section, employed ‘‘charge per-
sons’’ rather than charge nurses and team leaders rather than
staff nurses. Two of the five charge persons and six of the
fifteen team leaders were nonnurses, professionals with a
master’s in psychology or a related field; the rest were RNs.
All team leaders and charge persons, RN and non-RN, per-
formed virtually the same duties. Team leaders were assigned
to work the three round-the-clock shifts, and their
responsiblities included getting children up, taking vital
signs, checking personal hygiene, feeding the children, and
engaging in one-to-one counseling. The task of making med-
ical assessments and administering medication in the adoles-
1114 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
37 The Board acknowledged that the registered nurse team leaders,
unlike the non-RN team leaders, were licensed to administer medical
treatments, and that this difference in professional training might be
a crucial factor in finding a separate RN unit appropriate in other
circumstances. This factor was not dispositive in Mount Airy, the
Board held, because the RN team leaders were not generally re-
quired to administer medications.
38 The Petitioner also relies on a decision by this Region involving
registered nurses in a psychiatric setting. In Faulkner Hospital, Case
1–RC–17481, an acute care hospital with a psychiatric unit, the Act-
ing Regional Director found a separate RN unit appropriate based on
differences in the education, duties and responsiblities, licensure, and
supervision of the RNs, notwithstanding the psychiatric unit’s em-
phasis on teams composed of RNs and social workers which met
daily, and the fact that positions on the unit were defined by role
rather than discipline.
39 A request for review in Case 1–RC–19742 is presently pending
before the Board.
40 The Employer argues in its brief that Brattleboro II deserves
significant weight as the only opinion applying the Park Manor
cent section was delegated to an RN ‘‘associate charge
nurse’’; RN charge persons and RN team leaders did not get
involved with medical treatments, except for infrequent
emergencies when the associate charge nurse was unavail-
able. An RN team leader who called in sick could be re-
placed by a non-RN team leader. All team leaders, RN and
non-RN, were answerable to a head nurse, or in her absence,
to the charge person on duty. Observing that all team leaders
performed virtually the same daily tasks, substituted for each
other, received the same benefits, and were subject to the
same supervision, and that the responsibility for preparing
and administering medication had been generally removed
from the RN team leaders,37 the Board concluded that all the
team leaders stood in an identical position and that, under the
circumstances, the exclusion of nonnurse team leaders from
the unit would be improper. Finally, having found that the
unit must include nonnurse team leaders and charge persons,
the Board concluded that nine remaining professionals—
pharmacists, occupational therapists, social workers, and an
educator—must also be included in the unit, because the only
alternative would be to create a small residual unit of
nonnurse professionals who exhibited little community of in-
terest among themselves. Id. at 1006–1007.
I find that the factors which justified the inclusion of the
team leaders and charge persons with the registered nurses
in Mount Airy are absent at McLean. Unlike the nonnurse
team leaders and charge persons in Mount Airy, no nonnurse
professionals at McLean share the same title as staff nurses,
work side by side with them on three around-the-clock shifts,
or perform virtually identical tasks. In this regard, non-RN
team members at McLean do not perform such nursing tasks
as getting patients up in the morning, feeding them, and tak-
ing their vital signs. Staff nurses at McLean, unlike RN team
leaders at Mount Airy, are responsible for administering
medications and other medical treatments. While psychiatric
nurses may focus less on medical treatments than nurses at
acute care hospitals, the administration of medications is one
of their necessary functions and one which may be per-
formed by no other professionals with the exception of doc-
tors. Unlike the team leaders at Mount Airy, no other profes-
sionals at McLean can replace a staff nurse who calls in sick,
and no other professionals report to nurses.
The only other Board decision involving registered nurses
in a psychiatric setting is Newton-Wellesley Hospital, 250
NLRB 409 (1980).38 The Newton-Wellesley case involved an
acute care hospital which also had a psychiatric unit. Having
found an all-RN unit to be appropriate, the Board noted that
in reaching its conclusion it had paid special attention to the
close working relationship between the nurses and other pro-
fessionals in the psychiatric unit. The psychiatric nurses at
Newton-Wellesley co-led therapy groups with social workers.
