A final round of contract negotiations takes place Tuesday for more than 400 registered nurses who work at St. Luke's Hospital in Duluth. The talks will focus on a proposed code of conduct opposed by the nurses' union.
Staffing issues are the main issue in the contract dispute between the nurses union and the two main hospitals in Duluth -- St. Luke's and the SMDC Health System.
But nurses at St. Luke's haven't held back their distaste for the code of conduct proposal. An entry in a Minnesota Nurses Association blog calls it a "direct attempt to silence and intimidate nurses."
The code spells out inappropriate employee behavior, such as profanity or sexual advances. Violating the code could be grounds for discipline, even termination.
The code prohibits what it calls overt behaviors, including verbal outbursts or physical threats. But it also has provisions that could be considered vague, including a ban on "quietly exhibiting uncooperative attitudes during routine activities."
Examples include condescending voice intonation and impatience with reasonable questions. That language adheres closely to wording recommended by the Joint Commission, the national hospital accrediting organization.
But the nurses union said such provisions could be used to intimidate and muzzle nurses.
Cindy Prout, who chairs the St. Luke's nurses bargaining unit, said the new code could work against nurses and their patients.
"Sometimes one has to strongly advocate for something that is going on with a patient, and a need that you might have," Prout said. "That could be interpreted in the wrong manner in which it is intended, and it could lead to discipline."
The code was initially presented to every St. Luke's employee. But the Minnesota Nurses Association told nurses not to sign it, as it was an issue that required bargaining. Now that the conduct language is in St. Luke's proposed contract, the nurses still don't like it.
Prout said the new version would replace one which was written in 2003, with the help of nurses. She said St. Luke's should have employees help write a new code.
"Perhaps we need to go back to the drawing board with this code of conduct, pull in employees from all disciplines, and maybe let's work on it together," Prout said.
Officials at St. Luke's hospital declined to talk about the code. In a recent statement, St. Luke's President and CEO John Strange said the code is wrongly portrayed as a way to silence nurses. He said it specifically allows nurses and other employees the right to raise quality of care concerns, in a respectful manner.
Steven Beck, a Minneapolis attorney who specializes in employment and labor, said the code contains typical language. Beck, who assists health providers with contracts and regulations, has only minor departures from language provided by the Joint Commission.
"There are a couple of provisions that seem to have been added that aren't the same as what the Joint Commission requires, but they don't look particularly out of line," he said.
Beck is skeptical of the union's complaints.
"I can imagine someone saying that the code of conduct might prohibit or inhibit union behavior, or complaining about the work conditions," he said. "I don't think that's the intent of the rule, and I don't think that it would play out that way."
Like it or not, St. Luke's sees the code as key to its bottom line, The hospital needs to have the code in place to receive Joint Commission accreditation, which would qualify it for the federal Medicare program. A large number of the hospital's patients are older and on Medicare.
Prout, the nurses' negotiator, said nurses and the hospital are nearing an agreement on staffing levels, the other outstanding issue. The nurses hope to have more say in moving new admissions from understaffed units.
"I feel like we're very close on how that's going to go, with regards to temporarily closing the unit when the assignments are too much for one nurse to handle," she said. "I'm really optimistic."
There are no more negotiating sessions scheduled between St. Luke's and its nurses after Tuesday. The Minnesota Nurses Association is expected to announce soon the date for a one-day strike against Duluth's other hospital, St. Mary's-Duluth Clinic. Talks between SMDC and its 900 nurses stalled last week.
The outcome of the latest talks could determine whether they'll also be planning a walkout for St. Luke's nurses.