Stormont-Vail Healthcare, Inc.

National Labor Relations Board - Board Decisions

Nov 28, 2003

340 N.L.R.B. 1205 (N.L.R.B. 2003)

STORMONT-VAIL HEALTHCARE 1205
Stormont-Vail Healthcare, Inc. and International
Brotherhood of Teamsters, Local Union No. 959
Petitioner. Case 17–RC–12100
November 28, 2003
DECISION ON REVIEW AND ORDER
BY MEMBERS LIEBMAN, SCHAUMBER, AND
WALSH
The issue presented in this case is whether the Re-
gional Director properly excluded registered nurses
(RNs) in the Employer’s off-campus psychiatric facility,
outlying clinics, and community nursing centers from the
otherwise employerwide multifacility unit of RNs found
appropriate. As explained below, we find, contrary to
the Regional Director, that these excluded RNs must be
included in the unit. Therefore, we reverse the Regional
Director’s decision and include these RNs in the unit.
On July 2, 2002, the Regional Director for Region 17
issued a Decision and Direction of Election (pertinent
portions of which are attached as an appendix), in which
he found that a unit of approximately 700 full-time and
regular part-time RNs employed by the Employer at its
hospital complex and at about seven other buildings lo-
cated within six blocks of the hospital complex (the main
campus) in Topeka, Kansas is appropriate for bargain-
ing.1 Pursuant to a stipulation of the parties, the Re-
gional Director also included in the unit about 11 RNs
that work for LifeStar, a helicopter ambulance service
owned and operated by the Employer, based in locations
outside of the main campus. The Regional Director, ap-
plying the single facility presumption, excluded other
non-main campus RNs employed by the Employer in
Topeka and in surrounding towns throughout Topeka and
Shawnee counties. These include RNs at the Stormont-
Vail West psychiatric facility, outlying clinics, and
community nursing centers.
Thereafter, in accordance with Section 102.67 of the
National Labor Relations Board Rules and Regulations,
the Employer filed a timely request for review of the
Regional Director’s decision. The Employer contended
that the appropriate unit must also include the RNs em-
ployed in the Employer’s remaining facilities located off
of the main campus, specifically the Stormont-Vail West
psychiatric facility, the outlying clinics, and the commu-
nity nursing centers. On August 7, 2002, the Board
granted the Employer’s request for review.
1 The Petitioner sought to represent a unit of RNs employed in the
hospital complex only. The Regional Director found that the RNs
employed in the buildings on the main campus must also be included.
The Board denied the Petitioner’s request for review of this finding on
August 7, 2002.
The Board has delegated its authority in this proceed-
ing to a three-member panel.
We have carefully considered the entire record, includ-
ing the brief on review. Contrary to the Regional Direc-
tor, we have decided, for the reasons set forth below, that
the multifacility unit found appropriate by the Regional
Director must also include the RNs employed by the
Employer at its remaining facilities—the Stormont-Vail
West psychiatric facility, the outlying clinics, and the
community nursing centers. Accordingly, we reverse the
Regional Director’s decision.
I. BACKGROUND
The Employer operates a comprehensive regional
medical system, which is highly centralized. This inte-
grated health system includes a hospital complex in
Topeka consisting of four connected central inpatient
acute care hospital buildings with a single address, stipu-
lated to be a single building.2 The hospital complex
houses inpatient acute care departments, including oper-
ating rooms, recovery rooms, and the emergency room,
as well as other departments, including outpatient sur-
gery, admitting, and some central administrative offices.
The Pozez Educational Center, which houses a school of
nursing and a program called Health Connections (a tele-
phone nurse-assistance service), is attached to this com-
plex and accessible by an interior walkway.
As noted, the Employer has about seven other build-
ings within about a six-block radius of the hospital com-
plex, referred to at the hearing as the main campus.
These buildings house the Topeka Same Day Surgery
Center (outpatient surgery), a heart center, physician
offices, home health care and hospice, the central human
resources department, and central finance offices, and
include clinics that are part of the unit found appropriate.
There are also some clinics located in the hospital com-
plex that are included in the unit.
In about February 2001, the Employer moved its inpa-
tient acute care psychiatric department from the hospital
complex to a facility about 2 miles from the main cam-
pus called Stormont-Vail West (Stormont West). Stor-
mont West operates one unit for adults and another for
adolescents and children. The Employer has 20 full-time
RNs at this facility plus 10 RNs working part time or as
needed.
The Employer also provides inpatient psychiatric ser-
vices at the senior diagnostic unit, which remains in the
2 From the vantage point of the first floor of the hospital complex,
the hospital buildings appear to be one building. From the outside,
however, this hospital complex appears to consist of at least four build-
ings.
340 NLRB No. 143
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 1206
hospital complex. Older, “fragile” patients are placed in
the senior diagnostic unit.
In 1995, the Employer acquired a group of physicians’
clinics called the Cotton O’Neil Clinics. The Employer
now owns and operates these clinics (the outlying clin-
ics), located in about 17 locations in Topeka and sur-
rounding towns throughout Topeka and Shawnee Coun-
ties. As of the date of the hearing, three of these clinics
did not employ RNs. Most of these clinics are located
anywhere from 3 to 60 miles away from the main cam-
pus.3
The Employer operates community nursing centers at
two locations off the main campus. One center is located
six blocks from the hospital complex, and the other is
located in Oakland, a suburb of Topeka. The centers are
each staffed by two RNs, who primarily service indigent
patients. RNs perform blood pressure checks, health
management and assessment, and referrals to the emer-
gency room, if appropriate, or to other clinics or social
service agencies.
The Employer operates LifeStar, a helicopter ambu-
lance service, out of air fields at three locations: about
10 miles from the main campus at Forbes Field in
Topeka; about 25 to 30 miles away from the main cam-
pus in Lawrence, Kansas; and about 70 miles away from
the main campus in Junction City, Kansas. The LifeStar
RNs accompany patients by helicopter to the helipad at
the hospital complex and into the emergency room. As
noted, the Regional Director included the LifeStar RNs
in the unit pursuant to the parties’ stipulation.4
The Employer’s operations are highly centralized.
One central human resources department serves all de-
partments and locations. This department issues one set
of personnel policies applicable to all employees, which
may be supplemented by individual locations and de-
partments but not overridden. It performs the initial
screening interview for all applicants, and makes the
final hiring decision and offer of employment after the
department where the applicant will work has also inter-
viewed the applicant and made a recommendation.5 It
approves suspensions and discharges systemwide.