Both RNs and mental health counselors, who in that case
were professionals, served as ‘‘key persons’’ who coordi-
nated patient care, met with other professionals involved in
a given patient’s care, and shared other duties, such as ad-
missions screening. Both RNs and mental health counselors
rotated on a three-shift basis and shared clinical supervision.
Only RNs, however, could give medications, change
dressings, transcribe orders, serve in ‘‘charge’’ positions, or
give ‘‘reports’’ to the incoming shift of nurses. Based on
these differences in duties the Board declined to place the
mental health counselors in the registered nurses unit, noting
additionally that mental health counselors did not transfer to
other areas of the hospital as RNs did, were not licensed, and
were administratively responsible to a different chain of
command. Although not controlling, the Board also noted
that the Petitioner did not seek to represent the mental health
counselors.
The Employer also points to two prior decisions I issued
concerning another psychiatric hospital, Brattleboro Retreat,
in support of its position that only an all-professional unit is
appropriate in psychiatric hospitals. The Employer argues
that in my decision in Brattleboro Retreat, Case 1–RC–
19451 (Oct, 5, 1990), a prerulemaking case, I found that an
all-professional unit was ‘‘presumptively appropriate.’’ While
the quotation is correct, it is taken out of context. The Peti-
tioner in Brattleboro Retreat sought to represent a unit con-
sisting of all of the Employer’s professional employees. The
Employer proposed a unit consisting of all employees, both
professional and nonprofessional, who were involved in di-
rect patient care, but did not seek an election pursuant to
Sonotone Corp., 90 NLRB 1236 (1950). Therefore, the Em-
ployer sought a unit which, on its face, was prohibited by
the Act, and which I consequently rejected with the above
remark. While a unit of all professionals has always been
presumptively appropriate, both before and after rulemaking,
the issue presented here, whether a smaller petitioned-for
unit might be appropriate, was not litigated in Brattleboro
Retreat. With regard to my conclusion in Brattleboro Retreat
that school teachers should be included in the professional
unit, the Employer argues that it has made an even stronger
case for inclusion of McLean’s professionals on the treat-
ment team than was made for the teachers in Brattleboro Re-
treat. Whether or not one position should be included in a
professional unit, however, sheds no light on the issue in this
case, the propriety of an all-professional unit in the first in-
stance.
The Employer also argues that my decision in a subse-
quent case involving Brattleboro Retreat, Case 1–RC–19742
(dismissal letter from Regional Director to counsel for Peti-
tioner, March 26, 1992) (Brattleboro II),39 ‘‘again reflects an
unwillingness to allow separate bargaining units and the re-
sulting fragmentation of employees in psychiatric hos-
pitals.’’40 Employer’s posthearing brief at 135. In
1115MCLEAN HOSPITAL CORP.
analysis to psychiatric hospitals. After the briefs in this case were
filed, however, I issued my decision in the companion case involv-
ing this Employer, McLean Hospital Corp., Case 1–RC–19749 (Oct.
19, 1992), order denying review 309 NLRB 564 (1992). In that case
I approved the petitioned-for unit of skilled maintenance employees
over the Employer’s objection that an all nonprofessional unit was
the smallest appropriate unit in a psychiatric hospital. Thus, the Em-
ployer’s contention that I am invariably unwilling to allow bar-
gaining units smaller than all-professional or all nonprofessional in
psychiatric facilities has now been put to rest.
41 The Employer’s posthearing brief refers to Brattleboro Retreat
only as a psychiatric hospital, omitting mention of the fact that the
facility had two components, a psychiatric hospital and a nursing
home. In the decision I discussed the Board’s observations in rule-
making that there is generally less diversity among technical and
service employees, greater overlap of functions, and greater contact
among nonprofessional employees in nursing homes as opposed to
acute care hospitals, and I found those observations to be true at
Brattleboro Retreat. Thus, Brattleboro Retreat is, in part, a com-
pletely different kind of facility from McLean, and the Employer’s
reliance on the decision in that case is, to that degree, misplaced.
42 I note that in the incident described by Ettlinger involved a con-
flict between the nonstriking RNs and striking mental health work-
ers, the latter being nonprofessional employees who would never be
in the same bargaining unit with the nurses at McLean in any event.
