Nurses Flex Their Political Muscle in Sacramento and
By Darrell Smith and Phillip Reese Sacramento Bee
February 5, 2012
Rose Ann DeMoro is always ready for another fight.
And why not? During the past decade, the leader of the
California Nurses Association has won so many of her
Largely because of CNA efforts, California is poised to
become the first state where registered nurses make an
average salary above $100,000.
The union helped defeat gubernatorial candidate Meg
Whitman in 2010 and has become a political force,
throwing financial support behind candidates for
offices ranging from Santa Rosa City Council to state
And more recently, nurses flexed their muscles with a
series of one-day walkouts in support of other hospital
employees who are in tough contract negotiations.
"This is a significant career with responsibility for
life and death," DeMoro said. Hospitals, she said, "are
looking to make more money off the backs of nurses.
That's not going to happen."
The health care industry bristles at CNA tactics,
including last Tuesday's one-day nurse walkout at
Kaiser Permanente hospitals alongside striking workers
from the smaller National Union of Healthcare Workers.
Hospital officials say the solidarity strikes put
patients at risk.
"We don't see how taking 23,000 nurses out of hospitals
and having them walk the picket line advances quality
patient care," Jan Emerson-Shea, a vice president at
the Sacramento-based California Hospital Association,
said before a prior walkout in September.
"They're putting access to care at over 30 hospitals at
risk. In this economy, when is enough enough?"
Much of the union's influence is due to a seeming
contradiction: California has so many nurses, but not
About 240,000 registered nurses work in California,
making it one of the most common professions among
those with a college education. But Nevada is the only
state with a lower rate of nurses per 1,000 residents,
according to the federal Bureau of Labor Statistics.
Just to get to the national average, California would
need to hire 80,000 nurses - 33 percent more than the
state has now.
The shortage is expected to worsen, handing nurses more
ability to dictate terms. Already struggling to meet
demand, many higher education institutions that train
nurses are losing funding. Meanwhile, baby boomers are
getting older, requiring more health care services.
And then there's health care reform, which "will
increase demand for nursing," said Ken Jacobs, chairman
at the University of California, Berkeley Labor Center.
"Health care will be the part of the economy that will
grow. Nurses will have stronger bargaining power."
Nation's first staffing law
California's nurses have done plenty to increase demand
and their own bargaining power.
In 1999, they persuaded the state Legislature to pass a
first-in-the-nation law setting nurse-to-patient
ratios: the maximum number of patients assigned to a
licensed nurse at any one time.
The staffing ratios, implemented in 2004, range from
one nurse for every patient in a trauma unit, to one
nurse for every four patients in a specialty-care unit.
The ratios eased workloads while increasing the need
for nurses, pushing wages higher, said medical labor
expert Joanne Spetz, a professor at the Center for the
Health Professions at the University of California, San
"It's a huge cost for hospitals," Spetz said,
estimating about one-sixth of a hospital's total budget
goes toward compensation of registered nurses, licensed
vocational nurses and nurses aides.
The win was a defining moment for the CNA, affirming
its growing influence in the state Capitol.
"We waged a massive war that became a model for the
nation," DeMoro said. "It raised nurses' economic
standard, and they were able to care for the patient
longer. It was a hard battle. We mobilized thousands of
nurses and the public. We were relentless - relentless
- through this."
In the years since, the CNA has remained one of the
most active players in state politics.
It spent $750,000 lobbying the Legislature during the
2009-10 session. Over the past three years, its
political action committee gave more than $2 million to
candidates and campaigns statewide.
In the last decade, the union went from "a doormat . to
being someone that legislators rarely challenge," said
Sacramento political operative Steve Maviglio.
CNA's scathing portrayal of gubernatorial candidate Meg
Whitman as "Queen Meg" in the 2010 election was among
the more memorable images from the campaign, and the
union is credited with helping elect Gov. Jerry Brown.
"You softened her up," Brown told a group of nurses at
a conference a few months later, "so there was almost
nothing for me to do."
Highest nursing pay in U.S.
For many CNA members, there's a more potent measure of
the union's success: Nursing pay, already higher in
California than anywhere else, is rising fast.
The average salary for a California registered nurse
grew from $57,855 in 2001 to $88,714 in 2011, according
to the state Employment Development Department.
Adjusted for inflation, that represents a 21 percent
pay hike, compared with an 8 percent pay bump for other
California workers during that span.
At the current pace, the average salary for a
California registered nurse will eclipse six figures in
California nurses collectively earned $21 billion last
year, and a one percentage point increase in their
average salary equals $200 million in additional pay.
Hospital officials say the rapid growth in nurses' pay
increases patient costs. They say the recession,
reimbursement changes, regulatory requirements and
other factors are putting pressure on revenue, so
nurses must share the pain.
Hospital officials contacted by The Bee for this story
were reluctant to talk about nurses' pay head-on.
"We don't think nurses are paid too much, but they're
paid very well," Emerson-Shea said.
But ongoing negotiations between Sutter Health and Bay
Area nurses show that hospitals are determined to trim
costs. Sutter is seeking a series of reductions in
health and retirement benefits.
The CNA is refusing to accept any of the rollbacks,
countering that the health care industry is doing well.
Hospitals, they say, want to maximize profits instead
of giving employees a fair shake.
Kaiser Permanente's hospitals and health care plan, for
example, reported a combined $11.9 billion in operating
revenue in the quarter ended Sept. 30, 2011, up from
$11.1 billion in the year-previous quarter. Even with
stock market declines, the health network posted net
income of $1.5 billion through the first nine months of
Nurses repeatedly note that their raises often pale
next to the bumps received by their bosses.
The chief executive officer of Sacramento-based Sutter
Health, for example, made about $4.8 million in 2010,
up from $1.1 million in 2001, tax records show. Kaiser
Permanente's CEO made about $7.7 million in
compensation and benefits in 2010, according to tax
"Nurses finally achieve middle class and the industry
is trying to vilify them? That's a war they don't want
to have with us," DeMoro said. "This is one of the most
profitable industries. I have not an ounce of sympathy
for these employers. None."
Before they organized, she said, "we saw nurses making
less than grocery clerks - and clerks actually had
Kay McVay, 78, of Concord is a retired Kaiser nurse who
recalls her early career when nurses fetched coffee and
a double-digit hourly wage seemed a pipe dream.
"Orderlies made more than we did. Gardeners made more
than we did," she said.
Conditions slowly improved, but by the late 1990s,
McVay said, the nursing union's growing strength began
to pay dividends in wages and - with newly mandated
staffing levels - at bedsides.
"It was tremendous," she said.
The arguments, the walkouts, the pay increases - all
are likely to continue as long as demand for nurses
remains strong. In 2010, as the state buckled under 12
percent unemployment, the jobless rate among nurses was
1.8 percent, census figures show.
The shortages are worst in the state's rural corners
and the Southern California's Inland Empire.
"The feeling is that (shortages) are every bit as hard
as in the 1990s," Spetz said, adding that it
nonetheless can be hard to find a nursing job in a few
saturated urban markets.
Local colleges and institutions try to keep up, even as
they suffer budget cuts.
At the Sacramento Employment and Training Agency's One-
Stop program, one-third of the program's nearly $3.5
million budget is spent on health care training.
"We're still seeing demand," said Terri Carpenter, the
agency's spokeswoman. "But we can only train so many a
year. There's only so much space at the colleges."
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