3 The parties stipulated to the distances of 15 outlying clinics in rela-
tion to the main campus. Out of the 15 clinics, 3 are located less than
10 miles from the main campus, 3 are between 10 and 20 miles away, 3
are between 20 and 30 miles away, 3 are 40 to 45 miles away, and 2 are
50 miles away or more.
4 The Regional Director found that absent such stipulation, the geo-
graphic remoteness of their base facilities, their contrasting working
conditions, the lack of significant interchange, and separate day-to-day
supervision would have warranted the exclusion of these RNs.
5 The human resources department follows the recommendation of
the department where the applicant will work over 95 percent of the
time.
The administration and top supervisory and managerial
hierarchy is centralized under an operating committee.6
All employees enjoy common fringe benefits, and pay
scales are determined centrally. All employees, regardless
of work location, are sent to the employee health nurse at
the human resource center should the employee need
nonemergency care during worktime. The finance de-
partment oversees budgeting and finance for all facilities.
The Employer has centralized computer and software sys-
tem maintenance, employee training, orientation for new
employees, purchasing of supplies and equipment and
warehousing of bulky nonperishable supplies, housekeep-
ing,7 maintenance of medical equipment, X-ray and ultra-
sound imaging, lab work, laundry service, marketing, and
advertising. The Employer operates a retail pharmacy
available to all departments. There is a cafeteria operated
by the Employer in the hospital complex that is open to all
employees at a discount. There is an interoffice mail sys-
tem that makes deliveries twice a day to all facilities, in-
cluding the furthest outlying clinic located 60 miles away.
There is a central float pool for licensed practical nurses
and patient care technicians available to all locations, and
it appears that each department maintains a pool of RNs
who are available when needed.
The Employer frequently conducts training courses,8
orientation, and other meetings of all employees, includ-
ing those in the outlying clinics, at the Pozez Educational
Center. Security is centralized, with rounds made by the
security personnel on a regular basis, including at outly-
ing clinics. The annual merit increase process and ser-
vice awards, as well as the holiday party, summer picnic,
and an employee newsletter, are systemwide. Seniority
is calculated systemwide.
II. DISCUSSION
The Petitioner initially sought to represent RNs in the
hospital complex only, which, as noted, is stipulated to
be a single facility. The parties thereafter stipulated to
the inclusion of the LifeStar RNs, based in three loca-
tions 10 to 70 miles away from the hospital complex, and
the RNs based at the Pozez Educational Center, a facility
6 This committee is composed of vice presidents in charge of all of
the various operations. This committee reports to the Employer’s
president and makes operational and organizational decisions for all
locations.
7 The Employer, for the most part, employs the housekeeping em-
ployees. Although some of the housekeeping work for the outlying
clinics may be contracted out, the work remains centrally managed.
8 The Employer operates an extensive program of continuing medi-
cal education open to its employees free of charge. The RNs use these
courses to fulfill their 30 hours of continuing education that is required
every 2 years to maintain their licenses. Many of these courses are run
at the Pozez Educational Center.
STORMONT-VAIL HEALTHCARE 1207
connected to the hospital complex by a walkway.9 The
Regional Director further found that the unit must also
include the RNs working in facilities located on the main
campus based on such factors as geographic proximity,
similarity of skills and functions, central administration,
common high-level managerial and supervisory control,
employee interchange, contact, and functional integra-
tion. As noted, the Employer claims that the only appro-
priate unit of RNs is an employer wide unit that includes,
in addition to the foregoing, the RNs at Stormont-Vail
West psychiatric facility, the outlying clinics, and the
community nursing centers.
In determining whether a multifacility unit is appropri-
ate,10 the Board evaluates the following factors: employ-
ees’ skills and duties; terms and conditions of employ-
ment; employee interchange; functional integration; geo-
graphic proximity; centralized control of management
and supervision; and bargaining history. Alamo Rent-A-
Car, 330 NLRB 897 (2000); NLRB v. Carson Cable TV,
795 F.2d 879, 884 (9th Cir. 1986).
In evaluating these factors, we find that the multi-
facility unit found appropriate by the Regional Director,
excluding the Stormont West psychiatric facility, the
outlying clinics, and the community nursing centers is an
arbitrary grouping of employees, inasmuch as the evi-
dence fails to establish that the RNs in the unit found
appropriate share a community of interest distinct from
the excluded RNs. See Bashas’, Inc., 337 NLRB 710,
711 (2002).
A. Stormont West
The Regional Director found that the RNs at Stormont
West should be excluded from the unit of RNs found
appropriate. In so finding, he noted that the inpatient
psychiatric work of the RNs at Stormont West is very
different from that of the vast majority of RNs included
in the unit, that Stormont West is geographically and
organizationally separate, and that the Stormont West
RNs have separate day-to-day supervision. Contrary to
the Regional Director, we find that the exclusion of the
RNs in Stormont West is arbitrary.
In about February 2001, the Employer moved its inpa-
tient acute care psychiatric department from the hospital
complex to the Stormont West facility. The Employer’s
other inpatient psychiatric service, called the senior diag-
nostic unit, stayed in the hospital complex. The Regional
Director found, and the record shows, that there is some
interchange between the RNs at Stormont West and the

9 The parties did not specifically stipulate that Pozez is part of a sin-
gle facility with the hospital complex.
10 Because the unit agreed to by the Petitioner is a multifacility unit,
we find that the Regional Director erred by applying a single-facility
presumption.
senior diagnostic unit, and that the work of the RNs in
both of these inpatient psychiatric services is similar.
The record further shows supervisory/managerial in-
terchange between Stormont West and the senior diag-
nostic unit. Todd Crause, a charge nurse at the senior
diagnostic unit who used to work as a charge nurse at
Stormont West,11 provides MANDT training12 in the use
of patient restraints to all employees of the Employer
who take such training, including the RNs at Stormont
West. RNs from the senior diagnostic unit attend these
trainings at Stormont West. Moreover, Carolyn Jones,
the manager of patient care services at Stormont West,
also functions as a clinical educator for the main hospital,
including the senior diagnostic unit, and Stormont West,
teaching basic life support restraints and serving on sev-
eral committees that meet on the main campus. Further,
Jon Hartnett, the clinical manager at Stormont West,
leads patient group sessions on the senior diagnostic
unit.13
In addition, the RNs at Stormont West use the cafeteria
and fitness center located at the main campus, as do the
included RNs. The RNs at Stormont West attend em-
ployee meetings, training classes, new employee orienta-
tion, picnics, and holiday parties with all employees,
including those in the unit.