Continued
Brattleboro II I did reject the petitioned-for unit of technical
employees in favor of an all nonprofessional unit. I did not
conclude, however, as the Employer suggests, ‘‘that multiple
bargaining units are inappropriate for nonprofessionals in
psychiatric hospitals.’’ Id. at 135. Rather I found that carving
out a separate unit of technical employees at that particular
facility, which consisted of both a psychiatric hospital and a
nursing home,41 would be inappropriate on the facts of that
case, which differ from the facts of this case in many signifi-
cant respects. In Brattleboro II, I found that many of the em-
ployees in the petitioned-for unit, which consisted largely of
mental health workers, like many of the nontechnical, non-
professional employees, needed only a high school education
and did not acquire their skills through technical schools or
colleges. Thus the qualifications, skill level, and training of
the two groups were similar, as were the wage groupings. I
found that the technical employees had important and fre-
quent work-related contact with nontechnical, nonprofes-
sional employees and shared common duties and supervision
with some of them. Unlike acute care hospital technical em-
ployees, the technicals at Brattleboro were directly involved
in patient care. The facility, while large, was relatively small-
er than McLean, and I found that the specialized staffing and
lack of contact often seen in large institutions was not
present. By contrast, McLean is a large, world-reknowned,
elite institution, recently ranked as the top psychiatric hos-
pital in the country. With its highly sophisticated and special-
ized staff, McLean bears as close a resemblance as a psy-
chiatric facility can to the model of an acute care hospital
described by the Board.
The Employer contends that psychiatric hospitals must be
treated differently from acute care hospitals due to the nature
of their severely disturbed patient population and the impor-
tance of the therapeutic milieu. Specifically, the Employer
argues that having separate bargaining units and different
terms of employment for one professional group versus an-
other would strain the relationship between team members
and that this, in turn, could adversely affect the therapeutic
milieu. I find, as did the Board in rulemaking, that ‘‘[t]he
industry offered only unsubstantiated speculation that team
care would be adversely affected’’ by separate RN units. 53
Fed.Reg. 33913, 284 NLRB at 1546. In fact, the evidence
shows that the various professional groups on McLean’s
multidisciplinary teams already work under substantially dif-
ferent terms of employment and that, nonetheless, the teams
function smoothly. For example, for the most part, only doc-
tors, psychologists and social workers are eligible to practice
independently and participate in the unit system of reim-
bursement and McLean-supported private practice. Nurses
are the only professionals on the teams who receive shift dif-
ferentials, weekend differentials, overtime, charge pay, de-
gree differentials, and the weekend package. Nurses are eligi-
ble for 4 weeks’ vacation after 1 year, whereas other team
members, with the exception of joint appointees who have an
even more liberal vacation plan, must wait 4 or 5 years to
be entitled to 4 weeks. There is no reason to suggest that dif-
ferences in terms and conditions of employment achieved
through separate collective bargaining for nurses will cause
any more conflict than the numerous differences already in-
stituted unilaterally by this Employer. To the contrary, given
the fact that nonnurse professionals at McLean would still be
outnumbered by the nurses by 1.5 to 1, the potential for con-
flict between team members may be higher if they are all in
the same bargaining unit and nonnurse professionals feel that
their concerns aren’t given priority.
With respect to the Employer’s concern that having dif-
ferent holidays or vacation policies for different team mem-
bers will make it difficult to schedule team meetings, the fact
that employees take holidays and vacations always causes
scheduling problems for employers, whether they are in the
same or different bargaining units, represented or unrepre-
sented. Ettlinger testified that Marlboro Psychiatric Hospital
had difficulty scheduling vacation for its professionals not-
withstanding the fact that they were all in the same bar-
gaining unit. To the degree that is a concern for this Em-
ployer, it is free to unilaterally implement the same holiday
and vacation policies that it negotiates with the nurses for its
unrepresented professionals. With respect to McLean’s con-
cern that if a patient finds a relationship with a nurse or a
team member of another discipline to be the most thera-
peutic, the treatment team must be able to ‘‘flex’’ in that di-
rection, there is no apparent reason why a nurse in an RN
unit would be less willing or able than a nurse in an all-pro-
fessional unit to engage in a therapeutic relationship with a
given patient; such matters are not normally implicated by
collective bargaining, which is limited to terms and condi-
tions of employment. Finally, with respect to Mirin’s testi-
mony that it would be disruptive to have to follow a contrac-
tual seniority clause with respect to transfers and that a
‘‘third party’’ would undermine the relationship between
McLean and its staff, suffice it to say that the Employer’s
preference not to be unionized is not at issue here.
