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Health System with 21 Clinics Defeats Single Facility Bargaining Unit of Registered Nurses

By Roger P. Gilson Jr.
  • March 12, 2004

A health care system operating 21 clinics within a 55-mile radius was able to overcome a presumption that registered nurses at a single facility were an appropriate unit for collective bargaining. A divided panel of the National Labor Relations Board ruled a unit limited to the single clinic is inappropriate and sent the case back to the NLRB regional director for further proceedings. In the Board's words, the health system "demonstrated that the clinics operate as a single network and are functionally integrated both as to the services provided and as to the employees who provide them." [St. Luke's Health Sys. Inc., 340 NLRB No. 139 (11/28/03)

In a petition to represent registered nurses working for a multi-facility family practice clinic in Iowa, the United Food and Commercial Workers relied upon a legal construct established by the Labor Board in 1987. The presumption is that a single facility bargaining unit is appropriate even though the facility is part of a larger health system. That presumption may be defeated, however, if the employer can show that the facility operates as an integrated part of a single network, rather than as an autonomous unit with distinct services and staff.  

An NLRB regional director found the petitioned-for unit would be appropriate if it also included nurse practitioners and physician assistants at the clinic. Rejecting that conclusion, the employer appealed to the Labor Board, arguing that the smallest appropriate unit would consist of all professional employees, except doctors, at all 21 clinics located in the area.  

Agreeing with the employer, a 2-1 divided Labor Board found the single facility presumption did not apply given the integration of services and employees within and among the health system operations. Based on the evidence presented by the employer, the Board found that all the clinics operate as a single network, and patients can receive a full range of benefits from the various facilities. Moreover, it found "virtually all of the centralized."  

The Board majority found the clinics used uniform job application procedures, the same operational systems, and identical marketing initiatives. Other similarities included identical work hours and wage scales, workplace policies and procedures, and employee benefits. Job skills and duties at the clinics were the same, employees attended joint meetings and programs, and temporary and permanent transfers among the clinics were frequent.  

Onsite clinic managers had little autonomy and exercised only administrative authority in matters such as scheduling employees and approving leaves. Although clinic managers performed evaluations used for merit increases, actual increases were decided by a centralized human resources function. The Board noted that centralized human resources directed all labor relations functions for all clinic employees, and the three HR directors ultimately were responsible for supervision for all clinics. Finally, the Board found that the proximity of the 16 locations supported a multi-facility unit.  

Case Comment: In another case decided the same day, a three-member panel of the Board ruled that 800 RNs working for a comprehensive regional medical system at the main campus and its outlying facilities should be included in a single bargaining unit. The RNs were scattered throughout a hospital complex and seven outlying buildings, several helicopter ambulance services, an educational center, a psychiatric facility, 17 regional clinics and two community nursing centers. Board members found the RNs perform similar work, attend common meetings, are under a centralized administration and management, and experience some degree of interchange among locations (Stormont-Vail Healthcare, Inc. 340 NLRB No. 143, 11/28/03). 

While it is generally to the increase the size of bargaining units, determinations as to their appropriateness are largely factual and require an examination of indicators that may be susceptible to differing conclusions. As in the St. Luke's case, two of three Board members agreed a single facility bargaining unit should not be presumed appropriate. The dissenting member looked at the same facts but came to a different conclusion. For example, he saw the individual clinic managers as having greater autonomy in making hiring decisions, in scheduling time off and leaves, in resolving grievances, and in initiating discipline. Additionally, the dissent differed from the majority in concluding that the clinic in question did not participate in the interchange of employees among the other clinics.  

Despite differing conclusions from the same factors, multi-facility health care employers should analyze their operations in light of those factors to assess vulnerability to organizing attempts. Jackson Lewis attorneys are available to assist employers in conducting advantage to vulnerability audits.

©2004 Jackson Lewis P.C. This material is provided for informational purposes only. It is not intended to constitute legal advice nor does it create a client-lawyer relationship between Jackson Lewis and any recipient. Recipients should consult with counsel before taking any actions based on the information contained within this material. This material may be considered attorney advertising in some jurisdictions. Prior results do not guarantee a similar outcome.

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