The Regional Director noted that acute care psychiatric
care differs from other acute hospital care, and that em-
ployees are specially trained for this type of work, citing
Hartford Hospital, 318 NLRB 183 (1995); and Brattle-
boro Retreat, 310 NLRB 615 (1993). These cases, how-
ever, do not stand for the proposition that psychiatric
nurses must in all cases be excluded from units that in-
clude other RNs in acute care hospitals. Indeed, here the
Regional Director included psychiatric RNs at the senior
diagnostic unit in the unit with other RNs, and thus the
Regional Director’s reasoning with respect to the type of
work performed is not a rational basis for excluding the
psychiatric RNs at Stormont West. Moreover, Hartford
and Brattleboro involved the representation of technical
employees at freestanding psychiatric hospitals, and not
the representation of RNs.14
11 The parties stipulated that charge nurses are excluded as supervi-
sors under Sec. 2(11) of the Act.
12 The record shows that MANDT training is training in how to re-
strain a patient in the least restrictive manner. The training was devel-
oped for psychiatric or aggressive patients who need to be restrained.
All of the psychiatric staff as well as the security guards must be
trained in MANDT.
13 Until recently, these group sessions were weekly. The record
shows that the groups are still ongoing, but meet less frequently.
14 In Hartford, the Board found that the respondent violated Sec.
8(a)(5) and (1) of the Act by refusing to bargain with the union as the
exclusive representative of a 14-year-old bargaining unit of technical
employees in a psychiatric hospital, after that hospital merged with and
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 1208
Thus, we conclude that the psychiatric nurses at Stor-
mont West do not have a distinct community of interest
from the psychiatric RNs at the senior diagnostic unit or
other RNs included in the unit found appropriate. The
RNs at Stormont West worked at the hospital complex
prior to the relocation of the inpatient acute care psychiat-
ric department. There is some interchange between the
RNs at Stormont West and the senior diagnostic unit, and
the work of the RNs in both of these inpatient psychiatric
services is similar. Further, there is supervisory/managerial
interchange between Stormont West and the senior diag-
nostic unit. Finally, the RNs at Stormont West use the
cafeteria and fitness center located at the main campus,
and attend common meetings, classes, and social events
with included RNs.
B. Outlying Clinics
In 1995, the Employer acquired the Cotton O’Neil
clinics. These clinics are located in Topeka and in sur-
rounding towns throughout Topeka and Shawnee Coun-
ties, and many, but not all, are staffed with RNs. As dis-
cussed above, the distances from the main campus to
these freestanding clinics range from 3 to 60 miles away.
We find, contrary to the Regional Director, that the
RNs in the outlying clinics do not have a distinct com-
munity of interest from the RNs included in the multi-
facility unit. The skills and functions of the RNs in the
outlying clinics are similar to those of RNs included in
the unit. As discussed below, the geographic proximity
of the outlying clinics to the hospital complex and main
campus is similar to other included locations. Moreover,
the unit includes RNs who work at clinics that are lo-
cated in the hospital complex and main campus, and
some of these clinics are part of the same administrative
grouping as the outlying clinics and share common over-
sight. Further, the excluded clinics are well integrated
with the rest of the Employer’s centralized system.
Contrary to the Regional Director, we do not find that
the geographic distance of the outlying clinics warrants
their exclusion from the unit. Significantly, the unit
found appropriate includes, pursuant to the stipulation of
the parties, the three LifeStar facilities, which are geo-
graphically distant from the hospital complex and main
campus. Forbes Field is 10 miles away from the main
campus, the Lawrence, Kansas location is 25–30 miles
away, and the Junction City, Kansas location is 70 miles
away. Thus, the furthest LifeStar facility stipulated to be
included in the unit is further away than the most geo-

became a wholly-owned subsidiary of the respondent. In Brattleboro,
the petitioner sought to represent a unit of technical employees at the
employer’s psychiatric hospital and nursing home. The Board found
that the unit must include all nonprofessional employees.
graphically distant outlying clinic, which is 60 miles
away from the main campus. Further, two of the outly-
ing clinics are located in Lawrence, Kansas, which is in
the same vicinity as one of the LifeStar locations. In
addition, several of the outlying clinics are located closer
to the main campus than the LifeStar facility located 10
miles away in Forbes, and several additional clinics are
closer to the main campus than the LifeStar facility in
Lawrence. One of these disputed outlying clinics is lo-
cated only 3 miles from the main campus.
Further, the unit found appropriate by the Regional Di-
rector’s does not comport with the administrative/super-
visory grouping: some clinics within the medical services
division are included in the unit, and other clinics within
that same division are excluded. Thus, clinics located on
the main campus, all under the direction of Deb Yokum,
the vice president of the medical services division, are
included in the unit, while the outlying clinics in the medi-
cal services division, also reporting to Deb Yokum, were
excluded. Also, Joe Hopeck, cardiology services director,
also part of the medical services division, oversees numer-
ous outpatient operations at the heart center, located in the
main campus, and his clinics were included in the unit.
Finally, the record shows that the excluded clinics are
well integrated with the rest of the Employer’s central-
ized system. The operating committee is responsible for
the operational and organization decisions for all de-
partments and locations, including the outlying clinics.
The committee must approve the closing of any outlying
clinic, and has done so in a couple of instances. The
Employer’s personnel policies apply equally to the em-
ployees in the outlying clinics, and the human resource
department plays the same role there with respect to hir-
ing, terminations, and discipline as with other depart-
ments and clinics. The pay scales for RNs at the outlying
clinics are the same as those for other RNs, and the RNs
participate in the same new employee orientation and
trainings as other RNs. The nurse managers and supervi-
sors from all of the clinics attend meetings together regu-
larly. Although outlying clinics may receive postal mail
at their own addresses, the outlying clinics are also part
of the Employer’s interoffice mail system, which makes
deliveries to the outlying clinics twice a day. Contrary to
the Regional Director’s finding, while some of the outly-
ing clinics may contract out for housekeeping services,
even in such instances the services are centrally man-
aged. Further, security is centralized, with rounds made
on a regular basis that include outlying clinics. The em-
ployees in the outlying clinics participate in Employer-
wide holiday parties and picnics, and are eligible for sys-
tem-wide service awards. Seniority is calculated system-
wide.