Nor am I persuaded by Ettlinger’s testimony that multiple
units pose a danger to the therapeutic milieu because of pos-
sible ill feelings created when one unit strikes and another
crosses the picket lines. In the incident described by
Ettlinger, some members of the very same bargaining unit
that struck also crossed the picket line.42 Notwithstanding
1116 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
Ettlinger provided no examples of such conflicts between profes-
sional groups.
43 In any event, I question the relevance of testimony describing
the operations of acute care hospitals. When the Board stated in
Park Manor that it would be helpful to compare and contrast the
work force in the unit sought with the work force in acute care hos-
pitals, it meant to compare evidence about the work force in the dis-
puted facility to its findings in rulemaking about the work force in
acute care hospitals. This was not an invitation to reopen the exten-
sive record in rulemaking with regard to acute care hospitals. Child’s
Hospital, Case 3–RC–9734 (Sept. 20, 1991) (not reported in Board
volumes). (The Regional Director is cautioned not to permit evi-
dence that is merely duplicative of or cumulative to the evidence al-
ready considered by the Board in the rulemaking proceeding and set
forth in the supplemental information, but only to permit such evi-
dence unique and special to this employer.) St. Margaret Memorial
Hospital, 303 NLRB 923 (1981) (Denying review of Regional Direc-
tor’s decision that the hearing officer properly precluded Employer
of an acute care hospital from introducing evidence that contradicts
the Board’s findings in support of its rule regarding skilled mainte-
nance units). In view of this admonition, I have disregarded testi-
mony by other witnesses, including Reever, describing their experi-
ence as nurses in acute care hospitals.
44 If that was indeed the Petitioner’s intent in offerring the testi-
mony, I have not considered it for that purpose in light of the wit-
nesses’ lack of first-hand knowledge.
Ettlinger’s testimony that the striking workers at Marlboro
Psychiatric Hospital had no angry feelings toward their fel-
low bargaining unit members who worked during the strike,
common sense dictates that in the event of a strike, strikers
are likely to be equally if not more angry at members of
their own bargaining unit who cross the picket line than at
members of other bargaining units who do so. Thus, having
fewer and larger bargaining units at a psychiatric hospital
will not necessarily reduce the risk of the type of conflict de-
scribed by Ettlinger.
In any event, there is no evidence that separate representa-
tion for nurses will lead to an increase in disputes. I note that
none of the hospitals at which the Petitioner represents sepa-
rate RN units have ever complained to the Petitioner’s rep-
resentatives that representation of psychiatric nurses apart
from the other professionals on the psychiatric units has had
any adverse impact on their patients, and that there have
been no work jurisdiction disputes or grievances between
professionals at those facilities. Ettlinger similarly testified
that at HRI, where nurses were represented apart from the
other professionals, there was no adverse impact on the
therapeutic milieu due to differences in terms of employment
between represented and unrepresented professionals. The
only disputes that arose between nurses and unrepresented
professionals at HRI were the same sort of disagreements
over professionals roles that arose between nurses and other
professionals at a nonunionized facility where Ettlinger
worked.
The Employer asserts that the hearing officer committed
prejudicial error in excluding Ettlinger’s testimony com-
paring psychiatric hospitals with acute care hospitals, but al-
lowing MNA Representatives Reever and Pinkham to testify
about operations in psychiatric units in acute care hospitals
where they represent all-RN bargaining units. The hearing
officer permitted Ettlinger to testify about his experience
with bargaining units in other psychiatric hospitals, but ex-
cluded his testimony about the differences and similarities
between acute care and psychiatric hospitals on the ground
that Ettlinger was not qualified by virtue of his background
to testify as an expert about acute care hospitals. I concur
with the hearing officer’s ruling that Ettlinger’s experience at
acute care hospitals was too limited and dated to qualify him
to provide probative expert testimony on that subject.43
Ettlinger worked for 1 year in 1970 at Mount Sinai Medical
Center in New York as an assistant to the president where
he worked on special projects such as reducing patient wait-
ing time in the outpatient and radiology departments and re-
ducing redundant paperwork in the laboratory. For 3 years in
the early 1980s he was a part-time surveyor of acute care
hospitals for the Joint Commission on Accreditation of Hos-
pitals, where he was primarily responsible for surveying die-
tary, maintenance, and housekeeping departments. In 1986 he
worked for 9 months as a consultant to Massachusetts Osteo-
pathic Hospital while setting up a geropsychiatric unit, where
he spent some unspecified amount of time working with
other hospital departments. For 2-1/2 years in the late 1980s
Ettlinger sat on the board of trustees of the Massachusetts
Hospital Association, which primarily represents acute care
hospitals, and attended Association meetings during which
such issues as the reimbursement system for general hos-
pitals, quality assurance, and the relationship of the medical
staff to general hospitals was discussed. Ettlinger testified
that he has never personally supervised nurses or any other
types of employees in an acute care hospital, directly or indi-
rectly. He has never worked in patient care areas in an acute
care hospital. His service on the board of trustees did not
provide any experience which would provide insight into the
role of nurses at an acute care hospital or their community
of interest with other professionals. The hearing officer’s rul-
ing is affirmed.