STORMONT-VAIL HEALTHCARE 1209
The function of RNs who work in health connections
provides further evidence of integration among the facili-
ties. Health connections consists of 25 RNs who operate
out of the Pozez Educational Center and provide a tele-
phone bank that is accessible to all patients of all de-
partments and units of the Employer. Health connections
RNs also contact and follow up with surgery patients
after discharge. This program is staffed around the
clock, 7 days a week. Health connection RNs answer the
phone calls for the hospital, clinics, nursing centers, and
offsite locations that are closed overnight, weekends, or
holidays. Thus, patients from the outlying clinics who
call a clinic during these closed hours are automatically
transferred to Health Connections. The RNs then assess
the patient’s needs and provide information and direc-
tion. The guidance could be a referral to the emergency
room or their doctor, or first aid advice. The RNs then
document what occurred and transmit the information to
the doctor in the clinic by facsimile machine.
In addition, there is a float pool of LPNs and patient
care technicians that float throughout the facilities, in-
cluding between clinics. As noted by the Regional Di-
rector, there is also some evidence of interchange of RNs
among the clinics, and between the outlying clinics and
departments on the main campus.
Based on the above, we conclude that the RNs at the
outlying clinics do not share a community of interest
distinct from the multi-facility unit found appropriate and
were arbitrarily excluded.
C. Community Nursing Centers
Similarly, we find that the exclusion of the RNs in the
community nursing centers from the unit found appropri-
ate is arbitrary, and that these RNs must be included in
the unit. One of these centers is located only six blocks
from the hospital complex, and the other is located in a
suburb of Topeka. Thus, contrary to the Regional Direc-
tor, these clinics are geographically proximate to in-
cluded locations. Further, these centers share a common
administrative grouping with other included clinics as
part of the health services division.15 Finally, similar to
the other excluded outlying clinics, these clinics are well-
integrated with the rest of the Employer’s centralized
system.
III. CONCLUSION
For all of the foregoing reasons, we find that the multi-
facility unit found appropriate by the Regional Director
arbitrarily excludes the RNs at the Employer’s remaining
15 Carol Perry, vice president for patient care operations, oversees
the community nursing centers, and Regional Operations Vice Presi-
dent Carol Wheeler oversees the clinics included in the unit that are
part of the health services division.
facilities—Stormont West, the outlying clinics, and the
community nursing centers—and is, therefore, not an
appropriate unit for bargaining. Accordingly, we reverse
the Regional Director’s finding that a unit limited to the
hospital complex and main campus is appropriate, and
find that the unit must include the RNs at Stormont West,
the outlying clinics, and the community nursing cen-
ters.16
ORDER
The Regional Director’s Decision and Direction of
Election is reversed. This case is remanded to the Re-
gional Director for further appropriate action consistent
with the Order.

APPENDIX

DECISION AND DIRECTION OF ELECTION
1. The issue
The Petitioner seeks to represent registered nurses employed
in four buildings which make up the main hospital complex of
the Employer (the hospital complex). The Employer maintains
that the only appropriate unit of registered nurses is an em-
ployerwide unit composed of the hospital complex, plus the
registered nurses employed in the other seven buildings within
six blocks of the hospital complex (the central campus or the
main campus) and the registered nurses employed by the Em-
ployer in all other locations. In the alternative, the Employer
takes the position that the unit should be those registered nurses
employed on, or based at, the buildings on its central campus.
The Petitioner estimates that the Employer employs about
600 registered nurses in the hospital complex. The Employer
estimates that it employs about 800 registered nurses at all of its
locations. The Employer further estimates that it has over 3000
employees total at all locations.
After careful consideration of the record as a whole and the
law in this area, I conclude that the registered nurses employed
in the departments on the central campus share a community of
interest and should be included in the unit. It appears that there
may be about 700 registered nurses in this group. The parties
stipulated to the inclusion of 11 Life Flight registered nurses
located outside the central campus. I shall include the Life
Flight nurses in the unit.
2. An overview of the operations of the Employer
The Employer began years ago as an acute care hospital
which has grown, expanded, merged with other medical enter-
prises, and has emerged as a comprehensive regional medical
system. From the vantage point of the first floor of the hospital
complex, the four central inpatient acute care hospital buildings
appear to be one building. However, from the outside, this
hospital complex appears to consist of at least four buildings.
The complex houses the inpatient acute care departments in-
16 The Petitioner has not indicated whether it is willing to proceed to
an election in a unit different from the unit found appropriate by the
Regional Director.
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 1210
cluding operating rooms, recovery rooms, and the emergency
room, as well as other departments including outpatient sur-
gery, admitting, and some central administrative offices.
Attached to this complex and accessible by interior walkway,
is the Pozez Education Center (Pozez). Pozez houses a school
of nursing and the Employer’s telephone nurse assistance ser-
vice.
The Employer also has eight other buildings within about a
six block radius of the hospital complex which, at hearing, was
called the central campus or the main campus. These eight
buildings house the Topeka Same Day Surgery center (outpa-
tient surgery), a heart center, a building with physician offices,
a building which serves as a base for home health care and
hospice, a building for the central human resources department,
and a building for central finance offices.
In about February 2001, the Employer moved its inpatient
acute care psychiatric department to a facility about 2 miles
from the main campus called Stormont-Vail West (Stormont
West).
In 1995, the Employer acquired a group of physicians’ clin-
ics called the Cotton O’Neil Clinics. The Employer now owns
and operates these clinics at various locations, including some
17 outlying locations. Most of these clinics are located at dis-
tances from 3 miles away from central campus, to 60 miles
away from central campus.
The Employer operates Life Flight, a helicopter ambulance
service based at three locations: Forbes Field in Topeka, 10 to
15 miles away from the hospital complex; in Lawrence, Kan-
sas, and in Hutchinson, Kansas. The Lawrence location is 25 to
30 miles from the hospital complex and the Hutchinson base is
70 miles away.
3. Centralized administration and services
The operations of the Employer are highly centralized in
many respects. Along with registered nurses, many doctors,
other nursing, technical, and nontechnical employees are em-
ployees of the Employer. The Employer has one central human
resources department which serves all departments and all loca-
tions. The human resources department issues one set of per-
sonnel policies applicable to all employees. Individual loca-
tions and departments can supplement but cannot override these
policies. All employees enjoy the same set of fringe benefits.
Pay scales for classifications are determined centrally. Human
resources does the initial screening interview for all applicants.
Applicants who pass this screening are then sent to the individ-
ual departments for interviews and hiring recommendations.
Human resources then makes the final hiring decision, going
along with the department recommendations over 95 percent of
the time. The actual offer of employment is extended by the
human resources department. It appears, however, that day-to-
day supervision of work assignment, discipline and similar
matters is largely handled by supervision within the depart-
ments.
Administration and top supervisory and managerial hierar-
chy is centralized. All locations appear on the Employer’s
organizational chart. The operating committee is composed of
vice presidents in charge of all of the various operations. This
committee reports to the Employer’s president and makes op-
erational and organizational decisions for all locations. The
nonphysician vice presidents on this committee also rotate duty
on call to make decisions on problems which arise in all units
during the evenings and weekends. Such issues as patient care
and family complaints and legal questions that arise are referred
to the operating committee vice president on call.
The Employer has a finance department housed in a separate
building on the main campus which oversees budgeting and
finance for all facilities. All facilities and departments submit a
budget to this department. The finance department reports to
the president and the operations committee.
Maintenance of computers and software systems and training
and troubleshooting on these systems, is handled centrally, with
personnel (including two registered nurses) who work on the
main campus.
Training of employees and orientation attended by all new
employees are done centrally on the main campus. After the
general orientation for new employees, training is also done in
the department where each employee will work. The Employer
also operates an extensive program of continuing medical edu-
cation courses open to its employees free of charge. The Em-
ployer’s registered nurses use these courses to fulfill the 30
hours of continuing education required every 2 years to main-
tain their licenses. Many of these courses are run at the Pozez
Education Center on the main campus.
Purchasing of supplies and equipment and warehousing of
bulky nonperishable supplies is centralized. Cleaning of build-
ings on the central campus and maintenance of medical equip-
ment is done by a central department. The Employer operates a
retail pharmacy available to all departments. The Employer has
a central float pool for licensed practical nurses available to all
locations. It also appears that each department maintains a pool
of registered nurses who are available when needed. The fol-
lowing are managed centrally for all locations: X-ray and ul-
trasound imaging, lab work, laundry, marketing and advertis-
ing.
The Employer operates a cafeteria open to all employees and
the public in the hospital complex. Employees pay discounted
prices in the cafeteria. It appears that the cafeteria is used
mainly by the public and by employees who work on the cen-
tral campus. The Employer also operates a fitness center on the
central campus available to employees for discounted fees, as
well as a child care center run on the same basis.
All mail to buildings and departments on the central campus
goes to one address and the Employer then distributes it by
internal courier service to its various central campus depart-
ments.
4. Applicable legal principles
The Petitioner argues that a single-location presumption
should be applied to the hospital complex. The Petitioner is
also willing to include the adjacent Pozez Education Center
building. The Employer argues that the Union is trying to
gerrymander the unit, and that an employer-wide presumption
applies.
The hospital complex is much more extensive and inclusive
than a single acute care hospital. The vast majority of patients
served by the Employer are outpatients rather than patients
STORMONT-VAIL HEALTHCARE 1211
admitted as in-patients to an acute care unit. Accordingly, the
Board’s health care rule applicable to acute care facilities does
not apply in this case. In such circumstances, the Board weighs
the traditional community of interest factors to determine the
appropriate unit. In general, in evaluating a single location
versus a multi-location unit, there is a presumption that em-
ployees employed at a single facility are an appropriate unit.
Manor Healthcare Corp., 285 NLRB 224 (1987); Heritage
Park Health Care Center, 314 NLRB 447, 451 (1997); Lu-
theran Welfare Services of Northeastern Pennsylvania, Inc.,
319 NLRB 886 (1995). This presumption can be overcome
based upon an evaluation of the following factors:

1) Geographic proximity of the employees in ques-
tion;
2) Similarity of employee function and skill;
3) Similarity of employment conditions;
4) Centralization of administration;
5) Managerial and supervisory control of employees;
6) Employee interchange;
7) Functional integration of the employer;
8) Bargaining history.

Hartford Hospital, 318 NLRB 183, 191 (1995); Staten Island
University Hospital v. NLRB, 24 F.3d 450 (2d Cir. 1994); Uni-
versity Medical Center, 335 NLRB 1091 (2001); Passavant
Retirement & Health Center, 313 NLRB 1216, 1218 (1994).
There is no bargaining history in this case. The remaining
seven factors will be considered subsequently.
5. The hospital complex
The record includes an aerial photograph of the main cam-
pus. It is attached to this decision. In the center of this photo-
graph is the hospital complex. All of the buildings on the main
campus are marked with numbers from 1 through 12. The
buildings making up the hospital complex are numbered 3, 4, 5,
and 7.
The hospital complex houses acute care hospital and other
operations. It includes an outpatient surgery center which has
an admitting area through which all surgery patients are re-
ceived. Both outpatient and inpatient surgery utilize operating
rooms and recovery rooms. Following procedures, outpatients
are sent home; inpatients are taken to a room. Building 4 on
the aerial photograph is the “North Patient Tower” and building
3 on the photograph is the “South Patient Tower.” Registered
nurses work in all of these areas.
The hospital complex also includes an outpatient center (ae-
rial photograph building 5) which houses physical therapy,
occupational therapy and speech therapy. At this time, no reg-
istered nurses work in these areas. The hospital complex also
includes an endoscopy center and a pain management clinic,
both of which are staffed by registered nurses. It also includes
a “Senior Resource Center,” a membership program for seniors
which is a resource and referral network and which operates an
indigent drug program. This complex also houses the cafeteria
used both by employees and the public.
The inpatient floors in the hospital complex are open and
staffed by registered nurses around the clock, 7 days a week.
The emergency room, a part of this complex, is always open
and staffed with registered nurses. The Endoscopy Center is
not open evenings and weekends. Similarly, outpatient surger-
ies are not performed evenings and weekends.
Both parties agree that the registered nurses employed in the
four acute care hospital buildings at the hospital complex
should be included in any unit found appropriate. I find that
they share a community of interest and should be included in
the unit.
6. Pozez Education Center
The Pozez Education Center, one of the buildings in the
middle of the main campus, appears on the aerial photograph
(building 8) as the building to the right (immediately north) of
the hospital complex. It is connected to the hospital complex
by a walkway to afford interior access between the two build-
ings. Pozez houses a school of nursing and a program called
Health Connections. Health Connections is a nurse triage pro-
gram where about 25 registered nurses staff a telephone bank
accessible to patients of all departments and units of the Em-
ployer. This program is staffed around the clock, 7 days a
week. Patients with questions on a weekend or evening can
call the nurse line and will be given medical guidance. The
guidance could be a referral to the emergency room, or to their
doctor, or first aid advice. Health Connections nurses also
contact and follow up with surgery patients after discharge.