With regard to the testimony of the MNA representatives,
they testified, essentially, that they represent several all-RN
units which include nurses from psychiatric wards, that those
psychiatric units employ other professionals and use a team
approach, and that they have nonetheless never received
complaints from management at those facilities that represen-
tation of nurses apart from the other professionals on the
psychiatric units has caused any problems. The Employer
complains that Reever and Pinkham, unlike Ettlinger, were
allowed to testify over McLean’s hearsay objections about
the operations of psychiatric units at those hospitals, despite
the fact that they had never worked in those hospitals, they
had spent little or no time on the units, and their testimony
was based on conversations with nurses employed by those
hospitals. I affirm the hearing officer’s ruling allowing this
testimony. The purpose of the testimony was not to provide
a detailed comparison of the operation of psychiatric units in
acute care hospitals with McLean,44 a subject about which
I agree they did not have sufficient first-hand knowledge,
and, unlike Ettlinger, they were not purporting to offer expert
testimony regarding the operations of acute care hospitals.
Rather, the thrust of their testimony was to rebut Ettlinger’s
testimony that separate representation for various employee
groups at psychiatric hospitals where he had worked had
caused conflict between team members and disrupted the
therapeutic milieu. As the collective-bargaining representa-
tives for the bargaining units at those hospitals, the MNA
reps were clearly in a position to have first-hand knowledge
as to whether or not management at those institutions had
1117MCLEAN HOSPITAL CORP.
47 In view of my decision that a unit of registered nurses is appro-
priate, I find it unnecessary to decide whether the professionals at
the Arlington School and Adolescent Day Service have a community
of interest with the other professionals at McLean or to decide the
various issues relating to the supervisory, professional, and employee
status of certain employees in the larger unit proposed by the Em-
ployer.
ever complained that representing psychiatric nurses apart
from other psychiatric professionals had caused labor dis-
putes or adversely affected patient care. While they may not
have detailed first-hand knowledge concerning the operations
of those psychiatric units, Reever and Pinkham are clearly in
a position to know through their experience as labor rep-
resentatives such general information as whether or not those
psychiatric units employ other professionals or use multi-
disciplinary teams, group therapy, and milieu therapy. The
testimony of the MNA representatives with respect to this
general description was also corroborated by policy and pro-
cedure statements from two of the hospitals about which they
testified.
The Employer contends that the hearing officer also erred
in striking from the record Ettlinger’s testimony concerning
the frequency of disputes between the unions at Marlboro
Psychiatric Hospital. After describing four such disputes,
Ettlinger testified that they were ‘‘common occurences,’’ but
he was unable to recall any further examples. In light of
Ettlinger’s inability to recollect any further specifics, I affirm
the hearing officer’s ruling that this characterization be
stricken.
. . . .
Accordingly, based on the foregoing and the stipulations
of the parties, I find that the following employees of the Em-
ployer constitute a unit appropriate for collective bargaining
within the meaning of Section 9(b) of the Act:47
All full-time and part-time registered nurses employed
by the Employer at its Belmont, Massachusetts location,
including per diems nurses who work on average 4 or
more hours per week, but excluding all other employ-
ees, managerial employees, guards, and supervisors as
defined in the Act. [Footnote omitted.]