The fitness center, which is open to all employees at a dis-
counted fee, is in the basement of Pozez.
Both parties agree that the registered nurses who work at
Pozez Education Center should be included in the unit. Due to
the geographic proximity of the registered nurses at Pozez, the
similarity in working conditions, the extensive centralization of
administration and services and their functional integration with
the rest of the operations on the main campus, and in view of
the parties’ agreement, I find that the registered nurses who
work at Pozez should be included in the unit.
7. The O’Neil Building at 823 Mulvane
The door of the O’Neil Building at 823 Mulvane (aerial pho-
tograph building 1) is 680 feet from the dock door of the hospi-
tal complex. This building houses the Topeka Same Day Sur-
gery Center, the Endoscopy Center, the Women’s Center, and
the Employer’s Clinical Educator. All of these operations are
owned by the Employer and are staffed by its employees. Reg-
istered nurses of the Employer work in all of these department.
The Topeka Same Day Surgery Center (TSDS) is a center
for outpatient surgery. The Employer has two sites for outpa-
tient surgery-one at this location and one at the hospital com-
plex. Functions and skills of the registered nurses who work in
outpatient surgery at both locations are similar if not identical.
Some of the same types of surgeries are performed at both loca-
tions. The three or four registered nurses who work at TSDS
report to Jane Asher, the director of surgical services. Asher
also supervises the registered nurses who work in the operating
room, the recovery room and the outpatient center at the hospi-
tal complex. The Employer showed instances of interchange,
where registered nurses based in a department at the hospital
complex also worked at TSDS, and vice versa. Instances of
transfers of employees between TSDS and the hospital complex
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 1212
were also documented. The Petitioner argues that such in-
stances are minimal. I find that, given the small size of the
TSDS staff, the three or more instances of temporary inter-
change of employees in a recent 3-month period does not ap-
pear to be minimal. The three instances of permanent transfers
between TSDS and another main campus or hospital complex
department also does not appear to be minimal.
The Endoscopy Center is located at the O’Neil Building.
The Employer also has an endoscopy center in the hospital
complex. Registered nurses do similar work in both of these
areas. Registered nurses are hired to work in one area or the
other, but they also provide coverage to the other location when
needed. The record disclosed several instances of temporary
coverage and of permanent transfers between the endoscopy
departments, and between endoscopy and other main campus
departments. There is interchange of technical personnel be-
tween the two endoscopy centers as well. Equipment is inter-
changed between the endoscopy centers. As of the date of the
hearing, staffs of the two endoscopy centers were separately
supervised, but recently they have come under common super-
vision. Endoscopies are also performed at 901 Garfield, an-
other main campus building to be discussed below.
The Women’s Center is also located in the O’Neil Building.
It is primarily an outpatient diagnostic facility. Procedures
performed here include mammogram screenings and osteopo-
rosis screens. The Women’s Center also houses a weight loss
program and community education efforts. Four registered
nurses work at the Women’s Center. Work here is similar to
that done by two nurses who work in radiology at the hospital
complex and to the work done by two other registered nurses
who work in radiation therapy at the hospital complex. One
registered nurse, Mary Cochran, works part time in the
Women’s Center and also works in an area in the hospital com-
plex. Technicians with whom these registered nurses work
rotate regularly between various locations including the hospi-
tal complex and the Women’s Center.
The O’Neil Building at 823 Mulvane also houses physicians’
offices, sometimes called clinics. These physicians are em-
ployed by the Employer, as are the registered nurses who work
in their offices. In addition to the Women’s Center and the
endoscopy center, these clinics which employ registered nurses
specialize in oncology, nephrology, and pulmonary medicine.
(Several other clinics in this building employ no registered
nurses.) In nephrology, registered nurse Barb Livergood
works part of her day at 823 Mulvane and part of the day at the
hospital complex seeing patients there with a physician.
The clinical educator, registered nurse Vickie Sturgeon, also
works at the O’Neil Building. She teaches new procedures to
employees including registered nurses at various locations. I
note that clinical education coordinators are appropriately in-
cluded in units of acute care nurses. See St. Mary’s Hospital,
Inc., 220 NLRB 496 (1975); Milwaukee Children’s Hospital
Assn., 244 NLRB 1009 (1981).
Based upon geographic proximity, similarity of skills and
function, central administration, common high level managerial
and supervisory control and employee interchange, I find that
the registered nurses who work in the O’Neil Building should
be included in the unit. These registered nurses clearly share a
strong community of interest with the registered nurses at the
hospital complex. See Hartford Hospital, 318 NLRB 183, 191
(1995); Staten Island University Hospital v. NLRB, 24 F.3d 450
(2d Cir. 1994); Lutheran Welfare Services of Northeastern
Pennsylvania, Inc., 319 NLRB 886 (1995).
8. The Heart Center
Since January 2001, the Heart Center has been located in a
building at 929 Mulvane (aerial photograph building 2). Its
door is 759 feet from the dock door of the hospital complex.
Before that, it was in the hospital complex. Heart Center em-
ployees report to Joseph Hopeck, the director of cardiovascular
services for the Employer. Most cardiac services of the Em-
ployer report to Hopeck, including critical care areas at the
main hospital complex.
The Heart Center operations include the cardiac rehabilita-
tion department, cardiology offices, nuclear medicine, stress
testing, ultrasound, and the anticoagulation clinic. Three
groups of registered nurses work in the Heart Center, super-
vised by three registered nurse supervisors.
Five registered nurses report to supervisor Carol Frazee and
work in the cardiac rehabilitation department. The first phase
of the cardiac rehabilitation process is done in the hospital
complex by registered nurse Marian Bolz. Bolz works out of
two offices: one at the hospital complex on floor 5 North, and
one in the Heart Center. Bolz regularly performs duties in both
locations, helping in the later phases of cardiac rehabilitation
with the four other registered nurses who work at the Heart
Center. Bolz also regularly does stress testing, which is per-
formed at both the Heart Center and in the hospital complex.
On occasion , if a stress test is scheduled at the hospital and
Bolz is not available, one of the other registered nurses from
the Heart Center will go to the hospital complex and perform
the test there.
Eleven cardiologists work in the Heart Center, and have pa-
tients at the hospital. Their four registered nurses work both at
the Heart Center and at the hospital complex and report to Su-
pervisor Ladonna Andritsch.
Ten other registered nurses in the Heart Center report to Su-
pervisor Janelle Wade. Employees in the electro-physiology
lab in the hospital complex also report to Wade.
The Employer’s records show that registered nurses worked
hours in both the Heart Center and in the hospital complex.
The Employer’s records also show registered nurses transfer-
ring between the Heart Center and Home Health, Endoscopy,
and other main campus departments.
Inasmuch as the Heart Center is a part of the main campus
and geographically very close to the hospital complex, and in
view of the similarity of registered nurse functions and skills
between the Heart Center and the hospital complex, the similar-
ity of employment conditions, the strong centralization of the
Employer’s administration and support services, the integrated
managerial and supervisory hierarchy, and the functional inte-
gration of the Heart Center with the hospital complex, I find
that the registered nurses who work in the Heart Center should
be included in the unit. Staten Island University Hospital v.
NLRB, 24 F.3d 450 (2d Cir. 1994); Lutheran Welfare Services
of Northeastern Pennsylvania, Inc., supra.
STORMONT-VAIL HEALTHCARE 1213
9. 901 Garfield
The 901 Garfield Building (aerial photograph building 6) is
across the street from the hospital complex. The door of the
building is 215 feet from the dock door of the hospital complex.
This building houses physician’ offices and the Neurology
Department. The two registered nurses who work in neurology
divide their time between the 901 Garfield Building and the
hospital complex. The infusion center is also located in this
building. The two registered nurses who work here also spend
part of their time at the hospital and part in their clinic at the
901 Building. Another registered nurse works in infectious
diseases. She also works in other areas on the main campus.
The 901 Building also houses the oncology department.
Eight registered nurses work in this area. The building also
includes the gastro-intestinal specialty area. Five registered
nurses work in this area and its endoscopy center. Endoscopy
services are performed in two other areas noted above, includ-
ing the 823 Mulvane Building and the hospital complex.
The Employer has decided that the Diabetic Learning Center,
now in the hospital complex, will be moved to the 901 Build-
ing. That move has not yet taken place.
The “treatment nurse” also works in the 901 Building. She
is a registered nurse who does such procedures as blood pres-
sure checks, injections, and EKGs. When the registered nurse
who works in Human Relations and performs prehire physicals
is absent, the treatment nurse fills in for her.
The 901 Building also includes the retail pharmacy. No reg-
istered nurses work in the pharmacy.
Based upon geographic proximity, centralization of admini-
stration, functional integration of some of the clinics, similarity
of working conditions, and employee interchange, I conclude
that the registered nurses employed in the 901 Garfield Build-
ing should be included in the unit.
10. The Human Resource Center
The Human Resource Center (aerial photograph building 10)
is 774 feet from the dock door of the hospital complex and is a
part of the main campus. It houses the Human Resource De-
partment which services all employees and all departments.
This building is the work site for the registered nurse who does
pre-employment physicals for all employees. When this nurse
was absent last year, the treatment nurse did preemployment
screens at the 901 Garfield Building. The Board has included
employee health nurses in acute care units. See St. Mary’s
Hospital, Inc., 220 NLRB 496 (1975). Based upon geographic
proximity, centralization of administration, the fact that the
registered nurse’s job involves dealing with unit employees,
and interchange with another unit employee, I conclude that
this registered nurse should be included in the unit.
11. Home health and hospice
Home health and hospice are included in a single depart-
ment. The door to the building where home health is located
(aerial photograph building 9) is 331 feet from the dock door of
the hospital complex. About 13 registered nurses work in home
health, and 2 in hospice. There appears to be regular inter-
change between registered nurses who work in home health and
hospice. It also appears that the hospice registered nurses are
based in a building located at 10th and McVicker. It also ap-
pears, however, that both the home health and the hospice
buildings are a part of the main campus. The registered nurses
performing home health and those who perform hospice work
come to their home buildings on campus to receive assignments
at the beginning of their day and to do paperwork at the end of
their day, but their work is performed mainly at the patients’
homes. Often, home health nurses meet with patients and their
families in the hospital complex before the patients are dis-
charged from the hospital. Before home health patients are
discharged from the hospital, home health nurses consult with
hospital complex nurses regarding patients’ eligibility for home
health services and whether the home health criteria are met by
the patient. When the hospice patients are hospitalized, the
hospice nurses continue to see them in the hospital complex.
Several home health nurses also regularly work in the hospital.
Home health employees have often been included in appro-
priate units in acute care settings. See Frederick Memorial
Hospital, 254 NLRB 36 (1981); Long Island College Hospital,
256 NLRB 202, 207 (1981).
In view of the fact that the home health and hospice regis-
tered nurses are based on the main campus, and in light of cen-
tralization of administration and services, employee interchange
and functional integration, I conclude that the home health and
hospice registered nurses should be included in the unit. I fur-
ther find that, in the event that there are any home health and
hospice registered nurses who are not based at a building on the
central campus, they do not share the same community of inter-
est with other unit registered nurses and are excluded from the
unit.
12. Finance Building 1200 Washburn—Systems Applications
Two registered nurses are based in the finance building at
900 Washburn (aerial photograph building 12), the final build-
ing discussed by the parties at the hearing as a part of the main
campus. The two are classified as Clinical Application Ana-
lysts. They train nurses in the use of new software, and in the
use of the computer medical record system, the patient registra-
tion system, and the order entry system. They also provide
day-to-day troubleshooting support for all users.
Because they are registered nurses who have regular contact
with other unit registered nurses, because it appears that they
work mainly on the central campus, and because of the extent
of centralization of administration and services by this Em-
ployer, I shall include them in the unit.
13. Life Flight
As a joint venture with another hospital, the Employer owns
and operates Life Flight, a helicopter ambulance service. The
Life Flight employees are employees of the Employer. These
employees, including 11 registered nurses, are stationed at the
air fields at three locations: about 10 miles from the main cam-
pus at Forbes Field in Topeka; about 25 to 30 miles away from
the main campus in Lawrence, Kansas; and about 70 miles
away from the main campus in Hutchinson, Kansas. The Life
Flight registered nurses work 12-hour shifts at two locations,
and 24-hour shifts at the third location. They accompany pa-
tients by helicopter to the helipad at the hospital complex
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 1214
(marked 11 in ink on the foreground of the aerial photograph)
and into the emergency room.
The parties stipulated that the flight nurses should be in-
cluded in the unit. Absent such stipulation, the evidence of
geographic remoteness of their base facilities, their contrasting
working conditions, the lack of significant interchange, and
separate day-to-day supervision, would have warranted exclu-
sion of the flight nurses. However, inasmuch as both parties
agree to their inclusion, I shall include the Life Flight nurses in
the unit.
14. Outlying clinics
In 1995, the Employer acquired the Cotton O’Neil clinics.
These clinics are located in Topeka and in surrounding towns
throughout Topeka and Shawnee Counties. They are physi-
cians’ offices and many, but not all, are staffed with registered
nurses. As of the date of hearing, the clinics located at Bald-
win, Urish, and Meriden had no registered nurses. The dis-
tances from the main campus to the freestanding clinics was
stipulated to be as follows:
s
i
c
t
i
t
m
p
t
s
s
K
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s
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s
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hours, and recommendations for promotion. There was evi-
dence that these clinic nurse managers attend meetings at the
main campus once every other week. There was also some
evidence of interchange of registered nurses between the clin-
ics, and of some interchange with the departments on the main
campus. This interchange appears to be the exception rather
than the rule for the registered nurses who work at the clinics.
The clinics are not served by the central mail system. They
receive mail at their own addresses.
Not all clinic patients who are admitted to a hospital go to
the hospital complex: about 35 percent are admitted to a differ-
ent hospital.
The administrator in charge of the clinics testified that if the
hospital shut down, the clinics could still function, but they
would have very few support services (laundry, lab work, main-
tenance, computer assistance). She also testified that if the regis-
tered nurses at the hospital “left,” it is possible that the Employer
would decide to shift registered nurses from the clinics to the
hospital—that resources would be devoted to the highest

Site No. of miles distant Site No. of miles distant
Emporia 60 Emporia 18
Baldwin 40 Meriden 20
Urish 7 Croco 7
Rossville 15 Oskaloosa 40
Wamego 45 Lawrence
Alma 45 Wakarusa 25
Lebo 50 Lawrence Hospital 27
Osage City 30 Topeka Pediatric Care

According to Clinic Administrator Carol Yocum, who over-
ees these clinics, there is a distinct difference between hospital
npatient care of as is provided in the hospital complex and the
linical care of which she is in charge.
Although generally, housekeeping services are centralized,
he Employer contracts out housekeeping for the outlying clin-
cs because it is easier not to do so. Although most locations of
he Employer use identification badges with photographs and
agnetic strips with coded information, used for hourly em-
loyees to clock in and out, some clinics do not have automated
ime and attendance systems.
The clinics are part of the Employer’s medical services divi-
ion; the hospital complex is part of the Employer’s health
ervices division. The medical services division is headed by
ent Palmberg. The health services division is headed by
avid Knocke. Deb Yocum, the vice president of the medical
ervices division, was the administrator of the clinics when they
ecame a part of the Employer’s system in 1995. She contin-
ed in charge of the clinics. While the clinics are owned by the
mployer, and the employees are employees of the Employer,
hey appear to retain their premerger names and a separate
dentity (separate location and patients). Day-to-day supervi-
ion of the registered nurses is by supervisors and managers at
he clinics. The clinics use different titles for supervisory
urses than do the departments on the main campus. The clinic
urse manager is responsible for adherence to the budget for
he clinic, and is also responsible for hiring, firing, scheduling
(15
th & Gage) 3

priority, the acute care patients. She also believes it possible
that if there were a shortage of registered nurses at the hospital,
the Employer would transfer nurses from the clinics. This tes-
timony was elicited in answer to hypothetical questions. Ap-
parently no such scenarios have come to pass.
In addition to these freestanding clinics, physicians em-
ployed by the Employer see patients at various locations
throughout the region. Registered nurses are not ordinarily a
part of these “specialty clinics.”
The Employer also has community nursing centers at two lo-
cations off the main campus, in Topeka. As of the date of hear-
ing, the clinics located at Baldwin, Urish, and Meriden had no
registered nurses. Here, registered nurses do blood pressure
checks, health management and assessment and referrals to the
emergency room, if appropriate, or referrals to other clinics or
social service agencies. Each of the Employer’s two commu-
nity nursing centers are staffed by two registered nurses. They
primarily see indigent patients.
Based upon their geographic separation from the main cam-
pus, their functional separation, and their separate organization
and distinct day-to-day working conditions, I conclude that the
registered nurses who work in the clinics off the main campus
possess interests predominantly separate from the registered
nurses who work on the main campus and should be excluded
from the unit of registered nurses employed at the main cam-
pus.
STORMONT-VAIL HEALTHCARE 1215
15. Stormont-Vail West
Stormont-Vail West is an inpatient psychiatric facility lo-
cated about two miles from the main campus. As an inpatient
facility, it is open around the clock, seven days a week. Until
late February 2001, this department was located in the hospital
complex. With the closing of the competing Menninger Clinic
in Topeka, many of the patients were transferred to Stormont-
Vail, and more space was needed. At that point, the department
was moved to its present location off the main campus. As of
the date of the hearing, Stormont-Vail West operates two units–
one for adults and one for adolescents and children. The Em-
ployer has 20 full-time registered nurses at Stormont-Vail West
plus 10 registered nurses working part time or as needed (prn).
The Employer has inpatient psychiatric services at two loca-
tions. After the move, the senior diagnostic unit remains at the
hospital complex on floor 6 West. Older, “fragile” patients are
placed at 6 West. The choice between Stormont-Vail West and
6 West is based not upon age but upon acuity. The more acute
geriatric patients are treated on 6 West.
The Board has noted that acute psychiatric care differs from
other acute hospital care, and that employees are specially
trained for this type of work. See, e.g., Hartford Hospital, 318
NLRB 183, 191 (1995); Brattleboro Retreat, 310 NLRB 615,
616 (1993).
Treatment of psychiatric patients differs from treatment of
other patients. Possibly for that reason, there is minimal con-
tact and interchange of personnel between the psychiatric de-
partments and other departments. There is some interchange
between registered nurses at Stormont-Vail West and 6 West.
The work of the registered nurses at Stormont-Vail West and
those on 6 West is similar. The charge nurses on 6 West report
to Carolyn Jones. The charge nurses at Stormont-Vail West
report to Jon Hartnett. Some of the clinics also perform some
mental health care.
Todd Crause, a charge nurse on 6 West, provides training in
the use of patient restraints to all employees of the Employer
who take such training, including the registered nurses at Stor-
mont-Vail West.
Because the inpatient psychiatric work of the registered
nurses at Stormont-Vail West is very different from that of the
vast majority of registered nurses on the main campus, because
of the geographic and organizational separation of Stormont-
Vail West, and because of the separate day-to-day supervision,
I find that the registered nurses at Stormont-Vail West should
be excluded from the unit of registered nurses who work on the
main campus.